Clinical outcomes of acute displaced posterior cruciate ligament tibial avulsion fracture: A retrospective comparative study between the arthroscopic suture and EndoButton fixation techniques

Zhao, Daqing; Zhong, Jia; Zhao, Bo; Li, Yan; Shen, Duo; Gui, Shiqiang; Hu, Weiping; Liu, Chao; Qian, Donggang; Li, Jinghua

doi:10.1016/j.otsr.2020.102798

Cited by 14 publications

(14 citation statements)

References 22 publications

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“…Hence, the tissue is easy to separate and blood vessel ligation is not required, thereby saving surgical time and lowering the risk of iatrogenic injury when compared to the traditional approach. (4) The surgery has a shorter learning curve than the arthroscopic technique, making it more suitable for surgeons working in hospitals without specialized equipment ( Zhao et al, 2021b ).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, surgical reduction and internal fixation are often required ( Forkel et al, 2020 ). Surgical treatment can be accomplished by open reduction and internal fixation at the back of the knee (or posterior aspect of the knee) either with a traditional “L”-shaped incision ( Burks & Schaffer, 1990 ) or with a minimally invasive arthroscopic approach ( Zheng et al, 2021 ; Zhao et al, 2021a ). Currently, there are a variety of treatment approaches for PCL avulsion fractures, but none of them has yet emerged as a gold-standard surgical technique ( Malempati et al, 2015 ).…”

Section: Introductionmentioning

confidence: 99%

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Minimally invasive versus traditional inverted “L” approach for posterior cruciate ligament avulsion fractures: a retrospective study

Zhao

Guo

Gao³

et al. 2022

PeerJ

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Purpose To evaluate the clinical efficacy of a minimally invasive arthroscopic approach and to compare it with the traditional inverted “L” approach for the treatment of posterior cruciate ligament (PCL) avulsion fractures. Methods From January 2016 to January 2020, the clinical data from patients with PCL avulsion fracture of the tibial insertion were analyzed retrospectively. They were divided into two groups based on surgical approaches: minimally invasive approach group (n = 15) and traditional inverted “L” group (n = 15 cases). The operation time, incision length, intraoperative blood loss, hospitalization time and complications were all recorded and compared between the two groups. The fracture healing time, knee range of motion (ROM), and residual relaxation degree were compared between the two groups after regular follow-up. The International Knee Documentation Committee (IKDC) and Lysholm scores were used to assess knee joint function. Results There were no significant differences between the two groups in terms of gender, age, side, body mass index, cause of injury, Meyers McKeever classification and time from injury to operation (P > 0.05). The incision length and intraoperative bleeding in the minimally invasive group were significantly lower (P < 0.05) than those in the traditional group. There were no significant differences between the two groups in terms of operative time, fracture healing time, or residual relaxation (P > 0.05). The Lachman test and posterior drawer test were both negative, and there were no postoperative complications. The VAS pain score within 2 weeks and ROM within 4 weeks in the minimally invasive group were significantly better (P < 0.05) than those in the traditional inverted “L” approach group. The knee joint stability of both groups was good 12 months after surgery, and there were no significant differences in IKDC score, Lysholm score and ROM (P > 0.05) between the two groups. Conclusion The minimally invasive approaches for the treatment of PCL avulsion fractures provide adequate exposure without the surgical complications associated with traditional open surgical approaches. The procedure is safe, fast and minimally invasive, and does not need a long learning curve.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Minimally invasive versus traditional inverted “L” approach for posterior cruciate ligament avulsion fractures: a retrospective study

Zhao

Guo

Gao³

et al. 2022

PeerJ

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“…With the advancement of less-invasive arthroscopic technology, arthroscopic surgery for the treatment of PCL avulsion fractures has become increasingly popular [12][13][14]. Meanwhile, it can identify damage to other structures of the knee [15]. Both arthroscopic and open methods for the treatment of PCL tibial-side avulsion injuries result in comparably good clinical outcomes, radiological healing, and stable knees according to a systematic review [16].…”

Section: Discussionmentioning

confidence: 99%

“…Perfect fixation should have the advantages of easy operation, reliable reduction and appropriateness for popularization. Metal screws [19], plates [20], toothed plates combined with hollow lag screws [2] and sutures [15,21] are surgical fixation materials reported in the literature. Screw fixation is a reliable technique for major avulsion fractures, but it can induce refragmentation and unstable fixation in minor avulsed or comminuted fractures.…”

