Arthroscopic Tibial Spine Fixation
Yi-Meng Yen, MD, PhD
Indications
Unreducible hinged tibial spine fracture (Type II)
Completely displaced or comminuted tibial spine fracture (Type III) (Figure 23-1)
 Figure 23-1 ▪ Completely displaced tibial spine fracture. |
Sterile Instruments/Equipment
Standard OR table setup for knee arthroscopy
High thigh nonsterile tourniquet
Standard arthroscopic equipment
Arthroscopic shaver
Tibial ACL guide
5/64” Kirschner wires
Cannulated suture passer (Figure 23-2)
Figure 23-2 ▪ Cannulated suture passer is pictured on the left. The nitinol wire that comes with the passer can be replaced with a #2 PDS suture, or the nitinol wire can be used to shuttle in a #2 Fiberwire. The Hewson suture passer is shown on the right.
(2) Hewson suture passers
Suture – surgeon preference, #2 PDS or #2 Fiberwire or other suture
Patient Positioning (Figures 23-3 and 23-4)
Supine on a standard table with knee holder or knee post to enable valgus stress of the knee
If fluoroscopy is used, it should be placed on the contralateral side to obtain lateral radiographs
 Figure 23-3 ▪ Standard OR table with lateral knee post. |
 Figure 23-4 ▪ Left knee after sterile preparation and draping. |
Surgical Approaches (Picture of Arthroscopic Entry, Arthroscopic Picture of Displaced Piece)
Anteromedial and anterolateral knee arthroscopy portals should be made just adjacent to the pateallar tendon (Figure 23-5).
A trans-patellar portal can be made to aid with suture management or reduction of the fracture.
The knee should be irrigated to remove the lipohemarthrosis
Complete visualization of the entire knee joint should be achieved with arthroscopy (Figure 23-6). Debridement of the fat pad is usually necessary.
Care must be taken to identify meniscal or intermeniscal ligament entrapment in the tibial spine fracture
If the anterior horn of the medial meniscus or intermeniscal ligament is trapped, a probe can be used to pull the structure out of the fracture site (Figure 23-7). An outside-in suture can be placed for retraction if necessary. A suture is passed around the meniscus using a spinal needle and a heavy clamp around the suture outside the knee will provide the tension on the suture for retraction of the meniscus.
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