Comparison of Arthroscopic Suturing Vs. Open Posterior Approach for Acute Displaced PCL Avulsion

Background: Injuries involving tibial-side avulsions of the posterior cruciate ligament (PCL) are generally regarded as uncommon. This study aimed to retrospectively evaluate and compare the clinical outcomes of displaced PCL avulsion fractures on the tibial side, managed using either open reduction with screw fixation or arthroscopic suture fixation. Materials and Methods: A retrospective review was conducted for patients treated surgically for displaced PCL tibial-side avulsion. The study included cases showing radiographic displacement exceeding 3 mm and/or grade II or III posterior laxity as determined by the posterior drawer test. Associated injuries were addressed appropriately, and a conservative rehabilitation protocol was implemented until radiologic confirmation of fracture healing. Data from clinicoradiologic evaluations at the 1-year follow-up were analyzed to compare outcomes between the two groups. Results: 78 patients with 1-year follow-up data were included, comprising 39 in the open reduction group and 39 in the arthroscopic fixation group. Over 90% of patients in both groups reported normal or nearly normal knee function. At 1 year, knee function outcomes, as assessed by the Lysholm score and Tegner activity level, were comparable between the groups. Performance on the one-leg hop test was also similar. However, postoperative arthrometric laxity measurements with indicated better stability in the arthroscopic group compared to that in the open group. Fracture union was typically achieved within three months post-surgery, and no significant complications were observed. Conclusion: Both open reduction with screw fixation and arthroscopic suture fixation resulted in comparable short-term clinical outcomes, radiologic fracture healing, and knee stability for patients with PCL tibial-side avulsion fractures. However, arthroscopic fixation demonstrated slightly superior postoperative laxity outcomes.