Beatty Evan W, Pang Joshua H, Quinn Michael, Yen Yi-Meng, Kramer Dennis E, Kocher Mininder S, Heyworth Benton E
Cooper Bone and Joint Institute, Cooper University Hospital, Camden, New Jersey, USA.
Orthopedic Center, Boston Children's Hospital, Boston, Massachusetts, USA.
Orthop J Sports Med. 2025 Jun 27;13(6):23259671251350304. doi: 10.1177/23259671251350304. eCollection 2025 Jun.
Posterior cruciate ligament (PCL) avulsion fractures pose unique technical challenges for surgical fixation in the pediatric and adolescent population. Both arthroscopic and open management have been pursued; nonetheless, the literature is devoid of comparative studies elucidating factors for technique selection or relative outcomes.
To compare the demographic characteristics, presenting features, clinical course, return to sports (RTS), patient-reported outcomes (PROs), and complications associated with open and arthroscopic fixation cohorts of pediatric patients who sustained an isolated tibial-sided PCL avulsion fracture.
Cohort study; Level of evidence, 3.
A medical record review was performed for all patients aged 8 to 19 years who underwent operative fixation of a tibial-sided PCL avulsion fracture between 2003 and 2021 at a single pediatric tertiary referral center. Patients were excluded if they sustained a femoral-sided avulsion fracture, underwent a PCL reconstruction, or presented with multiligamentous knee injury requiring surgical intervention for >1 ligament. All patients were sent 3 PRO instruments validated for children: Pediatric International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score-Child, and Hospital for Special Surgery Functional Activity Brief Scale.
A total of 20 patients met the inclusion criteria, of whom 10 patients were treated with open fixation and 10 with arthroscopic fixation. Also, 15 (75%) patients (7 open, 8 arthroscopic) returned PROs. No differences were detected in demographic characteristics, RTS, or PROs between cohorts. One patient in the open cohort developed a deep-tissue infection in the popliteal fossa, requiring open irrigation and debridement. One patient in the arthroscopic cohort eventually required PCL reconstruction for fracture nonunion associated with persistent instability.
No differences in outcomes were detected in this study between cohorts of pediatric patients undergoing open and arthroscopic fixation of tibial-sided PCL avulsion injuries. Regardless of surgical technique, most patients healed without complications and returned to high activity levels. Given the postoperative complications seen in the arthroscopic cohort, further research is needed to investigate the potential biomechanical superiority of open technique fixation constructs.
后交叉韧带（PCL）撕脱骨折给儿童和青少年人群的手术固定带来了独特的技术挑战。关节镜和开放手术治疗均有采用；然而，文献中缺乏阐明技术选择因素或相对疗效的比较研究。
比较孤立性胫骨侧PCL撕脱骨折的儿童患者开放固定组和关节镜固定组的人口统计学特征、临床表现、临床病程、恢复运动（RTS）情况、患者报告结局（PROs）及并发症。
队列研究；证据等级为3级。
对2003年至2021年在一家儿科三级转诊中心接受胫骨侧PCL撕脱骨折手术固定的所有8至19岁患者的病历进行回顾。若患者为股骨侧撕脱骨折、接受了PCL重建或存在需要对>1条韧带进行手术干预的多韧带膝关节损伤，则将其排除。所有患者均收到3份经儿童验证的PRO工具：儿童国际膝关节文献委员会问卷、膝关节损伤与骨关节炎结局评分-儿童版以及特殊外科医院功能活动简表。
共有20例患者符合纳入标准，其中10例接受开放固定治疗，10例接受关节镜固定治疗。此外，15例（75%）患者（7例开放固定、8例关节镜固定）返回了PROs。两组在人口统计学特征、RTS情况或PROs方面未检测到差异。开放固定组有1例患者在腘窝处发生深部组织感染，需要进行开放冲洗和清创。关节镜固定组有1例患者最终因骨折不愈合伴持续不稳定而需要进行PCL重建。
本研究中，接受胫骨侧PCL撕脱伤开放固定和关节镜固定的儿童患者队列在结局方面未检测到差异。无论采用何种手术技术，大多数患者愈合良好且无并发症，并恢复到较高的活动水平。鉴于关节镜固定组出现的术后并发症，需要进一步研究以探讨开放技术固定结构潜在的生物力学优势。
