Early Rehabilitationin in Tibial Spine Avulsion Fracture Managed With Arthoscopic Fibre Wire Fixation
概览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- Abdul Jabbar
- 入组人数
- 56
- 试验地点
- 1
- 主要终点
- Change in Knee Range of Motion (ROM)
概览
简要总结
Tibial spine avulsion fracture is a common knee injury in adolescents and young adults, often caused by sports trauma or falls. It involves avulsion of the anterior cruciate ligament (ACL) attachment from the tibial eminence and may lead to pain, restricted range of motion, instability, and long-term functional limitations. Arthroscopic fixation using fiber wire is a widely accepted surgical technique for restoring joint stability. However, there is ongoing debate regarding the optimal timing of postoperative rehabilitation.
Traditionally, delayed rehabilitation protocols have been used to protect the surgical repair, but prolonged immobilization may lead to joint stiffness, quadriceps atrophy, delayed recovery, and prolonged return to sports. Early rehabilitation protocols aim to initiate controlled mobilization soon after surgery to enhance recovery of knee range of motion, muscle strength, and functional performance while maintaining surgical stability.
This randomized clinical trial will compare the effectiveness of early rehabilitation versus conventional (delayed) rehabilitation in patients aged 15-25 years who undergo arthroscopic fiber wire fixation for tibial spine avulsion fracture. Outcomes including knee range of motion (measured using a goniometer), muscle strength (measured using a hand-held dynamometer), and functional disability (assessed using the International Knee Documentation Committee (IKDC) Score) will be evaluated at baseline, 6 weeks, and 12 weeks postoperatively.
The findings of this study may help establish evidence-based rehabilitation guidelines and determine whether early rehabilitation provides superior functional outcomes compared to conventional therapy following tibial spine fixation.
详细描述
Tibial spine avulsion fractures are frequently observed in young individuals following sports injuries or traumatic falls. The injury occurs when the anterior cruciate ligament (ACL) pulls off a fragment of bone from the tibial eminence. Arthroscopic fiber wire fixation is a minimally invasive surgical technique that provides stable fixation and allows for anatomical reduction of the avulsed fragment. Despite surgical advancements, postoperative rehabilitation protocols remain controversial.
Conventional rehabilitation protocols typically emphasize prolonged immobilization and delayed initiation of knee range of motion exercises to protect the fixation. However, immobilization may lead to complications such as arthrofibrosis, quadriceps weakness, delayed neuromuscular recovery, and prolonged return to daily and sports activities. Early rehabilitation protocols propose controlled and progressive mobilization immediately after surgery to promote joint nutrition, prevent muscle atrophy, and enhance functional recovery without compromising surgical healing.
This randomized clinical trial will be conducted at the Department of Orthopedics & Sports Surgery, Jinnah Hospital, Allama Iqbal Medical College, Lahore. Eligible participants aged 15-25 years undergoing arthroscopic fiber wire fixation for tibial spine avulsion fracture will be recruited. After informed consent, participants will be randomly allocated into two groups using the lottery method:
Group A (Experimental Group): Early rehabilitation protocol beginning immediately after surgery, including controlled range of motion exercises, progressive strengthening, proprioceptive training, and gradual weight-bearing progression over 12 weeks.
Group B (Control Group): Conventional rehabilitation protocol with knee immobilization for the first 6 weeks postoperatively, followed by gradual initiation of rehabilitation.
Outcome measures include:
- Knee Range of Motion measured using a universal goniometer
- Muscle strength of quadriceps and hamstrings assessed using a hand-held dynamometer
- Functional disability assessed using the International Knee Documentation Committee (IKDC) Score
Assessments will be conducted at baseline, at the end of 6 weeks, and at the end of 12 weeks postoperatively.
Data will be analyzed using SPSS version 23. Normality of data will be assessed using Kolmogorov-Smirnov and Shapiro-Wilk tests. Repeated Measures ANOVA or Friedman test will be used for within-group comparisons, while Independent t-test or Mann-Whitney U test will be applied for between-group analysis. A p-value ≤ 0.05 will be considered statistically significant.
This study aims to provide clinical evidence regarding the safety and effectiveness of early rehabilitation following arthroscopic fiber wire fixation of tibial spine avulsion fractures and may contribute to improved postoperative rehabilitation guidelines and patient outcomes.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 15 Years 至 25 Years（Child, Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Both Gender Age 15-25 Years General Population History of Fall, Sports Activity
排除标准
- •Neglected Tibial Spine Avulsion Fracture for more than 6 months. Polytrauma, e.g., femur fracture, tibial fracture (other than tibial spine or condylar fracture), patella fracture.
- •Multiligamentous Knee Injury, e.g., PCL injury, PLC, LCL, MCL, patellofemoral ligament (MPFL) injury, meniscus injury.
- •Other Deformative Problems, Genu Valgus, Genu Varus
研究组 & 干预措施
group A Early Rehabilitation After Arthroscopic Fiber Wire Fixation
Participants in this arm will receive an early rehabilitation protocol beginning immediately after arthroscopic fiber wire fixation of tibial spine avulsion fracture. Rehabilitation will start in the immediate postoperative period with controlled range of motion exercises, quadriceps and hamstring isometric strengthening, ankle pumps, and straight leg raises. The protocol will progressively advance over 12 weeks, including gradual increase in knee flexion, progressive weight bearing, resistance training, proprioceptive exercises, balance training, cycling, functional strengthening, and sport-specific drills. Range of motion, muscle strength, and functional disability (IKDC score) will be assessed at baseline, 6 weeks, and 12 weeks.
干预措施: Early Postoperative Rehabilitation Program (Behavioral)
group B Conventional
Participants in this arm will follow a conventional postoperative protocol involving knee immobilization for the first 6 weeks after surgery. During this period, patients will perform basic home-based management including ankle pumps, icing, elevation, straight leg raises, and isometric exercises without active knee mobilization. Structured rehabilitation will begin after 6 weeks, focusing on gradual restoration of knee range of motion, strengthening of quadriceps and hamstrings, and progressive functional training. Outcomes will be measured at baseline, 6 weeks, and 12 weeks.
干预措施: Conventional (Delayed) Rehabilitation Program (Behavioral)
结局指标
主要结局
Change in Knee Range of Motion (ROM)
时间窗: Baseline (Postoperative Week 1), Week 6, and Week 12
Knee range of motion (flexion and extension) will be measured using a universal goniometer. The goniometer will be aligned with the lateral femoral epicondyle as the axis, with the stationary arm aligned with the femur and the moving arm aligned with the fibula. Active knee flexion and extension will be recorded in degrees. The primary outcome will be the change in ROM from baseline to 12 weeks postoperatively. Greater degrees of flexion and restoration of full extension indicate better recovery and improved joint mobility.
次要结局
未报告次要终点
研究者
Abdul Jabbar
principal investigator
University of Lahore