Abstract
Surgical treatment of the posterior cruciate ligament (PCL) tibial avulsion fracture
is challenging due to the deep-seated location of the lesion with complex adjacent
anatomy and usually with small-sized bone fragment. We introduce a novel arthroscopic
reduction technique using two cross-linked pull-out sutures (2XLPOS) through triple
bone tunnels in posterior cruciate ligament (PCL) tibial avulsion fracture.
Posterior trans-septal portal was established following the four standard arthroscopic
portals. Bilateral margins of the PCL with 1∼2 mm margin from the border were penetrated
using suture hook. Fiberwire sling tied with a No. 0 PDS knot was introduced anterior
to the PCL by the two posteriorly pulled shuttle sutures. Three bone tunnels were
drilled in the inferomedial, inferolateral, and apex edge of the avulsed tibial crater.
Each end of the Fiberwire was drawn out through the inferomedial and inferolateral
bone tunnel, respectively. Two ends of the No. 0 PDS were drawn out through the apex
tunnel by the same manner. Fiberwire was tied on the anteromedial aspect of the proximal
tibia with one strand of the No. 0 PDS placed underneath the Fiberwire knot. And,
the No. 0 PDS loop was tied to complete cross-linking of pull-out construct.
Arthroscopic reduction of PCL tibial insertion avulsion fracture using 2XLPOS technique
was performed in eleven patients. Mean range of motion at the first postoperative
year was 126.8°. Mean Lysholm score, Tegner activity scale, and IKDC was 69.2, 4.2,
and 58.1, respectively. Posterior instability decreased from mean 12.6 mm preoperatively
to 3.2 mm at 1-year postoperative follow up. Radiographic union of the fracture site
was confirmed in 11 cases. Our new surgical technique yielded good clinical and radiological
outcome, and we consider it is unique in utilizing two cross-linked sling type pull-out
suture constructs and triple bone tunnels for their passage.
Keywords
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Article info
Publication history
Published online: November 12, 2018
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