Management of displaced posterior cruciate ligament avulsion fractures using arthroscopic suture fixation technique versus Burks and Schaffer approach

Purpose
The purpose of this study was to analyze and compare the results of management of displaced posterior cruciate ligament (PCL) avulsion fractures using cannulated screws through the Burks and Schaffer open approach versus the arthroscopic suture technique.
Patients and methods
Forty patients with PCL avulsion fractures were included in this randomized prospective study. Twenty patients in group A were treated using the arthroscopic suture technique, whereas 20 patients in group B underwent open reduction and internal fixation of the avulsed PCL fragment by a 4-mm cannulated screw using the Burks and Schaffer approach. The mean follow-up period was 26.75 and 28.55 months for group A and B, respectively. Functional assessment was done using the Lysholm and International Knee Documentation Committee scores. Radiographic evaluation was done by plain radiographs and computerized tomography to assess the rate and time for bone union. Clinical examination compared the regained flexion range of motion and degree of posterior laxity.
Results
All patients were available at the final follow-up. All patients in both groups achieved bone union at 7–10 weeks postoperative. The Lysholm and International Knee Documentation Committee scores in both groups increased significantly at the final follow-up. There was no statistically significant difference between both groups apart from the operative time for the arthroscopic group being longer than the open group and the regained flexion range in the arthroscopic group was higher than the open group. Eight (40%) patients in the arthroscopic had associated meniscal pathologies, which were treated during the arthroscopic procedure. No neurovascular, nonunion or wound complications were reported in either group.
Conclusion
Displaced tibial PCL avulsion fractures can be successfully managed using both the open and arthroscopic techniques. Arthroscopic management required a longer operative time than the open approach; however, the regained flexion range was better than the open technique and concomitant pathologies were managed during the arthroscopic procedure. Level of evidence: Level III; prospective comparative study.