Arthroscopic fixation versus open reduction and internal fixation for displaced tibial side posterior cruciate ligament avulsion fractures: A systematic review and meta-analysis.

BACKGROUND

The reported incidence of the posterior cruciate ligament (PCL) injury ranges from 3 to 23 % of all knee injuries. Several injury patterns of the PCL have been described, including intra-substance, femoral detachment, and tibial avulsion, of which the last two are more common. Displaced PCL avulsion injury from the tibial side requires surgical fixation; however, there is no consensus in the literature regarding the optimal surgical approach for the fixation of these injuries.

PURPOSE: To perform a systematic review and meta-analysis of the outcomes and complications of arthroscopic and open fixation of displaced tibial side PCL avulsion fractures.

METHODS

We performed a primary electronic search across PubMed, Embase, Scopus, and Cochrane Library databases and looked for comparative studies that evaluated and compared the outcomes of arthroscopic versus open reduction and fixation of displaced tibial side PCL avulsion fractures. Statistical analyses were executed with the software RevMan-5.4.1.

RESULTS

This meta-analysis included two RCTs, one prospective and seven retrospective comparative studies. Evaluation across all ten studies suggested no statistically significant difference for arthroscopic versus open fixation in terms of postoperative International Knee Documentation Committee (IKDC) score (MD 4.43 [-0.73, 9.42; p = 0.09]), Lysholm score (MD 2.69 [-1.07,6.45; p = 0.16], knee range of motion (ROM) (MD -1.08 [-2.80,0.63; p = 0.21]), complications (OR1.75 [0.86, 3.54; P = 0.12]), Tegner activity (MD 0.14 [-0.46,0.74; p = 0.64]), posterior tibial translation (PTT) (MD -0.60 [-1.51,0.31; p = 0.20, posterior drawer test (PDT), operating time (MD 12.03 [-0.47, 24.53; p = 0.06]), and length of hospital stay. The fracture union rate was 98.77 % in the arthroscopic group and 100 % in the open fixation group, with comparable union time. There is a significantly lesser amount of blood loss in the arthroscopic group compared to the open group.

CONCLUSION

Current evidence shows comparable outcomes and complications for tibial side PCL avulsion fracture fixation through arthroscopic or open methods.