Arthroscopically assisted treatment of avulsion fractures of the posteriorcruciate ligament from the tibia

Background: The attachment of the posterior cruciate ligament to the poster ior intercondylar fossa of the tibia is in a location that is difficult to access for arthroscopic surgical procedures. This report presents a variety of arthroscopically assisted reduction and fixation methods for managing a vulsion fractures of the posterior cruciate ligament from the tibia. Methods: Thirteen patients (fourteen knees) who had an avulsion fracture of the posterior cruciate ligament were treated with an arthroscopic procedur e. Eleven patients underwent the operation in the acute phase (four to; ten days after the injury), and two patients had delayed surgery (at nineteen and twenty months after the injury) because of nonunion. The choice of fixa tion method was based on the size of the avulsed fragment. Six knees that h ad a small bone fragment (<10 mm) with comminution were fixed with use of m ultiple sutures. Two knees that had a small bone fragment without comminuti on were fixed with 23-gauge wires. Two knees that had a medium-sized fragme nt (10 to 20 mm) were fixed with Kirschner wires. Four knees that had; a la rge single fragment of bone (>20 mm) that involved the condyles were fixed with one or two cannulated screws. Results: Ali patients had osseous union as determined on radiographs. Three injured knees in two patients showed limitation of motion after the operat ion; These patients had been immobilized for two or three months after the surgery because of concomitant fractures. The eleven patients who had under gone the operation in the acute phase, including two in whom,postoperative arthrofibrosis had developed, showed no or trace posterior instability foll owing the: procedure. However, the two patients in whom the surgery had bee n delayed had residual grade-I posterior instability. The postoperative sid e-to-side differences, when measured with use of the KT-2000 arthrometer an d posterior stress radiographs, showed better results in the patients in wh om the surgery had been performed in the acute phase than in the patients i n whom the operation had been delayed. Conclusion: Arthroscopic procedures can be used to treat tibial avulsion fr actures of the posterior cruciate ligament.