Avulsion FractureER-TSAVNCT07428291
Early Rehabilitationin in Tibial Spine Avulsion Fracture Managed With Arthoscopic Fibre Wire Fixation
A study testing Early Postoperative Rehabilitation Program and Conventional (Delayed) Rehabilitation Program in people with Avulsion Fracture, run by Abdul Jabbar at 1 site in Pakistan.
Trial 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… Read more about this study
- Who is it for?
- Ages 15 to 25 years
- Conditions the study is for
- Avulsion Fracture
- What is being tested?
- Early Postoperative Rehabilitation Program and Conventional (Delayed) Rehabilitation Program
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 56 participants
- Where
- 1 sitePakistan
- Study dates
- 27 Feb 2026to 30 May 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 15 to 25 years
- All sexes
- No healthy volunteers
- Child, Adult
Who may be able to join
- Both Gender
- Age 15-25 Years
- General Population
- History of Fall,
- Sports Activity
Who cannot join
- 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
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Pakistan1 site, 1 recruiting
- Recruiting
University of Lahore Teaching Hospital, Lahore
Lahore, Punjab Province, 54000
Abdul Jabbar, MSPTS, 03442077190, infodrabduljabbar@gmail.com
Montiha Azeem, MSPTN, 03479717317, muntahaazeem9@gmail.com
About this study
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.
Read more
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.
Read the detailed description
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.
- Conditions
- Avulsion Fracture
- Being tested
- Early Postoperative Rehabilitation Program, Conventional (Delayed) Rehabilitation Program
- Keywords
- Tibial Spine Avulsion Fracture, Arthroscopic Fiber Wire Fixation, Early Rehabilitation
- Medical subject headings
- Fractures, Avulsion
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Early Postoperative Rehabilitation ProgramBehavioural
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
Conventional (Delayed) Rehabilitation ProgramBehavioural
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.
| Study group | Role | What they receive |
|---|---|---|
| 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. Receives: 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. Receives: Behavioral: Conventional (Delayed) Rehabilitation Program |
What is being measured
The primary outcome is the main question the study is designed to answer.
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.
Measured: Baseline (Postoperative Week 1), Week 6, and Week 12
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted23 Feb 2026
- Study start27 Feb 2026 (estimated)
- Primary completion27 May 2026 (estimated)
- Study completion30 May 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Avulsion FractureStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 56 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Abdul Jabbar
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor-investigator, Abdul Jabbar, University of Lahore
- Investigators
- Abdul Jabbar, MSPTS, Principal investigator, The University of Lahore, Lahore
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07428291
- Sponsor's protocol ID
- UOL/IREB/25/15/03/07
- Acronym
- ER-TSAV
- Status last verified
- Feb 2026
- First submitted
- 16 Feb 2026
- Last updated
- 27 Feb 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 27 Feb 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Early Rehabilitationin in Tibial Spine Avulsion Fracture Managed With Arthoscopic Fibre Wire Fixation
- ClinicalTrials.gov ID
- NCT07428291
- Acronym / sponsor ID
- ER-TSAV / UOL/IREB/25/15/03/07
- Conditions
- Avulsion Fracture
- Keywords
- Tibial Spine Avulsion Fracture, Arthroscopic Fiber Wire Fixation, Early Rehabilitation
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 56 participants (estimated)
- Lead sponsor
- Abdul JabbarUniversity, hospital or other
- Study start
- 27 Feb 2026 (estimated)
- Primary completion
- 27 May 2026 (estimated)
- Study completion
- 30 May 2026 (estimated)
- First posted
- 23 Feb 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Detailed description
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.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| group A Early Rehabilitation After Arthroscopic Fiber Wire Fixation | Experimental | Behavioral: Early Postoperative Rehabilitation ProgramParticipants 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. |
| group B Conventional | Active comparator | Behavioral: Conventional (Delayed) Rehabilitation ProgramParticipants 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. |
Who may qualify
- Ages
- 15 to 25 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult
Key inclusion criteria (5 listed)
- Both Gender
- Age 15-25 Years
- General Population
- History of Fall,
- Sports Activity
Key exclusion criteria (4 listed)
- 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
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Early Postoperative Rehabilitation ProgramThe 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 | Behavioural | group A Early Rehabilitation After Arthroscopic Fiber Wire Fixation |
| Conventional (Delayed) Rehabilitation ProgramThe 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. | Behavioural | group B Conventional |
Primary outcome
Change in Knee Range of Motion (ROM)
Time frame: 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.
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 27 Feb 2026.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Abdul Jabbar, MSPTS principal investigator
The University of Lahore, Lahore
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Early Postoperative Rehabilitation Program and Conventional (Delayed) Rehabilitation Program in people with Avulsion Fracture, run by Abdul Jabbar at 1 site in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 27 Feb 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Abdul Jabbar, MSPTS (03442077190, 70176356@student.uol.edu.pk), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change in Knee Range of Motion (ROM) (time frame: Baseline (Postoperative Week 1), Week 6, and Week 12). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Feb 2026.