Arthroscopic treatment of posterior cruciate ligament avulsion fracture with knotted suture

Objective To evaluate the outcomes of arthroscopic treatment of posterior cruciate ligament (PCL) avulsion fracture with knotted suture. Methods We arthroscopically treated 17 patients with PCL avulsion fractures from January 2013 through December 2014. They were 11 males and 6 females, from 21 to 57 years of age (mean, 38.7 years). By Meyers-McKeever classification, there were type Ⅲ in 11 cases and type Ⅳ in 6. The PCL tendon close to the avulsion bone was surrounded with non-absorbable suture; 2 arms of the suture were knotted and then retrieved from 2 bone tunnels drilled from the anterior tibia to the lower part of fracture bone bed. Fine reduction and fixation was achieved by tying the sutures at the bone bridge of the anterior tibia. X-tray or CT scan was taken routinely to confirm the bone healing during postoperative follow-up. Visual analogue scale (VAS), Lysholm knee scoring and the posterior migration of the tibial plateau under KT-2000 were also recorded. Results The 17 patients obtained an average follow-up of 13.5 months (from 7 to 19 months). X-ray films at 1 to 2 months after surgery (mean, 1.3 months) showed porosis but no loss of fracture reduction. The final follow-ups showed bony union in all. The average ranges of motion were extension of 2.0°±3.5° and flexion of 134.2°±12.5°; the average Lysholm knee score was 89.3 (from 83 to 95). The average posterior migration of the tibial plateau under KT-2000 with the knee flexed at 90° was 1.5 mm (from 0.5 to 5.3 mm). Deep vein thrombosis occurred in one case, and 2 cases had a posterior migration of the tibial plateau of more than 5 mm. Conclusion Treatment of PCL avulsion fracture with knotted suture under arthroscopy can result in effective reduction and reliable fixation to restore the PCL tension, enhance the posterior stability of tibial plateau, and reduce incidence of secondary traumatic osteoarthritis. Key words: Posterior cruciate ligament; Tibial fractures; Fracture fixation, internal; Arthroscopy