Arthroscopy, sports medicine, and rehabilitation · 2026
Variation Exists Among Asia Pacific and American Surgeons in the Treatment of Pediatric Tibial Eminence Fractures.
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Loh Khin Yee Sammy, Lim Xinyi, Ganley Theodore, Hui James Hoi Po, Hong Chih-Kai
Аннотация
PURPOSE: To compare operative and nonoperative management strategies, fixation preferences, postoperative immobilization protocols, and approaches to managing postoperative complications among Asia Pacific (APAC) and North American surgeons.
METHODS: An online survey was distributed to orthopaedic surgeons within the Pediatric Research in Sports Medicine APAC group between January 2023 and June 2024. The survey, which is a modified version of the Pediatric Orthopaedic Society of North America (POSNA) survey, assessed surgeon demographics, treatment strategies, risk factors for postoperative arthrofibrosis, and responses to clinical vignettes.
RESULTS: Fifty-six out of 127 APAC surgeons responded to the survey. Compared with POSNA surgeons, APAC respondents were more likely to perform arthroscopic reduction and transphyseal suture fixation for type II (89.3% vs 37.4%, P < .001) tibial spine fracture regardless of patient's age. APAC surgeons also favored longer postoperative immobilization periods (14.3% vs 24.5%, P = .023) and identified time from injury to surgery (76.8% vs 31.9%, P < .001) as the main risk factor for arthrofibrosis. APAC surgeons were also more likely to manage early postoperative range-of-motion restriction nonoperatively with continued physiotherapy, whereas POSNA surgeons leaned toward arthroscopic lysis of adhesions (53.6% vs 33.6%, P = .015).
CONCLUSIONS: Although there was a 5-year gap between surveys, APAC surgeons were more likely than POSNA surgeons to perform arthroscopic reduction and transphyseal suture fixation for type 2 tibial spine fracture, favored longer postoperative immobilization, more frequently identified time from injury to surgery as the primary risk factor for arthrofibrosis, and were more inclined to manage early postoperative range-of-motion restriction nonoperatively.
CLINICAL RELEVANCE: Understanding regional differences in the management of tibial spine fractures may help identify areas of consensus and variation, inform best-practice guidelines, and ultimately improve patient outcomes.
METHODS: An online survey was distributed to orthopaedic surgeons within the Pediatric Research in Sports Medicine APAC group between January 2023 and June 2024. The survey, which is a modified version of the Pediatric Orthopaedic Society of North America (POSNA) survey, assessed surgeon demographics, treatment strategies, risk factors for postoperative arthrofibrosis, and responses to clinical vignettes.
RESULTS: Fifty-six out of 127 APAC surgeons responded to the survey. Compared with POSNA surgeons, APAC respondents were more likely to perform arthroscopic reduction and transphyseal suture fixation for type II (89.3% vs 37.4%, P < .001) tibial spine fracture regardless of patient's age. APAC surgeons also favored longer postoperative immobilization periods (14.3% vs 24.5%, P = .023) and identified time from injury to surgery (76.8% vs 31.9%, P < .001) as the main risk factor for arthrofibrosis. APAC surgeons were also more likely to manage early postoperative range-of-motion restriction nonoperatively with continued physiotherapy, whereas POSNA surgeons leaned toward arthroscopic lysis of adhesions (53.6% vs 33.6%, P = .015).
CONCLUSIONS: Although there was a 5-year gap between surveys, APAC surgeons were more likely than POSNA surgeons to perform arthroscopic reduction and transphyseal suture fixation for type 2 tibial spine fracture, favored longer postoperative immobilization, more frequently identified time from injury to surgery as the primary risk factor for arthrofibrosis, and were more inclined to manage early postoperative range-of-motion restriction nonoperatively.
CLINICAL RELEVANCE: Understanding regional differences in the management of tibial spine fractures may help identify areas of consensus and variation, inform best-practice guidelines, and ultimately improve patient outcomes.