Novel technique of PCL avulsion fracture fixation using a modified double pulley method

Abstract

Background: Posterior Cruciate Ligament (PCL) avulsion fractures are a rare injury and are seen to occur commonly in younger patients. Traditionally these injuries were treated conservatively and that resulted into malunion of avulsion piece and resultant PCL laxity and posterior tibial sag. This on longer run caused altered knee biomechanics, instability and early arthritis. Newer techniques are being tried in treatment in Posterior cruciate ligament avulsion fractures to prevent all these complications.Methods: We present here a surgical technique which makes use of suture anchors in a modified double pulley technique for the reduction and fixation of PCL avulsion fractures. In our institute we conducted a prospective study of 100 patients having PCL avulsion fracture in which all patients were in young age group and had a traumatic injury, less than 7 days old and followed them up at 6 weeks, 3 months, 6 months and 1 year post surgery to check for their functional and radiological outcomes. All were operated by same surgeon by same method and got the same physiotherapy protocol in same ward and come under same age group.Results: It was found that our technique showed excellent functional and radiological outcomes at 1 year follow up.Conclusions: By using this modified double pulley technique for fixation of the PCL avulsion fracture, the surgeon can achieve adequate compression and absolute stability of the fracture fragment. This method has several advantages over the other techniques used for fixation and produces equivalent or better functional and radiological outcome with very minimal complication rate.