Balancing Act: Screw vs. Suture Fixation in Tibial Eminence Fractures

Tibial eminence fractures demand a precise balance between stabilization and complication risk, yet surgeons often lack clear guidance on whether to favor screw or suture fixation.

As sports-related knee injuries rise in competitive and recreational athletes, orthopedic surgeons face a critical choice: Arthroscopic screw fixation promises biomechanical robustness, while suture fixation minimizes hardware concerns. A recent meta-analysis of arthroscopic fixation methods highlights this enduring debate by quantifying differences in immediate stability, healing trajectories and complication profiles.

Arthroscopic screw fixation consistently delivers superior initial rigidity, enabling accelerated mobilization—a critical advantage when early range of motion correlates with functional recovery. This analysis also reveals that the compressive force of screws can shorten the bridging callus formation period, translating into rehabilitation programs that progress to weight-bearing and active flexion sooner than with suture constructs. However, hardware prominence or migration remains a tangible concern.

In contrast, suture fixation circumvents metal-related complications such as screw back-out or removal, supporting a lower incidence of reoperation. Earlier findings suggest that while suture constructs may yield marginally increased tibial translation under load, clinical outcomes at one year demonstrate comparable patient-reported function when postoperative protocols accommodate a more gradual loading schedule.

Healing dynamics further underscore the trade-offs: screw-based constructs have been shown to reduce time to radiographic union by up to two weeks compared with suture-only approaches, yet this gain must be weighed against the risk of synovitis or screw impingement. Conversely, slower callus maturation with suture fixation demands extended protected weight-bearing, which can delay return-to-play for high-impact athletes.

Individual patient factors such as bone quality, sport-specific demands and surgeon expertise often tip the decision. For example, in a collegiate basketball player seeking rapid court return, screw fixation with vigilant hardware monitoring may offer the optimal path, whereas a skeletally immature patient might benefit from the lower-profile footprint of suture constructs.

Beyond fixation choice, procedural refinements can shape outcomes. A recent study on surgical technique optimization demonstrated that adjusting tunnel angles and tensioning sequences reduces soft tissue irritation and promotes smoother rehabilitation curves across a range of sports injuries.

As fixation technologies and surgical protocols continue to evolve, the clinician’s role is to match technique selection with individual anatomy, activity level and recovery goals, ensuring that each patient benefits from both biomechanical precision and minimized complication risk.

Key Takeaways:

• Tibial eminence fractures require balancing immediate biomechanical stability with the potential for hardware-related complications.
• Arthroscopic screw fixation shortens time to mobilization and radiographic union but carries a higher risk of screw prominence and synovitis.
• Suture fixation reduces hardware complications and reoperation rates but may necessitate extended protected weight-bearing.
• Refined surgical protocols, including tunnel placement and tensioning strategies, enhance outcomes across fixation methods.