Arthroscopic Fixation of Posterior Cruciate Ligament Tibial Bony Avulsion Fractures: The Double Suture Bridge Technique and Evaluation of Results
-
Mihir Patel
,
Mahesh Shinde
,
Ushma Butala
,
Lakshya Bhardwaj
,
Amit Yadav
,
Karthik Gowda
,
Saif Ansari
,
Atharva Sharma
Abstract
Background: Surgical fixation is required for displaced posterior cruciate ligament (PCL) tibial bony avulsion fractures or with fractures having grade 2 or more posterior instability. The purpose of this study is to evaluate the results of arthroscopic fixation of PCL tibial bony avulsion fractures using the double suture bridge technique.
Methods: A retrospective study was done involving 24 patients having displaced PCL tibial bony avulsion fractures. The arthroscopic double suture bridge technique was used to fix these fractures. Patients were followed up for three years and assessed for knee- related symptoms, signs, Lysholm Knee Score, and satisfaction.
Results: The study group consisted of 21 men and three women. Fracture union was achieved in all cases two months postoperatively. The mean Lysholm Knee Score at follow-ups of three months, six months, one year, two years, and three years was 86.6, 96.5, 98.8, 99.1, and 99.4, respectively. At the latest follow-up, all the patients were satisfied with their knee function with respect to pain, range of motion (ROM), stability, and resumption of pre-injury activity level.
Conclusion: The arthroscopic double suture bridge technique is an effective method for the fixation of PCL tibial bony avulsion fractures with respect to knee stability, ROM, and resumption of pre-injury activity level.
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2. Katsman A, Strauss EJ, Campbell KA, Alaia MJ. Posterior cruciate ligament avulsion fractures. Curr Rev Musculoskelet Med. 2018;11(3):503-9. doi: 10.1007/s12178-018-9491-2. [PubMed: 29869136]. [PubMed Central: PMC6105473].
3. Joshi S, Bhatia C, Gondane A, Rai A, Singh S, Gupta S. Open reduction and internal fixation of isolated posterior cruciate ligament avulsion fractures: Clinical and functional outcome. Knee Surg Relat Res. 2017;29(3):210-6. doi: 10.5792/ksrr.17.022. [PubMed: 28854767]. [PubMed Central: PMC5596399].
4. Hooper PO3rd, Silko C, Malcolm TL, Farrow LD. Management of posterior cruciate ligament tibial avulsion injuries: A systematic review. Am J Sports Med. 2018;46(3):734-42. doi: 10.1177/0363546517701911. [PubMed: 28437619].
5. Bianchi M. Acute tears of the posterior cruciate ligament: clinical study and results of operative treatment in 27 cases.
Am J Sports Med. 1983;11(5):308-14. doi: 10.1177/036354658301100505. [PubMed: 6638245].
6. Pardiwala D, Agrawal D, Patil V, Saini U, Dhawal P. Paper 133: Comparison of open versus arthroscopic fixation for isolated PCL tibial bony avulsions: A prospective randomized study with minimum 2 year follow-up. Arthroscopy. 2012;28(9): e413-e414. doi: 10.1016/j.arthro.2012.05.616.
7. Geissler WB, Whipple TL. Intraarticular abnormalities in association with posterior cruciate ligament injuries. Am J Sports Med. 1993;21(6):846-9. doi: 10.1177/036354659302100615. [PubMed: 8291637].
8. Zhao J, He Y, Wang J. Arthroscopic treatment of acute tibial avulsion fracture of the posterior cruciate ligament with suture fixation technique through Y-shaped bone tunnels. Arthroscopy. 2006;22(2):172-81. doi: 10.1016/j.arthro.2005.10.020. [PubMed: 16458803].
9. Hoogervorst P, Gardeniers JW, Moret-Wever S, van Kampen A. Pseudo-arthrosis repair of a posterior cruciate ligament avulsion fracture. Knee Surg Sports Traumatol Arthrosc. 2010;18(11):1612-6. doi: 10.1007/s00167-010-1114-4. [PubMed: 20405107]. [PubMed Central: PMC2957579].
10. Nourbakhsh ST, Bahramian F, Zafarani Z, Alidousti A, Aslani H. Arthroscopic bridge technique for pcl avulsion: surgical technique and key points. Arch Bone Jt Surg. 2016;4(4):393-5. [PubMed: 27847856]. [PubMed Central: PMC5100459].
