Arthroscopic suspension fixation with Endobutton in treatment of tibial insertion avulsion fractures of posterior cruciate ligament_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WAN Feng , WANG Song , WANG Yuan , WEN Geng’ao , TANG Jinlong , LI Hao ,  ZHENG Wei

Department of Orthopedics, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221000, P. R. China;

Corresponding?author：

ZHENG Wei, Email: xyfyydyxk@163.com

Keywords：

Posterior cruciate ligament; avulsion fracture; suspension fixation; arthroscopy; Endobutton

DOI：

10.7507/1002-1892.202401028

Video：

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Objective To investigate the effectiveness of arthroscopic suspension fixation with Endobutton in the treatment of tibial insertion avulsion fractures of posterior cruciate ligament (PCL). Methods A retrospective analysis was conducted on the clinical data of 52 patients (52 knees) with tibial insertion avulsion fractures of PCL, who were treated by arthroscopic suspension fixation with Endobutton between June 2017 and October 2022. There were 29 males and 23 females, with an average age of 40.6 years (range, 19-66 years). There were 24 cases of traffic accident injuries, 17 cases of sports injuries, and 11 cases of fall injuries. The time from injury to operation ranged from 6 to 19 days (mean, 13.3 days). According to the Meyers-McKeever classification, there were 30 cases of type Ⅱ and 22 cases of type Ⅲ fractures. All patients exhibited positive posterior drawer test results. Preoperative knee joint function was assessed with Lysholm score (21.3±6.7), International Knee Documentation Committee (IKDC) score (20.7±5.8), and visual analogue scale (VAS) score (5.3±0.7); and knee joint range of motion was (41.73±3.17)°. Based on preoperative CT three-dimensional reconstruction measurements, the longitudinal diameter of the avulsed bone fragment ranged from 13 to 25 mm (mean, 18.1 mm). Operation time and occurrence of complications were recorded, and postoperative imaging was used to assess fracture healing. Knee joint function and pain severity were evaluated using knee joint range of motion, Lysholm score, IKDC score, and VAS score. Results The operation time ranged from 46 to 81 minutes (mean, 56.2 minutes). All patients were followed up 12-28 months (mean, 20.1 months). The iatrogenic fractures of bone fragments occurred during operation in 4 cases; and knee effusion occurred in 2 cases and anterior knee pain in 1 case after operation. All incisions healed by first intention. Imaging evaluations at 3 months after operation showed the fracture healing and no internal fixation failure. All patients demonstrated good knee function and had returned to normal activities at 12 months after operation. At last follow-up, the knee joint range of motion was (133.44±4.17)°, Lysholm score 93.6±3.1, IKDC score 93.4±2.5, and VAS score 1.0±0.6, with significant differences compared to preoperative scores (P<0.05). Conclusion Arthroscopic suspension fixation with Endobutton in the treatment of tibial insertion avulsion fractures of PCL is simple to operate, and the knee joint function recovers well.

Citation： WAN Feng, WANG Song, WANG Yuan, WEN Geng’ao, TANG Jinlong, LI Hao, ZHENG Wei. Arthroscopic suspension fixation with Endobutton in treatment of tibial insertion avulsion fractures of posterior cruciate ligament. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(3): 267-271. doi: 10.7507/1002-1892.202401028 Copy

