Arthroscopic surgery via three posteromedial approaches for posterior cruciate ligament tibial avulsion fractures

doi:10.3877/ cma.j.issn.1674-134X.2025.02.006

Abstract

Abstract:

Objective

To evaluate the clinical outcomes of arthroscopic fixation for avulsion fractures of posterior cruciate ligament (PCL) tibial insertion through three posteromedial approaches.

Methods

A retrospective analysis was conducted on patients treated for PCL tibial avulsion fractures via arthroscopic tripleportal posteromedial approach in Yulin Hospital of the First Affiliated Hospital of Xi’an Jiaotong University between December 2019 and December 2021. Patients with concomitant ligament injuries of the knee were excluded. Fracture healing rate was recorded, and clinical outcomes were assessed using Lysholm score,International Knee Documentation Committee (IKDC) subjective knee form, Hospital for Special Surgery(HSS) knee score, and visual analog scale (VAS) for pain. Scores before operation and two years after operation were compared using paired t test and rank sum test.

Results

A total of eight patients were included. All the fractures achieved union, yielding a 100% healing rate. The posterior drawer test was negative in all cases.One patient reported residual knee pain. The overall satisfaction rate was 87.5%. At two-year follow-up,all clinical scores showed significant improvement compared to baseline: Lysholm score (45±13) vs. (89±8)(t=8.232, P<0.001), IKDC score (37±5) vs. (71±7) (t=10.03, P<0.001), HSS score (34±8 ) vs. (92±4) (t=17.87,P<0.001), and VAS score 6(6, 7) vs. 0(0, 0) (t=2.536, P=0.011). The excellent-to-good rates were 75.0%(6/8) in Lysholm score, 62.5% (5/8) in IKDC score, and 100% (8/8) in HSS score.

Conclusions

Arthroscopic fixation of PCL tibial avulsion fractures via three posteromedial approaches is a minimally invasive, reliable, and effective surgical technique. It ensures solid fixation, promotes early functional recovery, and meets the clinical demands for optimal outcomes in the treatment of PCL tibial avulsion fractures.

Key words: Arthroscope, Posterior cruciate ligament, Avulsion fracture

Haitao Hu, Huhu Wang, Jiaming He, Pengbo Liu, Shansong Gao, Hongwei Li, Jie Hu. Arthroscopic surgery via three posteromedial approaches for posterior cruciate ligament tibial avulsion fractures[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2025, 19(02): 172-177.

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URL: https://zhgjwkzz.cma-cmc.com.cn/EN/10.3877/ cma.j.issn.1674-134X.2025.02.006

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Figures/Tables 3

Figure 1 Surgical steps of arthroscopic treatment for avulsion fracture of PCL（posterior cruciate ligament） tibial insertion via three posteromedial portals. A to B demostrate the establish two posteromedial portals; C shows the medial head of the gastrocnemius tendon; D shows the avulsion fracture fragment of the PCL tibial insertion; E to F demonstrate establishment of the ultra-high posteromedial portal; G to H demonstrate that after repositioning the fracture fragment, a hollow nail is inserted

Table 1 Comparisons of evaluation scores before and after surgery

时间点Time points	Lysholm评分（ $\overset{ˉ}{x}$ ± s ）	IKDC评分（ $\overset{ˉ}{x}$ ± s ）	HSS（ $\overset{ˉ}{x}$ ± s ）	VAS评分 M（P₂₅，P₇₅）
术前Before surgery	45±13	37±5	34±8	6（6，7）
术后2年Two years after surgery	89±8	71±7	92±4	0（0，0）
W值	0. 9247	0. 9138	0. 9440	0. 8107
P值	>0. 05	>0. 05	>0. 05	0. 0038^*
t值	8. 232	10. 03	17. 87	2. 536
P值	＜0. 001	＜0. 001	＜0. 001	0. 011

Table 1 Comparisons of evaluation scores before and after surgery

时间点Time points	Lysholm评分（ $\overset{ˉ}{x}$ ± s ）	IKDC评分（ $\overset{ˉ}{x}$ ± s ）	HSS（ $\overset{ˉ}{x}$ ± s ）	VAS评分 M（P₂₅，P₇₅）
术前Before surgery	45±13	37±5	34±8	6（6，7）
术后2年Two years after surgery	89±8	71±7	92±4	0（0，0）
W值	0. 9247	0. 9138	0. 9440	0. 8107
P值	>0. 05	>0. 05	>0. 05	0. 0038^*
t值	8. 232	10. 03	17. 87	2. 536
P值	＜0. 001	＜0. 001	＜0. 001	0. 011

Figure 2 Images of right knee of typical case before and after surgery. A is the lateral X-ray image of right knee before surgery，demonstrating avulsion fracture of PCL（posterior cruciate ligament） tibial insertion site; B is MRI image of right knee before surgery,showing obvious displacement of the avulsion fracture fragment of the PCL; C demonstrates fixation of the PCL avulsion fracture fragment with two hollow screws under arthroscope; D is the lateral X-ray image of the right knee after surgery, showing good fracture reduction and optimal position of the internal fixation

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