Clinical Results of Double Button Plate Fixation for Posterior Cruciate Ligament Avulsion Fracture

Clinical Results of Double Button Plate Fixation for Posterior Cruciate Ligament Avulsion Fracture | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Results of Double Button Plate Fixation for Posterior Cruciate Ligament Avulsion Fracture Kai Sun, Meng Fan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1263713/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The posterior cruciate ligament plays an important role in maintaining the stability of the knee joint. To date, researchers have not reached agreement on which type of fixation material should be used to treat PCL tibial avulsion fractures. The aim of this study was to investigate the effects of double button plate fixation in the treatment of posterior cruciate ligament avulsion fractures.We retrospectively reviewed our database, which was collected prospectively. From January 2019 to January 2020, 33 patients with posterior cruciate ligament avulsion fractures. Hypothesis To verify the effects of double button plate fixation of PCL avulsion fractures. Methods Patients with posterior cruciate ligament avulsion fractures were treated with double button plate fixation. The primary outcomes of this study were surgical complications (fixation failure/displacement, implant breakage, nonunion, infection), radiological parameters, and knee function. Secondary outcomes included reoperation rates for the fixation methods and the prevalence of symptomatic hardware causing soft tissue irritation. Results The results showed that double button plate fixation have no incidence of complications and can recovery postoperative range of motion (ROM), Knee Society Score (KSS) function and Lysholm scores. Conclusion The use of double button plate fixation technology has the following advantages: less trauma, shorter operation time, convenient use of instruments and fixtures, and it does not need to be taken out again, thus avoiding secondary trauma. Moreover, the strength of the suture is large, and the tension of the posterior cruciate ligament can be fully reduced by tying the suture band. Double button plate fixation under direct vision is safe and reliable without the need for additional equipment. Even comminuted fractures can also be effectively fixed by knotting.Our results suggest that this technique is a reliable and useful alternative treatment for irreparable rotator cuff tears. Level of Evidence: Case-control study, Level III. Posterior cruciate ligament Avulsion fracture Double Button Plate Fixation Treatment Figures Figure 1 Figure 2 Figure 3 Background The posterior cruciate ligament plays an important role in maintaining the stability of the knee joint[1]. In general, simple PCL injury is not common, and tibial avulsion fracture is the most common type. It has been reported that avulsion fracture of the tibial insertion is common in young people. The main causes of avulsion fractures are traffic accidents and falling injuries during strenuous exercise[2]. The damage mechanisms usually include overflexion, anteroposterior and hyperextension. PCL tibial avulsion fracture is a special type of PCL injury, accounting for approximately 10% of all PCL injuries[2,3]. In the past, due to insufficient understanding and limited examination instruments, misdiagnosis and missed diagnosis led to untimely treatment, poor treatment effect, a high risk of fracture displacement, delayed union and nonunion, and the dysfunction of the knee joint in later stages[4]. The treatment of PCL tibial avulsion fractures includes nonoperative treatment, traditional open reduction internal fixation, and arthroscopic surgery[5]. Open surgery has been widely carried out, and the main internal fixation materials include absorbable screws, cannulated screws, and anchors with threads. Cannulated screw fixation has high fixation strength and stability, but all the stress is concentrated in the tail of the screw, which easily causes re-fracture and leads to internal fixation failure; at the same time, the huge tension of the PCL during knee joint movement may lead to higher risks of re-fracture and fracture block displacement, limiting early functional exercise and increasing complications. Arthroscopic internal fixation can complete the exploration of the knee joint through several small incisions and monitor the operation in the process of drilling the tunnel or screw placement. It has the advantages of minimal surgical trauma and fast patient recovery but also features high technical requirements for surgeons, a long learning curve, high requirements for equipment, and requirements for expensive equipment[6]. At present, open surgery and internal fixation are still mainstream. The appearance of internal fixation materials gives surgeons more choices. They can fix the fracture block directly through the posterior small incision. Internal fixation methods have many disadvantages, such as insufficient fixation strength, high tension on the cruciate ligament and long-term immobilization, which to some extent affect early postoperative rehabilitation exercise, resulting in knee joint adhesion, flexion and extension function limitations and other shortcomings[7]. An alternative is to utilize double button plate fixation methods. We adopted double button plate fixation in the management of posterior cruciate ligament avulsion fractures. To date, researchers have not reached an agreement on which type of fixation material should be used to treat PCL tibial avulsion fractures. Therefore, this study aimed to evaluate the associations of perioperative and postoperative outcomes of double button plate[3]. Methods Patients We retrospectively reviewed our database, which was collected prospectively. From January 2019 to January 2020, 33 patients with posterior cruciate ligament avulsion fractures underwent surgery by a single surgeon. The patients signed an informed consent form approved by the Institutional Review Board at our hospital (Tianjin First Center Hospital). The clinical data of 33 patients with regular follow-up were obtained, with 20 males and 13 females. The inclusion criterion was a single avulsion fracture of the posterior cruciate ligament, the time of injury was less than 3 weeks, all patients had complete imaging examination of the knee joint, with a positive posterior drawer test and Lanchman test, and they were type II and type III according to the Meyers classification. The exclusion criteria included combined tibial plateau fractures, fractures around the knee joint, comminuted fracture, pathological fracture, Meyers type I, anterior and posterior cruciate ligament injuries, medial and lateral collateral ligament injuries, and combined severe vascular and nerve injuries. Traffic accidents were the major mechanism of injury, accounting for 18 (55%) of 33 cases, along with 13 cases of fall injury (39%) and 2 cases of injury involving accidental sprains (6%) (Table 1). Table 1 Summary of Patients Knee Sex Age (year) Job Meyers classification Injury Operation 1 M 55 Manual worker Type II Traffic accident Primary 2 F 59 Housewife Type II Traffic accident Primary 3 M 61 Manual worker Type II Fall Primary 4 M 58 Housewife Type II Traffic accident Primary 5 M 59 Farmer Type III Fall Primary 6 F 64 Housewife Type III Traffic accident Primary 7 F 61 Housewife Type III Fall Primary 8 M 56 Manual worker Type II Fall Primary 9 M 59 Farmer Type II Traffic accident Primary 10 M 58 Farmer Type III Accidental sprains Primary 11 F 59 Housewife Type II Traffic accident Primary 12 M 55 Desk work Type II Traffic accident Primary 13 F 59 Farmer Type II Fall Primary 14 M 61 None Type II Traffic accident Primary 15 M 54 Farmer Type II Fall Primary 16 F 58 None Type II Traffic accident Primary 17 F 52 Desk work Type II Fall Primary 18 M 59 Farmer Type II Traffic accident Primary 19 F 58 None Type II Fall Primary 20 M 56 Farmer Type II Traffic accident Primary 21 M 57 