Open Posterior Approach versus Arthroscopic Suture Fixation for Displaced Posterior Cruciate Ligament Avulsion Fractures: Systematic Review

Abstract

PurposeTo compare the clinical outcomes between the open posterior approach and arthroscopic suture fixation for displaced posterior cruciate ligament (PCL) avulsion fractures.MethodsA literature search was performed on MEDLINE, EMBASE, and the Cochrane Library databases. The inclusion criteria were as follows: papers written in English on displaced PCL avulsion fractures, clinical trial(s) with clear description of surgical technique, adult subjects, a follow-up longer than 12 months and modified Coleman methodology score (CMS) more than 60 points.ResultsTwelve studies were included with a mean CMS value of 72.4 (standard deviation, 7.6). Overall, 134 patients underwent the open posterior approach with a minimum 12-month follow-up, and 174 patients underwent arthroscopic suture fixation. At final follow-up, the range of Lysholm score was 85–100 for the open approach and 80–100 for the arthroscopic approach. Patients who were rated as normal or nearly normal in the International Knee Documentation Committee subjective knee assessment were 92%–100% for the open approach and 90%–100% for the arthroscopic approach. The range of side-to-side difference was 0–5 mm for both approaches.ConclusionsBoth arthroscopic and open methods for the treatment of PCL tibial-side avulsion injuries resulted in comparably good clinical outcomes, radiological healing, and stable knees.

Arthroscopic Direct Anterior‐to‐Posterior Suture Suspension Fixation for the Treatment of Posterior Cruciate Ligament Tibial Avulsion Fracture

“…Multiple studies have shown that the Lysholm scores improved significantly pre‐ and postoperatively, from 36.5 to 95.0, respectively 17,19–21 . Similarly, we confirmed that the median Lysholm knee score increased from 40.4 preoperatively to 90.1 postoperatively.…”

“…Three recent papers which are in agreement with our results have reported reaching a preinjury level of activity, and all patients returned to their previous levels or sports. 1,17,18 The preinjury score averaged 7.1, while the postoperative score averaged 6.8. Multiple studies have shown that the Lysholm scores improved significantly pre-and postoperatively, from 36.5 to 95.0, respectively.…”

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

“… 1 Both open and arthroscopic procedures have been reported, and similar clinical results have been obtained. 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.…”

Editorial Commentary: Suspensory Fixation of Displaced Tibial Posterior Cruciate Ligament Avulsions: A Novel Application of a Familiar Technique

“…2,3 Collision with an object resulting in a dashboard injury or any traffic accident resulting in a kneeling injury on the ground are typical mechanisms. 4 There are urban centers in South Korea and China that treat a relatively high volume of isolated high-grade PCL injuries (including tibial PCL avulsions) with correspondingly a high output of isolated PCL surgical outcome studies in the past decade. 5 The hospital center represented in the article "Arthroscopic Treatment of a Tibial Avulsion Fracture of the Posterior Cruciate Ligament With the Use of a Suspensory Device" 6 by Zheng, Hou, Zhang, Li, Zhou, Li, and Pan is based in Xuzhou, a large city in Eastern China.…”