Arthroscopic Management of Posterior Cruciate Ligament Avulsion Fractures Utilizing Anterior Compartment Loop-and-Tack Suspension Fixation.

BACKGROUND

Posterior cruciate ligament (PCL) tibial avulsion fractures are infrequently observed clinical entities, primarily due to the challenges in arthroscopic management of the posterior compartmental process. This condition frequently leads to either significant injury sequelae or suboptimal outcomes.

PURPOSE: To evaluate the clinical outcomes for arthroscopic treatment for PCL avulsion fractures from anterior compartment loop-and-tack to the pulled-in posterior compartment with suspension fixation.

STUDY

DESIGN

Case Series; Level of evidence, 4.

METHODS

The study period spanned from May 2017 to June 2020, with a mean postoperative follow-up time of 30 months (range, 24-50 months). The study inclusion criteria included arthroscopic PCL tibial avulsion fracture fixation using our loop-and-track technique only. A total of 27 patients with acute PCL avulsion fractures who met our criteria were recruited. The exclusion criteria included PCL tibial avulsion malunioned fractures, multiple ligament injuries, and patients lost to follow-up. This technique was performed using an anterior compartment loop-and-tack and pulling in from the posterior compartment with suspension fixation via a tibial tunnel. Anterior fixation was achieved using the Endobutton device with knotted fixation and knotless rivets to secure the wire tails. Bony healing was examined by radiograph. Clinical and functional outcomes were scored using the Lysholm knee score, the International Knee Documentation Committee (IKDC) 2000 knee subjective function score, and the IKDC examination. Paired t tests were used to compare the Lysholm and subjective IKDC scores before and after treatment. A nonparametric paired test was used to compare IKDC knee examination scores before and after surgery.

RESULTS

A total of 24 patients, 19 male and 5 female patients, were included in this study. The arthroscopic anterior compartment loop-and-tack technique had a short operative time (50 ± 23.73 minutes, 45-90 minutes), with good stability, bony healing, and satisfactory functional recovery of the knee in all patients. No popliteal fossa neurovascular complications, implant loosening, or slippage were observed. The mean Lysholm knee score improved from 17.25 ± 6.30 preoperatively to 97.35 ± 2.94 (P < .001) at the last follow-up. The mean IKDC 2000 subjective knee function score improved from 19.95 ± 1.43 to 97.05 ± 2.89 (P < .001) at the previous follow-up. There was also a significant improvement in the IKDC examination grade (11 grade C and 13 grade D to 22 grade A and 2 grade B after the surgery).

CONCLUSION

Our loop-and-track technique for treating PCL tibial avulsion fractures improves clinical outcomes with minimal complications. This technique may be considered in the treatment options for patients with PCL tibial avulsion fractures.