1.	Kew ME, Miller MD. Posterior cruciate ligament reconstruction in the multiple ligament injured knee. J Knee Surg, 2020, 33(5): 421-430.
2.	朱意然, 袁堂波, 董家純, 等. 關節鏡下TightRope袢鋼板固定治療后交叉韌帶止點撕脫骨折的臨床療效觀察. 中華解剖與臨床雜志, 2023, 28(2): 93-97.
3.	Hooper PO, Silko C, Malcolm TL, et al. Management of posterior cruciate ligament tibial avulsion injuries: a systematic review. Am J Sports Med, 2018, 46(3): 734-742.
4.	Xu Z, Dong Y, Feng YE, et al. A simple arthroscopic technique for treatment of displaced “hinged” type of posterior cruciate ligament avulsion fractures. BMC Musculoskelet Disord, 2022, 23(1): 841.
5.	Guo Q, Li X, Tang Y, et al. Homemade pin-hook for surgical treatment of posterior cruciate ligament avulsion fractures. BMC Musculoskelet Disord, 2022, 23(1): 929.
6.	Gopinatth V, Mameri ES, Casanova FJ, et al. Systematic review and meta-analysis of clinical outcomes after management of posterior cruciate ligament tibial avulsion fractures. Orthop J Sports Med, 2023, 11(9): 23259671231188383.
7.	劉國華, 張宇, 張錢中逸, 等. 膝關節后正中直形小切口內固定治療后交叉韌帶脛骨止點撕脫骨折. 中國骨與關節損傷雜志, 2023, 38(10): 1082-1084.
8.	Huang W, Gong X, Rahul M, et al. Anterior arthroscopic-assisted fixation of posterior cruciate ligament avulsion fractures. Eur J Med Res, 2015, 20: 88.
9.	趙道洪, 李彥林, 姜兆偉, 等. 關節鏡下縫線及可吸收螺釘雙重固定治療前后交叉韌帶脛骨側撕脫骨折. 中國修復重建外科雜志, 2016, 30(7): 822-825.
10.	董軍, 樊緒國, 王弘德, 等. 關節鏡下單脛骨隧道免打結錨釘內固定治療后交叉韌帶脛骨止點撕脫骨折的近期療效. 中華創傷骨科雜志, 2019, 21(7): 569-574.
11.	Ren X, Wang J, Yang S, et al. The safety, efficacy, and functional outcomes on arthroscopic fixation of posterior cruciate ligament avulsion fracture by a bio-absorbable anchor or traditional pull-out technique: A prospective cohort study. Front Bioeng Biotechnol, 2022, 10: 1055176.
12.	Wu L, Xu H, Li B, et al. Improved arthroscopic high-strength suture fixation for the treatment of posterior cruciate ligament avulsion fracture. J Orthop Surg (Hong Kong), 2022, 30(2): 10225536221101701.
13.	Choi NH, Kim SJ. Arthroscopic reduction and fixation of bony avulsion of the posterior cruciate ligament of the tibia. Arthroscopy, 1997, 13(6): 759-762.
14.	吳錦, 張龍華, 曾德妙. 膝關節后交叉韌帶脛骨止點撕脫骨折的研究進展. 中國現代醫生, 2023, 61(31): 124-127.
15.	Li Q, Song K, Sun Y, et al. Severe cartilage damage from a broken absorbable screw head after fixation of an avulsion fracture of the tibial attachment of the posterior cruciate ligament: A case report. Medicine (Baltimore), 2016, 95(43): e5180.
16.	李明, 章軍輝, 劉華, 等. 兩種固定方式治療后交叉韌帶止點撕脫骨折的療效比較. 浙江醫學, 2018, 40(11): 1259-1260, 1276.
17.	王盼盼, 商曉軍, 徐鵬, 等. 鏡下雙內鈕扣固定治療后交叉韌帶脛骨止點撕脫骨折. 中國矯形外科雜志, 2017, 25(16): 1506-1510.
18.	Domnick C, K?sters C, Franke F, et al. Biomechanical properties of different fixation techniques for posterior cruciate ligament avulsion fractures. Arthroscopy, 2016, 32(6): 1065-1071.
19.	Zhang F, Ye Y, Yu W, et al. Treatment of tibia avulsion fracture of posterior cruciate ligament with total arthroscopic internal fixation with adjustable double loop plate: A retrospective cohort study. Injury, 2022, 53(6): 2233-2240.
20.	Wajsfisz A, Makridis KG, Van Den Steene JY, et al. Fixation of posterior cruciate ligament avulsion fracture with the use of a suspensory fixation. Knee Surg Sports Traumatol Arthrosc, 2012, 20(5): 996-999.

