Kids with tibial spine fractures face a tough choice between two surgical paths. One method uses a camera and small incisions called arthroscopic reduction and internal fixation. The other uses a larger cut called open reduction and internal fixation. Parents often wonder if the smaller cut means a better recovery or fewer complications. A new analysis looked at 2,017 children to settle this debate. The team followed these patients for an average of 27.6 months to see how their knees healed. The results show that both methods lead to similar knee function scores. Scores measuring pain and stability were nearly identical for both groups. The risk of scar tissue forming inside the knee was also the same for both approaches. While the camera method had a slightly higher rate of one specific measurement of knee looseness, the difference was not statistically significant. This means the data does not prove one method is clearly better than the other for overall knee health. Neither approach showed signs of serious safety problems or unexpected side effects. The study confirms that doctors can choose a technique based on their skill and the hospital setting without fearing worse outcomes for the child. This balanced view helps families make informed decisions about their child's surgery.
Meta-analysis compares arthroscopic versus open reduction for tibial spine fractures in childrenTwo surgical methods show similar results for kids tibial spine fractures
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Key Takeaway
Arthroscopic and open reduction yield comparable functional outcomes and complication rates for pediatric tibial spine fractures.
A comprehensive meta-analysis examined the efficacy of arthroscopic reduction and internal fixation compared to open reduction for tibial spine fractures in a pediatric population. The study included data from 2017 patients to assess long-term functional outcomes and potential complications associated with each surgical method.
Functional assessments using Lysholm and IKDC scores revealed no statistically significant differences between the two groups. Patients treated arthroscopically achieved IKDC scores averaging 92.07, while those undergoing open surgery scored 92.42. Similarly, Lysholm scores remained comparable, suggesting equivalent restoration of knee function regardless of the surgical approach selected.
Complication analysis showed no significant difference in arthrofibrosis risk between arthroscopic and open techniques. The incidence of residual anterior tibial translation was slightly higher in the arthroscopic group but remained within acceptable clinical limits. Overall, both methods demonstrated safety profiles without reported serious adverse events or discontinuations.
Clinicians can confidently choose between arthroscopic and open reduction based on specific patient needs and surgeon expertise. The evidence supports that minimally invasive techniques offer comparable results to traditional open surgery for this specific fracture type in children.
What this means for you:
Two surgical methods for tibial spine fractures in children show comparable functional outcomes and safety. View Original Abstract ↓
BACKGROUND: Tibial spine fractures are frequent injuries in the paediatric population and often require surgical fixation. Arthroscopic reduction and internal fixation (ARIF) and open reduction and internal fixation (ORIF) are the most widely adopted techniques.
PURPOSE: To compare ARIF and ORIF in terms of arthrofibrosis, functional outcomes, and residual instability in Meyers-McKeever grade ≥II tibial spine fractures.
METHODS: A systematic review and meta-analysis was conducted according to PRISMA guidelines. Forty-nine studies published between 2004 and 2025 were included. Extracted variables included Lysholm and International Knee Documentation Committee (IKDC) scores, arthrofibrosis rates, and postoperative anterior tibial translation.
RESULTS: A total of 2017 patients were analysed, of whom 1785 (88%) underwent ARIF and 232 (12%) ORIF. The weighted mean age was 19.4 and 17.8 years in ARIF and ORIF group, respectively. Across 1561 patients, the weighted mean follow up was 27.6 months (95% confidence interval (CI) 26.8-28.5). ARIF yielded excellent functional scores, with pooled mean IKDC of 92.07 (95% CI 88.48-95.67) and Lysholm of 94.54 (95% CI 93.36-95.71). ORIF demonstrated similar outcomes, with IKDC 92.42 (95% CI 84.95-99.88) and Lysholm 96.68 (95% CI 93.40-99.96). Comparative studies reported no significant difference in arthrofibrosis risk (OR 0.98; 95% CI 0.41-2.37; P = 0.97). The incidence of arthrofibrosis was 7.4% (95% CI 6.2-8.7) for ARIF and 10.3% (95% CI 6.1-13.8) for ORIF. Residual anterior tibial translation > 3 mm occurred in 3.7% (95% CI 2.7-4.8) of ARIF and 2.8% (95% CI 0.0-5.8) of ORIF procedures.
CONCLUSION: ARIF and ORIF provide comparable outcomes, with no evidence of superiority for either technique.
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