University of Oulu

Jääskelä M, Turati M, Lempainen L, et al. Long-term Outcomes of Tibial Spine Avulsion Fractures After Open Reduction With Osteosuturing Versus Arthroscopic Screw Fixation: A Multicenter Comparative Study. Orthopaedic Journal of Sports Medicine. 2023;11(6). doi:10.1177/23259671231176991

Long-term outcomes of tibial spine avulsion fractures after open reduction with osteosuturing versus arthroscopic screw fixation : a multicenter comparative study

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Author: Jääskelä, Maija1; Turati, Marco2,3,4; Lempainen, Lasse4,5,6;
Organizations: 1Department of Pediatric Orthopaedics and Surgery, Oulu University Hospital; Research Unit of Clinical Medicine, University of Oulu; and Medical Research Center, Oulu, Finland
2Orthopedic Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
3Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
4Ripoll y De Prado FIFA Medical Centre of Excellence, Madrid, Spain
5FinnOrthopaedics/Hospital Pihlajalinna, Turku, Finland
6Department of Physical Activity and Health, Paavo Nurmi Centre, University of Turku, Turku, Finland
7Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
8Department of Paediatric Orthopaedic Surgery, Hospital Couple Enfant, Grenoble Alpes University, Grenoble, France
9Unité de Médecine du Sport, Centre Hospitalier Francois Mitterand de Pau, Pau, France
10Department of Orthopaedic Surgery, Hôpital des Enfants, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
11Hospital TerveysTalo, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.1 MB)
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Language: English
Published: SAGE Publications, 2023
Publish Date: 2023-10-02


Background: More information is needed regarding return to preinjury sport levels and patient-reported outcomes after tibial spine avulsion (TSA) fracture, which is most common in children aged 8 to 12 years.

Purpose: To analyze return to play/sport (RTP), subjective knee-specific recovery, and quality of life in patients after TSA fracture treated with open reduction with osteosuturing versus arthroscopic reduction with internal screw fixation.

Study Design: Cohort study; Level of evidence, 3.

Methods: This study included 61 patients <16 years old with TSA fracture treated via open reduction with osteosuturing (n = 32) or arthroscopic reduction with screw fixation (n = 29) at 4 institutions between 2000 and 2018; all patients had at least 24 months of follow-up (mean ± SD, 87.0 ± 47.1 months; range, 24–189 months). The patients completed questionnaires regarding ability to return to preinjury-level sports, subjective knee-specific recovery, and health-related quality of life, and results were compared between treatment groups. Univariate and multivariate logistic regression analyses were conducted to determine variables associated with failure to return to preinjury level of sport.

Results: The mean patient age was 11 years, with a slight male predominance (57%). Open reduction with osteosuturing was associated with a quicker RTP time than arthroscopy with screw implantation (median, 8.0 vs 21.0 weeks; P < .001). Open reduction with osteosuturing was also associated with a lower risk of failure to RTP at preinjury level (adjusted odds ratio, 6.4; 95% CI, 1.1-36.0; P = .035). Postoperative displacement >3 mm increased the risk of failure to RTP at preinjury level regardless of treatment group (adjusted odds ratio, 15.2; 95% CI, 1.2-194.9; P = .037). There was no difference in knee-specific recovery or quality of life between the treatment groups.

Conclusion: Open surgery with osteosuturing was a more viable option for treating TSA fractures because it resulted in a quicker RTP time and a lower rate of failure to RTP as compared with arthroscopic screw fixation. Precise reduction contributed to improved RTP.

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Series: Orthopaedic journal of sports medicine
ISSN: 2325-9671
ISSN-E: 2325-9671
ISSN-L: 2325-9671
Volume: 11
Issue: 6
DOI: 10.1177/23259671231176991
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
3123 Gynaecology and paediatrics
Copyright information: © The Author(s) 2023. This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (