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The attachment of the posterior cruciate ligament to the posterior intercondylar fossa of the tibia is in a location that is difficult to access for arthroscopic surgical procedures. This report presents a variety of arthroscopically assisted reduction and fixation methods for managing avulsion fractures of the posterior cruciate ligament from the tibia.Thirteen patients (fourteen knees) who had an avulsion fracture of the posterior cruciate ligament were treated with an arthroscopic procedure. Eleven patients underwent the operation in the acute phase (four to ten days after the injury), and two patients had delayed surgery (at nineteen and twenty months after the injury) because of nonunion. The choice of fixation method was based on the size of the avulsed fragment. Six knees that had a small bone fragment (10 mm) with comminution were fixed with use of multiple sutures. Two knees that had a small bone fragment without comminution were fixed with 23-gauge wires. Two knees that had a medium-sized fragment (10 to 20 mm) were fixed with Kirschner wires. Four knees that had a large single fragment of bone (20 mm) that involved the condyles were fixed with one or two cannulated screws.All patients had osseous union as determined on radiographs. Three injured knees in two patients showed limitation of motion after the operation. These patients had been immobilized for two or three months after the surgery because of concomitant fractures. The eleven patients who had undergone the operation in the acute phase, including two in whom postoperative arthrofibrosis had developed, showed no or trace posterior instability following the procedure. However, the two patients in whom the surgery had been delayed had residual grade-I posterior instability. The postoperative side-to-side differences, when measured with use of the KT-2000 arthrometer and posterior stress radiographs, showed better results in the patients in whom the surgery had been performed in the acute phase than in the patients in whom the operation had been delayed.Arthroscopic procedures can be used to treat tibial avulsion fractures of the posterior cruciate ligament.

Twenty patients underwent operative arthroscopic procedures of the hip joint. All procedures were performed with the patient in the supine position on a standard fracture table using fluoroscopy through three arthroscopic portals (anterolateral, anterior paratrochanteric, and posterior paratrochanteric). The initial indications were therapeutic in 16 patients: loose bodies in four, synovial chondromatosis in three, rheumatoid arthritis in five, ankylosing spondylitis in one, septic arthritis in one, avascular necrosis of femoral head in one, and primary osteoarthritis in one. In four patients who had unexplained hip pain, the initial indications were diagnostic: minimal synovial change was seen in two patients, a synovial chondromatosis was present in another, and a tear of the acetabular labrum and hypertrophy of ligament teres were present in a fourth patient. In one patient who had primary osteoarthritis, the insertion of the arthroscopic instrument into the hip joint failed because of profuse osteophytes along the acetabular rim. Twelve of the 19 patients showed significant improvement of the symptoms after the arthroscopic procedure, but seven patients had no benefit from the procedure. One patient had a postoperative reflex sympathetic dystrophy.