Arthroscopic suture bridge fixation technique with multiple crossover ties for posterior cruciate ligament tibial avulsion fracture.
OBJECTIVE
This study examined the clinical outcomes of a newly developed technique, arthroscopic suture bridge fixation with crossover ties of PCL tibial avulsion fracture using two tibial tunnels and a posterior trans-septal portal.


METHODS
Records were reviewed of 18 patients (median age 33.5 years, range 13-55 years) with PCL tibial avulsion fractures treated with an arthroscopic suture bridge technique. Knee function before surgery and at last follow-up was evaluated by Lysholm and Tegner scores. A KT-2000 arthrometer was used to evaluate knee stability, and fracture union was assessed by plain radiographs.


RESULTS
Mean postoperative Lysholm (P < 0.001) and Tegner (P = 0.011) scores showed significant improvements compared with preoperative scores. Arthrometry showed that the mean side-to-side difference improved significantly, from 7.8 ± 0.8 mm preoperatively to 3 ± 1.2 mm postoperatively (P = 0.012). Radiographic evaluation showed solid union at the fracture site in all 18 patients at last follow-up.


CONCLUSIONS
This new arthroscopic double-tunnel pull-out suture bridge fixation with multiple crossover ties and posterior trans-septal technique for PCL tibial avulsion fracture yielded good clinico-radiological outcomes, including satisfactory stability and fracture site healing. This technique can be a useful treatment option for PCL tibial avulsion fracture even with small comminuted fracture due to compression by the unique crossover configuration mesh of multiple fixation sutures.


METHODS
IV.
Department of Orthopedic Surgery, Seoul Veterans Hospital, Seoul, South Korea.
Jung-Ro
JR
Yoon
Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 135-710, South Korea.
Chan-Deok
CD
Park
Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 135-710, South Korea. eoak22@empal.com.
Dae-Hee
DH
Lee
D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D005260:Female; D017102:Fracture Healing; D000071562:Fractures, Avulsion / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016119:Posterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D012189:Retrospective Studies; D013536:Suture Techniques; D013537:Sutures; D013977:Tibia / Q000601:surgery; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult
Arthroscopy; Avulsion; Posterior cruciate ligament; Pull-out suture
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Arthroscopy. 2015 May;31(5):874-81
25700771
Arthroscopy. 2006 Dec;22(12):1270-1275.e3
17157724
Knee Surg Relat Res. 2011 Sep;23(3):135-41
22570824
Bone Joint J. 2015 Sep;97-B(9):1220-5
26330588
Arthroscopy. 2011 May;27(5):728-34
21398077
Clin Orthop Relat Res. 2008 Nov;466(11):2878-83
18648903
Emerg Radiol. 2013 Oct;20(5):429-40
23525909
Oper Orthop Traumatol. 2012 Sep;24(4-5):348-53
23010885
J Surg Res. 1994 Apr;56(4):372-7
8152233
Knee Surg Relat Res. 2015 Dec;27(4):274-7
26673356
Orthopedics. 2011 Jan 01;34(2):137
21323274
Am J Sports Med. 2007 Mar;35(3):404-10
17170161
Knee Surg Sports Traumatol Arthrosc. 2012 Feb;20(2):315-21
21761230
Arthroscopy. 2012 Oct;28(10):1454-63
22929009
Clin Orthop Relat Res. 2012 Dec;470(12 ):3616-23
23054525