Arthroscopic Suture Fixation for Avulsion Fracture of the Tibial Attachment of the Posterior Cruciate Ligament (SS-62)

Abstract

Introduction The clinical results of a procedure for 36 patients with posterior cruciate ligament (PCL) avulsion fracture with various tibial fragmentation size treated with arthroscopically assisted reduction and suture fixation with multiple No. 5 Ethibond sutures (Ethicon, Somerville, NJ) are presented in this study. Methods This prospective study analyzed 36 patients (24 male, and 12 female) who underwent arthroscopic reduction and suture fixation for image-proven PCL avulsion fractures from tibia. The mean follow-up period was 36 months (range, 24 to 45). Follow-up assessment included Lysholm knee score, Tegner activity score, International Knee Documentation Committee (IKDC) score, and KT-1000 arthrometer and radiographic evaluations. Results The mean preoperative Lysholm score in the 36 knees was 8.4 (range, 0 to 17); the mean postoperative Lysholm score was 87.5 (range, 43 to 100). The mean preoperative and postoperative Tegner scores in the 36 knees were 0.5 (range, 0 to 2) and 4.8 (range, 2 to 7), respectively. According to our modified Meyers and McKeever classification, completely displaced fragmentation (Type III) is the most common type. Four (11.7%) of seventeen patients were diagnosed to have type II fractures in this study, 25 (70.6%) were type III fractures, and 7 (17.6%) were type IV fractures. At final follow-up, 33 patients (91.6%) were classified by IKDC score as normal or nearly normal (grade A or B). The IKDC classification was abnormal (grade C) in 3 patients (8.3%). All 36 fractures achieved osseous union or stable fibrous union at final follow-up visits. No significant complications, such as arthrofibrosis, loss of initial fixation, or wound infection, were noted in this series. Conclusion Treating PCL avulsion fracture with different tibial fragmentation size by arthroscopic reduction and suture fixation by use of multiple No. 5 Ethibond sutures can reduce osseous fragments, restore joint stability, promote early motion, and minimize morbidity. The clinical results of a procedure for 36 patients with posterior cruciate ligament (PCL) avulsion fracture with various tibial fragmentation size treated with arthroscopically assisted reduction and suture fixation with multiple No. 5 Ethibond sutures (Ethicon, Somerville, NJ) are presented in this study. This prospective study analyzed 36 patients (24 male, and 12 female) who underwent arthroscopic reduction and suture fixation for image-proven PCL avulsion fractures from tibia. The mean follow-up period was 36 months (range, 24 to 45). Follow-up assessment included Lysholm knee score, Tegner activity score, International Knee Documentation Committee (IKDC) score, and KT-1000 arthrometer and radiographic evaluations. The mean preoperative Lysholm score in the 36 knees was 8.4 (range, 0 to 17); the mean postoperative Lysholm score was 87.5 (range, 43 to 100). The mean preoperative and postoperative Tegner scores in the 36 knees were 0.5 (range, 0 to 2) and 4.8 (range, 2 to 7), respectively. According to our modified Meyers and McKeever classification, completely displaced fragmentation (Type III) is the most common type. Four (11.7%) of seventeen patients were diagnosed to have type II fractures in this study, 25 (70.6%) were type III fractures, and 7 (17.6%) were type IV fractures. At final follow-up, 33 patients (91.6%) were classified by IKDC score as normal or nearly normal (grade A or B). The IKDC classification was abnormal (grade C) in 3 patients (8.3%). All 36 fractures achieved osseous union or stable fibrous union at final follow-up visits. No significant complications, such as arthrofibrosis, loss of initial fixation, or wound infection, were noted in this series. Treating PCL avulsion fracture with different tibial fragmentation size by arthroscopic reduction and suture fixation by use of multiple No. 5 Ethibond sutures can reduce osseous fragments, restore joint stability, promote early motion, and minimize morbidity.