Manual worker Type II Fall Primary 22 M 54 Desk work Type II Traffic accident Primary 23 F 53 Desk work Type II Fall Primary 24 M 58 Manual worker Type III Traffic accident Primary 25 M 58 Farmer Type III Traffic accident Primary 26 F 57 None Type III Traffic accident Primary 27 M 63 Manual worker Type III Fall Primary 28 F 57 Housewife Type III Traffic accident Primary 29 M 58 Manual worker Type III Fall Primary 30 F 51 Desk work Type III Traffic accident Primary 31 M 59 Farmer Type II Traffic accident Primary 32 M 60 Manual worker Type III Fall Primary 33 M 59 Manual worker Type II Accidental sprains Primary Abbreviations: M, male; F, female; The patients provided a standard history and underwent physical examination that consisted of measurement of the knee range of motion ,KSS function scores and Lysholm scores by a single surgeon before surgery; at 3, 6, and 12 months after surgery; and yearly thereafter. Radiography and Magnetic Resonance Imaging We obtained preoperative and follow-up radiographs in all patients. Magnetic resonance imaging (MRI) was performed with a 3.0-T closed-type scanner (MRT-2000/V2,Tianjin,China). Oblique coronal, oblique sagittal, and axial T2-weighted MR images were acquired for structural and qualitative assessment of the posterior cruciate ligament, and repair integrity was determined. Radiography and MRI were performed by a single surgeon before surgery; at 3, 6, and 12 months after surgery; and yearly thereafter, and this study used the final data. Average follow-up was 14 months (range, 12 to16 months) after surgery. Surgical Technique We performed surgery using general anaesthesia with patient in the prone position, and the injury leg was bound with a tourniquet. We examined knee range of motion and positive posterior drawer test and Lanchman test with the patient under general anesthesia. A 6-cm-long longitudinal incision was made, and the posterior edge of the tibia was exposed. After reduction, Kirschner wire was used for temporary fixation, a bone canal was established , and double button plate fixation was used for compression fixation. During the operation, the fracture was stable through passive movement. Physical examination showed that the knee joint was stable. X-ray fluoroscopy showed that the fracture was well reduced and fixed, and the position of the titanium plate was acceptable (Figure 1, Figure 2). The limb was fixed with plaster at 10 degrees of extension. Postoperative Protocol Postoperative radiographs were taken after surgery. Patients were given a plaster as protection postoperatively. In general, 0 to 90 degrees of flexion in the brace was allowed for the first 2 weeks postoperatively. Patients were given their first follow-up appointment at 2 weeks postoperatively for wound inspection, and then they were followed up every 2 to 4 weeks to monitor for functional return and clinical/radiological fracture union. The knee joint activity gradually strengthened by the fourth week after the operation, the passive flexion activity was 120°, and some weight-bearing walking began at the sixth week after the operation. Weight-bearing walking was completely carried out 8 weeks after the operation, and the injured state was essentially restored at 12 weeks after the operation. Statistical Analysis Data were analyzed using SPSS 13.0 software (SPSS, Chicago, IL, USA). All data were reported as the mean±standard deviation (SD). One-way ANOVA was employed for all statistical analyses, followed by Student-Newman-Keul’s test. Values were compared using multiple comparisons, where p-values of 0.05 or less were considered significant. Results Mean operation time and average bleeding loss were recorded (Table 1). The primary outcomes of this study were surgical complications (fixation failure/displacement, implant breakage, nonunion, infection), radiological parameters, and knee function. Secondary outcomes included reoperation rates for the fixation methods and the prevalence of symptomatic hardware causing soft tissue irritation. At 2 weeks after the operation, the plaster was removed, all patients had normal flexion and extension of the knee joint at 6-8 weeks, and 3 months after the operation, the fracture had reached the healing standard. Functional outcome was assessed by means of walking status, range of motion, and KSS function and Lysholm scores upon final follow-up (Table 2, Figure 3). Overall, average time to final follow-up was 20 months (range, 16 to 24months), and the fractures had healed 3 months after the operation. There were no neurovascular fractures or infections. Follow-up X-rays showed that the avulsion fracture fragments of the tibial attachment point of the posterior cruciate ligament healed well, and there was no displacement or implant breakage of the fracture fragments (Table 3). Table 2. Summary of Patients’ Knee Functional Scores Knee KSS function (scores) Lysholm (scores) ROM (degree) Preoperative Postoperative Preoperative Postoperative Preoperative Postoperative 1 40 95 40.5 91.5 0-40 0-120 2 45 98 41.5 92.5 0-45 0-120 3 35 90 38.5 90.5 0-35 0-120 4 50 100 41.5 100 0-40 0-130 5 55 100 42.5 100 0-45 0-130 6 45 98 40.5 96.5 0-40 0-125 7 40 100 40.5 100 0-45 0-130 8 35 92 36.5 89.5 0-40 0-120 9 40 95 40.5 90.5 0-45 0-125 10 45 98 42.5 92.5 0-40 0-125 11 40 90 40.5 92.5 0-45 0-120 12 40 91 40.5 91.5 0-40 0-125 13 45 95 41.5 92.5 0-45 0-125 14 35 92 38.5 90.5 0-35 0-115 15 50 100 41.5 100 0-40 0-130 16 55 100 42.5 100 0-45 0-130 17 45 95 40.5 91.5 0-40 0-120 18 40 90 40.5 92.5 0-45 0-120 19 35 92 36.5 89.5 0-40 0-120 20 40 90 40.5 90.5 0-45 0-125 21 45 90 42.5 92.5 0-40 0-125 22 40 90 40.5 92.5 0-45 0-120 23 40 90 40.5 91.5 0-40 0-125 24 45 95 41.5 92.5 0-45 0-125 25 35 92 38.5 90.5 0-35 0-115 26 50 100 41.5 100 0-40 0-130 27 55 100 42.5 100 0-45 0-130 28 45 95 40.5 91.5 0-40 0-130 29 40 95 40.5 92.5 0-45 0-120 30 35 92 36.5 89.5 0-40 0-120 31 40 90 40.5 90.5 0-45 0-125 32 45 90 42.5 92.5 0-40 0-125 33 40 92 40.5 92.5 0-45 0-120 Abbreviations: ROM, Range of motion; KSS, Knee Society Score; Table 3 . Summary of Patients ’ C omplication Knee FWB (weeks) Nonunion Any infection Revision Implant removal 1 10 N0 N0 N0 N0 2 11 N0 N0 N0 N0 3 11 N0 N0 N0 N0 4 12 N0 N0 N0 N0 5 10.5 N0 N0 N0 N0 6 11 N0 N0 N0 N0 7 11.5 N0 N0 N0 N0 8 12 N0 N0 N0 N0 9 11 N0 N0 N0 N0 10 12 N0 N0 N0 N0 11 11.5 N0 N0 N0 N0 12 11 N0 N0 N0 N0 13 12 N0 N0 N0 N0 14 11 N0 N0 N0 N0 15 12 N0 N0 N0 N0 16 10.5 N0 N0 N0 N0 17 11 N0 N0 N0 N0 18 11.5 N0 N0 N0 N0 19 12 N0 N0 N0 N0 20 11 N0 N0 N0 N0 21 12 N0 N0 N0 N0 22 11.5 N0 N0 N0 N0 23 11 N0 N0 N0 N0 24 12 N0 N0 N0 N0 24 11 N0 N0 N0 N0 26 13 N0 N0 N0 N0 27 10.5 N0 N0 N0 N0 28 11 N0 N0 N0 N0 29 11.5 N0 N0 N0 N0 30 12 N0 N0 N0 N0 31 11 N0 N0 N0 N0 32 12 N0 N0 N0 N0 33 11.5 N0 N0 N0 N0 Abbreviations: FWB, full weight bearing; Discussion The tension of the PCL is highest in the flexion position of the knee joint, and tibial avulsion fracture mainly occurs in knee flexion. In the flexion position, the lateral condyle of the femur moves backward, and the femur rotates outwards. The force from front to back causes the posterior tibia to be impacted by the femoral condyle, and the tension of the PCL increases sharply, which eventually leads to avulsion fracture of the PCL tibial insertion point[8]. Because the contact area between the posteromedial tibia and the medial femoral condyle is larger than that between the posterolateral tibia and the lateral femoral condyle, PCL tibial avulsion fracture fragments are increasingly larger. If not intervened, they can seriously affect the stability of the posterior part of the knee joint, and the fracture block protrudes behind the tibial intercondylar ridge, which may induce impingement syndrome[9]. In the late stage, quadriceps atrophy, joint effusion, articular cartilage degeneration and secondary meniscus injury can become aggravated, which will seriously affect the quality of life of patients. Therefore, the current view is that PCL tibial avulsion fractures should be firmly