11. Patel MR, Butala UK, Thakor NS, Bansod RR, Dhotre RA. Arthroscopic fixation of anterior cruciate ligament tibial avulsion fractures: the suture “bridge” pull out technique and evaluation of results. Int J Res Orthop. 2017;3(5):979-85. doi: 10.18203/issn.2455-4510.IntJResOrthop20173375
12. Kakarlapudi TK, Bickerstaff DR. Knee instability: Isolated and complex. West J Med. 2001;174(4):266-72. doi: 10.1136/ewjm.174.4.266. [PubMed: 11290686]. [PubMed Central: PMC1071355].
13. Kim SJ, Shin SJ, Choi NH, Cho SK. Arthroscopically assisted treatment of avulsion fractures of the posterior cruciate ligament from the tibia. J Bone Joint Surg Am. 2001;83(5):698-708. doi: 10.2106/00004623-200105000-00008. [PubMed: 11379739].
14. Akseki D, Ozcan O, Boya H, Pinar H. A new weight-bearing meniscal test and a comparison with McMurray's test and joint line tenderness. Arthroscopy. 2004;20(9):951-8. doi: 10.1016/j.arthro.2004.08.020. [PubMed: 15525928].
15. Corea JR, Moussa M, al OA. McMurray's test tested. Knee Surg Sports Traumatol Arthrosc. 1994;2(2):70-2. doi: 10.1007/BF01476474. [PubMed: 7584186].
16. Anderson AF, Lipscomb AB. Clinical diagnosis of meniscal tears. Description of a new manipulative test. Am J Sports Med. 1986;14(4):291-3. doi: 10.1177/036354658601400408. [PubMed: 3755297].
17. Briggs KK, Kocher MS, Rodkey WG, Steadman JR. Reliability, validity, and responsiveness of the Lysholm knee score and Tegner activity scale for patients with meniscal injury of the knee. J Bone Joint Surg Am. 2006;88(4):698-705. doi: 10.2106/JBJS.E.00339. [PubMed: 16595458].
18. Briggs KK, Lysholm J, Tegner Y, Rodkey WG, Kocher MS, Steadman JR. The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later. Am J Sports Med. 2009;37(5):890-7. doi: 10.1177/0363546508330143. [PubMed: 19261899].
19. Briggs KK, Steadman JR, Hay CJ, Hines SL. Lysholm score and Tegner activity level in individuals with normal knees. Am J Sports Med. 2009;37(5):898-901. doi: 10.1177/0363546508330149. [PubMed: 19307332].
20. ChenSY,ChengCY,ChangSS,TsaiMC,ChiuCH,ChenAC,etal. Arthroscopic suture fixation for avulsion fractures in the tibial attachment of the posterior cruciate ligament. Arthroscopy. 2012;28(10):1454-63. doi: 10.1016/j.arthro.2012.04.141. [PubMed: 22929009].
21. Sabat D, Jain A, Kumar V. Displaced posterior cruciate ligament avulsion fractures: A retrospective comparative study between open posterior approach and arthroscopic single-tunnel suture fixation. Arthroscopy. 2016;32(1):44-53. doi: 10.1016/j.arthro.2015.06.014. [PubMed: 26311286].
22. Deehan DJ, Pinczewski LA. Arthroscopic reattachment of an avulsion fracture of the tibial insertion of the posterior cruciate ligament. Arthroscopy. 2001;17(4):422-5. doi: 10.1053/jars.2001.21841. [PubMed: 11288019].
23. GuiJ,WangL,JiangY,WangQ,YuZ,GuQ.Single-tunnelsuture fixation of posterior cruciate ligament avulsion fracture. Arthroscopy. 2009;25(1):78-85. doi: 10.1016/j.arthro.2008.08.011. [PubMed: 19111222].
24. Meyers MH. Isolated avulsion of the tibial attachment of the posterior cruciate ligament of the knee. J Bone Joint Surg Am. 1975;57(5):669-72. [PubMed: 1150710].
25. ChenCA,ChenW,GoodmanSB,HargreavesBA,KochKM,LuW, et al. New MR imaging methods for metallic implants in the knee: Artifact correction and clinical impact. J Magn Reson Imaging. 2011;33(5):1121-7. doi: 10.1002/jmri.22534. [PubMed: 21509870]. [PubMed Central: PMC3081101].
26. Wendt RE3rd, Wilcott MR3rd, Nitz W, Murphy PH, Bryan RN. MR imaging of susceptibility-induced magnetic field inhomogeneities. Radiology. 1988;168(3):837-41. doi: 10.1148/radiology.168.3.3406413. [PubMed: 3406413].
