A Novel Arthroscopic Fixation Technique versus Open Posteromedial Fixation

Purpose: The purpose of this study was to compare the results of Posteromedial (PM) open reduction internal fixation versus arthroscopic reduction and adjustable loop fixation of displaced Posterior Cruciate Ligament (PCL) tibial avulsion fractures, regarding healing, degree of posterior stability, Range of Motion (ROM), level of activity, complications and diagnosis of associated injuries. Hypothesis: arthroscopic fixation of posterior cruciate ligament tibial avulsion would have similar results to Open reduction internal fixation in terms of stability however is a less invasive technique. Methods: All patients with acute displaced PCL tibial avulsion fractures presented to our institute between 2009 and 2014 were included in the study. 12 patients were managed by Arthroscopic reduction and fixation with a double button adjustable loop, (arthroscopic group AG). 17 patients were managed by open reduction and internal fixation with screw and washer through a posteromedial approach. The mean follow-up period was 32 ± 6 months. The operative time, time for healing and 3 different knee scores were compared between both groups. Results: all patients 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 reported in all patients of both groups. All patients of AG 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%) of OG. Associated injuries were found in 10 out of 12 (83.3%) patients in the AG 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.