Arthroscopic-Assisted Reduction and Fixation of a Posterior Cruciate Ligament Avulsion Using Endobutton

Journal of Orthopaedics and Trauma is an open-access journal that publishes & accepts all types of articles that comes under the scope of the journal. APJOT published an article on the titled Arthroscopic-Assisted Reduction and Fixation of a Posterior Cruciate Ligament Avulsion Using Endobutton

Here authors present a new technique of arthroscopic portal fixation of a posterior cruciate ligament (PCL) avulsion using an Endobutton (Acufex Microsurgical, Inc; Mansfield, MA, USA). The PCL bone avulsion was reduced using an anterior cruciate ligament (ACL) aimer guide. An Endobutton is used to maintain and restore the anatomical position of the PCL. The full step-by-step technique is described in this article. Anatomical reduction and fixation of a PCL avulsion is achieved via arthroscopic surgery.

The posterior cruciate ligament (PCL) prevents posterior translation of the tibia on the femur. Posterior cruciate ligament injuries have in the past been frequently misdiagnosed or missed and, therefore, managed inappropriately, potentially leading to chronic pain and anteromedial knee and patellar degeneration. Avulsions of the PCL can be diagnosed on plain radiography, resulting in operative management including open reduction and internal fixation or arthroscopically assisted surgery. Traditionally, open surgery is a difficult procedure necessitating a posterior approach to the knee, which is infrequently performed in most institutions. With intra-articular PCL avulsions, most surgeons would employ the standard posterior approach. We present the arthroscopic portal fixation of a PCL avulsion using an Endobutton (Acufex Microsurgical, Inc; Mansfield, MA, USA) device in a patient with combined anterior cruciate ligament (ACL), medial collateral ligament (MCL), and PCL deficiency. This technique has not been previously reported in the literature. The PCL avulsion was large fragment with extension to both the medial and lateral tibial plateau. The PCL was secured via this technique with MCL reattachment at the same surgery. ACL reconstruction was performed six weeks later. The patient presented with a massive hemarthrosis, inability to bear weight and gross instability in both the anteroposterior plane and valgus stressing.

Traditionally open reduction and internal fixation is required using a complex posterior approach. We describe a new method, using arthroscopic surgery without the need for a posterior approach to the knee.

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