Department of Orthopedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Department of Physical Education, Sanjiang University, Nanjing, China.
Orthop Surg. 2022 Sep;14(9):2031-2041. doi: 10.1111/os.13401. Epub 2022 Jul 27.
A posterior cruciate ligament (PCL) avulsion fracture of the tibial attachment site is a specific type of PCL injury that is difficult and unpleasant to manage. The objective of this study is to report the preliminary results of a newly developed technique: arthroscopic endobutton-suture fixation using a single tibial tunnel.
From January 2016 to January 2018, 120 patients with PCL avulsion fracture who met our criteria were recruited. Sixty cases were treated by arthroscopic direct anterior-to-posterior suture suspension fixation (endobutton-suture group), and 60 cases were treated by arthroscopic screw-suture fixation (screw-suture group). All radiographic studies were recorded. The curative effect was evaluated by the range of motion (ROM), KT-2000, International Knee Documentation Committee (IKDC) scores, Tegner activity scale, and Lysholm scoring system. For statistical analysis the Student t-test was used.
The average follow-up duration was 24 months. Findings and difficulties in surgery are the following. The lax anterior cruciate ligament is one of the diagnostic criteria. The anatomic location of PCL avulsion fractures is deep and surrounded by nerves and vessels; thus, operating through this region is difficult. After each tunnel drilling, the debris at the edge of opening needs to be cleaned to avoid obscuring the operator's vision or wearing the sutures. In endobutton-suture group, ROM improved from 0° preoperatively to 140.0° ± 5.6° at the last follow-up (P < 0.001). The postoperative KT-2000 arthrometric data at 90 N were available for all patients. The IKDC score was 23.6 ± 2.6 and 91.4 ± 4.1 pre- and postoperatively, respectively. The Tegner score improved from 1.2 ± 0.6 to 7.3 ± 2.3 (p < 0.001). The median Lysholm knee score increased from 40.4 ± 5.2 preoperatively to 90.1 ± 10.1 postoperatively (p < 0.001). The operative time was shorter in the endobutton-suture group (p < 0.001). The Lysholm knee score in the endobutton-suture group was lower than that in the endobutton-suture group (3.1 ± 1.2 vs. 4.2 ± 1.8, p < 0.01). No significant complications were noted in the study.
The arthroscopic direct anterior-to-posterior suture suspension fixation is a simple and reliable method that not only provides better clinical outcomes, but also fixes avulsion fragments of any size.
后交叉韧带（PCL）胫骨止点撕脱骨折是一种特定类型的 PCL 损伤，其治疗具有一定难度且并不舒适。本研究的目的是报告一种新开发技术的初步结果：使用单个胫骨隧道的关节镜下 Endobutton 缝线固定。
自 2016 年 1 月至 2018 年 1 月，我们共招募了符合标准的 120 例 PCL 撕脱骨折患者。60 例患者采用关节镜下直接前向后缝线悬吊固定（Endobutton 缝线组）治疗，60 例患者采用关节镜下螺钉缝线固定（螺钉缝线组）治疗。所有影像学研究均进行了记录。采用活动范围（ROM）、KT-2000、国际膝关节文献委员会（IKDC）评分、Tegner 活动量表和 Lysholm 评分系统评估疗效。采用学生 t 检验进行统计学分析。
平均随访时间为 24 个月。手术中的发现和困难如下：松弛的前交叉韧带是诊断标准之一。PCL 撕脱骨折的解剖位置较深，周围有神经和血管，因此在此区域操作较为困难。每个隧道钻孔后，都需要清理边缘开口处的碎屑，以避免遮挡术者的视线或磨损缝线。在 Endobutton 缝线组中，ROM 从术前的 0°改善至末次随访时的 140.0°±5.6°（P<0.001）。所有患者均获得术后 90 N 时的 KT-2000 关节测量数据。IKDC 评分分别为术前 23.6±2.6 和术后 91.4±4.1。Tegner 评分从 1.2±0.6 改善至 7.3±2.3（p<0.001）。Lysholm 膝关节评分中位数从术前的 40.4±5.2 改善至术后的 90.1±10.1（p<0.001）。Endobutton 缝线组的手术时间更短（p<0.001）。Endobutton 缝线组的 Lysholm 膝关节评分低于螺钉缝线组（3.1±1.2 比 4.2±1.8，p<0.01）。研究中未出现明显并发症。
关节镜下直接前向后缝线悬吊固定是一种简单可靠的方法，不仅提供了更好的临床效果，而且还可以固定任何大小的撕脱碎片。
