eMedicine Specialties > Orthopedic Surgery > Knee

Intercondylar Eminence Fractures: Treatment

Author: Brett D Owens, MD, Chief, Sports Medicine and Shoulder Service, William Beaumont Army Medical Center
Coauthor(s): Troilus Plante, MD, University of Massachusetts Medical School; Brian D Busconi, MD, Associate Professor, Department of Orthopedic Surgery, University of Massachusetts Memorial Health Care
Contributor Information and Disclosures

Updated: Mar 16, 2009

Treatment

Medical Therapy

Most authors recommend aspiration of the hemarthrosis and casting for nondisplaced type I intercondylar eminence fractures. This is also the initial management used for displaced fractures. The position of immobilization is still controversial. It was thought initially that the immobilization should be in full extension so that the fracture fragment is reduced by condylar contact. However, because full extension is the tightest position for the ACL, this method may result in increased tension and displacement at the fracture site.

Surgical Therapy

Although most authors agree that displaced intercondylar eminence fractures need repair, the choice of fixation is still debated. Meyers and McKeever used sutures to tack the fragment onto the anterior horn of the medial meniscus. Zaricznyj reported the use of multiple K-wires. Others have reported good results with cannulated screw fixation, which is usually the fixation chosen for adults. In skeletally immature patients, screw fixation is secure but may require hardware removal.

Arthroscopic photo of intercondylar eminence frac...

Arthroscopic photo of intercondylar eminence fracture after hematoma evacuation.

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Arthroscopic photo of intercondylar eminence frac...

Arthroscopic photo of intercondylar eminence fracture after hematoma evacuation.


Arthroscopic photo of intercondylar eminence frac...

Arthroscopic photo of intercondylar eminence fracture.

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Arthroscopic photo of intercondylar eminence frac...

Arthroscopic photo of intercondylar eminence fracture.


Whether via open, mini-open, or arthroscopic approach, suture fixation does provide secure fixation but may limit the speed of rehabilitation.6,7,8,9,10,11,12,13

Intraoperative Details

The details of intercondylar eminence fracture reduction depend mainly on the approach used. However, the basic steps are the same. The fracture bed is cleared of any hematoma and debris. Because the attachments of the medial and lateral menisci also may inhibit reduction, these are retracted out of the way as the avulsed tibial eminence is reduced to its bed. The avulsed tibial eminence can be held by sutures to the medial meniscus or through a drill hole or held by K-wires or a cannulated screw (depending on the degree of comminution).

Postoperative Details

The traditional approach to postoperative care for intercondylar eminence fractures has been long leg casting in extension (or slight flexion) for 4 weeks, followed by a rehabilitation program. Recent studies have reported use of early ACL rehabilitation protocols, with excellent results achieved.

Follow-up

Patients with intercondylar eminence fractures should be monitored at least until bony union is seen radiographically. At that point, hardware may need to be removed. Continued follow-up is warranted as patients resume their preinjury levels of activity, because ACL laxity can become symptomatic.

Complications

The most devastating complication of open or arthroscopic fixation of a displaced intercondylar eminence fracture is infection. Sterile technique and implants, intraoperative antibiotics, and proper wound closure should keep this complication to a minimum.

Another concern with acute surgery is fluid extravasation, leading to the potential for lower-extremity compartment syndrome. The use of the arthroscopy fluid pump should be avoided in this situation.

The most frequently reported complication is ACL laxity. The cause of this laxity could be fixation in a nonanatomic position (thereby functionally lengthening the ACL) or microtearing of the ACL prior to eminence fracture. Although many studies report an increase in KT1000 knee ligament arthrometer measurements, patients do not report associated symptoms of instability.

Another complication is diminished range of motion, caused by immobilization. Most authors report an extensor lag, which can be minimized by secure fixation and an early, aggressive rehabilitation program.

More on Intercondylar Eminence Fractures

Overview: Intercondylar Eminence Fractures
Workup: Intercondylar Eminence Fractures
Treatment: Intercondylar Eminence Fractures
Follow-up: Intercondylar Eminence Fractures
Multimedia: Intercondylar Eminence Fractures
References
Further Reading
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References

  1. Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg Am. Mar 1959;41-A(2):209-20; discussion 220-2. [Medline].

