Abstract
BackgroundPosterior cruciate ligament (PCL) avulsion fracture of the tibia is an uncommon but serious complication during primary cruciate-retaining total knee arthroplasty (TKA). The first objective of this report was to conduct a retrospective cohort study to investigate the incidence and potential risk factors of PCL avulsion fracture in primary cruciate-retaining TKA. The second objective was to assess the functional outcomes of the knee after reduction of PCL avulsion fracture.MethodsFrom January 2014 to January 2016, 56 patients who experienced PCL avulsion fracture of the tibia in primary cruciate-retaining TKA were included in the study group. Patients in this group underwent reduction of avulsion fracture. In this period, we selected 224 patients (control group) for comparison. Patients in this group also underwent the same TKA, but no PCL avulsion fracture occurred. The range of motion of the knee and Knee Society Scores were assessed. The Forgotten Joint Score was used to analyze the ability to forget the joint. Differences were considered statistically significant at p < 0.05.ResultsIn our series, the incidence of PCL avulsion fracture was 4.6%. There were no significant differences (p > 0.05) with regard to the preoperative or postoperative range of motion of the knee, final 4-year mean clinical score in the study and control groups 92.4 ± 2.7 and 93.6 ± 1.9, respectively, and mean functional scores of 85.1 ± 1.8 and 87.1 ± 1.2, respectively.ConclusionsThe incidence of PCL avulsion fracture of the tibia is relatively high. Older age and female gender were the two risk factors of fracture in primary cruciate-retaining TKA. Reduction of PCL avulsion fracture with a high-strength line can achieve good stability and function of the knee.
Highlights
Posterior cruciate ligament (PCL) avulsion fracture of the tibia is an uncommon but serious complication during primary cruciate-retaining total knee arthroplasty (TKA)
We found no significant differences between the study and control groups with regard to age, gender, body mass index, size of components, or follow-up period
We found no significant difference with regard to preoperative or postoperative range of motion of the knee
Summary
Posterior cruciate ligament (PCL) avulsion fracture of the tibia is an uncommon but serious complication during primary cruciate-retaining total knee arthroplasty (TKA). In a posterior cruciate ligament (PCL)-retaining TKA, PCL avulsion fracture of the tibia is an uncommon but serious complication. The outcomes of reinsertion and reduction of PCL are rarely reported Both PCL and anterior cruciate ligament contribute stability of the knee. When performing a trial reduction, if the flexion gap is too tight, a PCL avulsion fracture may occur accidentally. This fracture is an incomplete fracture, so it is not necessary to convert to a posterior-stabilized TKA. Few surgeons reported the reduction of PCL avulsion fracture of the tibia in primary cruciateretaining TKA
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