fixed to avoid postoperative displacement or poor healing, resulting in the instability of the knee joint [10]. There are many kinds of surgical methods for PCL tibial avulsion fracture, including arthroscopic and open surgical approaches. Arthroscopic surgery has the advantages of minimal trauma, a small amount of soft tissue damage and fast recovery. However, in most total arthroscopic surgeries, a bone tunnel must be drilled on the tibia. The tunnel introduces an internal fixator through the tunnel, which has the characteristics of complex operation, high equipment requirements and a long learning time, limiting its development [11]. Open surgery for PCL tibial avulsion fractures has been widely carried out. The internal fixation materials mainly include steel wires, absorbable screws, hollow screws, Kirschner wires, and wire anchors. Steel wire fixation is convenient and economical, but it easily causes further fracture of the fracture block in the process of the operation, causing secondary damage to the blood supply of the fracture block and affecting fracture healing; moreover, to avoid the fracture of the steel wire after the operation, long-term braking is necessary, resulting in limited joint function and joint stiffness[12]. The absorbable screw material can be absorbed after the operation, and it is unnecessary to remove the internal fixator, avoiding a secondary operation and trauma. However, the external fixation time of absorbable screws, such as plasters or braces, is long, and 4~6 weeks of fixation is advocated. At the same time, absorbable screws have low strength and are characterized by weak fixation and easy displacement[13]. Simple cannulated screw fixation has high fixation strength and stability, but all the stress is concentrated in the screw tail, which easily leads to stress concentration, refracture and internal fixation failure[14]. Due to comminuted fracture, small bone fragments are often difficult to fix, but early rehabilitation exercise requires relatively stable fixation. For the treatment of this kind of fracture, in addition to conventional surgical methods such as tension band steel wire fixation, purse suture fixation and special plate fixation are also currently commonly used. For patients with posterior cruciate ligament avulsion fracture and repair difficulties, a more classic treatment method is to insert two button plates into the broken end of the fracture. The sutures are sewn out along the aponeurosis, and then the two circuits are sewn and knotted with each other. With a button plate, the fracture block is fixed reliably, the fracture surface is in good contact, and the PCL is connected by a nonabsorbable tension suture. This method can reduce any large movement of the fracture block during knee joint functional exercise, disperse the concentrated stress around the button plate during knee joint flexion, reduce the risk of refracture, promote fracture healing and avoid joint adhesion complications[15,16]. The use of double button plate fixation technology has the following advantages: less trauma, shorter operation time, convenient use of instruments and fixtures, and it does not need to be taken out again, thus avoiding secondary trauma. Moreover, the strength of the suture is large, and the tension of the posterior cruciate ligament can be fully reduced by tying the suture band. Double button plate fixation under direct vision is safe and reliable without the need for additional equipment. Even comminuted fractures can also be effectively fixed by knotting. Limitations There are also shortcomings in this study, such as small sample size , which may lead to deviations in the evaluation of curative effect. Further expansion of sample size and long-term follow-up are needed to confirm this. Conclusion In this study, double button plate fixation technology for the treatment of posterior cruciate ligament avulsion fractures has the advantages of minimal trauma, simple operation, reliable fixation and a large fracture contact area, fewer postoperative complications, and restored stability and function of knee joints. Our results suggest that this reconstruction technique is a reliable and useful alternative treatment. Declarations Ethical Approval and Consent to participate The study was approved by the institutional review board of Tianjin First Center Hospital. All authors and patients have read and approved the final manuscript. Consent for publication All authors have read and approved the final manuscript. Availability of data and materials Not applicable. Competing interests The authors declare that they have no competing interests. Funding The author(s) received no financial support for the research, authorship, and/or publication of this article. Authors' contributions Kai Sun designed the study protocol, participated in the data analysis, and drafted the manuscript. Meng Fan participated in the analysis and revision of the manuscript. All authors have read and approved the final manuscript. Acknowledgement The authors would like to thank Tianjin First Center Hospital for providing the database. Authors' information 1 Department of Orthopaedic Surgery, Tianjin First Center Hospital; 300192, China References MutchameeS, GanokrojP. Arthroscopic Transosseous Suture-bridge Fixation for Anterior Cruciate Ligament Tibial Avulsion Fractures[J]. Arthrosc Tech, 2020, 9(10): e1607-e1611. GilmerBB. Editorial Commentary: Anterior Cruciate Ligament Tibial Eminence Avulsion Fractures: Are They Trying to Tell Us Something？[J]. Arthroscopy, 2019, 35( 5): 1545-1546. LeieM, HeathE, ShumborskiS. Midterm Outcomes of Arthroscopic Reduction and Internal Fixation of Anterior Cruciate Ligament Tibial Eminence Avulsion Fractures With K-Wire Fixation[J]. Arthroscopy, 2019,35(5):1533-1544. ShenFX, DuWB, ChenRL, et al. High strength wire under arthroscopy combined with outside anchor nail in treating Meyers McKeever II, III avulsion fracture of anterior cruciate ligament tibial check point[J]. Zhongguo Gu Shang, 2019, 32(11): 1034-1037. Dong, Wang, Kai, et al. Mini-plate versus Kirschner wire internal fixation for treatment of metacarpal and phalangeal fractures.[J].The Journal of international medical research, 2019:2147483647-2147483647. Marom N, Ruzbarsky JJ, Boyle C, Marx RG. Complications in Posterior Cruciate Ligament Injuries and Related Surgery. Sports Med Arthrosc Rev. 2020, 28(1):30-33. Kew ME, Miller MD. Posterior Cruciate Ligament Reconstruction in the Multiple Ligament Injured Knee. J Knee Surg. 2020, 33(5):421-430. LeebergV, Lekdorf J, Wong C, et al. Tibial eminentia avulsion fracture in children a systematic review of the current literature [J]. Dan Med J. 2014, 61(3):A4792. Chen LB, Wang H, Tie K, etal. Arthroscopic fixation of an avulsion fracture of the tibia involving the posterior cruciate ligament: A modified technique in a series of 22cases [J]. Bone Joint J. 2015, 97B(9):1220-5. Meng Fan, Dong Wang, Kai Sun,Wenxue Jiang. Study of double button plate fixation in treatment of inferior pole of patella fracture. Injury. 2020; 51(3):774 - 8 Schlumberger M, Schuster P, Eichinger M, Mayer P, Mayr R, Immendörfer M, Richter J. Posterior cruciate ligament lesions are mainly present as combined lesions even in sports injuries. Knee Surg Sports Traumatol Arthrosc. 2020, 28(7):2091-2098. Sabat, D, Jain, A, Kumar, V.kumar. Displaced Posterior Cruciate Ligament Avulsion Fractures: A Retrospective Comparative Study Between Open Posterior Approach and Arthroscopic Single-Tunnel Suture Fixation.Arthroscopy. 2016,32(1), 44-53. BourasT, FennemaP, BurkeS, et al. Stenotic intercondylar notch type is correlated with anterior cruciate ligament injury in female patients using magnetic resonance imaging[J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(4): 1252-1257. ZhangC, XieG, DongS, et al. A novel morphological classification for the femoral notch based on MRI: a simple and effective assessment method for the femoral notchs[J]. Skeletal Radiol, 2020, 49(1): 75-83. BernhardsonAS, DePhillipoNN, DaneyBT, et al. Posterior tibial slope and risk of posterior cruciate ligament injury[J]. Am J Sports Med, 2019, 47(2): 312-317. van KuijkKSR, ReijmanM, Bierma-ZeinstraSMA, et al. Posterior cruciate ligament injury is influenced by intercondylar shape and size of tibial eminence[J]. Bone Joint J, 2019, 101-B(9): 1058-1062. