title: Displaced Posterior Cruciate Ligament Avulsion Fractures: A Retrospective Comparative Study Between Open Posterior Approach and Arthroscopic Single-Tunnel Suture Fixation.
abstract: OBJECTIVE
  To retrospectively compare the clinical outcomes of displaced tibial-side posterior cruciate ligament (PCL) avulsion fractures treated with open reduction and screw fixation versus arthroscopic suture fixation.
  
  
  METHODS
  From 2005 to 2013, all displaced PCL tibial-side avulsion fractures treated surgically-initially by an open posterior approach and later by arthroscopic-assisted suture fixation-were retrospectively reviewed. The cases with radiographic evidence of greater than 3 mm of displacement and/or grade II or III laxity on the posterior drawer test were included in the study group. The associated injuries were duly treated. A conservative rehabilitation protocol was followed until radiologic fracture union occurred. The patients' clinicoradiologic assessment data at 1 year of follow-up were used for comparison between the open and arthroscopic groups.
  
  
  RESULTS
  Forty-seven patients were available with 1 year of follow-up: 27 in the open group and 20 in the arthroscopic group. More than 90% of patients in both groups rated their knee function as normal or nearly normal. At 1 year of follow-up, knee function in terms of the Lysholm score (mean of 95.3 with 95% confidence interval [CI] 92.85 to 97.75 in open group and mean of 94.8 with 95% CI 91.38 to 98.22 in arthroscopic group; P = .812), Tegner activity level (mean of 6.8 with 95% CI 6.16 to 7.44 in open group and mean of 7.0 with 95% CI 6.44 to 7.66 in arthroscopic group, P = .677), International Knee Documentation Committee evaluation, and 1-leg hop test was comparable in both groups. The postoperative arthrometric laxity measurements with a KT-2000 arthrometer (MEDmetric, San Diego, CA) were better in the arthroscopic group, with 0 to 3 mm of laxity in 85% of cases in the arthroscopic group versus 74% in the open group. Avulsed fracture fragments were usually united by 3 months after surgery. No significant complication was noted.
  
  
  CONCLUSIONS
  Both arthroscopic and open methods of treatment for PCL tibial-side avulsion injuries resulted in comparably good clinical outcomes, radiologic healing, and stable knees at short-term follow-up.
  
  
  METHODS
  Level III, retrospective comparative study.
authors: Department of Orthopedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India. Electronic address: drdsabat@rediffmail.com.
authors: Dhananjaya
authors: D
authors: Sabat
authors: Department of Orthopedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
authors: Atul
authors: A
authors: Jain
authors: Department of Orthopedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
authors: Vinod
authors: V
authors: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D053587:Arthrometry, Articular; D001182:Arthroscopy; D001863:Bone Screws; D005260:Female; D006801:Humans; D065466:Lysholm Knee Score; D008297:Male; D008875:Middle Aged; D016119:Posterior Cruciate Ligament / Q000293:injuries* / Q000601:surgery*; D012189:Retrospective Studies; D013536:Suture Techniques