Suture Bridge Fixation for Posterior Cruciate Ligament Tibial Avulsion Fracture in Children

Abstract

Posterior cruciate ligament (PCL) tibial avulsion fractures in children are extremely rare. Due to the rarity of these injuries, careful attention to the specific physical examination and imaging findings is necessary for a proper diagnosis. PCL avulsion fractures can be missed on plain radiography in skeletally immature patients. Magnetic resonance imaging should be considered if sagging or posterior drawer sign is positive after a strong hit to the anterior aspect of the lower leg. With this knowledge, clinicians can formulate treatment plans that can return patients to their original functionality while avoiding potential morbidity from misdiagnoses. We treated these patients using the suture bridge method. In children, ossification is incomplete, and they possess a lot of cartilage, so screw fixation easily destroys avulsed fragment. The suture bridge method can firmly fix the avulsed fragments, reducing the risk of damage to the bone fragment; therefore, a secondary surgery for implant removal is not needed. Arthroscopic surgery also was expected to be technically difficult in children due to the limited scope of the operation. We used open fixation because the outcome was unaffected by open surgery and arthroscopic surgery, and all patients returned to full sporting activity postoperatively.