Meta-analysis compares arthroscopic versus open reduction for tibial spine fractures in children
Photo by DIANA HAUAN / Unsplash
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.
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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