What is the treatment for an intercondylar eminence fracture of the tibia?

Treatment of Intercondylar Eminence Fracture of the Tibia

Displaced intercondylar eminence fractures (Type II, III, and IV) should be treated with arthroscopic reduction and internal fixation, while truly non-displaced Type I fractures can be managed conservatively with close monitoring for displacement. 1, 2, 3

Classification-Based Treatment Algorithm

Type I Fractures (Non-displaced)

• Conservative management with long leg cast immobilization is acceptable, BUT close radiographic surveillance is critical 4
• Consider primary arthroscopic fixation even for Type I fractures because non-displaced fragments can displace secondarily during the immobilization period, making subsequent arthroscopic reduction technically more difficult 4
• If displacement occurs during cast treatment, convert immediately to surgical fixation 4

Type II, III, and IV Fractures (Displaced)

• Arthroscopic reduction and internal fixation is the definitive treatment 1, 2, 3, 5
• Surgery provides superior outcomes compared to conservative management for displaced fractures 1, 2, 3

Surgical Technique and Fixation Options

Arthroscopic Approach

• Use standard anterolateral or anteromedial portals for arthroscopic access 3
• Irrigate and inspect the joint thoroughly 3
• Release any interposed soft tissue (intermeniscal ligament in most cases, anterior medial meniscus in some) that prevents reduction 2, 3
• Reduce the fragment under direct arthroscopic visualization 1, 2, 3

Fixation Methods (All Equally Effective)

The choice of fixation material does not significantly affect outcomes—all methods provide adequate stability 3. Options include:

• Cannulated screw fixation (with or without washer): Provides the most rigid fixation, allowing immediate mobilization and weight-bearing 2
• Non-absorbable suture fixation: Particularly useful for comminuted or small fragments where screw fixation is not feasible 1
• Kirschner wire fixation: Effective but requires hardware removal 3, 5
• Absorbable suture: Avoids second surgery for hardware removal 3

Key advantage of cannulated screw fixation: It is stable enough to eliminate the need for postoperative immobilization 2

Postoperative Management

For Cannulated Screw Fixation

• Immediate continuous passive and active motion starting the day after surgery 2
• Immediate weight-bearing as tolerated on crutches 2
• No immobilization required 2
• Average treatment duration: 12 weeks 2

For Suture or Wire Fixation

• Immobilize in hinged knee brace locked in full extension for 4 weeks with non-weight bearing 1
• Begin range of motion and quadriceps strengthening at 4 weeks 1
• Progress to partial weight-bearing at 8 weeks 1

For Percutaneous Pin Fixation

• Extension and cast immobilization after arthroscopic reduction and pin fixation 5
• Significantly shorter hospitalization compared to open techniques 5

Expected Outcomes

Excellent functional results are consistently achieved:

• Average Lysholm scores: 95.6-98.8 1, 2
• Knee flexion: 135-140 degrees with minimal extension deficit (0.6-1.2 degrees) 1, 2
• Knee stability: Negative Lachman test and no pivot shift in properly treated cases 1, 2
• KT-1000 testing: Average 1.1 mm side-to-side difference 2
• Radiographic union achieved in all cases 1, 2, 3

Critical Pitfalls to Avoid

• Do not assume Type I fractures remain stable—they can displace during conservative treatment, and delayed displacement makes arthroscopic reduction more difficult 4
• Always inspect for associated injuries: Medial collateral ligament involvement and lateral meniscus tears occur frequently and require separate surgical repair through additional incisions 5
• Do not attempt screw fixation in comminuted or very small fragments—use suture fixation instead 1
• Metal implants require a second surgery for removal, unlike absorbable materials 3

Advantages of Arthroscopic Treatment

• Minimally invasive with excellent visualization of the operative field 3
• No arthrotomy required for reduction or fixation 2
• Significantly decreased hospital stay and morbidity compared to open techniques 5
• Allows identification and treatment of associated meniscal and ligamentous injuries 5
• Simple, safe, reproducible, and effective procedure 2