All-arthroscopic fixation of tibial posterior cruciate ligament avulsion fractures with a suture-button technique

Objective To restore the posterior stability of the knee after a tibial posterior cruciate ligament (PCL) avulsion with a suture-button construct. Indications Acute solid and monofragment bony avulsion of the tibial PCL insertion. Contraindications Chronic condition of avulsion fractures or posterior instability, multifragment avulsions, thin bone pieces, advanced knee osteoarthritis, high-grade soft tissue injury, infection. Surgical technique Supine position, all-arthroscopic treatment via posteromedial and posterolateral portal, arthroscopic visualization and fracture reduction, transtibial drilling with a cannulated 2.4 mm drill, reduction of the fragment via FiberTape (TM) and Dog Bone. Knotting of the tapes against an additional Dog Bone at the anterior aspect of the tibia. Intraoperative x-ray. Postoperative management Knee extension brace with posterior tibial support for 6 weeks, 20 kg partial weight-bearing and restricted flexion up to 90 degrees for 6 weeks, physiotherapy in prone position from the first postoperative day. Full weight bearing after x-ray and clinical control after 6 weeks. Results Since 2016 eight tibial PCL avulsions were treated. In 6 patients a suture-bridge technique via a mini-open approach was performed due to a small or comminuted fracture fragment. In 2 patients an all-arthroscopic technique was performed. No complications. The all-arthroscopic technique requires a solid fragment and enables the surgeon to treat additional pathologies. In general, the arthroscopic technique makes the open posterior approach unnecessary. The arthroscopic techniques achieve slightly higher objective and subjective values compared to the open procedure, despite a higher rate of arthrofibrosis.