Abstract
Purpose: The purpose of this study was to analyse the difference between arthroscopic fixation and open reduction internal fixation (ORIF) of posterior cruciate ligament (PCL) tibial avulsion fractures.
Methods: This retrospective study analysed patients with an acute PCL tibial avulsion fracture who underwent surgical treatment at our hospital and follow-up for at least 24 months. Variables based on sex, age, Meyers-McKeever type, surgical method, meniscus tear, external fixation, labour or sports, Lysholm knee score, IKDC score, and KT-1000 value were also recorded. Multifactor unconditional logistic regression and Student’s t test with 1:1 propensity score matching (PSM) to remove confounding factors were used for analysis.
Results: Sixty-five cases achieved knee function graded as “good” or better, and 9 cases not. Single-factor analysis indicated that Meyers-McKeever type (c2=4.669, P=0.031) and surgical approach (c2=9.428, P=0.002) are related to functional outcomes. Multifactorial logistic regression analysis further confirmed that Meyers-McKeever typing (OR=10.763, P=0.036, [95% CI, 1.174-98.693]) and surgical approach (OR=9.274, P=0.008, [95% CI, 1.794-47.934]) are independent risk factors affecting prognosis. In addition, PSM verified significant differences in the Lysholm score (t=3.195, P=0.006), IKDC score (t=4.703, P=0.000) and A-KT/H-KT (t=2.859, P=0.012). However, the affected-side KT-1000 value (A-KT, mm, t=1.225, P=0.239) and healthy-side KT-1000 value (H-KT, mm, t=1.436, P=0.172) did not significantly differ between the two groups. The proportions of cases in which the Lysholm score, IKDC and A-KT/H-KT exceeded the minimal clinically important difference (MCID) were 62.5% (20/32), 62.5% (20/32) and 93.75% (30/32), respectively.
Conclusion: Compared with ORIF, an arthroscopic approach for PCL tibial avulsion fractures achieves better results.
Level of evidence: Retrospective cohort study; Level II.