Zhang XH, Yu J, Zhao MY, Cao JH, Wu B, Xu DF. Arthroscopic M-shaped suture fixation for tibia avulsion fracture of posterior cruciate ligament: A modified technique and case series. World J Orthop 2024; 15(7): 642-649 [DOI: 10.5312/wjo.v15.i7.642]
Corresponding Author of This Article
Dan-Feng Xu, MD, PhD, Professor, Surgeon, Department of Orthopaedic Surgery, Shaoxing Central Hospital, No. 1 Hua-yu Road, Keqiao, Shaoxing 312000, Zhejiang Province, China. xdf@zju.edu.cn
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Xiao-Hui Zhang, Jian Yu, Meng-Yao Zhao, Jin-Hui Cao, Bing Wu, Dan-Feng Xu, Department of Orthopaedic Surgery, Shaoxing Central Hospital, Shaoxing 312000, Zhejiang Province, China
Xiao-Hui Zhang, Jian Yu, Meng-Yao Zhao, Jin-Hui Cao, Bing Wu, Dan-Feng Xu, Department of Orthopaedic Surgery, The Central Hospital of Shaoxing University, Shaoxing 312000, Zhejiang Province, China
Bing Wu, Dan-Feng Xu, Central Laboratory, Shaoxing Central Hospital, Shaoxing 312000, Zhejiang Province, China
Co-corresponding authors: Jian Yu and Dan-Feng Xu.
Author contributions: Zhang XH, Yu J and Xu DF contributed to the study’s conception and design; Data collection were performed by Zhao MY, Cao JH and Wu B; Data were analyzed by Zhang XH and Zhao MY; The first draft of the manuscript was written by Xu DF; Xu DF and Yu J edited the draft and revised it; all the authors read and approved the final manuscript. Xu DF and Yu J contributed equally to this work as co-corresponding authors.
Institutional review board statement: The protocols of study were approved by the Ethics Committee of The Central Hospital of Shaoxing University, Shaoxing, People’s Republic of China (Approval No. 2024007).
Informed consent statement: Informed consent was obtained from all individual participants included in the study.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dan-Feng Xu, MD, PhD, Professor, Surgeon, Department of Orthopaedic Surgery, Shaoxing Central Hospital, No. 1 Hua-yu Road, Keqiao, Shaoxing 312000, Zhejiang Province, China. xdf@zju.edu.cn
Received: March 12, 2024 Revised: May 3, 2024 Accepted: June 11, 2024 Published online: July 18, 2024 Processing time: 121 Days and 19.1 Hours
Abstract
BACKGROUND
Tibial avulsion fractures of the posterior cruciate ligament (PCL) are challenging to treat and compromise knee stability and function. Traditional open surgery often requires extensive soft tissue dissection, which may increase the risk of morbidity. In response to these concerns, arthroscopic techniques have been evolving. The aim of this study was to introduce a modified arthroscopic technique utilizing an M-shaped suture fixation method for the treatment of tibial avulsion fractures of the PCL and to evaluate its outcomes through a case series.
AIM
To evaluate the effects of arthroscopic M-shaped suture fixation on treating tibia avulsion fractures of the PCL.
METHODS
We developed a modified arthroscopic M-shaped suture fixation technique for tibia avulsion fractures of the PCL. This case series included 18 patients who underwent the procedure between January 2021 and December 2022. The patients were assessed for range of motion (ROM), Lysholm score and International knee documentation committee (IKDC) score. Postoperative complications were also recorded.
RESULTS
The patients were followed for a mean of 13.83 ± 2.33 months. All patients showed radiographic union. At the final follow-up, all patients had full ROM and a negative posterior drawer test. The mean Lysholm score significantly improved from 45.28 ± 8.92 preoperatively to 91.83 ± 4.18 at the final follow-up (P < 0.001), and the mean IKDC score improved from 41.98 ± 6.06 preoperatively to 90.89 ± 5.32 at the final follow-up (P < 0.001).
CONCLUSION
The modified arthroscopic M-shaped suture fixation technique is a reliable and effective treatment for tibia avulsion fractures of the PCL, with excellent fracture healing and functional recovery.
Core Tip: In this study, we describe a novel modification to the arthroscopic M-shaped suture fixation approach for tibial avulsion fractures of the posterior cruciate ligament (PCL), which emphasizes the creation of a suture fixation configuration resembling the letter "M", intended to achieve a more secure anatomical fixation of the avulsed bony fragment to the tibia. And we evaluate its outcomes through a case series. Our results showed that our modified arthroscopic treatment of PCL tibial avulsion fractures provides good clinical outcomes, radiologic healing, and knee stability. This fixation technique is worthy of widespread promotion.
