Novel arthroscopic tension band fixation of posterior cruciate ligament avulsion fractures using double-suture tape loops.

Abstract

Posterior cruciate ligament (PCL) avulsion fractures are rare injuries that require surgical management to stabilise the knee and prevent further injuries. Since the first documented arthroscopic fixation in 2001, many variations of the technique have been reported. Yet there has been no large scale study evaluating the efficacy and complications of these techniques. The authors describe their novel technique for the arthroscopic fixation of PCL avulsion fractures using two suture loops with endobuttons, to create a tension band construct, allowing early range of motion exercises. Single-centre, single-surgeon successive case series of five patients with isolated PCL avulsion fractures who underwent surgical fixation using the above-mentioned technique. Surgical duration, intra-operative and postoperative complications, 12-month postoperative follow up examination and patient-reported outcomes are reported. All patients underwent delayed arthroscopic fixation, ranging from 7 to 25 days. No intra-operative or postoperative complications were recorded. At 12 months follow up postoperatively, all had returned to full weightbearing, achieving knee flexion past 120° with no instability and had returned to baseline activity levels. Average Visual Analogue Scale (VAS) and Lysholm scores were 1.4 ± 1.02 and 95 ± 2.1, respectively, at 12 months postoperatively. Our novel 'M technique' of arthroscopic PCL avulsion fracture fixation demonstrated reproducible and satisfactory patient outcomes at 12 months follow up. This tension band construct confers the advantage of immediate postoperative range of motion exercises, which have not been reported with previous techniques. More studies and longer-term follow up are required to validate this technique and study its cost-effectiveness.