Seventeen-Year Follow-up of a Reattachment of a Nonunited Anterior Tibial Spine Avulsion Fracture

Seventeen years ago we treated a nonunited avulsion fracture of the anterior tibial spine with open reduction and pull-out wires. When the patient was 9 years old, she fell and bruised her left knee. The knee was immobilized for a month in a long cast. When she was 24 years old, she felt severe knee pain and giving way after playing tennis 1 month before her first visit to our hospital. She complained of knee pain, giving way, locking, and 15° loss of knee extension. Radiographs showed a large nonunited fragment at the intercondylar eminence of the tibia. She underwent a reattachment surgery. When she was re-evaluated 17 years after surgery, she had no pain, no giving way, no locking, and no loss of knee extension. On physical examination, there was no instability. Plain anteroposterior and lateral radiographs showed a well-united fragment of the anterior tibial spine. In conclusion, the open reduction for knee pain, giving way, locking, and loss of knee extension caused by nonunion of avulsion of the anterior tibial spine yielded satisfactory results. We believe that in cases of nonunited anterior tibial spine fractures it is necessary to attempt to secure the anterior cruciate ligament in an anatomic position.