[1]方晓辉郜倩倩**黄恺**.关节镜下Orthocord缝线联合外排锚钉固定治疗后交叉韧带胫骨平台止点骨折[J].中国微创外科杂志,2026,01(6):369-375.
　Fang Xiaohui,Gao Qianqian,Huang Kai..Arthroscopic Orthocord Suture Combined With Knotless Anchor Fixation for Tibial Plateau Avulsion Fracture of the Posterior Cruciate Ligament[J].Chinese Journal of Minimally Invasive Surgery,2026,01(6):369-375.
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关节镜下Orthocord缝线联合外排锚钉固定治疗后交叉韧带胫骨平台止点骨折()

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2026年6期
页码:
369-375
栏目:
技术改良
出版日期:
2026-06-22

文章信息/Info

Title:
Arthroscopic Orthocord Suture Combined With Knotless Anchor Fixation for Tibial Plateau Avulsion Fracture of the Posterior Cruciate Ligament
作者:
方晓辉郜倩倩**黄恺**
(江苏省常州市肿瘤医院骨科，常州213031)
Author(s):
Fang Xiaohui;  Gao Qianqian;  Huang Kai.
Department of Orthopedics, Changzhou Tumor Hospital, Changzhou 213031, China
关键词:
关节镜手术; 后交叉韧带; 骨折; 外排锚钉
Keywords:
Arthroscopy; Posterior cruciate ligament; Fracture; Knotless anchor
文献标志码:
B
摘要:
目的探讨关节镜下Orthocord缝线联合外排锚钉固定治疗后交叉韧带(posterior cruciate ligament，PCL)胫骨平台止点骨折的临床疗效。方法2019年4月~2025年4月，28例PCL胫骨平台止点骨折接受关节镜下Orthocord缝线联外排锚钉固定术治疗，MeyersMcKeever分型Ⅱ型16例，Ⅲ型11例，Ⅳ型1例，合并膝关节半月板损伤10例，膝关节副韧带损伤5例。借鉴PCL重建技术建立胫骨骨道，镜下通过2根Orthocord缝线环绕PCL胫骨平台止点后将缝线自胫骨骨道拉出，牵拉缝线尾端收紧PCL复位骨折块，胫骨端予以外排锚钉固定。术后通过X线检查评估骨折复位情况，应用疼痛视觉模拟评分(Visual Analogue Scale，VAS)评价围手术期疼痛程度，后抽屉试验评价膝关节稳定性，膝关节功能恢复情况通过比较手术前后Lysholm评分、国际膝关节文献委员会(International Knee Documentation Committee，IKDC)评分评价。结果28例均顺利完成关节镜手术，术后未出现关节腔感染、血栓、腘窝血管及神经损伤等并发症。28例术后随访8~60个月，(26.7±11.0)月，其中<1年7例，1~3年14例，3~5年7例。PCL胫骨平台止点骨折均愈合，膝关节无伸屈功能障碍，其中2例后抽屉试验Ⅰ度，其余26例均为阴性。IKDC评分术前、末次随访时分别为(36.7±3.9)、(91.9±1.9)分(P<0.01)。Lysholm评分术前、末次随访时分别为(39.8±1.9)、(94.9±1.6)分(P<0.01)，优16例，良12例。结论膝关节镜下Orthocord缝线联合外排锚钉固定治疗后交叉韧带胫骨平台止点骨折疗效满意，无需二期取出内固定。
Abstract:
ObjectiveTo investigate the clinical outcomes of Orthocord suture combined with knotless anchor fixation under arthroscope for the treatment of tibial plateau avulsion fracture of the posterior cruciate ligament.MethodsFrom April 2019 to April 2025, 28 patients with posterior cruciate ligament tibial plateau avulsion fractures underwent arthroscopic Orthocord suture combined with knotless anchor fixation. According to the MeyersMcKeever classification, there were 16 cases of type Ⅱ, 11 cases of type Ⅲ, and 1 case of type Ⅳ. There were 10 cases combined with meniscus injury and 5 cases combined with collateral ligament injury. The principle of the reconstruction technique of the posterior cruciate ligament was used to establish a tibial tunnel. Under arthroscope, two Orthocord sutures were looped around the posterior cruciate ligament and pulled out through the tibial tunnel. The tail ends of the sutures were tightened to reduce the posterior cruciate ligament tibial fracture, and then the sutures were fixed with a knotless anchor. Postoperative Xray imaging examinations were used to evaluate fracture reduction and healing. The Visual Analogue Scale (VAS) was used to assess perioperative pain, and the knee joint condition was evaluated through the posterior drawer test. The recovery of knee joint function was assessed by comparing the pre and postoperative scores of the Lysholm scale and the International Knee Documentation Committee (IKDC) score.ResultsAll the 28 patients underwent arthroscopic surgery successfully, without postoperative complications such as infection, thrombosis, or popliteal vascular and nerve injury. All the patients were followed up for 8-60 months after surgery, with an average of (26.7±11.0) months. Among them, 7 cases were followed up for less than 1 year, 14 cases for 1 to 3 years, and 7 cases for 3 to 5 years. At the final followup, all the patients achieved bone healing, and there was no restriction in knee joint extension or flexion function. Two patients exhibited a grade Ⅰ posterior drawer test, while the remaining patients were negative. The IKDC scores before surgery and at the last followup were (36.7±3.9) and (91.9±1.9) points (P<001), respectively. The Lysholm knee scores before surgery and at the last followup were (39.8±1.9) and (94.9±16) points (P<0.01), respectively, showing excellent in 16 cases and good in 12 cases.ConclusionThe technique of arthroscopic Orthocord suture combined with knotless anchor fixation for the treatment of posterior cruciate ligament tibial avulsion fractures has satisfactory results, eliminating the need for secondary removal of internal fixation.