Section: Discussionmentioning

confidence: 99%

Homemade pin-hook for surgical treatment of posterior cruciate ligament avulsion fractures

Guo

Tang

et al. 2022

BMC Musculoskelet Disord

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Background How to treat the posterior cruciate ligament (PCL) tibial insertion small and comminuted avulsion fracture is still challenging. Our study evaluated the clinical and radiological outcomes after ORIF of PCL tibial insertion avulsion fractures through the inverted L-shaped postero-medial approach using a homemade pin-hook. Methods Between January 2009 and December 2020, twenty-four patients with isolated PCL tibial insertion bony avulsion were enrolled. There were 16 males and 8 females. The age range was 18-48 (32.5 ± 9.3) years. The time from injury to surgery was 1-10 (4.4 ± 2.8) days. There were 11 cases in the left knee and 13 cases in the right knee. The patients received anticoagulant therapy to prevent thrombosis. Preoperative standard X-ray, computerized tomography (CT) and magnetic resonance imaging (MRI) were performed. According to the Meyers-McKeever classification, there were 8 cases of type II and 16 cases of type III. Results The operation time was 60-120 (89.6 ± 19.8) min. Postoperative follow-up ranged from 3 to 18 months. The average follow-up was 11.4 ± 4.3 months. In all patients, one or two homemade pin-hooks were used to fix different sizes of fracture segments. X-ray or CT scans taken after surgery revealed fracture union. The fractures healed in 9-16 (11.8 ± 1.7) weeks. At the last follow-up, the patients were able to fully straighten. The ROM (132.6° ± 3.9°), the Tegner-Lysholm score (96.2 ± 2.3) and the IKDC scores (95.5 ± 1.6) were all significantly improved compared with the preoperative values (77.5° ± 13.1°, 46.8 ± 8.9, 36.2 ± 7.9). The posterior drawer test was negative. The gastrocnemius muscle strength did not diminish. No internal fixation migration was observed during the follow-up. No neurovascular bundle- or hardware-related complications were reported. Conclusions The inverted L-shaped postero-medial approach with homemade pin-hook fixation for the treatment of PCL avulsion fractures produces acceptable clinical and radiological results. Moreover, the homemade pin-hook made of K-wires is affordable and reduces patient costs. It is a practical application and worth recommending, especially for community hospitals.

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“… 2 , 3 Regarding open procedures, the fixation is direct and simple and there is no need for the learning curve of arthroscopic surgical procedures, 4 , 5 , 6 , 7 but these procedures are invasive. The advantage of arthroscopic procedures 8 , 9 , 10 is that the fracture can be directly exposed intra-articularly and combined intra-articular lesions can be treated simultaneously, in addition to their minimally invasive nature. Thus, in this article, we introduce an arthroscopic fracture reduction and fixation technique, in which fracture reduction and fixation are performed with ligating sutures and an adjustable suture loop.…”

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confidence: 99%

Arthroscopic Suture-to-Loop Fixation of Posterior Cruciate Ligament Tibial Avulsion Fracture

Tang

Zhao

2021

Arthroscopy Techniques

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Avulsion fracture of the tibial insertion of the posterior cruciate ligament (PCL) receives constant concern. Arthroscopic procedures have long been attempted because of their minimally invasive nature, and various related techniques have been reported. However, the best arthroscopic method is still being pursued. In this article, we introduce an arthroscopic suture ligation and backup adjustable-loop fixation technique for PCL tibial avulsion fracture. The critical points of this technique are proper ligation of the PCL, proper location of the 2 tibial tunnels to create pulleys for posteriorinferior reduction of the bone fragment, and additional backup suture loop fixation. Our experience indicates that this technique is efficient and relatively simple. We consider that the introduction of this technique will provide a reasonable choice in the treatment of PCL tibial avulsion fracture.

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Clinical outcomes of acute displaced posterior cruciate ligament tibial avulsion fracture: A retrospective comparative study between the arthroscopic suture and EndoButton fixation techniques

Cited by 14 publications

References 22 publications

Minimally invasive versus traditional inverted “L” approach for posterior cruciate ligament avulsion fractures: a retrospective study

Minimally invasive versus traditional inverted “L” approach for posterior cruciate ligament avulsion fractures: a retrospective study

Homemade pin-hook for surgical treatment of posterior cruciate ligament avulsion fractures

Arthroscopic Suture-to-Loop Fixation of Posterior Cruciate Ligament Tibial Avulsion Fracture

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