Cleveland Clinic, South Pointe Hospital, Warrensville Heights, Ohio, USA.
New York-Presbyterian Hospital, New York, New York, USA.
Am J Sports Med. 2018 Mar;46(3):734-742. doi: 10.1177/0363546517701911. Epub 2017 Apr 24.
Tibial-sided avulsion injuries of the posterior cruciate ligament (PCL) generally require surgical intervention. No consensus exists concerning the optimal surgical treatment approach for these injuries.
To perform a systematic review investigating the open and arthroscopic surgical treatment modalities, outcomes, and complications of PCL tibial-sided bony avulsions.
Systematic review; Level of evidence, 4.
The authors performed a systematic review of the literature utilizing PubMed and EMBASE from 1975 to present outlining open versus arthroscopic surgical repair of PCL bony avulsion injuries and comparing subjective and objective postoperative patient-reported outcomes, including Tegner, IKDC (International Knee Documentation Committee), and Lysholm scoring systems, as well as rates of patient complications. The quest was performed in June 2016, and searched terms included posterior cruciate ligament, PCL, bony, avulsion(s), tibial-sided, open, and arthroscopic. Inclusion criteria included English-language studies involving surgical fixation strategies for PCL tibial-sided bony avulsions. Exclusion criteria included non-English language, case studies/case series, and subject matter not pertaining to PCL bony avulsions.
Twenty-eight articles comprising 637 patients met the criteria and were included in the final review. PCL injuries with a tibial-sided avulsion were the result of motor vehicle accidents in 68.4% of patients, with 59.0% of these injuries resulting from motorcycle accidents. The arthroscopic group had better IKDC grade A scores (78.9%), indicating a normal knee postoperatively, as compared with the open group (65.9%). The postoperative Lysholm scores were similar between the groups, with a mean of 95.0 in the arthroscopic group and 92.8 in the open group. The arthroscopic group also reported 100% return to preinjury level of activity, compared with 86.2% in the open group. The most common complication in both groups was arthrofibrosis, which was reported more often in the arthroscopic group (0%-35%) versus the open treatment group (0%-25%).
In patients with displaced tibial-sided PCL avulsion fractures treated operatively, surgical approaches render similar outcomes and risks. While the arthroscopic group had somewhat higher subjective and objective knee outcome scores, it demonstrated a slightly higher rate of arthrofibrosis. The clear advantage of the arthroscopic approach is that concomitant intra-articular injuries seen on preoperative magnetic resonance imaging, such as meniscal tears or osteochondral loose fragments, can be addressed at the time of the index operation.
后交叉韧带（PCL）胫骨侧撕脱伤一般需要手术干预。对于这些损伤，尚无关于最佳手术治疗方法的共识。
进行系统评价，以调查 PCL 胫骨侧骨撕脱伤的开放性和关节镜手术治疗方法、结果和并发症。
系统评价；证据水平，4 级。
作者对 1975 年至现在的文献进行了系统评价，使用了 PubMed 和 EMBASE，包括开放性与关节镜下修复 PCL 胫骨侧撕脱伤的对比，以及比较术后患者报告的主观和客观结果，包括 Tegner、IKDC（国际膝关节文献委员会）和 Lysholm 评分系统，以及患者并发症发生率。2016 年 6 月进行检索，检索词包括后交叉韧带、PCL、骨、撕脱、胫骨侧、开放性和关节镜。纳入标准包括涉及 PCL 胫骨侧骨撕脱伤的手术固定策略的英语语言研究。排除标准包括非英语语言、病例研究/病例系列以及与 PCL 胫骨侧撕脱伤无关的主题。
28 篇文章包含 637 例患者符合标准，最终纳入综述。68.4%的患者 PCL 损伤合并胫骨侧撕脱伤是由机动车事故引起的，其中 59.0%是由摩托车事故引起的。与开放性组（65.9%）相比，关节镜组的 IKDC 分级 A 评分（78.9%）更好，表明术后膝关节正常。两组的术后 Lysholm 评分相似，关节镜组平均为 95.0，开放性组为 92.8。关节镜组的患者 100%恢复到损伤前的活动水平，而开放性组为 86.2%。两组最常见的并发症都是关节僵硬，关节镜组（0%-35%）的发生率高于开放性治疗组（0%-25%）。
对于接受手术治疗的移位性 PCL 胫骨侧撕脱骨折患者，手术入路的结果和风险相似。虽然关节镜组的膝关节主观和客观评分略高，但关节僵硬的发生率略高。关节镜入路的明显优势是可以在初次手术时处理术前磁共振成像上发现的关节内合并损伤，如半月板撕裂或骨软骨游离碎片。
