ACL tibial spine avulsion: mid-term outcomes and rehabilitation

Tibial spine fractures are characterized by fractures at the insertion site of the anterior cruciate ligament (ACL) on the tibia and were first classified into 3 types. For displaced (type II/III) fractures, surgical treatment has included fixation with screws, sutures, or wires performed through either open or arthroscopic approaches. Optimal treatment methods remain controversial and are varied by classification type, surgeon preference, and patient age. We retrospectively studied the outcome of 22 surgically treated patients with tibial spine fractures. We analyzed factors such as age, skeletal maturity, fixation device, surgical approach, presence of comminution, loss of reduction, and rehabilitation protocol against the development of arthrofibrosis and clinical and functional outcomes. We found that age older than 18 years was a statistically significant factor for lower outcome scores. Two factors trended toward significance including; those with comminution had lower Tegner scores, and those with early range of motion returned to previous activity level more frequently. Factors found to be insignificant included surgical approach, fixation device, weight bearing, skeletal maturity, postoperative immobilization, and loss of reduction. Those with screw fixation had a higher reoperation rate due to symptomatic hardware removal. Age was the only factor that negatively impacted final functional scores.