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1263713","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":77443676,"identity":"0e825718-7fde-4a12-8ac4-0b87f9acaddf","order_by":0,"name":"Kai Sun","email":"","orcid":"","institution":"Tianjin First Center Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kai","middleName":"","lastName":"Sun","suffix":""},{"id":77443677,"identity":"75083157-7d56-4a7b-8996-2f567d25dc5a","order_by":1,"name":"Meng Fan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCUlEQVRIiWNgGAWjYBAC9gY4k4eB4YEBSKix8cEHPFp4DsBYbEAtCSAtPIebDWcQrwXEkEhvk+bAp4X97NENH3fUypnP7z34IKHgsBz/zIcN0gwMdnK6DTi08OSl3Zx55rixzDG+ZIMEg8PGErcTG4wLGJKNzQ5g12LPkGN2m7ftWOIMNh4ziQSDtMQGoJbkGQwHErfh0MLD/8bs9l8kLfXzbx5sOMyDT4sE0BbGthqYFpsEgxuMjc34tbwxu9nbdsBYgi3HGOgXG8ONZxKbGWcY4PYLD3+O2Y2fbXVyEsxnDB98+CMhL3f8+PMfHyrs5HBpgYLD6AIGeJWDQB1BFaNgFIyCUTCCAQBoC18XKxrPDgAAAABJRU5ErkJggg==","orcid":"","institution":"Tianjin First Center Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Meng","middleName":"","lastName":"Fan","suffix":""}],"badges":[],"createdAt":"2022-01-15 14:44:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1263713/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1263713/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":17504099,"identity":"a76ea4b4-f2fd-4393-8abb-f2338ed83b0b","added_by":"auto","created_at":"2022-01-20 16:27:46","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":68671,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative radiograph of posterior cruciate ligament (PCL) avulsion fracture\u003c/p\u003e\u003cp\u003ePCL avulsion fracture of a 55-year-old male was fixed with double button plate\u003c/p\u003e\u003cp\u003ea, CT showed the tibial intercondylar eminence fracture. b MRI confirmed thefragment size and displacement of the PCL avulsion fracture. Fragment involved the medial and lateral tibial plates.\u003c/p\u003e","description":"","filename":"fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1263713/v1/54b25c040c43122b0e39b9cd.jpg"},{"id":17504101,"identity":"e4ffdcb0-1500-45e1-9428-537b5f276e05","added_by":"auto","created_at":"2022-01-20 16:27:47","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":161129,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative radiograph of double button plate fixation\u003c/p\u003e","description":"","filename":"fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1263713/v1/80a727400435554ab4b7de2c.jpg"},{"id":17504100,"identity":"39134585-e206-44da-b500-7c91511885b2","added_by":"auto","created_at":"2022-01-20 16:27:46","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":63430,"visible":true,"origin":"","legend":"\u003cp\u003ePostoperative radiograph of double button plate fixation (4 months)\u003c/p\u003e","description":"","filename":"fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1263713/v1/01044c29979ec961fdfb18e8.jpg"},{"id":18680563,"identity":"748276d2-e4c2-48da-b661-69f9cec95274","added_by":"auto","created_at":"2022-02-28 11:44:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":524484,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1263713/v1/a889aa63-2ee7-4f98-9833-2651e0656cea.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Results of Double Button Plate Fixation for Posterior Cruciate Ligament Avulsion Fracture","fulltext":[{"header":"Background","content":"\u003cp\u003eThe posterior cruciate ligament plays an important role in maintaining the stability of the knee joint[1]. In general, simple PCL injury is not common, and tibial avulsion fracture is the most common type. It has been reported that avulsion fracture of the tibial insertion is common in young people. The main causes of avulsion fractures are traffic accidents and falling injuries during strenuous exercise[2]. The damage mechanisms usually include overflexion, anteroposterior and hyperextension. PCL tibial avulsion fracture is a special type of PCL injury, accounting for approximately\u0026nbsp;10% of all PCL injuries[2,3]. In the past, due to insufficient understanding and limited examination instruments, misdiagnosis and missed diagnosis led to untimely treatment, poor treatment effect, a high risk of fracture displacement, delayed union and nonunion, and the dysfunction of the knee joint in later stages[4].\u003c/p\u003e\n\u003cp\u003eThe treatment of PCL tibial avulsion fractures includes nonoperative treatment, traditional open reduction internal fixation, and arthroscopic surgery[5]. Open surgery has been widely carried out, and the main internal fixation materials include absorbable screws, cannulated screws, and anchors with threads. Cannulated screw fixation has high fixation strength and stability, but all the stress is concentrated in the tail of the screw, which easily causes re-fracture and leads to internal fixation failure; at the same time, the huge tension of the PCL during knee joint movement may lead to higher risks of re-fracture and fracture block displacement, limiting early functional exercise and increasing complications. Arthroscopic internal fixation can complete the exploration of the knee joint through several small incisions and monitor the operation in the process of drilling the tunnel or screw placement. It has the advantages of minimal surgical trauma and fast patient recovery but also features high technical requirements for surgeons, a long learning curve, high requirements for equipment, and requirements for expensive equipment[6]. At present, open surgery and internal fixation are still mainstream. The appearance of internal fixation materials gives surgeons more choices. They can fix the fracture block directly through the posterior small incision.\u003c/p\u003e\n\u003cp\u003eInternal fixation methods have many disadvantages, such as insufficient fixation strength, high tension on the cruciate ligament and long-term immobilization, which to some extent affect early postoperative rehabilitation exercise, resulting in knee joint adhesion, flexion and extension function limitations and other shortcomings[7]. An alternative is to utilize double button plate fixation methods. We adopted double button plate fixation in the management of posterior cruciate ligament avulsion fractures. To date, researchers have not reached an agreement on which type of fixation material should be used to treat PCL tibial avulsion fractures. Therefore, this study aimed to evaluate the associations of perioperative and postoperative outcomes of double button plate[3].