Anterior Cruciate Ligament Injury at the Time of Anterior Tibial Spine Fracture in Young Patients: An Observational Cohort Study
The relationship between anterior tibial spine fractures (ATSF) and anterior cruciate ligament (ACL) injury in the pediatric population has not been defined though the injuries may occur together. ATSF occur at the point on the tibia where the ACL attaches and are thought to be seen more frequently in the pediatric population because of weaker muscles surrounding the knee joint in kids and higher elasticity of knee ligaments. After experiencing an ATSF, many patients continue to have instability on exam, which may be the result of damage to the actual ligament when a fracture occurs. This concept has been suggested by previous cadaveric studies that found that the ACL experiences damage prior to tibial fracture.
Through assessment of 129 ATSF in the pediatric population, this study found that 19% of patients also experienced an ACL injury. Compared to patients with an isolated ASTF, patients experiencing ATSF with ACL injury were more likely to be male, older, need surgical fixation of the ATSF, and have additional injury (meniscus or chondral). Although MRI is often used to determine injury extent, it failed to identify up to 75% ACL injuries occurring with ASTF. Interestingly, there was no difference in mechanism of injury for patients experiencing an isolated ATSF versus ATSF with ACL injury.