27. Butts K, Pauly JM, Gold GE. Reduction of blurring in view angle tilting MRI. Magn Reson Med. 2005;53(2):418-24. doi: 10.1002/mrm.20375. [PubMed: 15678535].
28. Cho ZH, Kim DJ, Kim YK. Total inhomogeneity correction including chemical shifts and susceptibility by view angle tilting. Med Phys. 1988;15(1):7-11. doi: 10.1118/1.596162. [PubMed: 3352554].
2. Katsman A, Strauss EJ, Campbell KA, Alaia MJ. Posterior cruciate ligament avulsion fractures. Curr Rev Musculoskelet Med. 2018;11(3):503-9. doi: 10.1007/s12178-018-9491-2. [PubMed: 29869136]. [PubMed Central: PMC6105473].
3. Joshi S, Bhatia C, Gondane A, Rai A, Singh S, Gupta S. Open reduction and internal fixation of isolated posterior cruciate ligament avulsion fractures: Clinical and functional outcome. Knee Surg Relat Res. 2017;29(3):210-6. doi: 10.5792/ksrr.17.022. [PubMed: 28854767]. [PubMed Central: PMC5596399].
4. Hooper PO3rd, Silko C, Malcolm TL, Farrow LD. Management of posterior cruciate ligament tibial avulsion injuries: A systematic review. Am J Sports Med. 2018;46(3):734-42. doi: 10.1177/0363546517701911. [PubMed: 28437619].
5. Bianchi M. Acute tears of the posterior cruciate ligament: clinical study and results of operative treatment in 27 cases.
Am J Sports Med. 1983;11(5):308-14. doi: 10.1177/036354658301100505. [PubMed: 6638245].
6. Pardiwala D, Agrawal D, Patil V, Saini U, Dhawal P. Paper 133: Comparison of open versus arthroscopic fixation for isolated PCL tibial bony avulsions: A prospective randomized study with minimum 2 year follow-up. Arthroscopy. 2012;28(9): e413-e414. doi: 10.1016/j.arthro.2012.05.616.
7. Geissler WB, Whipple TL. Intraarticular abnormalities in association with posterior cruciate ligament injuries. Am J Sports Med. 1993;21(6):846-9. doi: 10.1177/036354659302100615. [PubMed: 8291637].
8. Zhao J, He Y, Wang J. Arthroscopic treatment of acute tibial avulsion fracture of the posterior cruciate ligament with suture fixation technique through Y-shaped bone tunnels. Arthroscopy. 2006;22(2):172-81. doi: 10.1016/j.arthro.2005.10.020. [PubMed: 16458803].
9. Hoogervorst P, Gardeniers JW, Moret-Wever S, van Kampen A. Pseudo-arthrosis repair of a posterior cruciate ligament avulsion fracture. Knee Surg Sports Traumatol Arthrosc. 2010;18(11):1612-6. doi: 10.1007/s00167-010-1114-4. [PubMed: 20405107]. [PubMed Central: PMC2957579].
10. Nourbakhsh ST, Bahramian F, Zafarani Z, Alidousti A, Aslani H. Arthroscopic bridge technique for pcl avulsion: surgical technique and key points. Arch Bone Jt Surg. 2016;4(4):393-5. [PubMed: 27847856]. [PubMed Central: PMC5100459].
11. Patel MR, Butala UK, Thakor NS, Bansod RR, Dhotre RA. Arthroscopic fixation of anterior cruciate ligament tibial avulsion fractures: the suture “bridge” pull out technique and evaluation of results. Int J Res Orthop. 2017;3(5):979-85. doi: 10.18203/issn.2455-4510.IntJResOrthop20173375
12. Kakarlapudi TK, Bickerstaff DR. Knee instability: Isolated and complex. West J Med. 2001;174(4):266-72. doi: 10.1136/ewjm.174.4.266. [PubMed: 11290686]. [PubMed Central: PMC1071355].
13. Kim SJ, Shin SJ, Choi NH, Cho SK. Arthroscopically assisted treatment of avulsion fractures of the posterior cruciate ligament from the tibia. J Bone Joint Surg Am. 2001;83(5):698-708. doi: 10.2106/00004623-200105000-00008. [PubMed: 11379739].
14. Akseki D, Ozcan O, Boya H, Pinar H. A new weight-bearing meniscal test and a comparison with McMurray's test and joint line tenderness. Arthroscopy. 2004;20(9):951-8. doi: 10.1016/j.arthro.2004.08.020. [PubMed: 15525928].
