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Modified suture-bridge technique for tibial avulsion fractures of the posterior cruciate ligament: a biomechanical comparison

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

Displaced tibial posterior cruciate ligament (PCL) avulsion fractures require surgical fixation in order to provide an adequate bone healing and to avoid a loss of posterior stability. The purpose of this study was to compare the biomechanical properties of a recently established modified suture bridge technique to a well-established transtibial pullout technique. It was hypothesized that the suture bridge technique shows lower elongation and higher load to failure force compared to a transtibial pullout fixation.

Methods

Twelve fresh-frozen human cadaveric knees were biomechanically tested using an uniaxial hydrodynamic material testing system. A standardized bony avulsion fracture of the tibial PCL insertion was generated. Two different techniques were used for fixation: (A) suture bridge configuration and (B) transtibial pullout fixation. In 90° of flexion elongation, initial stiffness and failure load were determined.

Results

The suture-bridge technique resulted in a significant lower elongation (4.5 ± 2.1 mm) than transtibial pullout technique (12.4 ± 3.0 mm, p < 0.001). The initial stiffness at the beginning of cyclic loading was 46.9 ± 3.9 N/mm in group A und 40.8 ± 9.0 N/mm in group B (p = 0.194). Load to failure testing exhibited 286.8 ± 88.3 N in group A and 234.3 ± 96.8 N in group B (p = 0.377).

Conclusion

The suture bridge technique provides a significant lower construct elongation during cyclic loading. But postoperative rehabilitation must respect the low construct strength of both techniques because both fixation techniques did not show a sufficient fixation strength to allow for a more aggressive rehabilitation.

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References

  1. Chen W et al (2016) Treatment of posterior cruciate ligament avulsion fractures of the tibia using a toothed plate and hollow lag screw. Singap Med J 57(1):39–44

    Article  Google Scholar 

  2. Domnick C et al (2016) Biomechanical properties of different fixation techniques for posterior cruciate ligament avulsion fractures. Arthroscopy 32(6):1065–1071

    Article  Google Scholar 

  3. Gwinner C et al (2014) Arthroscopic treatment of acute tibial avulsion fracture of the posterior cruciate ligament using the TightRope fixation device. Arthrosc Tech 3(3):e377–e382

    Article  Google Scholar 

  4. Hooper PO III et al (2018) Management of posterior cruciate ligament tibial avulsion injuries: a systematic review. Am J Sports Med 46(3):734–742

    Article  Google Scholar 

  5. Inoue M et al (2004) Primary repair of posterior cruciate ligament avulsion fracture: the effect of occult injury in the midsubstance on postoperative instability. Am J Sports Med 32(5):1230–1237

    Article  Google Scholar 

  6. Lee KW et al (2015) Suture bridge fixation technique for posterior cruciate ligament avulsion fracture. Clin Orthop Surg 7(4):505–508

    Article  Google Scholar 

  7. Veselko M, Saciri V (2003) Posterior approach for arthroscopic reduction and antegrade fixation of avulsion fracture of the posterior cruciate ligament from the tibia with cannulated screw and washer. Arthroscopy 19(8):916–921

    Article  Google Scholar 

  8. Zhao J, He Y, Wang J (2006) Arthroscopic treatment of acute tibial avulsion fracture of the posterior cruciate ligament with suture fixation technique through Y-shaped bone tunnels. Arthroscopy 22(2):172–181

    Article  Google Scholar 

  9. Willinger L et al (2018) Fixation of bony avulsions of the posterior cruciate ligament by a suture-bridge technique. Oper Orthop Traumatol

  10. Gwinner C et al (2016) All-arthroscopic treatment of tibial avulsion fractures of the posterior cruciate ligament. GMS Interdiscip Plast Reconstr Surg DGPW 5:Doc02. https://doi.org/10.3250/iprs000081

    Article  PubMed  PubMed Central  Google Scholar 

  11. Nakagawa S et al (2017) Arthroscopic pullout fixation for a small and comminuted avulsion fracture of the posterior cruciate ligament from the Tibia. Knee Surg Relat Res 29(4):316–320

