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

Yao Zhao; Huihui Guo; Liang Gao; Chang Liu; Xinzhong Xu; Wendan Cheng

doi:10.7717/peerj.13732

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

PeerJ. 2022 Jul 14:10:e13732. doi: 10.7717/peerj.13732. eCollection 2022.

Authors

Yao Zhao^#¹, Huihui Guo^#¹, Liang Gao², Chang Liu³, Xinzhong Xu¹, Wendan Cheng¹

Affiliations

¹ The Second Affiliated Hospital of Anhui Medical University, Hefei, China, China.
² Center for Clinical Medicine, Huatuo Institute of Medical Innovation (HTIMI), Berlin, Germany.
³ Anhui Provincial Armed Police General Hospital, Hefei, China.

^# Contributed equally.

Abstract

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.

Keywords: Avulsion fracture; Clinical effects; Minimally invasive; Posterior cruciate ligament; Traditional approach.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Arthroscopy / methods
Fractures, Avulsion* / surgery
Humans
Posterior Cruciate Ligament* / surgery
Retrospective Studies
Tibial Fractures* / diagnostic imaging

Grants and funding

This study was supported by the special project of local scientific and technological development guided by the Central Committee of Anhui Province (S202007d07050015) and the Hefei independent innovation policy “Borrow-transfer-supplement” project (J2020Y07). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.