Clinical experience with arthroscopic suture pull technique in isolated PCL avulsion injuries

Abstract

Objective: to assess twenty two cases of isolated PCL avulsion fractures from tibial insertion, arthroscopically treated with suture pull technique, and to evaluate achieved clinical outcomes in terms of radiographic laxometry (objective) and Lysholm scale (subjective). Material and method: Study includes 22 cases operated between April 2014 and March 2017. Patients less than 18 years old, presentation after 3 weeks of injury, concomitant injury in the same limb, with open wounds or with comminuted avulsed fragment were excluded from the study. All cases were MRI proven. All arthroscopic suture fixation technique was used in all cases. Follow up was done at 3 weeks, 6 weeks, 3 months, 6 months and 12 months. Mean follow up was one year. Subjective complaints, Knee flexion, Lysholm score and stress radiographs were noted. Results: Average Lysholm score was 96.3. Seventeen patients had excellent results and Five had good results based on Lysholm scores. In two patients, grade 2 laxity (5e10 mm) was present on stress radiographs but there were no clinical complaints. All patients achieved osseous union and had no functional limitation. Three Patients developed arthrofibrosis initially but gained functional range later. Conclusion: Arthroscopic suture fixation method for PCL avulsion fracture from tibia is a good and safe method of choice for fixation.

Modified Arthroscopic Suture Fixation of Posterior Cruciate Ligament Tibial Avulsion Fracture in the Setting of Multiligament Knee Injury in Teenager

“…PCL is the primary restraint to posterior tibial translation and the secondary restraint to external rotation of the knee joint [1]. Its injury varies from 3 to 23% of all knee injuries, and it is more frequent in the younger age group [3,6].…”

“…Its injury varies from 3 to 23% of all knee injuries, and it is more frequent in the younger age group [3,6]. It is commonly seen as part of multiligament knee injuries and associated to an increase of road traffic accidents and sports injuries [1,3,7]. The true incidence of multiligament knee injuries in the skeletally immature population is unknown owing the difficulty to promptly identify it at admission, and there is no consensus regarding the optimal management [6].…”

“…In young patients, these injuries mainly manifest as an avulsion fracture due to the strength of the ligamentous structures and weakness of the bone and physis; in contrast, adults are more likely to experience ligamentous failure within the substance of the ligament [7]. PCL rupture can occur at its mid substance, femoral, or tibial attachment, with or without bony avulsion [1,6].…”

“…PCL has a central role in knee biomechanics and stability. It represents the center of rotation of the knee, and it is the main structure to resist to posterior tibial translation [1]. Its damage impairs knee biomechanics with increased contact pressures in medial tibiofemoral and patellofemoral compartments and consequently progressive degenerative changes [2].…”

“…Its damage impairs knee biomechanics with increased contact pressures in medial tibiofemoral and patellofemoral compartments and consequently progressive degenerative changes [2]. Avulsion fractures of PCL are more frequent in the younger age group and associated to high energy trauma [1,3]. Reduction and fixation of the fragment assisted by arthroscopy favor minimal scarring, less tissue trauma, and early rehabilitation than open approaches, and it is actually indicated for PCL injuries with displacement and posterior instability [2,4,5].…”