Open Versus Arthroscopic Fixation of Tibial-Sided Posterior Cruciate Ligament (PCL) Avulsion Fractures in Pediatric and Adolescent Athletes.

Background: Posterior cruciate ligament (PCL) avulsion fractures pose unique technical challenges for surgical fixation in the pediatric and adolescent population. Both arthroscopic and open management have been pursued; nonetheless, the literature is devoid of comparative studies elucidating factors for technique selection or relative outcomes.

Purpose: To compare the demographic characteristics, presenting features, clinical course, return to sports (RTS), patient-reported outcomes (PROs), and complications associated with open and arthroscopic fixation cohorts of pediatric patients who sustained an isolated tibial-sided PCL avulsion fracture.

Study design: Cohort study; Level of evidence, 3.

Methods: A medical record review was performed for all patients aged 8 to 19 years who underwent operative fixation of a tibial-sided PCL avulsion fracture between 2003 and 2021 at a single pediatric tertiary referral center. Patients were excluded if they sustained a femoral-sided avulsion fracture, underwent a PCL reconstruction, or presented with multiligamentous knee injury requiring surgical intervention for >1 ligament. All patients were sent 3 PRO instruments validated for children: Pediatric International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score-Child, and Hospital for Special Surgery Functional Activity Brief Scale.

Results: A total of 20 patients met the inclusion criteria, of whom 10 patients were treated with open fixation and 10 with arthroscopic fixation. Also, 15 (75%) patients (7 open, 8 arthroscopic) returned PROs. No differences were detected in demographic characteristics, RTS, or PROs between cohorts. One patient in the open cohort developed a deep-tissue infection in the popliteal fossa, requiring open irrigation and debridement. One patient in the arthroscopic cohort eventually required PCL reconstruction for fracture nonunion associated with persistent instability.

Conclusion: No differences in outcomes were detected in this study between cohorts of pediatric patients undergoing open and arthroscopic fixation of tibial-sided PCL avulsion injuries. Regardless of surgical technique, most patients healed without complications and returned to high activity levels. Given the postoperative complications seen in the arthroscopic cohort, further research is needed to investigate the potential biomechanical superiority of open technique fixation constructs.