15. Corea JR, Moussa M, al OA. McMurray's test tested. Knee Surg Sports Traumatol Arthrosc. 1994;2(2):70-2. doi: 10.1007/BF01476474. [PubMed: 7584186].
16. Anderson AF, Lipscomb AB. Clinical diagnosis of meniscal tears. Description of a new manipulative test. Am J Sports Med. 1986;14(4):291-3. doi: 10.1177/036354658601400408. [PubMed: 3755297].
17. Briggs KK, Kocher MS, Rodkey WG, Steadman JR. Reliability, validity, and responsiveness of the Lysholm knee score and Tegner activity scale for patients with meniscal injury of the knee. J Bone Joint Surg Am. 2006;88(4):698-705. doi: 10.2106/JBJS.E.00339. [PubMed: 16595458].
18. Briggs KK, Lysholm J, Tegner Y, Rodkey WG, Kocher MS, Steadman JR. The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later. Am J Sports Med. 2009;37(5):890-7. doi: 10.1177/0363546508330143. [PubMed: 19261899].
19. Briggs KK, Steadman JR, Hay CJ, Hines SL. Lysholm score and Tegner activity level in individuals with normal knees. Am J Sports Med. 2009;37(5):898-901. doi: 10.1177/0363546508330149. [PubMed: 19307332].
20. ChenSY,ChengCY,ChangSS,TsaiMC,ChiuCH,ChenAC,etal. Arthroscopic suture fixation for avulsion fractures in the tibial attachment of the posterior cruciate ligament. Arthroscopy. 2012;28(10):1454-63. doi: 10.1016/j.arthro.2012.04.141. [PubMed: 22929009].
21. Sabat D, Jain A, Kumar V. Displaced posterior cruciate ligament avulsion fractures: A retrospective comparative study between open posterior approach and arthroscopic single-tunnel suture fixation. Arthroscopy. 2016;32(1):44-53. doi: 10.1016/j.arthro.2015.06.014. [PubMed: 26311286].
22. Deehan DJ, Pinczewski LA. Arthroscopic reattachment of an avulsion fracture of the tibial insertion of the posterior cruciate ligament. Arthroscopy. 2001;17(4):422-5. doi: 10.1053/jars.2001.21841. [PubMed: 11288019].
23. GuiJ,WangL,JiangY,WangQ,YuZ,GuQ.Single-tunnelsuture fixation of posterior cruciate ligament avulsion fracture. Arthroscopy. 2009;25(1):78-85. doi: 10.1016/j.arthro.2008.08.011. [PubMed: 19111222].
24. Meyers MH. Isolated avulsion of the tibial attachment of the posterior cruciate ligament of the knee. J Bone Joint Surg Am. 1975;57(5):669-72. [PubMed: 1150710].
25. ChenCA,ChenW,GoodmanSB,HargreavesBA,KochKM,LuW, et al. New MR imaging methods for metallic implants in the knee: Artifact correction and clinical impact. J Magn Reson Imaging. 2011;33(5):1121-7. doi: 10.1002/jmri.22534. [PubMed: 21509870]. [PubMed Central: PMC3081101].
26. Wendt RE3rd, Wilcott MR3rd, Nitz W, Murphy PH, Bryan RN. MR imaging of susceptibility-induced magnetic field inhomogeneities. Radiology. 1988;168(3):837-41. doi: 10.1148/radiology.168.3.3406413. [PubMed: 3406413].
27. Butts K, Pauly JM, Gold GE. Reduction of blurring in view angle tilting MRI. Magn Reson Med. 2005;53(2):418-24. doi: 10.1002/mrm.20375. [PubMed: 15678535].
28. Cho ZH, Kim DJ, Kim YK. Total inhomogeneity correction including chemical shifts and susceptibility by view angle tilting. Med Phys. 1988;15(1):7-11. doi: 10.1118/1.596162. [PubMed: 3352554].
| Files | ||
| Issue | Vol 10 No 3 (2024) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v10i3.16783 | |
| Keywords | ||
| Knee Arthroscopy Avulsion Fractures Lysholm Knee Score | ||
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How to Cite
1.
Patel M, Shinde M, Butala U, Bhardwaj L, Yadav A, Gowda K, Ansari S, Sharma A. Arthroscopic Fixation of Posterior Cruciate Ligament Tibial Bony Avulsion Fractures: The Double Suture Bridge Technique and Evaluation of Results. J Orthop Spine Trauma. 2024;10(3):119-123.