\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003ePatients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe retrospectively reviewed our database, which was collected prospectively. From January 2019 to January 2020, 33 patients with posterior cruciate ligament avulsion fractures underwent surgery by a single surgeon. The patients signed an informed consent form approved by the Institutional Review Board at our hospital (Tianjin First Center Hospital). The clinical data of 33 patients with regular follow-up were obtained, with 20 males and 13 females. The inclusion criterion was a single avulsion fracture of the posterior cruciate ligament, the time of injury was less than 3 weeks, all patients had complete imaging examination of the knee joint, with a positive posterior drawer test and Lanchman test, and they were type II and type III according to the Meyers classification. The exclusion criteria included combined tibial plateau fractures, fractures around the knee joint, comminuted fracture, pathological fracture, Meyers type I, anterior and posterior cruciate ligament injuries, medial and lateral collateral ligament injuries, and combined severe vascular and nerve injuries. Traffic accidents were the major mechanism of injury, accounting for 18 (55%) of 33 cases, along with 13 cases of fall injury (39%) and 2 cases of injury involving accidental sprains (6%) (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 Summary of Patients\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnee\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(year)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003e\u003cstrong\u003eJob\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeyers classification\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003e\u003cstrong\u003eInjury\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOperation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eManual\u0026nbsp;worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eTraffic accident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eTraffic accident\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eManual\u0026nbsp;worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eFall \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eTraffic accident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eFall \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eTraffic accident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eFall\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eManual\u0026nbsp;worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eFall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eTraffic accident\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eAccidental sprains\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eTraffic accident\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eDesk work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eTraffic accident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eFall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eTraffic accident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eFall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eTraffic accident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eDesk work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eFall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eTraffic accident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eFall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eTraffic accident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eManual\u0026nbsp;worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eFall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eDesk work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eTraffic accident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eDesk work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eFall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eManual\u0026nbsp;worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eTraffic accident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eTraffic accident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eTraffic accident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eManual\u0026nbsp;worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eFall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eTraffic accident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eManual\u0026nbsp;worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eFall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eDesk work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eTraffic accident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eTraffic accident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eManual\u0026nbsp;worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eFall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"8.925869894099849%\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.110438729198185%\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.379727685325264%\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.700453857791224%\"\u003e\n \u003cp\u003eManual\u0026nbsp;worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.431164901664145%\"\u003e\n \u003cp\u003eType II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"26.172465960665658%\"\u003e\n \u003cp\u003eAccidental sprains\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.279878971255673%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: M, male; F, female;\u003c/p\u003e\n\u003cp\u003eThe patients provided a standard history and underwent physical examination that consisted of measurement of the knee range of motion ,KSS function scores and Lysholm scores by a single surgeon before surgery; at 3, 6, and 12 months after surgery; and yearly thereafter.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRadiography and Magnetic Resonance Imaging\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe obtained preoperative and follow-up radiographs\u0026nbsp;in all patients.\u0026nbsp;Magnetic resonance imaging (MRI) was performed with\u0026nbsp;a\u0026nbsp;3.0-T closed-type scanner (MRT-2000/V2,Tianjin,China). Oblique coronal, oblique sagittal, and\u0026nbsp;axial T2-weighted MR images were acquired for structural\u0026nbsp;and qualitative assessment of the\u0026nbsp;posterior cruciate ligament, and repair integrity was determined. Radiography and MRI\u0026nbsp;were performed by a single surgeon before surgery; at\u0026nbsp;3, 6, and 12 months after surgery; and yearly thereafter,\u0026nbsp;and this study used the final data. Average\u0026nbsp;follow-up was\u0026nbsp;14 months (range,\u0026nbsp;12\u0026nbsp;to16\u0026nbsp;months)\u0026nbsp;after surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical Technique\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe performed surgery using general anaesthesia with patient in the prone position, and the injury leg was bound with a tourniquet. We examined knee range of motion and positive posterior drawer test and Lanchman test with the patient under general anesthesia. A 6-cm-long longitudinal incision was made, and the posterior edge of the tibia was exposed. After reduction, Kirschner wire was used for temporary fixation, a bone canal was established , and double button plate fixation was used for compression fixation. During the operation, the fracture was stable through passive movement. Physical examination showed that the knee joint was stable. X-ray fluoroscopy showed that the fracture was well reduced and fixed, and the position of the titanium plate was acceptable (Figure 1, Figure 2). The limb was fixed with plaster at 10 degrees of extension.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePostoperative Protocol\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePostoperative radiographs were taken after surgery. Patients were given a plaster as protection postoperatively. In general, 0 to 90 degrees of flexion in the brace was allowed for the first 2 weeks postoperatively. Patients were given their first follow-up appointment at 2 weeks postoperatively for wound inspection, and then they were followed up every 2 to 4 weeks to monitor for functional return and clinical/radiological fracture union. The knee joint activity gradually strengthened by the fourth week after the operation, the passive flexion activity was 120\u0026deg;, and some weight-bearing walking began at the sixth week after the operation. Weight-bearing walking was completely carried out 8 weeks after the operation, and the injured state was essentially restored at 12 weeks after the operation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using SPSS 13.0 software (SPSS, Chicago, IL, USA). All data were reported as the mean\u0026plusmn;standard deviation (SD). One-way ANOVA was employed for all statistical analyses, followed by Student-Newman-Keul\u0026rsquo;s test. Values were compared using multiple comparisons, where p-values of 0.05 or less were considered significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eMean operation time and average bleeding loss were recorded (Table 1).