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Tibial tubercle fractures are sports injuries in male adolescents with a considerable risk of complications and reoperations: a systematic review

Knee Surgery, Sports Traumatology, Arthroscopy (2023)Cite this article

Abstract

Purpose

There is growing interest in tibial tubercle fractures in pediatric and adolescent population within the last decade. However, there is limited evidence in the existing literature. Therefore, the purpose of this systematic review was to analyze and provide up-to-date data that may prove valuable in decision making and management of these injuries in the general as well as the athletic population.

Methods

A systematic review of the literature in PubMed, Cochrane library and Virtual Health Library was conducted using the "Preferred Reporting Items for Systematic Reviews and Meta-Analysis" (PRISMA) guidelines. Articles published in English or Spanish, during the past 20 years, reporting outcomes of tibial tubercle fracture management in patients younger than 18 years old, with a mean follow-up of at least 6 months reporting outcomes, type of management and classification were included.

Results

A total of 919 patients with 956 fractures in 25 retrospective cohort studies were included. The mean age was 14.4 ± 0.6 years while 766 [83%] were males and 740 [81%] of the injuries were sports-related. Associated injuries were reported in 91[10%] cases, most common being patellar tendon avulsion. Surgical management was chosen for 845[88%] of the cases, the vast majority being open reduction internal fixation (ORIF) with screws. Union was achieved in 954 [99.8%] cases. Complications and re-operations rate stood at 172[18%] and 161 [19% of the operations], respectively. Return to play (RTP) was reported in 11 [44%] of the studies standing at an average of 98.9% ± 3.6.

Conclusion

Essentially, this is an adolescent sports knee injury that needs careful planning before decision making because it may affect both RTP and joint preservation. Although union was achieved in almost all patients, there is a high risk of associated injuries, complications and reoperations. The surgeon should be confident to perform fracture fixation as well as addressing associated knee soft tissue injuries to achieve optimal outcomes.

Level of evidence

Level IV.

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Acknowledgements

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The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Trauma & Orthopaedics, Hull Royal Infirmary, Anlaby Rd, Hull, HU3 2JZ, UK

    Georgios Kalifis & Sally Hobson

  2. Department of Orthopaedic Surgery Faculty of Medicine, School of Health Sciences, University of Hospital of Larissa, Larissa, Greece

    Georgios Kalifis & Michael Hantes

  3. Aspetar Hospital, Aspetar Orthopaedic and Sports Medicine Hospital, Sportscity Street 1, Aspire Zone, P.O. Box 29222, Doha, Qatar

    Theodorakys Marin Fermin & Emmanuel Papakostas

  4. Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d’Eich, 78 Rue d’Eich, 1460, Luxembourg, Luxembourg

    Romain Seil

  5. Sports Medicine and Science, Luxembourg Institute of Research in Orthopaedics, Luxembourg, Luxembourg

    Romain Seil

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  1. Georgios Kalifis
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Contributions

G.K. and T.M.F. conceived of the presented idea, designed the study, independently conducted the systematic search and collected the data. T.M.F. and E.P. did the methodological quality assessment. T.M.F., S.H. and G.K. proceeded to interpretation and synthesis of the results. R.S. and M.H. were the mentors and supervisors of this work as well as the ones critically reviewed the manuscript. The final review was performed by M.H. All authors discussed the results and contributed to the final manuscript.

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Correspondence to Georgios Kalifis.

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Kalifis, G., Marin Fermin, T., Seil, R. et al. Tibial tubercle fractures are sports injuries in male adolescents with a considerable risk of complications and reoperations: a systematic review. Knee Surg Sports Traumatol Arthrosc (2023). https://doi.org/10.1007/s00167-023-07322-1

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Keywords

  • Tibial tubercle
  • Tibial tuberosity
  • Adolescent
  • Knee
  • Pediatric
  • Sports