Fixation of tibial avulsion fractures of the posterior cruciate ligament using pull through suture and malleolar screw

Abstract

BACKGROUND: Tibial avulsion fractures of the posterior cruciate ligament are not infrequent. However, controversies exist between the fixation of the fragments and their reconstruction in the cases with small bony fragments. This prospective study was undertaken to study the results after fixation of the fragments by the malleolar screw and the pull through suture techniques.  METHODS: From June 2003 to March 2005, 26 patients with acute isolated posterior cruciate ligament avulsion fracture of the tibial attachment were treated surgically at Qhaem and Emam Reza hospitals at Mashhad University of Medical Sciences. The screw fixation was used in 18 cases with large bony fragments and the suturing method for other cases who had small or comminuted fragments. The patients were followed for an average of 14 months; and according to The International Knee Documentation Committee the results were evaluated.  RESULTS:  All our patients were men and all the avulsion fractures achieved union at an average of 4.8 months (range, 3-8 months). All the patients had sever posterior instability (>10mm) pre-operatively. However, when the union of the fracture was achieved, no one suffered severe instability.

CONCLUSIONS: Both of these two techniques (especially screw fixation) had satisfactory results. Although the number of our cases was not high enough, it can be claimed that when the bony fragment is small and the screw fixation increases the risk of fragment breakage, the double bundles pull-through suture technique is an effective alternative choice.