\u0026nbsp;The primary outcomes of this study were surgical complications (fixation failure/displacement, implant breakage, nonunion, infection), radiological parameters, and knee function. Secondary outcomes included reoperation rates for the fixation methods and the prevalence of symptomatic hardware causing soft tissue irritation.\u003c/p\u003e\n\u003cp\u003eAt 2 weeks after the operation, the plaster was removed, all patients had normal flexion and extension of the knee joint at 6-8 weeks, and 3 months after the operation, the fracture had reached the healing standard. Functional outcome was assessed by means of walking status, range of motion, and KSS function and Lysholm scores upon final follow-up (Table\u0026nbsp;2,\u0026nbsp;Figure 3).\u0026nbsp;Overall, average time to final follow-up was\u0026nbsp;20\u0026nbsp;months (range, 16 to\u0026nbsp;24months), and the fractures had healed 3 months after the operation.\u0026nbsp;There were no neurovascular fractures or infections. Follow-up X-rays showed that the avulsion fracture fragments of the tibial attachment point of the posterior cruciate ligament healed well, and there was no displacement or implant breakage of the fracture fragments\u0026nbsp;(Table\u0026nbsp;3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Summary of Patients\u0026rsquo;\u003c/strong\u003e\u003cstrong\u003eKnee\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Functional Scores\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnee\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003eKSS function\u0026nbsp;(scores)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003eLysholm\u0026nbsp;(scores)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003eROM (degree)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.93044822256569%\"\u003e\n \u003cp\u003ePreoperative \u0026nbsp; \u0026nbsp; Postoperative \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.76661514683153%\"\u003e\n \u003cp\u003ePreoperative \u0026nbsp; Postoperative \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"32.30293663060278%\"\u003e\n \u003cp\u003ePreoperative \u0026nbsp;Postoperative \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e40.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 91.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-120\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e45 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e41.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 92.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-45 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-120\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e35 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e38.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 90.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-35 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-120\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e50 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e41.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-130\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e55 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e42.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-45 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-130\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e45 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e40.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 96.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e40.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-45 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-130\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e35 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e36.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 89.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-120\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e40.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 90.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-45 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e45 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e42.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 92.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e40.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 92.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-45 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-120\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e40.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 91.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e45 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e41.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 92.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-45 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e35 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e38.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 90.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-35 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-115\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e50 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e41.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-130\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e55 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e42.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-45 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-130\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e45 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e40.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 91.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-120\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e40.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 92.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-45 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-120\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e35 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e36.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 89.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-120\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e40.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 90.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-45 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e45 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e42.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 92.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e40.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 92.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-45 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-120\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e40.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 91.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e45 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e41.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 92.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-45 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e35 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e38.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 90.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-35 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-115\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e50 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e41.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-130\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e55 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e42.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-45 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-130\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e45 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e40.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 91.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-130\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e40.