Percutaneous ultrasound-guided reduction and fixation for displaced hinged-type posterior cruciate ligament avulsion fractures

Abstract Background The surgical treatment options for tibial avulsion fractures of the posterior cruciate ligament (PCL) mainly include arthroscopic repair and open reduction with internal fixation.While both methods have demonstrated favourable outcomes, challenges persist in treating these fractures.This study presents preliminary outcomes of an innovative ultrasound-guided percutaneous reduction and fixation method for managing displaced hinged-type PCL avulsion fractures. Methods Twenty-three patients with displaced hinged-type PCL tibial avulsion fractures underwent percutaneous ultrasound-guided reduction and fixation.Under ultrasound guidance, a hollow screwdriver was advanced along the medial side of the neurovascular bundle to the posterior edge of the fracture. Reduction was achieved by leveraging the screwdriver, followed by fixation using a hollow lag screw.Clinical outcomes were evaluated using the Lysholm score, Tegner activity score,IKDC score and knee range of motion. Radiographic assessments were conducted to evaluate fracture reduction and union. Results All patients underwent successful surgery without any complications related to popliteal neurovascular damage. All patients were followed up 10–16 months,with an average of 12.42 ± 2.08 months. The Lysholm score significantly increased from preoperative 26.17 ± 1.70 to postoperative 95.52 ± 1.78 (P=0.000).The Tegner score was 6.74 ± 0.75 preinjury and 7.13 ± 0.63 at the final follow-up with no statistical difference (P༝0.059).The IKDC score significantly increased from preoperative 30.73 ± 2.25 to postoperative 89.25 ± 2.89 (P༝0.000),and the knee range of motion was 120–135° with an average of 127.83 ± 5.02°.Radiographic evaluations demonstrated satisfactory reduction and solid union in all patients. Conclusion Percutaneous ultrasound-guided reduction and fixation provides excellent clinical and radiological outcomes for the treatment of displaced hinged-type PCL tibial avulsion fractures. Clinical trial number: not applicable.