Articles Vol. 67 No. 8 28/08/2026

EARLY OUTCOMES OF ARTHROSCOPIC FIXATION TECHNIQUES FOR TIBIAL AVULSION FRACTURES OF THE POSTERIOR CRUCIATE LIGAMENT AT SAI GON ITO PHU NHUAN HOSPITAL

Nguyen Van Huy1,2, Ho Sy Nam1,2, Nguyen Minh Duong1,2, Nguyen Van Thuat1,2, Phan Van Ngoc1,2, Nguyen Thanh Chon1,2, Le Chi Dung1,2
1 Saigon ITO Phu Nhuan Hospital
2 Bệnh viện Sài Gòn ITO Phú Nhuận
DOI: 10.52163/yhc.v67i8.6256
17 Views
0 Downloads
Abstract

Objective: To evaluate fracture union, complications, and functional recovery of the knee after arthroscopic fixation of tibial avulsion fractures of the posterior cruciate ligament.

Subjects and methods: This retrospective descriptive case series included 27 patients with tibial avulsion fractures of the posterior cruciate ligament who underwent arthroscopic fixation techniques between August 2019 and August 2025. Clinical characteristics, injury classification, associated intra-articular lesions, fixation methods, fracture union, complications, and functional outcomes assessed by the Lysholm and subjective IKDC scores at the fixed time points of 3 and 6 months postoperatively were recorded and analyzed.

Results: Anatomic reduction was achieved in 24/27 cases (88.9%; 95% CI 70.8% - 97.6%). Fracture union was observed in 26/27 patients at 3 months (96.3%; 95% CI 81.0% - 99.9%) and in all 27 patients at 6 months (100%; 95% CI 87.2% - 100%). Within 6 months of follow-up, no infection, popliteal neurovascular injury, fixation loosening or failure, or reoperation was recorded (0/27; 95% CI 0% - 12.8%). The mean Lysholm score increased from 80.78 ± 11.71 at 3 months to 94.04 ± 8.78 at 6 months (mean change 13.26; 95% CI 10.63 - 15.89), and the mean subjective IKDC score increased from 72.29 ± 12.17 to 91.09 ± 10.87 (mean change 18.79; 95% CI 17.18 - 20.40); both p < 0.001.

Conclusion: In this case series of 27 patients, arthroscopic fixation techniques yielded favorable early outcomes, with fracture union achieved in all patients at 6 months, no prespecified complications observed during follow-up, and significant improvements in Lysholm and subjective IKDC scores between 3 and 6 months postoperatively. Further studies with larger sample sizes and more rigorous study designs are needed to evaluate the long-term safety and effectiveness of these techniques.

References
[1]
Ouyang J, Hui M, Lu J, Jiang C, Guo W. Arthroscopic Management of Posterior Cruciate Ligament Avulsion Fractures Utilizing Anterior Compartment Loop-and-Tack Suspension Fixation. Orthop J Sports Med. 2025;13(12):23259671251386462. doi:10.1177/23259671251386462 Google Scholar
[2]
Zhu Y, Yuan T, Cai D, Tao J, Dong J, Hu B, et al. Adjustable-Loop Cortical Button Fixation Results in Good Clinical Outcomes for Acute Tibial Avulsion Fracture of the Posterior Cruciate Ligament. Arthrosc Sports Med Rehabil. 2023;5(2):pp. e307-e13. doi: 10.1016/j.asmr.2022.11.012 Google Scholar
[3]
Zheng W, Hou W, Zhang Z, Li P, Zhou B, Li H, et al. Results of Arthroscopic Treatment of Acute Posterior Cruciate Ligament Avulsion Fractures With Suspensory Fixation. Arthroscopy. 2021;37(6):pp. 1872-80. doi: 10.1016/j.arthro.2021.01.044 Google Scholar
[4]
Gwinner C, Kopf S, Hoburg A, Haas NP, Jung TM. Arthroscopic Treatment of Acute Tibial Avulsion Fracture of the Posterior Cruciate Ligament Using the TightRope Fixation Device. Arthrosc Tech. 2014;3(3):pp. e377-82. doi: 10.1016/j.eats.2014.02.005 Google Scholar
[5]
Kan H, Nakagawa S, Hino M, Komaki S, Arai Y, Inoue H, et al. Arthroscopic Fixation Technique for Avulsion Fracture of the Posterior Cruciate Ligament From the Tibia. Arthrosc Tech. 2020;9(11):pp. e1819-e24. doi: 10.1016/j.eats.2020.08.006 Google Scholar
[6]
Chen LB, Wang H, Tie K, Mohammed A, Qi YJ. Arthroscopic fixation of an avulsion fracture of the tibia involving the posterior cruciate ligament: a modified technique in a series of 22 cases. Bone Joint J. 2015;97-B(9):pp. 1220-5. doi: 10.1302/0301-620X.97B9.35765 Google Scholar
[7]
Xu Z, Dong Y, Feng YE, Xie P, Gu J, Kang K, et al. A simple arthroscopic technique for treatment of displaced “hinged” type of posterior cruciate ligament avulsion fractures. BMC Musculoskelet Disord. 2022;23(1):pp. 841. doi: 10.1186/s12891-022-05795-8 Google Scholar
[8]
Dhariwal HV, Kannaiyan M, Thirumeni T, Rajagopal N. Outcome Analysis of Arthroscopic Fixation of Posterior Cruciate Ligament Avulsion Fracture Using a Single Tibial Tunnel and Suture Loop with Button Configuration - A Case Series Study. J Orthop Case Rep. 2024;14(4):pp. 170-5. doi: 10.13107/jocr.2024.v14.i04.4400 Google Scholar
[9]
Thonse C, Magar MT, Paul D. Arthroscopic “Crisscross” Fixation Technique for Avulsion Fracture of the Posterior Cruciate Ligament From the Tibia. Arthrosc Tech. 2024;14(3):pp. 103277. doi: 10.1016/j.eats.2024.103277 Google Scholar
[10]
Li X, Ma Q, Zheng Q, Dou Q, Zhou L, Sun L, et al. Modified arthroscopic repair of a posterior cruciate ligament tibial avulsion fracture improves IKDC and Lysholm score compared to open reduction. J Orthop Surg Res. 2024;19(1):pp. 362. doi: 10.1186/s13018-024-04851-4 Google Scholar
[11]
Joshi A, Thaiba A, Paudyal H, Ahmad U. A modified classification of tibial avulsion of the posterior cruciate ligament and its association with meniscal and ligament injuries. Journal of ISAKOS. 2025;13:100921. doi:10.1016/j.jisako.2025.100921. Google Scholar
[12]
Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;(198):43-9. Google Scholar
[13]
Migliorini F, Maffulli N, Jeyaraman M, Schäfer L, Rath B, Huber T. Minimal clinically important difference (MCID), patient-acceptable symptom state (PASS), and substantial clinical benefit (SCB) following surgical knee ligament reconstruction: a systematic review. Eur J Trauma Emerg Surg. 2025;51(1):32. doi:10.1007/s00068-024-02708-3. Google Scholar