Does the mini-open technique still have a role in the modern management of pediatric tibial eminence fractures?

BACKGROUND: Tibial eminence fractures are uncommon pediatric injuries that often require surgical fixation. Although arthroscopic fixation is widely adopted, the role of mini-open physeal-sparing techniques remains incompletely defined. This study evaluated the medium- and long-term clinical and radiographic outcomes of pediatric patients treated with this technique for displaced tibial eminence fractures. METHODS: A retrospective study was conducted on 26 consecutive patients (mean age 12.1 ± 2.3 years) treated between 2017 and 2019 with a mini-open physeal-sparing transosseous suture technique. Clinical and radiographic follow-up averaged 7.6 ± 2.9 years. Outcomes included fracture union, range of motion, residual anterior laxity, return to sport, complications, and patient-reported outcome measures (Lysholm Knee Score, subjective International Knee Documentation Committee score, and Tegner Activity Scale). Non-parametric statistical analyses were performed to evaluate correlations between baseline characteristics and clinical outcomes, as well as differences between patients with and without residual anterior laxity. RESULTS: Fracture union was achieved in all patients at a mean of 35.8 ± 6.4 days. No cases of infection, nonunion, arthrofibrosis, growth disturbance, limb-length discrepancy, or fixation failure were observed. At final follow-up, no patient had persistent range-of-motion limitation, and all returned to their pre-injury level of sports activity after a mean of 5.1 ± 1.1 months. The median Lysholm score was 99 (IQR 98-100), the median subjective IKDC score was 97.8 (IQR 96.5-99.4), and the median Tegner Activity Score was 8.5 (IQR 8-9). Residual anterior laxity was detected in 11 patients (42.3%), although only one reported subjective instability. Patients with residual anterior laxity had lower Lysholm scores. Although final Tegner Activity Scores were also lower, this reflected lower pre-injury activity levels, as all patients returned to their individual pre-injury Tegner Activity Score. Subjective IKDC scores were comparable between groups. CONCLUSIONS: This technique provided reliable fracture healing, excellent functional outcomes, complete return to pre-injury activity levels, and a low complication rate at medium- to long-term follow-up. Although arthroscopic fixation is currently the most commonly used technique, the mini-open approach represents a safe and effective alternative for selected displaced pediatric tibial eminence fractures, particularly when fracture characteristics or local resources limit the use of arthroscopy.