Arthroscopic suture bridge fixation technique with multiple crossover ties for posterior cruciate ligament tibial avulsion fracture

  • Jung-Ro Yoon
  • Chan-Deok Park
  • Dae-Hee LeeEmail author



This study examined the clinical outcomes of a newly developed technique, arthroscopic suture bridge fixation with crossover ties of PCL tibial avulsion fracture using two tibial tunnels and a posterior trans-septal portal.


Records were reviewed of 18 patients (median age 33.5 years, range 13–55 years) with PCL tibial avulsion fractures treated with an arthroscopic suture bridge technique. Knee function before surgery and at last follow-up was evaluated by Lysholm and Tegner scores. A KT-2000 arthrometer was used to evaluate knee stability, and fracture union was assessed by plain radiographs.


Mean postoperative Lysholm (P < 0.001) and Tegner (P = 0.011) scores showed significant improvements compared with preoperative scores. Arthrometry showed that the mean side-to-side difference improved significantly, from 7.8 ± 0.8 mm preoperatively to 3 ± 1.2 mm postoperatively (P = 0.012). Radiographic evaluation showed solid union at the fracture site in all 18 patients at last follow-up.


This new arthroscopic double-tunnel pull-out suture bridge fixation with multiple crossover ties and posterior trans-septal technique for PCL tibial avulsion fracture yielded good clinico-radiological outcomes, including satisfactory stability and fracture site healing. This technique can be a useful treatment option for PCL tibial avulsion fracture even with small comminuted fracture due to compression by the unique crossover configuration mesh of multiple fixation sutures.

Level of evidence



Posterior cruciate ligament Avulsion Arthroscopy Pull-out suture 


Compliance with ethical standards

Conflict of interest

The authors report that no conflicts of interest have occurred that are associated with the current study.


This work was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science (NRF2013R1A1A2A10010605).

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

Video 1 shows the whole process of arthroscopic suture bridge fixation technique with multiple crossover ties for posterior cruciate ligament tibial avulsion fracture (WMV 31,080 kb)


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016

Authors and Affiliations

  1. 1.Department of Orthopedic SurgerySeoul Veterans HospitalSeoulSouth Korea
  2. 2.Department of Orthopaedic Surgery, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea

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