ObjectiveTo investigate the effectiveness of arthroscopic fixation using a four-leaf clover-shaped titanium plate combined with an adjustable loop for posterior cruciate ligament (PCL) tibial insertion avulsion fractures. MethodsThe clinical data of 48 patients with acute PCL tibial insertion avulsion fractures who met the selection criteria and treated between August 2019 and October 2023 were retrospectively analyzed. The cohort comprised 26 males and 22 females, aged 18-66 years, with a mean age of 41.6 years. According to the Meyers-McKeever-Zaricznyj classification, 28 cases were classified as type Ⅱ, 18 as type Ⅲ, and 2 as type Ⅳ. The interval from injury to surgery ranged from 3 to 18 days, with a mean of 10.4 days. All patients underwent arthroscopic fixation using a four-leaf clover-shaped titanium plate combined with an adjustable loop. The operation time and postoperative complications were recorded. The visual analogue scale (VAS) score, knee range of motion (ROM), Lysholm score, International Knee Documentation Committee (IKDC) score, and posterior tibial translation under posterior drawer stress position were assessed preoperatively and at last follow-up to evaluate pain, knee function, and posterior stability. Postoperative X-ray films and CT scans were obtained regularly to assess fracture reduction, healing, and implant status. ResultsAll procedures were completed successfully. The operation time ranged from 52 to 87 minutes, with a mean of 67.44 minutes. All incisions healed primarily, and no wound infection or iatrogenic neurovascular injury occurred. Two patients developed intermuscular venous thrombosis of the lower extremity, which improved after anticoagulant therapy; no serious complication, such as pulmonary embolism, occurred. All 48 patients were followed up 12-26 months, with a mean time of 19.8 months. Bony union was achieved in all patients within 2-4 months, with a mean time of 2.7 months. No fracture redisplacement or implant loosening, migration, or breakage was observed during follow-up. At last follow-up, the knee ROM, VAS score, Lysholm score, IKDC score, and the posterior tibial translation under posterior drawer stress position X-ray films significantly improved when compared with those before operation (P<0.05). ConclusionArthroscopic fixation using a four-leaf clover-shaped titanium plate combined with an adjustable loop for PCL tibial insertion avulsion fractures provides reliable fracture fixation and satisfactory short-term recovery of knee function, with the advantages of minimal surgical trauma, stable fixation, and a low incidence of complication.