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 92.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-45 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-120\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e35 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e36.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 89.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-120\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e40.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 90.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-45 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e45 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e42.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 92.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"9.38375350140056%\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.65266106442577%\"\u003e\n \u003cp\u003e40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.69187675070028%\"\u003e\n \u003cp\u003e40.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 92.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"29.27170868347339%\"\u003e\n \u003cp\u003e0-45 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0-120\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations: ROM, Range of motion; KSS, Knee Society Score;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003cstrong\u003e. Summary of Patients\u003c/strong\u003e\u003cstrong\u003e\u0026rsquo;\u003c/strong\u003e\u003cstrong\u003eC\u003c/strong\u003e\u003cstrong\u003eomplication\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnee\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003eFWB (weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eNonunion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eAny infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eRevision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eImplant removal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"11.694915254237289%\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.220338983050848%\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.898305084745763%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"21.016949152542374%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"23.728813559322035%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.440677966101696%\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations: FWB, full weight bearing;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe tension of the PCL is highest in the flexion position of the knee joint, and tibial avulsion fracture mainly occurs in knee flexion.\u0026nbsp;In the flexion position, the lateral condyle of the femur moves backward, and the femur rotates outwards. The force from front to back causes the posterior tibia to be impacted by the femoral condyle, and the tension of the PCL increases sharply, which eventually leads to avulsion fracture of the PCL tibial insertion point[8]. Because the contact area between the posteromedial tibia and the medial femoral condyle is larger than that between the posterolateral tibia and the lateral femoral condyle, PCL tibial avulsion fracture fragments are increasingly larger. If not intervened, they can seriously affect the stability of the posterior part of the knee joint, and the fracture block protrudes behind the tibial intercondylar ridge, which may induce impingement syndrome[9]. In the late stage, quadriceps atrophy, joint effusion, articular cartilage degeneration and secondary meniscus injury can become aggravated, which will seriously affect the quality of life of patients. Therefore, the current view is that PCL tibial avulsion fractures should be firmly fixed to avoid postoperative displacement or poor healing, resulting in the instability of the knee joint [10].\u003c/p\u003e\n\u003cp\u003eThere are many kinds of surgical methods for PCL tibial avulsion fracture, including arthroscopic and open surgical approaches. Arthroscopic surgery has the advantages of minimal trauma, a small amount of soft tissue damage and fast recovery. However, in most total arthroscopic surgeries, a bone tunnel must be drilled on the tibia. The tunnel introduces an internal fixator through the tunnel, which has the characteristics of complex operation, high equipment requirements and a long learning time, limiting its development [11]. Open surgery for PCL tibial avulsion fractures has been widely carried out. The internal fixation materials mainly include steel wires, absorbable screws, hollow screws, Kirschner wires, and wire anchors. Steel wire fixation is convenient and economical, but it easily causes further fracture of the fracture block in the process of the operation, causing secondary damage to the blood supply of the fracture block and affecting fracture healing; moreover, to avoid the fracture of the steel wire after the operation, long-term braking is necessary, resulting in limited joint function and joint stiffness[12]. The absorbable screw material can be absorbed after the operation, and it is unnecessary to remove the internal fixator, avoiding a secondary operation and trauma. However, the external fixation time of absorbable screws, such as plasters or braces, is long, and 4~6 weeks of fixation is advocated. At the same time, absorbable screws have low strength and are characterized by weak fixation and easy displacement[13]. Simple cannulated screw fixation has high fixation strength and stability, but all the stress is concentrated in the screw tail, which easily leads to stress concentration, refracture and internal fixation failure[14].\u003c/p\u003e\n\u003cp\u003eDue to comminuted fracture, small bone fragments are often difficult to fix, but early rehabilitation exercise requires relatively stable fixation. For the treatment of this kind of fracture, in addition to conventional surgical methods such as tension band steel wire fixation, purse suture fixation and special plate fixation are also currently commonly used. For patients with posterior cruciate ligament avulsion fracture and repair difficulties, a more classic treatment method is to insert two button plates into the broken end of the fracture. The sutures are sewn out along the aponeurosis, and then the two circuits are sewn and knotted with each other. With a button plate, the fracture block is fixed reliably, the fracture surface is in good contact, and the PCL is connected by a nonabsorbable tension suture. This method can reduce any large movement of the fracture block during knee joint functional exercise, disperse the concentrated stress around the button plate during knee joint flexion, reduce the risk of refracture, promote fracture healing and avoid joint adhesion complications[15,16].\u003c/p\u003e\n\u003cp\u003eThe use of double button plate fixation technology has the following advantages: less trauma, shorter operation time, convenient use of instruments and fixtures, and it does not need to be taken out again, thus avoiding secondary trauma. Moreover, the strength of the suture is large, and the tension of the posterior cruciate ligament can be fully reduced by tying the suture band. Double button plate fixation under direct vision is safe and reliable without the need for additional equipment. Even comminuted fractures can also be effectively fixed by knotting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are also shortcomings in this study, such as small sample size , which may lead to deviations in the evaluation of curative effect. Further expansion of sample size and long-term follow-up are needed to confirm this.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this study, double button plate fixation technology for the treatment of posterior cruciate ligament avulsion fractures has the advantages of minimal trauma, simple operation, reliable fixation and a large fracture contact area, fewer postoperative complications, and restored stability and function of knee joints. Our results suggest that this reconstruction technique is a reliable and useful alternative treatment.