Outcomes of surgical treatment of posterior cruciate ligament tibial avulsion fractures through an open posterior approach

Abstract

Background Avulsion of the tibial insertion of the posterior cruciate ligament (PCL) is believed to be an uncommon injury. A nondisplaced bony avulsion can be treated conservatively with a plaster cast, holding the knee flexed and the tibia pulled forward to diminish tension on the PCL. There is general consensus that a displaced bony PCL avulsion should be surgically reduced and fixed immediately to stabilize the knee joint and prevent nonunion. Hypothesis Our hypothesis was that surgically reduced and fixed displaced bony PCL avulsions stabilize the knee joint and prevent nonunion. Patients and methods This prospective study was performed between January 2010 and August 2013. A total of 11 patients (three females and eight males) with PCL avulsion fracture of the tibial attachment (six isolated and five associated with other ligamentous injuries, meniscal injuries or bony fractures) were treated surgically through a posterior approach at the trauma unit of our university hospital. The mean age of patients was 24.72 years (range, 18–33years). Fixation with a single screw and washer was used in nine cases with a large bony fragment and multiple screws in two cases with comminuted fragments. The operating time was 60 min (range, 45–70 min). All patients were followed for an average of 22 months (range, 19–26 months), and at the end of the follow-up period, patients were evaluated using and Lysholm scoring system. Results All 1-year postoperative radiographs demonstrated union at the fracture site. At the end of the follow-up period, the mean Lysholm score was 88.7 points (range, 70–100 points) with a good overall outcome. Conclusion Treatment of displaced large PCL avulsion injuries with a single lag screw and washer or multiple screws through the open posterior approach results in good clinical and radiographic outcomes.