Robot-assisted Arthroscopic All-epiphyseal PCLR with Remnant Preservation in A 13-year-old boy: A Case Report and Review of the Literature

Chaofan Liao^1,2Jiang Zheng²Qiuzhen Liang²Peidong Liu²Panpan Pang²Liang Zhang^2*

• ¹Xi'an Medical University, Xi'an, China
• ²Department of Sports Medicine, Xi'an Honghui Hospital, Xian, China

There was limited research worldwide on posterior cruciate ligament (PCL) tears in pediatric and adolescent patients (PAPs). This report aimed to share our treatment methods to provide new references for clinical surgery.We reported on a 13-year-old boy with a PCL tear who underwent robot-assisted arthroscopic all-epiphyseal PCL reconstruction (PCLR) with remnant preservation using the TiRobot surgical robot. The patient was followed up for 6 months postoperatively.The surgery lasted 110 minutes, with four X-ray exposures and one guide pin insertion without requiring positional adjustment. Postoperative magnetic resonance imaging (MRI) on Day 2 indicated that the femoral and tibial bone tunnels were within the epiphysis, with good graft fixation.The angle between the reconstructed tibial bone tunnel and the graft was approximately 104.1°. Sutures were removed after 2 weeks, showing good wound healing and full extension of the affected limb. Knee flexion to full angle was achieved by 8 weeks, with muscle strength of the affected limb exceeded 85% of the contralateral side by 12 weeks, allowing the patient to start jogging. By 16 weeks, the patient resumed badminton training. At the last follow-up, the knee function scores improved from a preoperative International Knee Documentation Committee (IKDC) score of 43.68 to 82.76 and a Lysholm score from 46 to 95.The arthroscopic all-epiphyseal PCLR with remnant preservation assisted by the TiRobot orthopedic robot navigation system demonstrated some clinical advantages. It theoretically avoided damage to the PAPs' growth plate, preserved the PCL remnants, reduced the "Killer Turn" effect, and minimized injury to surrounding blood vessels and nerves. Serial radiographic evaluations during 6 months follow-up revealed no evidence of physis demage in this case.