Open reduction and fixation with cannulated screws via the modified Burks-Schaffer approach versus arthroscopic EndoButton plating for avulsion fracture of the tibial attachment of the posterior cruciate ligament

Objective To compare the clinical outcomes between open reduction and fixation with cannulated screws via the modified Burks-Schaffer approach versus arthroscopic EndoButton plating for avulsion fracture of the tibial attachment of the posterior cruciate ligament(PCL). Methods From February 2013 to August 2017, 41 patients with acute displaced avulsion fracture of the tibial PCL attachment were treated operatively at Department of Trauma Surgery, The Affiliated Hospital to Qingdao University. They were 24 men and 17 women, aged from 18 to 65 years (average, 39 years). The left knee was injured in 22 cases and the right knee in 19. They were divided into 2 groups according to their different fixation methods. The open reduction and fixation group (23 cases) received open reduction and fixation with cannulated screws via the modified Burks-Schaffer approach while the arthroscopic group (18 cases) arthroscopic Endobutton plating. The 2 groups were compared in terms of operation time, bleeding, objective knee scores and knee range of motion (ROM) after operation. Results All the 41 patients were followed up from 23 to 40 months (average, 27.2 months). Their follow-up revealed no incision infection, malunion, nonunion or loosening of the implants. Their knee X-ray films at the final follow-ups showed bony union of all the avulsion fractures. There were significant differences between the open reduction and fixation group and the arthroscopic group in operation time (52.6±7.3 min versus 86.8±9.2 min) and bleeding (63.9±12.7 mL versus 19.7±10.2 mL) (P 0.05). Conclusions Both open reduction and cannulated screw fixation via the modified Burks-Schaffer approach and arthroscopic EndoButton plating can achieve satisfactory clinical outcomes in the treatment of avulsion fracture of the tibial PCL attachment. Although the 2 methods make no significant differences in stability of the knee joint or in clinical scores, the latter leads to less bleeding and the former shorter operation time. Key words: Knee joint; Arthroscopy; Fracture fixation, internal; Posterior cruciate ligament; Avulsion fracture of the tibial attachment; Modified Burks-Schaffer’s approach