参考文献/References:

[1]朱波涛,董佩龙,唐晓波,等.关节镜下单隧道缝线套捆固定术治疗成人后交叉韧带胫骨止点骨折.中国修复重建外科杂志,2023,37(6):658-662.
[2]Ghoti SD,Shah NZ,Marfatia A,et al.Posterior cruciate ligament avulsion fracture of tibia:fixation with screw and augmentation using ethibond suture for improved clinical outcomes.J Orthop Case Rep,2024,14(9):194-201.
[3]Kanakamedala AC,Mannino BJ,Kruckeberg BM,et al.Displaced posterior cruciate avulsion fracture fixation with medial collateral ligament and lateral meniscus injury using combined open and arthroscopic methods.Arthrosc Tech,2024,13(3):102886.
[4]DeFroda SF,Hodax JD,Shah KN,et al.Tibial eminence fracture repair with double hewson suture passer technique.Arthrosc Tech,2017,6(4):e1275-e1279.
[5]Zaricznyj B.Avulsion fracture of the tibial eminence: treatment by open reduction and pinning.J Bone Joint Surg Am,1977,59(8):1111-1114.
[6]Lysholm J,Gillquist J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale.Am J Sports Med,1982,10(3):150-154.
[7]Rossi MJ,Lubowitz JH,Guttmann D.Development and validation of the International Knee Documentation Committee Subjective Knee Form.Am J Sports Med,2002,30(1):152.
[8]Zhu Y,Yuan T,Cai D,et al.Adjustableloop cortical button fixation results in good clinical outcomes for acute tibial avulsion fracture of the posterior cruciate ligament.Arthrosc Sports Med Rehabil,2023,5(2):e307-e313.
[9]Wen G,Chen C,Wang S,et al.Comparison of three surgical methods for displaced posterior cruciate ligament tibial insertion avulsion fractures:a retrospective study.J Orthop Surg Res,2025,20(1):333.
[10]Beatty EW,Pang JH,Quinn M,et al.Open versus arthroscopic fixation of tibialsided posterior cruciate ligament (PCL) avulsion fractures in pediatric and adolescent athletes.Orthop J Sports Med,2025,13(6):23259671251350304.
[11]Li X,Ma Q,Zheng Q,et al.Modified arthroscopic repair of a posterior cruciate ligament tibial avulsion fracture improves IKDC and Lysholm score compared to open reduction.J Orthop Surg Res,2024,19(1):362.
[12]Song JG,Nha KW,Lee SW.Open posterior approach versus arthroscopic suture fixation for displaced posterior cruciate ligament avulsion fractures:systematic review.Knee Surg Relat Res,2018,30(4):275-283.
[13]Capella M,D’Antonio D,Drocco L,et al.Arthroscopic allinside posterior cruciate ligament avulsion fracture suture fixation with doubletunnel pullout and highstrength suture tape augmentation using transseptal approach.Arthrosc Tech,2024,13(10):103091.
[14]Dhariwal HV,Kannaiyan M,Thirumeni T,et al.Outcome analysis of arthroscopic fixation of posterior cruciate ligament avulsion fracture using a single tibial tunnel and suture loop with button configuration:a case series study.J Orthop Case Rep,2024,14(4):170-175.
[15]Hooper PO 3rd,Silko C,Malcolm TL,et al.Management of posterior cruciate ligament tibial avulsion injuries:a systematic review.Am J Sports Med,2018,46(3):734-742.
[16]方晓辉,袁晓庆,吴一雄,等.关节镜下单胫骨隧道技术治疗前交叉韧带胫骨止点撕脱性骨折的近期疗效.天津医药,2020,48(12):1218-1222.
[17]高磊,方晓辉,高立波,等.膝关节镜下单隧道Orthocord缝线联合外排铆钉固定治疗胫骨髁间嵴骨折.中国微创外科杂志,2021,21(3):267-271.
[18]郭思远,罗信,冯仕明.全内镜下袢钢板悬吊固定治疗后交叉韧带胫骨止点撕脱骨折的临床疗效.中国骨与关节损伤杂志,2024,39(12):1275-1281.
[19]王于治,孙羽,赵庆华,等.镜下EndoButton固定后交叉韧带胫骨撕脱骨折.中国矫形外科杂志,2022,30(8):753-756.
[20]温志嘉,刘伟乐,郑少伟,等.关节镜下缝线联合穿肌腱双重复位纽扣钢板技术治疗后交叉韧带胫骨止点撕脱骨折.中华创伤杂志,2023,39(9):801-806.
[21]Seifeldin AF,AbdelKader KFM,Abdel Meguid KS,et al.Arthroscopic management of avulsion fractures of the tibial attachment of the posterior cruciate ligament:a novel technique and midterm outcomes.J Clin Orthop Trauma,2023,42:102177.
[22]Ramos LA,Astur D,Novaretti JV,et al.An anatomic study of the posterior septum of the knee.Arthroscopy,2012,28(1):100-104.
[23]Katonis P,Papoutsidakis A,Aligizakis A,et al.Mechanoreceptors of the posterior cruciate ligament.J Int Med Res,2008,36(3):387-393.

备注/Memo

备注/Memo:
基金项目：江苏省常州市卫健委科技项目(QN202459)**通讯作者，Email：air33214@163.com(黄恺)；gaoqianqian8410085@126.com(郜倩倩)
更新日期/Last Update: 2026-06-22