Comparison between arthroscopic surgery and open reduction internal fixation in patients with posterior cruciate ligament tibial avulsion fracture: a systematic review with meta-analysis.

BACKGROUND

Studies comparing arthroscopic surgery with open reduction internal fixation (ORIF) for posterior cruciate ligament (PCL) tibial avulsion fracture have exploded in recent years; however, the results are not consistent. This meta-analysis aimed to summarize the efficacy and safety profile of arthroscopic surgery and ORIF in patients with PCL tibial avulsion fracture.

METHODS

Relevant studies were searched across the Web of Science, PubMed, EMBASE, Wan Fang, CNKI, and VIP databases. The standardized mean difference (SMD) or odds ratio (OR) with 95% confidence interval (CI) was pooled for analyses.

RESULTS

Twenty-seven studies were included in this meta-analysis. Compared with those in the ORIF group, the incision length (SMD: -4.701, 95%CI: -5.717~-3.686), perioperative bleeding (SMD: -3.304, 95%CI: -3.834~-2.774), postoperative drainage volume (SMD: -1.071, 95%CI: -1.870~-0.273), time to first ambulation (SMD: -2.294, 95%CI: -4.127~-0.460), and hospital stays (SMD: -1.918, 95%CI: -2.594~-1.242) were lower, but the operation duration (SMD: 1.998, 95%CI: 0.595 ~ 3.401) was greater in the arthroscopy group. After treatment, the Lysholm score (SMD: 1.424, 95%CI: 0.858 ~ 2.837), International Knee Documentation Committee score (SMD: 1.848, 95%CI: 0.858 ~ 2.837), range of motion (SMD: 0.527, 95%CI: 0.001 ~ 1.053) were greater in the arthroscopy group than in the ORIF group, but no statistically significant difference was observed in the pain score (SMD: -0.250, 95%CI: -0.664 ~ 0.165), and posterior drawer test negative rate (OR: 1.040, 95%CI: 0.460 ~ 2.351). Moreover, the incidence of postoperative complications (OR: 0.458, 95%CI: 0.149 ~ 1.411) was not significantly different between the arthroscopy group and the ORIF group.

CONCLUSION

Arthroscopic surgery appears to provide better functional outcomes and a comparable risk of complications than ORIF does to some extent, although longer operative time and study heterogeneity warrant caution, for PCL tibial avulsion fracture.