  2. Zaricznyj B. Avulsion fracture of the tibial eminence: treatment by open reduction and pinning. J Bone Joint Surg Am. Dec 1977;59(8):1111-4. [Medline].

  3. Wiley JJ, Baxter MP. Tibial spine fractures in children. Clin Orthop Relat Res. Jun 1990;54-60. [Medline].

  4. Burstein DB, Viola A, Fulkerson JP. Entrapment of the medial meniscus in a fracture of the tibial eminence. Arthroscopy. 1988;4(1):47-50. [Medline].

  5. Lowe J, Chaimsky G, Freedman A. The anatomy of tibial eminence fractures: arthroscopic observations following failed closed reduction. J Bone Joint Surg Am. 2002;84-A:1933-8. [Medline].

  6. Matthews DE, Geissler WB. Arthroscopic suture fixation of displaced tibial eminence fractures. Arthroscopy. Aug 1994;10(4):418-23. [Medline].

  7. Delcogliano A, Chiossi S, Caporaso A. Tibial intercondylar eminence fractures in adults: arthroscopic treatment. Knee Surg Sports Traumatol Arthrosc. Jul 2003;11(4):255-9. [Medline].

  8. Owens BD, Crane GK, Plante T. Treatment of type III tibial intercondylar eminence fractures in skeletally immature athletes. Am J Orthop. Feb 2003;32(2):103-5. [Medline].

  9. Yang SW, Lu YC, Teng HP. Arthroscopic reduction and suture fixation of displaced tibial intercondylar eminence fractures in adults. Arch Orthop Trauma Surg. May 2005;125(4):272-6. [Medline].

  10. Bonin N, Jeunet L, Obert L, Dejour D. Adult tibial eminence fracture fixation: arthroscopic procedure using K-wire folded fixation. Knee Surg Sports Traumatol Arthrosc. Jul 2007;15(7):857-62. [Medline].

  11. Horibe S, Shi K, Mitsuoka T. Nonunited avulsion fractures of the intercondylar eminence of the tibia. Arthroscopy. Oct 2000;16(7):757-62. [Medline].

  12. Louis ML, Guillaume JM, Toth C, Launay F, Jouve JL, Bollini G. [Fracture of the intercondylar eminence of the tibia type II in children: 20 surgically-treated cases]. Rev Chir Orthop Reparatrice Appar Mot. Feb 2007;93(1):56-62. [Medline].

  13. Park HJ, Urabe K, Naruse K, Aikawa J, Fujita M, Itoman M. Arthroscopic evaluation after surgical repair of intercondylar eminence fractures. Arch Orthop Trauma Surg. Nov 2007;127(9):753-7. [Medline].

  14. Binnet MS, Gürkan I, Yilmaz C. Arthroscopic fixation of intercondylar eminence fractures using a 4-portal technique. Arthroscopy. May 2001;17(5):450-60. [Medline].

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Keywords

tibial eminence fractures, tibial spine fractures, anterior cruciate ligament avulsion injuries, ACL avulsion injuries, broken leg, knee injury, knee pain, anterior cruciate ligament pathology

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Contributor Information and Disclosures

Author

Brett D Owens, MD, Chief, Sports Medicine and Shoulder Service, William Beaumont Army Medical Center
Brett D Owens, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Society of Military Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Troilus Plante, MD, University of Massachusetts Medical School
Disclosure: Nothing to disclose.

Brian D Busconi, MD, Associate Professor, Department of Orthopedic Surgery, University of Massachusetts Memorial Health Care
Disclosure: Nothing to disclose.

Medical Editor

Robert D Bronstein, MD, Associate Professor, Department of Orthopedic Surgery, University of Rochester School of Medicine
Robert D Bronstein, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Medical Society of the State of New York
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Thomas M DeBerardino, MD, Director, John A Feagin, Jr, Sports Medicine Fellowship at West Point, Associate Professor of Orthopedic Surgery, Uniformed Services University of the Health Sciences and Keller Army Community Hospital
Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, and American Orthopaedic Society for Sports Medicine
Disclosure: Arthrex, Inc. Grant/research funds None; Arthrex, Inc. Honoraria Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds Other; Musculoskeletal Transplant Foundation Grant/research funds Other; Histogenics Grant/research funds None

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

 
 
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