Arthroscopic treatment of acute tibial avulsion fracture of the posterior cruciate ligament with suture fixation technique through Y-shaped bone tunnels

Abstract

Purpose: The purpose of this study was to evaluate the clinical results of arthroscopic treatment of tibial avulsion fracture of the posterior cruciate ligament (PCL) with suture fixation technique through Y-shaped bone tunnels.

Type of study: Retrospective case series.

Methods: We treated 29 cases of acute PCL tibial avulsion fracture arthroscopically through double posteromedial portals. The PCL and avulsion bony fragment was fixed with 2 No. 6 polyester sutures, which were pulled out through Y-shaped bone tunnels and fixed on a titanium button. The 2 branch openings of the Y-shaped bone tunnels were at the posterior edge of the tibial bed; the common outer opening was at medial side of the tibial tubercle. Through twisting of the button, the suture were tightened to ensure the fixation. The patients were followed-up for more than 2 years and were evaluated according to the International Knee Documentation Committee, Lysholm, and Tegner rating scales.

Results: There was no extension limitation. Except for 2 patients who had 5 degrees flexion limitation, all the patients gained normal flexion. Before surgery, all patients had 1 degrees to 2 degrees positive posterior drawer test, and KT-1000 examination showed that the side-to-side difference of the posterior drawer test was 7 to 14 mm, with an average of 10.3 +/- 1.7 mm. At the last follow-up, 1 patient had 1 degrees positive posterior drawer test, the other patients had negative posterior drawer tests. The side-to-side difference of the posterior drawer test was 0 to 2 mm in 28 patients, and 4 mm in 1 patient, with an average of 0.6 +/- 0.4 mm. The Lysholm score was 93 to 100, with an average of 97.4 +/- 1.4. The Tegner scores were 6.8 +/- 0.8 before injury, and 6.6 +/- 0.7 at the last follow-up (P > .05).

Conclusions: Arthroscopic treatment of acute tibial avulsion fracture of the PCL with this fixation technique can restore the stability and function of the joint in most patients. Visualization and manipulation through double posteromedial portals are convenient. Y-shaped bone tunnels and the button-twisting technique are useful to ensure the results of reduction and fixation.

Level of evidence: Level IV.