Arthroscopic fixation of an avulsion fracture of the tibia involving the posterior cruciate ligament

Abstract

A total of 22 patients with a tibial avulsion fracture involving the insertion of the posterior cruciate ligament (PCL) with grade II or III posterior laxity were reduced and fixed arthroscopically using routine anterior and double posteromedial portals. A double-strand Ethibond suture was inserted into the joint and wrapped around the PCL from anterior to posterior to secure the ligament above the avulsed bony fragment. Two tibial bone tunnels were created using the PCL reconstruction guide, aiming at the medial and lateral borders of the tibial bed. The ends of the suture were pulled out through the bone tunnels and tied over the tibial cortex between the openings of the tunnels to reduce and secure the bony fragment. Satisfactory reduction of the fracture was checked arthroscopically and radiographically. The patients were followed-up for a mean of 24.5 months (19 to 28). Bone union occurred six weeks post-operatively. At final follow-up, all patients had a negative posterior drawer test and a full range of movement. KT-1000 arthrometer examination showed that the mean post-operative side-to-side difference improved from 10.9 mm (standard deviation (sd) 0.7) pre-operatively to 1.5 mm (sd 0.6) (p = 0.001). The mean Tegner and the International Knee Documentation Committee scores improved significantly (p = 0.001). The mean Lysholm score at final follow-up was 92.0 (85 to 96). We conclude that this technique is convenient, reliable and minimally invasive and successfully restores the stability and function of the knee.

What is the impact of knee morphology on posterior cruciate ligament avulsion fracture in men and women: a case control study

“…Previous studies mainly focused on the surgical technique or clinical outcomes of this injury [3][4][5]. To our knowledge, our study is the rst to identify the association between MRI measurements of the knee and PCL avulsion fracture and nd the independent factor that may help explain the risk of PCL avulsion fracture and the predisposition of patients toward knee injury.…”

“…It is generally agreed that a displaced PCL avulsion fracture should be anatomically reduced and xed. Both open and arthroscopic methods of xation have been reported to produce good outcomes [3][4][5].…”

Open Posterior Approach versus Arthroscopic Suture Fixation for Displaced Posterior Cruciate Ligament Avulsion Fractures: Systematic Review

“…Recently, due to its deep location and the complexity of the adjacent anatomy, minimally invasive arthroscopic techniques are gaining interest 6) . The additional advantages of the arthroscopic approach are direct visualization of fragment reduction and concomitant intra-articular injuries in the form of meniscal tears; further, osteochondral loose fragments or ligament injuries may be addressed at the time of the operation 5 – 10) . Despite comparable biomechanical properties of open and arthroscopic techniques 11) , there is a paucity of comparative clinical studies (open vs. arthroscopic) in the literature.…”

Short-term clinical outcomes of arthroscopic fixation of displaced posterior cruciate ligament avulsion fractures with the use of an adjustable loop suspensory device

“…Other arthroscopic techniques have also been described using the suture bridge method, 18,19 percutaneous screws, 20,21 suture anchors 22 or suture fixations. 1,[14][15][16] The suture bridge technique has been studied to have good clinical outcomes but has a possible steeper learning curve than the TightRope technique described in this article. In addition, as compared to just an additional posteromedial portal in our technique, the described suture bridge technique requires two additional portals (posteromedial and posterolateral), with the added risk of common peroneal nerve injury.…”

“…7 Minimally invasive and arthroscopic approaches have since been developed to mitigate the risks associated with open surgical approaches. 1,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Arthroscopic surgical fixation of isolated PCL avulsion fractures has been described 8,9 with limited clinical data. The technique of suspensory fixation devices has also been described to simplify the procedure.…”