Bi Mingguang, Zhao Chen, Chen Jihang, Hong Zheping, Wang Zhen, Gan Kaifeng, Tong Yu, Bi Qing
Lihuili Hospital, Ningbo Medical Center, Ningbo University School of Medicine, Ningbo, China.
Department of Orthopaedic Surgery, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, China.
Orthop J Sports Med. 2020 Aug 25;8(8):2325967120944047. doi: 10.1177/2325967120944047. eCollection 2020 Aug.
The optimal surgical treatment of delayed avulsion fractures of the posterior cruciate ligament (PCL) is still controversial.
To evaluate the clinical results of arthroscopic suture fixation of tibial avulsion fractures of the PCL with autograft augmentation reconstruction.
Case series; Level of evidence, 4.
From January 2013 to February 2017, we treated 15 patients with delayed tibial avulsion fractures of the PCL arthroscopically through posteromedial and posterolateral portals. The PCL and avulsion bone fragment were fixed with No. 2 nonabsorbable FiberWire sutures that were pulled out through a single tibial bone tunnel and fixed on a small Endobutton. Concomitantly, anatomic PCL augmentation reconstruction was performed, and the graft was pulled out through the same tunnel and fixed with an interference screw. Knee stability was assessed using the posterior drawer test, and the side-to-side difference was determined using a KT-1000 arthrometer with 134 N of posterior force at 30° of knee flexion. The International Knee Documentation Committee (IKDC) 2000 subjective form and Lysholm scale were used to evaluate clinical outcomes at follow-up. Overall, 12 patients were enrolled for analysis. The mean follow-up period was 34.4 months (range, 26-49 months).
At the final follow-up, 2 patients encountered 10° terminal flexion limitations. All patients had negative posterior drawer test results. The KT-1000 arthrometer side-to-side difference was significantly decreased from 8.25 ± 1.96 mm preoperatively to 1.08 ± 0.86 mm at the last follow-up ( < .001). The mean IKDC and Lysholm scores, respectively, increased from 54.67 ± 7.13 and 53.50 ± 7.90 preoperatively to 91.13 ± 3.78 and 94.25 ± 3.32 at the final follow-up ( < .001 for both).
Arthroscopic suture fixation with autograft augmentation reconstruction for delayed tibial avulsion fractures of the PCL showed good clinical stability and function in this study.
后交叉韧带（PCL）延迟性撕脱骨折的最佳手术治疗方法仍存在争议。
评估关节镜下自体移植增强重建术治疗PCL胫骨撕脱骨折的临床效果。
病例系列；证据等级，4级。
2013年1月至2017年2月，我们通过后内侧和后外侧入路对15例PCL胫骨延迟性撕脱骨折患者进行了关节镜治疗。PCL和撕脱骨块用2号不可吸收的FiberWire缝线固定，缝线通过单个胫骨骨隧道引出并固定在一个小的Endobutton上。同时，进行PCL解剖增强重建，移植物通过同一隧道引出并用挤压螺钉固定。使用后抽屉试验评估膝关节稳定性，使用KT-1000关节测量仪在膝关节屈曲30°时施加134 N的后向力测定两侧差异。采用国际膝关节文献委员会（IKDC）2000主观量表和Lysholm量表评估随访时的临床结果。总共纳入12例患者进行分析。平均随访期为34.4个月（范围26 - 49个月）。
在末次随访时，2例患者出现10°的终末屈曲受限。所有患者后抽屉试验结果均为阴性。KT-1000关节测量仪两侧差异从术前的8.25±1.96 mm显著降至末次随访时的1.08±0.86 mm（P <.001）。IKDC和Lysholm平均评分分别从术前的54.67±7.13和53.50±7.90提高到末次随访时的91.13±3.78和94.25±3.32（两者P <.001）。
本研究中，关节镜下自体移植增强重建术治疗PCL胫骨延迟性撕脱骨折显示出良好的临床稳定性和功能。
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