Fixation of bony avulsions of the posterior cruciate ligament by asuture-bridge™ technique

Abstract

Anatomical reduction of bony avulsions of the posterior cruciate ligament (PCL) by asuture-bridge™ (Arthrex, Naples, FL, USA) technique to restore posterior knee stability. Acute bony tibial avulsions of the PCL and multifragmentary fractures. Chronic condition of avulsion fractures or posterior instability, advanced knee osteoarthritis, high-grade soft tissue injury, infection. Prone position, minimally invasive posterior medial approach, exposure and reduction of the bony fragment, positioning of the proximal suture-anchor (interfragment), suturing the PCL and knotting to achieve repositioning of the anterior part of the fragment, tighten both ends of the tape by two suture anchors distally to the PCL insertion to fix the posterior part of the fragment. Knee extension brace with posterior tibial support for 6weeks, 20 kg partial weight-bearing and restricted flexion up to 90° for 6weeks, physiotherapy in prone position from the first postoperative day. Full weight bearing after x‑ray and clinical control after 6weeks. Since 2016, 6cases of abony avulsion of the PCL treated with this technique (mean age 38years; range 17-60years). Postoperative x‑ray at 6weeks showed no fragment dislocation and complete bone healing. Irritation due to the anchor material was not observed up to 6months postoperatively. No wound healing problems, infections, thrombosis or arthrofibrosis observed. No revisions. According to a recent review comparing the open with an arthroscopic fracturetreatment the arthroscopic treatment may lead to a slightly higher subjective and objective outcome. Interestingly, the rate of arthrofibrosis was slightly elevated in the arthroscopic group. Seven of 18included studies describe a suture fixation in case of a comminuted fracture. Especially in these cases asuture-bridge ™ fixation seems to be reasonable.