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the institutional review board of Tianjin First Center Hospital. All authors and patients have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKai Sun designed the study protocol, participated in the data analysis, and drafted the manuscript. Meng Fan participated in the analysis and revision of the manuscript. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank Tianjin First Center Hospital for providing the database.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1 Department of Orthopaedic Surgery, Tianjin First Center Hospital; 300192, China\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMutchameeS, GanokrojP. Arthroscopic Transosseous Suture-bridge Fixation for Anterior Cruciate Ligament Tibial Avulsion Fractures[J]. Arthrosc Tech, 2020, 9(10): e1607-e1611.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGilmerBB. Editorial Commentary: Anterior Cruciate Ligament Tibial Eminence Avulsion Fractures: Are They Trying to Tell Us Something？[J]. Arthroscopy, 2019, 35( 5): 1545-1546.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLeieM, HeathE, ShumborskiS. Midterm Outcomes of Arthroscopic Reduction and Internal Fixation of Anterior Cruciate Ligament Tibial Eminence Avulsion Fractures With K-Wire Fixation[J]. Arthroscopy, 2019,35(5):1533-1544.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eShenFX, DuWB, ChenRL, et al. High strength wire under arthroscopy combined with outside anchor nail in treating Meyers McKeever II, III avulsion fracture of anterior cruciate ligament tibial check point[J]. Zhongguo Gu Shang, 2019, 32(11): 1034-1037.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDong, Wang, Kai, et al. Mini-plate versus Kirschner wire internal fixation for treatment of metacarpal and phalangeal fractures.[J].The Journal of international medical research, 2019:2147483647-2147483647.\u003c/li\u003e\n \u003cli\u003eMarom N, Ruzbarsky JJ, Boyle C, Marx RG. Complications in Posterior Cruciate Ligament Injuries and Related Surgery. Sports Med Arthrosc Rev. 2020, 28(1):30-33.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKew ME, Miller MD. Posterior Cruciate Ligament Reconstruction in the Multiple Ligament Injured Knee. J Knee Surg. 2020, 33(5):421-430.\u003c/li\u003e\n \u003cli\u003eLeebergV, Lekdorf J, Wong C, et al. Tibial eminentia avulsion fracture in children a systematic review of the current literature [J]. Dan Med J. 2014, 61(3):A4792.\u003c/li\u003e\n \u003cli\u003eChen LB, Wang H, Tie K, etal. Arthroscopic fixation of an avulsion fracture of the tibia involving the posterior cruciate ligament: A modified technique in a series of 22cases [J]. Bone Joint J. 2015, 97B(9):1220-5.\u003c/li\u003e\n \u003cli\u003eMeng Fan, Dong Wang, Kai Sun,Wenxue Jiang. Study of double button plate fixation in treatment of inferior pole of patella fracture. Injury. 2020; 51(3):774 - 8\u003c/li\u003e\n \u003cli\u003eSchlumberger M, Schuster P, Eichinger M, Mayer P, Mayr R, Immend\u0026ouml;rfer M, Richter J. Posterior cruciate ligament lesions are mainly present as combined lesions even in sports injuries. Knee Surg Sports Traumatol Arthrosc. 2020, 28(7):2091-2098.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSabat, D, Jain, A, Kumar, V.kumar. Displaced Posterior Cruciate Ligament \u0026nbsp; Avulsion Fractures: A Retrospective Comparative Study Between Open Posterior \u0026nbsp;Approach and Arthroscopic Single-Tunnel Suture Fixation.Arthroscopy. 2016,32(1), 44-53.\u003c/li\u003e\n \u003cli\u003eBourasT, FennemaP, BurkeS, et al. Stenotic intercondylar notch type is correlated with anterior cruciate ligament injury in female patients using magnetic resonance imaging[J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(4): 1252-1257.\u003c/li\u003e\n \u003cli\u003eZhangC, XieG, DongS, et al. A novel morphological classification for the femoral notch based on MRI: a simple and effective assessment method for the femoral notchs[J]. Skeletal Radiol, 2020, 49(1): 75-83.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBernhardsonAS, DePhillipoNN, DaneyBT, et al. Posterior tibial slope and risk of posterior cruciate ligament injury[J]. Am J Sports Med, 2019, 47(2): 312-317.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003evan KuijkKSR, ReijmanM, Bierma-ZeinstraSMA, et al. Posterior cruciate ligament injury is influenced by intercondylar shape and size of tibial eminence[J]. Bone Joint J, 2019, 101-B(9): 1058-1062.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Posterior cruciate ligament, Avulsion fracture, Double Button Plate Fixation, Treatment","lastPublishedDoi":"10.21203/rs.3.rs-1263713/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1263713/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground \u003c/strong\u003eThe posterior cruciate ligament plays an important role in maintaining the stability of the knee joint. To date, researchers have not reached agreement on which type of fixation material should be used to treat PCL tibial avulsion fractures.\u003cstrong\u003e \u003c/strong\u003eThe aim of this study was to investigate the effects of double button plate fixation in the treatment of posterior cruciate ligament avulsion fractures.We retrospectively reviewed our database, which was collected prospectively. From January 2019 to January 2020, 33 patients with posterior cruciate ligament avulsion fractures.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eHypothesis \u003c/strong\u003eTo verify the effects of double button plate fixation of PCL avulsion fractures.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e Patients with posterior cruciate ligament avulsion fractures were treated with double button plate fixation. The primary outcomes of this study were surgical complications (fixation failure/displacement, implant breakage, nonunion, infection), radiological parameters, and knee function. Secondary outcomes included reoperation rates for the fixation methods and the prevalence of symptomatic hardware causing soft tissue irritation.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eThe results showed that double button plate fixation have no incidence of complications and can recovery postoperative range of motion (ROM), Knee Society Score (KSS) function and Lysholm scores.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e The use of double button plate fixation technology has the following advantages: less trauma, shorter operation time, convenient use of instruments and fixtures, and it does not need to be taken out again, thus avoiding secondary trauma. Moreover, the strength of the suture is large, and the tension of the posterior cruciate ligament can be fully reduced by tying the suture band. Double button plate fixation under direct vision is safe and reliable without the need for additional equipment. Even comminuted fractures can also be effectively fixed by knotting.Our results suggest that this technique is a reliable and useful alternative treatment for irreparable rotator cuff tears.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eLevel of Evidence: Case-control study, Level III.\u003c/strong\u003e\u003c/p\u003e","manuscriptTitle":"Clinical Results of Double Button Plate Fixation for Posterior Cruciate Ligament Avulsion Fracture","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-01-20 16:27:45","doi":"10.21203/rs.3.rs-1263713/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5d9f0420-8151-41ff-8dba-233fbe57a28a","owner":[],"postedDate":"January 20th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-02-28T11:44:15+00:00","versionOfRecord":[],"versionCreatedAt":"2022-01-20 16:27:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1263713","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1263713","identity":"rs-1263713","version":["v1"]},"buildId":"cBFmMYwuxLRRLfASyISRj","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}