Early Rehabilitationin in Tibial Spine Avulsion Fracture Managed With Arthoscopic Fibre Wire Fixation

NCT07428291 | Recruiting DMC

• 1 other identifier: UOL/IREB/25/15/03/07
• Study Type: interventional
• Target: 56
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Avulsion Fracture

Keywords

Tibial Spine Avulsion Fracture; Arthroscopic Fiber Wire Fixation; Early Rehabilitation

Outcome Measures

Primary Outcomes (1)

• Change in Knee Range of Motion (ROM)

  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.

  Baseline (Postoperative Week 1), Week 6, and Week 12

Study Arms (2)

group A Early Rehabilitation After Arthroscopic Fiber Wire Fixation

EXPERIMENTAL

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.

Behavioral: Early Postoperative Rehabilitation Program

group B Conventional

ACTIVE COMPARATOR

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.

Behavioral: Conventional (Delayed) Rehabilitation Program

Interventions

Conventional (Delayed) Rehabilitation Program BEHAVIORAL

The Conventional Rehabilitation Program will involve knee immobilization for the first 6 postoperative weeks following arthroscopic fiber wire fixation. During this period, patients will use a knee immobilizer and perform home-based management including ankle pumps, straight leg raises, quadriceps isometric exercises, icing, leg elevation, and non-weight-bearing ambulation. Formal rehabilitation will begin after week 6 and will include gradual restoration of knee range of motion, progressive strengthening of quadriceps and hamstrings, controlled weight-bearing progression, and functional training exercises. Advanced strengthening, proprioceptive training, and sport-specific exercises will be introduced only after adequate healing and surgeon clearance.

group B Conventional

Early Postoperative Rehabilitation Program BEHAVIORAL

The Early Postoperative Rehabilitation Program will begin immediately after arthroscopic fiber wire fixation of tibial spine avulsion fracture. During the first postoperative week, patients will perform protected exercises including ankle pumps, quadriceps isometrics, straight leg raises, and controlled active knee flexion limited to 30 degrees without resistance. The PRICE protocol (Protect, Rest, Ice, Compression, Elevation) will be applied. From weeks 2-6, controlled progression of knee flexion (up to 90-100 degrees by week 6), gradual introduction of partial weight-bearing (up to 30%), and supervised strengthening exercises will be implemented. From weeks 7-12, rehabilitation will focus on progressive resistance training of quadriceps and hamstrings, balance an

group A Early Rehabilitation After Arthroscopic Fiber Wire Fixation

Eligibility Criteria

• Age: 15 Years - 25 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• Both Gender
• Age 15-25 Years
• General Population
• History of Fall,
• Sports Activity

You may not qualify if:

• 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

Sponsors & Collaborators

• Abdul Jabbar: lead

Study Sites (1)

University of Lahore Teaching Hospital, Lahore

Lahore, Punjab Province, 54000, Pakistan

RECRUITING

MeSH Terms

Conditions

Fractures, Avulsion

Interventions

Congresses as Topic; Rehabilitation

Condition Hierarchy (Ancestors)

Fractures, Bone; Wounds and Injuries

Intervention Hierarchy (Ancestors)

Organizations; Health Care Economics and Organizations; Aftercare; Continuity of Patient Care; Patient Care; Therapeutics; Health Services; Health Care Facilities Workforce and Services

Study Officials

• Abdul Jabbar, MSPTS

  The University of Lahore, Lahore

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Abdul Jabbar, MSPTS

CONTACT

03442077190; 70176356@student.uol.edu.pk

Montiha Azeem, MSPTN

CONTACT

03479717317; muntahaazeem9@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: principal investigator

Study Record Dates

• First Submitted: February 16, 2026
• First Posted: February 23, 2026
• Study Start: February 27, 2026
• Primary Completion: May 27, 2026
• Study Completion: May 30, 2026
• Last Updated: February 27, 2026

Record last verified: 2026-02

Locations

PA (1)