Does the mini-open technique still have a role in the modern management of pediatric tibial eminence fractures?

Abstract

Background Tibial eminence fractures are uncommon pediatric injuries that often require surgical fixation. Although arthroscopic fixation is widely adopted, the role of mini-open physeal-sparing techniques remains incompletely defined. This study evaluated the medium- and long-term clinical and radiographic outcomes of pediatric patients treated with this technique for displaced tibial eminence fractures. Methods A retrospective study was conducted on 26 consecutive patients (mean age 12.1 ± 2.3 years) treated between 2017 and 2019 with a mini-open physeal-sparing transosseous suture technique. Clinical and radiographic follow-up averaged 7.6 ± 2.9 years. Outcomes included fracture union, range of motion, residual anterior laxity, return to sport, complications, and patient-reported outcome measures (Lysholm Knee Score, subjective International Knee Documentation Committee score, and Tegner Activity Scale). Non-parametric statistical analyses were performed to evaluate correlations between baseline characteristics and clinical outcomes, as well as differences between patients with and without residual anterior laxity. Results Fracture union was achieved in all patients at a mean of 35.8 ± 6.4 days. No cases of infection, nonunion, arthrofibrosis, growth disturbance, limb-length discrepancy, or fixation failure were observed. At final follow-up, no patient had persistent range-of-motion limitation, and all returned to their pre-injury level of sports activity after a mean of 5.1 ± 1.1 months. The median Lysholm score was 99 (IQR 98–100), the median subjective IKDC score was 97.8 (IQR 96.5–99.4), and the median Tegner Activity Score was 8.5 (IQR 8–9). Residual anterior laxity was detected in 11 patients (42.3%), although only one reported subjective instability. Patients with residual anterior laxity had lower Lysholm scores. Although final Tegner Activity Scores were also lower, this reflected lower pre-injury activity levels, as all patients returned to their individual pre-injury Tegner Activity Score. Subjective IKDC scores were comparable between groups. Conclusions This technique provided reliable fracture healing, excellent functional outcomes, complete return to pre-injury activity levels, and a low complication rate at medium- to long-term follow-up. Although arthroscopic fixation is currently the most commonly used technique, the mini-open approach represents a safe and effective alternative for selected displaced pediatric tibial eminence fractures, particularly when fracture characteristics or local resources limit the use of arthroscopy.