Original Article
Open Screw Fixation Versus Arthroscopic Suture Fixation of Tibial Posterior Cruciate Ligament Avulsion Injuries: A Mechanical Comparison

https://doi.org/10.1016/j.arthro.2007.06.012Get rights and content

Purpose: The objective of this study was to compare an arthroscopic suture technique with an open posterior screw fixation technique, by use of mechanical testing, for the treatment of posterior cruciate ligament (PCL) tibial bony avulsion. Methods: We split 10 intact human cadaveric knee pairs (20 knees) into 2 groups (A and B) with 1 knee from each pair and mounted them in a conventional tensile tester (Kratos 5002 Universal Biomechanical Test Machine; Kratos Dynamômetros, São Paulo, Brazil). By applying a posterior tibial load up to 100 N at 90° of flexion, tibial displacement and stiffness were recorded. After a simulated PCL tibial avulsion fracture, the knees underwent PCL reattachment, with open screw fixation in group A and arthroscopic suture fixation in group B. The tests were performed first on intact and then on injured and operated knees. A direct visual inspection was performed postoperatively on all operated knees after a posterior arthrotomy to verify the fixation integrity. Results: One knee in each group had a fixation failure on visual inspection. Analysis of variance testing showed no differences between groups A and B for tibial posterior displacement (P = .229) and stiffness (P = .285) analysis. Conclusions: The arthroscopic PCL tibial avulsion suture technique that we present is as reliable as open screw fixation for this lesion in terms of initial fixation. Clinical Relevance: Various PCL avulsion surgery techniques have been reported, including alternatives to avoid potentially injurious exposure of the popliteal fossa. Following on this research line, we present a new arthroscopic suture for the treatment of this lesion that requires no special surgical skill or materials.

Section snippets

Specimen Preparation

We used 20 fresh-frozen undamaged human cadaveric knees (10 pairs), all male, ranging in age from 44 to 63 years, in this study. The femur was cut 20 cm and the tibia was cut 30 cm from the joint line. The iliotibial tract was incised to the mid thigh, and the popliteus musculotendinous unit and the joint capsule were left intact. The fibula was secured to the tibia to simulate the restraint provided by the interosseous membrane. The knees were stored at −20°C and, before testing, were thawed

Results

One knee in each group had a fixation failure detected by direct visual inspection after the repaired condition tests. Table 1, Table 2 show the mean posterior displacement and stiffness, respectively, for groups A and B for the 3 conditions. Analysis of variance showed no differences between these 2 groups in terms of posterior displacement (P = .229) and stiffness (P = .285).

Discussion

Recently, arthroscopic techniques to treat PCL tibial avulsion fracture fixation have become a reality. In the beginning, there was percutaneous screw fixation described by Martinez-Moreno and Blanco-Blanco,17 followed by proposals for cannulated screw fixation by Choi and Kim24 and Littlejohn and Geissler,18 as well as K-wire percutaneous fixation described by Deehan and Pinczewski25 (used on small fragments), and finally an evolution to arthroscopic suture techniques, as reported by Kim et

Conclusions

We have reported an arthroscopic suture technique for fixation of PCL tibial bony avulsion fractures. Our technique is as reliable as open screw fixation for PCL tibial bony avulsion fractures with respect to initial fixation in a human cadaveric model.

References (32)

  • E.L. Trickey

    Rupture of the posterior cruciate ligament of the knee

    J Bone Joint Surg Br

    (1968)
  • T. Torisu

    Isolated avulsion of the tibial attachment of the posterior cruciate ligament

    J Bone Joint Surg Am

    (1977)
  • M.H. Meyers

    Isolated avulsion of the tibial attachment of the posterior cruciate ligament of the knee

    J Bone Joint Surg Am

    (1975)
  • E.L. Trickey

    Injuries to the posterior cruciate ligamentDiagnosis and treatment of early injuries and reconstruction of late instability

    Clin Orthop Relat Res

    (1980)
  • T. Torisu

    Avulsion fracture of the tibial attachment of the posterior cruciate ligament: Results of operative treatment

    J Bone Joint Surg Am

    (1980)
  • W.C. Loos et al.

    Acute posterior ligament injuries

    Am J Sports Med

    (1981)
  • Cited by (0)

    The authors report no conflict of interest.

    View full text