    Article  Google Scholar 

  12. Yoon JR, Park CD, Lee DH (2018) Arthroscopic suture bridge fixation technique with multiple crossover ties for posterior cruciate ligament tibial avulsion fracture. Knee Surg Sports Traumatol Arthrosc 26(3):912–918

    Article  Google Scholar 

  13. Zhang X et al (2013) A minimally invasive postero-medial approach with suture anchors for isolated tibial avulsion fracture of the posterior cruciate ligament. Knee 20(2):96–99

    Article  CAS  Google Scholar 

  14. Frosch K et al (2012) Treatment of bony avulsions of the posterior cruciate ligament (PCL) by a minimally invasive dorsal approach. Oper Orthop Traumatol 24(4–5):348–353

    Article  Google Scholar 

  15. Fox RJ et al (1998) Determination of the in situ forces in the human posterior cruciate ligament using robotic technology. A cadaveric study. Am J Sports Med 26(3):395–401

    Article  CAS  Google Scholar 

  16. Griffith JF et al (2004) Cruciate ligament avulsion fractures. Arthroscopy 20(8):803–812

    Article  Google Scholar 

  17. Pandey V et al (2017) Management of comminuted tibial end bony avulsion of posterior cruciate ligament by open posterior approach using suture bridge technique: a case series. J Clin Orthop Trauma 8(Suppl 2):S36–S39

    Article  Google Scholar 

  18. Harner CD et al (1998) The effects of a popliteus muscle load on in situ forces in the posterior cruciate ligament and on knee kinematics. A human cadaveric study. Am J Sports Med 26(5):669–673

    Article  CAS  Google Scholar 

  19. Pandy MG, Shelburne KB (1997) Dependence of cruciate-ligament loading on muscle forces and external load. J Biomech 30(10):1015–1024

    Article  CAS  Google Scholar 

  20. Shelburne KB, Pandy MG (1997) A musculoskeletal model of the knee for evaluating ligament forces during isometric contractions. J Biomech 30(2):163–176

    Article  CAS  Google Scholar 

  21. Yastrebov O, Lobenhoffer P (2010) Refixation of tibial bony avulsions of the posterior cruciate ligament with a hook plate. Oper Orthop Traumatol 22(4):347–353

    Article  Google Scholar 

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Funding

There was no funding of the study.

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Authors and Affiliations

  1. Department of Orthopaedic Sports Medicine, Klinikum Rechts Der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany

    Philipp Forkel, Lucca Lacheta, Louis Buchmann, Andreas B. Imhoff & Lukas Willinger

  2. Department of Orthopedics and Sports Orthopedics, Hospital Rechts Der Isar, Technical University of Munich, Munich, Germany

    Constantin von Deimling, Jan Lang & Rainer Burgkart

Authors
  1. Philipp Forkel
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  2. Lucca Lacheta
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  3. Constantin von Deimling
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  4. Jan Lang
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  5. Louis Buchmann
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  6. Andreas B. Imhoff
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  7. Rainer Burgkart
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  8. Lukas Willinger
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Corresponding author

Correspondence to Philipp Forkel.

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Conflict of interest

Andreas B. Imhoff is consultant for Arthrex, Arthrosurface and Medi. Andreas B. Imhoff receives royalties from Arthrex and Arthrosurface. The other authors declare that they have no conflict of interest.

Ethical approval

All specimens were obtained from MedCure, Portland/OR, USA for biomechanical testing. The use and removal of the specimen was in accordance to Medcure guidelines. An approval of the local ethics committee was not obtained for this biomechanical cadaver study.

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Forkel, P., Lacheta, L., von Deimling, C. et al. Modified suture-bridge technique for tibial avulsion fractures of the posterior cruciate ligament: a biomechanical comparison. Arch Orthop Trauma Surg 140, 59–65 (2020). https://doi.org/10.1007/s00402-019-03278-5

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  • DOI: https://doi.org/10.1007/s00402-019-03278-5

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