Arthroscopic management of avulsion fractures of the tibial attachment of the posterior cruciate ligament: A novel technique and mid-term outcomes

Ahmed Fouad Seifeldin; Khaled F M Abdel-Kader; Kamal Samy Abdel Meguid; Mohamed Wahsh; Ahmed Rabie Fekry

doi:10.1016/j.jcot.2023.102177

Arthroscopic management of avulsion fractures of the tibial attachment of the posterior cruciate ligament: A novel technique and mid-term outcomes

J Clin Orthop Trauma. 2023 Jun 17:42:102177. doi: 10.1016/j.jcot.2023.102177. eCollection 2023 Jul.

Authors

Ahmed Fouad Seifeldin¹, Khaled F M Abdel-Kader¹, Kamal Samy Abdel Meguid², Mohamed Wahsh², Ahmed Rabie Fekry²

Affiliations

¹ Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
² Department of Orthopaedic Surgery, Faculty of Medicine, Fayoum University, Fayoum, Egypt.

PMID: 37529547
PMCID: PMC10388572 (available on 2024-06-17)
DOI: 10.1016/j.jcot.2023.102177

Abstract

Purpose: This study assessed the outcomes of arthroscopic management of avulsion fractures of the tibial attachment of the posterior cruciate ligament (PCL), with holding of the PCL with two ''cinch knots''.

Methods: 15 patients with avulsion fractures of the tibial attachment of the PCL were treated with arthroscopic reduction and fixation with holding of the PCL with two ''cinch knots''. All patients were males with mean age of 28 (range, 15-44) years. Patients were assessed by the Lysholm Tegner knee scale and IKDC (International knee documentation committee) objective grade.

Results: The mean follow-up period was 40 (range, 12-60) months. Mean postoperative flexion was 134.7° (range, 120-150). Mean Lysholm score was 90.27 (range, 67-99). Lysholm score was excellent in seven (46.7%) patients, good in six (40%) patients, fair in two (13.3%) patients, and none of the patients was poor. 11 (73.3%) patients had IKDC grade A, and four (26.7%) patients had IKDC grade B due to residual grade 1+ posterior drawer. Current Tegner activity level remained the same in nine (60%) patients, decreased one level in three (20%) patients, and decreased two levels in three (20%) patients as compared to the preinjury level. There wasn't any vascular or nerve complications.

Conclusion: Arthroscopic treatment of PCL tibial avulsion fractures with the cinch knot technique has many advantages, and it proved to be safe and effective. The technique is simple and easy to be reproduced. Early results are promising to encourage surgeons to make this novel technique.

Level of evidence: Therapeutic study, prospective case series with no comparison group, Level IV.

Keywords: Arthroscopy; Bony avulsion; PCL.