2017 ISAKOS Biennial Congress Paper #229

 

Posterior Cruciate Ligament Tibial Avulsion Fracture a Novel Arthroscopic Fixation Technique Versus Open Posterior Fixation

Mohamed A. Badran, MD, Mansoura, Dakahlia EGYPT
Adham E. Elgeidi, MD, Mansoura, Dakahlia EGYPT
Abd Elrahman Ahmed Elganainy, MD, Mansoura, Daqahlia EGYPT
Roshdy M. Elsallab, MD, Prof., Mansoura, EG EGYPT

Mansoura University , Mansoura, EGYPT

FDA Status Not Applicable

Summary

Arthroscopic reduction and fixation of displaced posterior cruciate ligament tibial avulsion gives a better results than the open approach

Abstract

Purpose

The purpose of the study was to compare the results of open versus arthroscopic fixation of displaced tibial posterior cruciate ligament (PCL) avulsion fractures, as regard range of motion (ROM), level of activity, complications and diagnosis of associated injuries.

Hypothesis

we proposed that the arthroscopic group would have a better score and ROM at the final follow up

Methods

All patients with acute displaced tibial posterior cruciate ligament (PCL) avulsion fractures presenting to our institute between 2009 and 2014 were classified into two groups The first group included patients who had undergone arthroscopic reduction and fixation with AC tightrope 12 patients. The second group was managed by open posterior approach and direct fixation by screw and washer 17 patients. The mean follow-up period was 31 months (range, 24 to 43 months). Follow-up assessment included 3 different functional scores, KT-1000 arthrometry (MEDmetric, San Diego, CA), and radiographic evaluation.

Results

all patient were available at the final follow up. The healing in both groups was obtained at 3 month with no nonunion. There were no neurovascular complications at both groups. All patients of arthroscopic group achieved full flexion at 2 month with the ability to pray on ground however the full flexion was achieved only by 14 patients (82.3%) in the open group. Associated injuries were found in 10 out of 12 (83.3%) patients in the arthroscopy group in the form of 5 medial meniscal tears, 4 avulsion of the tibial ACL, one avulsion of the ACL together with the anterior horn lateral meniscus. All associated lesions were managed by repair during arthroscopic procedure.

Conclusions

Both open and arthroscopic treatment for displaced tibial posterior cruciate ligament (PCL) avulsion fractures give good results in term of range of motion and knee stability, however the arthroscopy has the advantage of diagnosis and treatment of associated injuries in the knee.
Level of Evidence: Level III, prospective comparative study.