Arthroscopic Treatment of Acute Tibial Avulsion Fracture of the Posterior Cruciate Ligament Using the TightRope Fixation Device  Clemens Gwinner, M.D., Sebastian Kopf, M.D., Arnd Hoburg, M.D., Norbert P. Haas, M.D., Tobias M. Jung, M.D.  Arthroscopy Techniques  Volume 3, Issue 3, Pages e377-e382 (June 2014) DOI: 10.1016/j.eats.2014.02.005 Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 1 (A, B) Preoperative anteroposterior and (C, D) lateral computed tomography scans confirm the presence of a displaced tibial avulsion fracture of the PCL. Arthroscopy Techniques 2014 3, e377-e382DOI: (10.1016/j.eats.2014.02.005) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 2 (A) En-face view of tibial head with dislocated PCL avulsion fracture. (B) The fragment is reduced using a tibial PCL guide by arthroscopic visualization. (Image courtesy of Arthrex.) Arthroscopy Techniques 2014 3, e377-e382DOI: (10.1016/j.eats.2014.02.005) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 3 Intraoperative setting. The guidewire placement and drilling direction are controlled under an arthroscopic view. Arthroscopy Techniques 2014 3, e377-e382DOI: (10.1016/j.eats.2014.02.005) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 4 (A) Using a nitinol suture passer, (B) the TightRope is pulled through the fragment. (Image courtesy of Arthrex.) Arthroscopy Techniques 2014 3, e377-e382DOI: (10.1016/j.eats.2014.02.005) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 5 Postoperative placement of TightRope device. (Image courtesy of Arthrex.) Arthroscopy Techniques 2014 3, e377-e382DOI: (10.1016/j.eats.2014.02.005) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 6 Intraoperative views. A probe from the anteromedial portal shows the displaced PCL avulsion fracture. (A) Arthroscopic view from anterolateral portal. (B) The arthroscope is placed in the posteromedial portal, and the fragment is reduced with a PCL tibial guide. (C) A 2.4-mm guidewire secures the reduction and (D) is over-drilled. (E) With a shuttle relay technique, (F) a TightRope is pulled in a transtibial manner through the fragment. (G) The TightRope is then flipped and (H) tensioned until (I) complete reduction of the tibial avulsion fracture is confirmed through the anterolateral portal. Arthroscopy Techniques 2014 3, e377-e382DOI: (10.1016/j.eats.2014.02.005) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 7 (A) Anteroposterior and (B) lateral radiographs obtained 6 weeks after surgery show that the tibial insertion of the PCL is anatomically united. Arthroscopy Techniques 2014 3, e377-e382DOI: (10.1016/j.eats.2014.02.005) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions