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Arthroscopic modular suspensory fixation of posterior cruciate ligament tibial avulsion fracture: a novel technique
Arthrosc Orthop Sports Med 2021;8:61-66
Published online November 1, 2021;
© 2021 Korean Arthroscopy Society and Korean Orthopedic Society for Sports Medicine.

Joel Lee Zhao Jie, Lushun Wang

Department of Orthopaedics, Ng Teng Fong General Hospital, Singapore
Correspondence to: Lushun Wang,
Department ofOrthopaedics, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore 609606. Tel: +65-6716-2000, E-mail:
Received May 19, 2020; Revised October 7, 2020; Accepted October 26, 2020.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Displaced posterior cruciate ligament (PCL) tibial avulsion fractures lead to knee instability and often require anatomic reduction and fixation to restore function. We describe an arthroscopic modular suspensory fixation method using a novel double Endobutton construct. The patient was a 42-year-old male who sustained the above injury in a motorcycle accident. Radiographic imaging showed a displaced fragment measuring 3.1 cm × 2.6 cm × 1.5 cm. The patient subsequently underwent arthroscopic surgical fixation 13 days after the initial injury. Standard and posteromedial arthroscopic portals were created and the fragment was reduced with a tibial PCL drill guide and temporarily held by a 2.4-mm guidewire. Subsequently, a double Endobutton construct, which was created with two UltraTapes, a 10-mm titanium ULTRABUTTON, and a 15-mm round titanium XTENDOBUTTON that was introduced, tightened, and fixed distally with another round 15-mm XTENDOBUTTON as well as a suture anchor augmentation. The patient recovered well and was last reviewed in the clinic 8 weeks postoperatively with a good clinical outcome. The authors believe that this novel modification to the previously established transtibial all-inside Endobutton technique allows for the optimal distribution of compression pressure and reduces the risk of button pull through and should be considered in such cases in the future.
Keywords : Posterior cruciate ligament reconstruction; Arthroscopy; Avulsion fracture
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