Lessons learned after second-look arthroscopy in type III fractures of the tibial spine

Ten patients with type III intercondylar eminence fractures with 6 years of follow-up underwent second-look arthroscopy after new injuries or complaints. Initial treatment was closed reduction (group I), arthroscopic reduction (group II), and arthroscopic reduction with internal fixation (group III). Lysholm ratings and one leg hop tests were normal in groups II and III and < 90% in group I. Tegner levels were 8, 9, and 10 in groups I, II, and III, respectively. International Knee Documentation Committee ratings were grades C, B, and A for groups I, II, and III, respectively. Arthroscopy revealed > 3 mm offset in groups I and II, suggesting loss of reduction, and grades II and III retropatellar chondromalacia. The fracture "footprint" is not congruous with the femoral condyle in extension or flexion. Loss of reduction led to laxity and prolonged morbidity.

Loss of reduction is common after closed treatment of tibial spine fractures and should be closely monitored. Type III fractures that are unreducible or displaced require reduction, appropriate tensioning, internal fixation, and aggressive rehabilitation.