Comparison of three surgical methods for displaced posterior cruciate ligament tibial insertion avulsion fractures: a retrospective study.

Abstract

Background: The aim of this study was to evaluate the clinical outcomes of three surgical methods, three types of arthroscopic suture fixation, suspension fixation with EndoButton, and open screw fixation, in the treatment of displaced posterior cruciate ligament tibial insertion avulsion fractures.

Methods: A retrospective analysis of the clinical data of 104 patients with posterior cruciate ligament avulsion fractures between 2010 and 2023 was performed. The patients were divided into three groups according to the surgical approach used: suture fixation in Group A (24 patients), suspension fixation with EndoButton in Group B (37 patients), and hollow screw fixation in Group C (43 patients). The Lysholm score, International Knee Documentation Committee (IKDC) score, Tegner activity score, and postoperative imaging findings of all patients were collected. The final follow-up data were used to compare the differences among the three groups.

Results: There was no statistically significant difference in the general information of the three groups of patients. Among the 104 patients, the mean postoperative Lysholm score was 92.9 (CI, 91.0-94.8) in Group A, 93.4 (CI, 92.3-94.6) in Group B, and 93.5 (CI, 92.6-94.4) in Group C. Postoperative IKDC subjective assessment of knee function was considered normal or near normal in more than 95% of the patients in all three groups. More than 93% of the patients in all three groups did not have severe abnormalities in knee range of motion. The mean postoperative Tegner activity score was 6.7 (CI, 6.3-7.1) in Group A, 7.0 (CI, 6.7-7.3) in Group B, and 6.9 (CI, 6.6-7.1) in Group C. Imaging at 3 months after surgery revealed bone healing, and no serious postoperative complications were found in any of the three groups.

Conclusion: All three treatments yielded good clinical results and imaging healing. In particular, arthroscopic suspension fixation with EndoButton is recommended as the preferred treatment because of its low invasiveness, good mechanical properties and low complication rate.