Four Risk Factors for Arthrofibrosis in Tibial Spine Fractures: A National 10-Site Multicenter Study

Joshua T. Bram, Julien T. Aoyama, R. Justin Mistovich, Henry B. Ellis, Gregory A. Schmale, Yi Meng Yen, Scott D. McKay, Peter D. Fabricant, Daniel W. Green, R. Jay Lee, Aristides I. Cruz, Indranil V. Kushare, Kevin G. Shea, Theodore J. Ganley

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Tibial spine fractures (TSFs) are relatively rare pediatric injuries. Postoperative arthrofibrosis remains the most common complication, with few studies having examined factors associated with its development. Purpose: To identify risk factors for arthrofibrosis and required MUA or lysis of adhesions in the largest known cohort of patients with TSFs. Study Design: Case-control study; Level of evidence, 3. Methods: This was a multicenter study of 249 patients ≤18 years old who had a TSF between January 2000 and February 2019. Patients were separated into cohorts based on whether they developed arthrofibrosis, defined as a 10° deficit in extension and/or 25° deficit in flexion at postoperative 3 months or a return to the operating room for manipulation under anesthesia (MUA) and/or lysis of adhesions. Results: A total of 58 (23.3%) patients developed postoperative arthrofibrosis, with 19 (7.6%) requiring a return to the operating room for MUA. Patients with arthrofibrosis were younger (mean ± SD, 11.3 ± 2.7 vs 12.3 ± 2.8 years; P =.029). They were more likely to have a nonsport, trauma-related injury (65.4% vs 32.1%; P '.001) and a concomitant ACL injury (10.3% vs 1.1%; P =.003). Those with arthrofibrosis had longer operative times (135.0 vs 114.8 minutes; P =.006) and were more likely to have been immobilized in a cast postoperatively (30.4% vs 16.6%; P =.043). In multivariate regression, concomitant anterior cruciate ligament (ACL) injury (odds ratio [OR], 20.0; P =.001), traumatic injury (OR, 3.8; P '.001), age '10 years (OR, 2.2; P =.049), and cast immobilization (OR, 2.4; P =.047) remained significant predictors of arthrofibrosis. Concomitant ACL injury (OR, 7.5; P =.030) was additionally predictive of a required return to the operating room for MUA. Conclusion: Surgeons should be cognizant of arthrofibrosis risk in younger patients with concomitant ACL tears and traumatic injuries not resulting from athletics. Furthermore, postoperative immobilization in a cast should be avoided given the high risk of arthrofibrosis. Concomitant ACL injury is associated with a higher return to the operating room for MUA.

Original languageEnglish (US)
Pages (from-to)2986-2993
Number of pages8
JournalAmerican Journal of Sports Medicine
Volume48
Issue number12
DOIs
StatePublished - Oct 1 2020
Externally publishedYes

Keywords

  • anterior cruciate ligament
  • arthrofibrosis
  • intercondylar eminence
  • knee
  • tibial spine fractures

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

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