Single-tunnel suture fixation of posterior cruciate ligament avulsion fracture

The purpose of this study was to evaluate the clinical results of arthroscopic treatment of tibial avulsion fracture of the posterior cruciate ligament (PCL) by suture fixation technique through a single bone tunnel.

We arthroscopically treated 28 patients (mean age, 35.3 years) with PCL avulsion fractures using 2 posteromedial portals. The bony fragment was sutured by use of a suture hook and was then reduced into the top of the tibial bone tunnel created from the anterior tibial cortex to the bottom of the fracture bed. Slight depression of 1 to 3 mm of the osseous fragment was achieved. We followed up 24 cases for more than 2 years.

The fracture usually healed at 6 to 12 weeks (mean, 2.8 months) after surgery. At the last follow-up, all patients achieved normal range of motion of the knees, except for 2 patients who had 5 degrees and 10 degrees terminal flexion limitations of the involved knees, respectively. KT-1000 examination (MEDmetric, San Diego, CA) showed that the side-to-side difference was 0 to 2 mm in 23 patients and 3 mm in 1 patient, with a mean of 0.7 +/- 0.8 mm. The Lysholm score was 92 to 100, with a mean of 95.2 +/- 2.3. On the basis of the International Knee Documentation Committee knee examination form, the results were graded as normal in 20 patients and as nearly normal in the other 4. The mean Tegner score was 6.8 +/- 0.4 preoperatively and 6.6 +/- 0.5 at the last follow-up (P = .23).

The single-tibial tunnel technique seemed not only to simplify the procedure but also to facilitate slight depression of the bony fragment, which might have been useful to restore normal tension of the PCL. Clinically, this technique was reproducible and effective.

Level IV, therapeutic case series.