A Novel Technique for Posterior Cruciate Ligament Tibial Avulsion Fixation through the Burks and Schaffer Approach

Introduction: Numerous techniques for the treatment of posterior cruciate ligament (PCL) avulsion fractures have been described in literature from closed reduction to definitive fixation, both open and arthroscopically assisted fixation. Aim: In this study, we evaluated the clinical and functional outcome after open reduction and internal fixation of tibial avulsion injuries of the PCL using number 5 polyester sutures (Ethicon-Ethibond excel) with Titanium AL (Tit) endobutton (Nebula Surgicals Private Limited, India) through burks and Schaffer posteromedial approach. Materials and Methods: It was a prospective study of 22 patients of PCL tibial avulsion fractures; fixed using number 5 polyester sutures with Tit endobutton through burks and Schaffer approach with the patient in the prone position. We included only those patients who had isolated PCL avulsion injuries and came within 12 weeks of injury. The final functional outcome was compared using the Lysholm knee scoring system. Student's t-tests were used for intergroup comparison of Lysholm knee scores before and after surgery. Results: The mean follow-up was of 11.9 months, with the loss of two patients in follow-up. Bony union was achieved in all patients within 8–15 weeks (mean-11.6 weeks). The average flexion of 122.8° with full extension achieved in all patients. Slight instability (1+) was noted in four patients. The Lysholm functional score was excellent in 16 patients and good in four patients with an average score of 94.6 ± 4.6. Conclusion: Using sutures and endobuttons for PCL tibial avulsion fixation provides secure fixation leading to satisfactory functional and clinical outcomes as well as omits placement of any hardware in joint, thus obviating risk of joint damage and burden of second surgery for removing the implant.