1. Kew ME, Miller MD. Posterior cruciate ligament reconstruction in the multiple ligament injured knee. J Knee Surg, 2020, 33(5): 421-430.
2. 朱意然, 袁堂波, 董家純, 等. 關節鏡下TightRope袢鋼板固定治療后交叉韌帶止點撕脫骨折的臨床療效觀察. 中華解剖與臨床雜志, 2023, 28(2): 93-97.
3. Hooper PO, Silko C, Malcolm TL, et al. Management of posterior cruciate ligament tibial avulsion injuries: a systematic review. Am J Sports Med, 2018, 46(3): 734-742.
4. Xu Z, Dong Y, Feng YE, et al. A simple arthroscopic technique for treatment of displaced “hinged” type of posterior cruciate ligament avulsion fractures. BMC Musculoskelet Disord, 2022, 23(1): 841.
5. Guo Q, Li X, Tang Y, et al. Homemade pin-hook for surgical treatment of posterior cruciate ligament avulsion fractures. BMC Musculoskelet Disord, 2022, 23(1): 929.
6. Gopinatth V, Mameri ES, Casanova FJ, et al. Systematic review and meta-analysis of clinical outcomes after management of posterior cruciate ligament tibial avulsion fractures. Orthop J Sports Med, 2023, 11(9): 23259671231188383.
7. 劉國華, 張宇, 張錢中逸, 等. 膝關節后正中直形小切口內固定治療后交叉韌帶脛骨止點撕脫骨折. 中國骨與關節損傷雜志, 2023, 38(10): 1082-1084.
8. Huang W, Gong X, Rahul M, et al. Anterior arthroscopic-assisted fixation of posterior cruciate ligament avulsion fractures. Eur J Med Res, 2015, 20: 88.
9. 趙道洪, 李彥林, 姜兆偉, 等. 關節鏡下縫線及可吸收螺釘雙重固定治療前后交叉韌帶脛骨側撕脫骨折. 中國修復重建外科雜志, 2016, 30(7): 822-825.
10. 董軍, 樊緒國, 王弘德, 等. 關節鏡下單脛骨隧道免打結錨釘內固定治療后交叉韌帶脛骨止點撕脫骨折的近期療效. 中華創傷骨科雜志, 2019, 21(7): 569-574.
11. Ren X, Wang J, Yang S, et al. The safety, efficacy, and functional outcomes on arthroscopic fixation of posterior cruciate ligament avulsion fracture by a bio-absorbable anchor or traditional pull-out technique: A prospective cohort study. Front Bioeng Biotechnol, 2022, 10: 1055176.
12. Wu L, Xu H, Li B, et al. Improved arthroscopic high-strength suture fixation for the treatment of posterior cruciate ligament avulsion fracture. J Orthop Surg (Hong Kong), 2022, 30(2): 10225536221101701.
13. Choi NH, Kim SJ. Arthroscopic reduction and fixation of bony avulsion of the posterior cruciate ligament of the tibia. Arthroscopy, 1997, 13(6): 759-762.
14. 吳錦, 張龍華, 曾德妙. 膝關節后交叉韌帶脛骨止點撕脫骨折的研究進展. 中國現代醫生, 2023, 61(31): 124-127.
15. Li Q, Song K, Sun Y, et al. Severe cartilage damage from a broken absorbable screw head after fixation of an avulsion fracture of the tibial attachment of the posterior cruciate ligament: A case report. Medicine (Baltimore), 2016, 95(43): e5180.
16. 李明, 章軍輝, 劉華, 等. 兩種固定方式治療后交叉韌帶止點撕脫骨折的療效比較. 浙江醫學, 2018, 40(11): 1259-1260, 1276.
17. 王盼盼, 商曉軍, 徐鵬, 等. 鏡下雙內鈕扣固定治療后交叉韌帶脛骨止點撕脫骨折. 中國矯形外科雜志, 2017, 25(16): 1506-1510.
18. Domnick C, K?sters C, Franke F, et al. Biomechanical properties of different fixation techniques for posterior cruciate ligament avulsion fractures. Arthroscopy, 2016, 32(6): 1065-1071.
19. Zhang F, Ye Y, Yu W, et al. Treatment of tibia avulsion fracture of posterior cruciate ligament with total arthroscopic internal fixation with adjustable double loop plate: A retrospective cohort study. Injury, 2022, 53(6): 2233-2240.
20. Wajsfisz A, Makridis KG, Van Den Steene JY, et al. Fixation of posterior cruciate ligament avulsion fracture with the use of a suspensory fixation. Knee Surg Sports Traumatol Arthrosc, 2012, 20(5): 996-999.

Chinese Journal of Reparative and Reconstructive Surgery

Arthroscopic suspension fixation with Endobutton in treatment of tibial insertion avulsion fractures of posterior cruciate ligament

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