Abstract
Background:
Arthrofibrosis is the most common postoperative complication following surgical fixation of tibial spine fractures (TSF)1. The purpose of this analysis is to identify the rate and associated risk factors for stiffness in surgically treated pediatric TSF patients.
Hypothesis:
We hypothesize patient age, injury severity, and screw fixation all increase rate of postoperative knee stiffness following TSF fixation.
Methods:
A prospective registry of consecutive cases from 43 surgeons across 26 institutions in the United States was queried. Demographic, operative, post-operative rehabilitation, and complication data from pediatric TSF cases (<19 years old) between 2018-2025 with minimum 8-month follow-up was collected. The Modified Clavien-Dindo-Sink Complication Classification System (CDS) was used for complication grading; with Grade II and III stiffness included for analysis2. Descriptive statistics were calculated and analyzed for associations with postoperative stiffness using Chi-Squared and Fisher's Exact Test for categorical variables, and Mann-Whitney U Test for continuous variables, while controlling for confounding variables including patient age, sex, rehabilitation type, and injury characteristics.
Results:
464 (348 TSF, 116 TSF with meniscus repair) patients were included for analysis. Mean age was 12.02 ± 2.77 years (range: 5-18), BMI was 21.13 ± 5.94, injury to surgery interval was 97.88 ± 38.74 days, and there were 343 (73.9%) males. A total of 64 patients (13.8%) developed postoperative stiffness, of which 26 (40.6%) required surgical reoperation (CDS Grade III) and 38 (59.4%) were managed nonoperatively (CDS Grade II).
Univariate analysis revealed that higher rates of postoperative stiffness was observed in patients <13 years of age (19.0% vs 0.9%; p=0.001), patients without concomitant meniscal tear (16.0% vs 10.0%; p=0.048), and patients with fracture extending to the weight bearing surface of the tibia (19.0% vs 12.0%; p=0.026). When controlling for patient, surgical, and rehabilitation variables, there was a significantly higher risk of developing postoperative knee stiffness in patients <13 years (OR 3.25; 95% CI:1.65-6.42; p=0.001) and when fractures extended to the weight bearing surface of the tibia (OR 2.03; 95% CI: 1.09-3.78, p=0.025). those who underwent TSF fixation with a screw (includes hybrid screw-and-suture fixation) were more likely to develop postoperative stiffness when compared with suture alone (OR 2.92; 95% CI: 1.067-8.35; p=0.037) (Table 1).
Conclusion:
Postoperative knee stiffness following surgical treatment of TSF occurs in approximately 1 in every 7 patients treated (13.8%). Stiffness is associated with younger patients (≤13 years), fracture extension into the weight bearing surface of the tibia, and screw fixation of TSF.
