Journal Article

Clinical outcomes and complications of four surgical techniques for tibial avulsion fractures of the posterior cruciate ligament: a retrospective comparative study

She, Chang, Li, Liubing, Xu, Wei, Hu, Zhenghui, Xia, Yanze

2025

Overview

Objective The optimal surgical approach for tibial avulsion fractures of the posterior cruciate ligament (PCL) remains controversial. This study aimed to compare the clinical outcomes of four techniques: arthroscopic suture fixation, arthroscopic loop plate fixation, open reduction with cannulated screw fixation, and open reduction with anchor suture bridge fixation. Methods A retrospective review was conducted of 73 patients treated between January 2019 and December 2023 using one of four surgical techniques: arthroscopic suture fixation (Group A, n  = 26), arthroscopic loop plate fixation (Group B, n  = 14), open reduction with cannulated screw fixation (Group C, n  = 16), and open reduction with anchor suture bridge fixation (Group D, n  = 17). Demographic data, operative time, pre- and postoperative visual analog scale (VAS) pain scores, Lysholm scores, International Knee Documentation Committee (IKDC) scores, knee range of motion (ROM), and postoperative complications were analyzed. Results No significant differences were observed in baseline demographic data among the four groups ( P  >.05). Operative time was shortest in Group D (60.41 ± 12.39 min), significantly less than in the other groups ( P  =.0001). At 3 months postoperatively, all groups demonstrated significant improvements in VAS, Lysholm, and IKDC scores ( P  <.0001); however, intergroup differences were not statistically significant ( P  >.05). Group A demonstrated significantly less ROM recovery compared with the other groups ( P  =.0171). At final follow-up, further improvements in functional scores and ROM were observed in all groups, with no significant intergroup differences ( P  >.05). Complication rates differed significantly among the groups ( P  =.0361), with Group D reporting the lowest rate (0%) and Group A the highest (34.6%). Conclusion No significant differences were found in overall clinical outcomes among the four techniques. However, open reduction with anchor suture bridge fixation demonstrated favorable operative efficiency and complication profile, suggesting clinical advantages in selected patients. Trial registration Chinese Clinical Trial Registry: ChiCTR2500100641. Registration Date: 2025-04-11, Retrospectively registered.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adolescent / Adult / Arthroscopy / Arthroscopy - adverse effects / Arthroscopy - methods / Avulsion fractures / Bone implants / Bone Plates / Bone Screws / Bone surgery / Care and treatment / Clinical outcomes / Complications / Complications and side effects / Demography / Female / Fracture Fixation, Internal - adverse effects / Fracture Fixation, Internal - methods / Fractures / Fractures, Avulsion - surgery / Hematoma / Humans / Internal fixation in fractures / Knee / Ligaments / Male / Medicine / Medicine & Public Health / Middle Aged / Open Fracture Reduction - adverse effects / Open Fracture Reduction - methods / Operative Time / Orthopedics / Patient outcomes / Patients / Posterior cruciate ligament / Posterior Cruciate Ligament - injuries / Posterior Cruciate Ligament - surgery / Postoperative / Postoperative Complications - epidemiology / Postoperative Complications - etiology / Range of motion / Range of Motion, Articular / Retrospective Studies / Retrospective study / Statistical analysis / Surgeons / Surgical Orthopedics / Surgical techniques / Suture Anchors / Suture Bridge fixation / Suture Techniques / Sutures / Tibial avulsion fracture / Tibial Fractures - surgery / Treatment Outcome / Visualization / Young Adult