Abstract
Introduction: The posterior cruciate ligament plays a major role in knee stabilization. Clinically isolated tear or avulsion of the PCL can be caused by a fall on a flexed knee or striking the flexed tibia on the dashboard in a motor vehicle accident. Postero-medial (burks and schaffer) approach is a simpler, less invasive approach to fix PCL avulsion fracture that better preserves muscular elements. Materials and Method: 20 patients with acute isolated PCL avulsion fracture of the tibial attachment are treated surgically by fixation with cannulated cancellous screws through posteromedial approach at tertiary care teaching hospital of Southern Rajasthan. Preoperative MRI was performed to rule out other concomitant intra-articular ligamentous and meniscal lesions. Patients were assessed for intra and post-operative for stability and complications also clinically by using knee society score and radiographically with x-ray at post-operative day 1, 2 weeks, 3 months, 6 months. Results: Out of 20 patients,18 were men and 2 were women. According to knee society score 14 patients showed excellent and 6 patients showed good functional outcome. Postoperative radiographs showed all PCL avulsed fragment fixation were maintained and consecutive radiographs showed fracture healing in all cases by the end of 3 months. Posterior drawer and reversed pivot shift signs were negative in all patients. And from all none was having neurovascular complications. Conclusion: The treatment of PCL avulsion fracture with placement of an appropriately sized lag screw through the “safe postero-medial approach” results in good clinical and radiographic outcomes. Keywords: PCL, Avulsion fracture, Posteromedial approach (Burks and Schaffer)
Highlights
The posterior cruciate ligament plays a major role in knee stabilization
The anterolateral bundle acts as a restraint to posterior tibial translation at midrange knee flexion while the posteromedial bundle acts as a restraint to posterior tibial translation during extension and hyperflexion[5]
A total of 20 patients with PCL avulsion fracture who gave consent to participate with age >18 years were included in the study
Summary
PCL is an important ligamentous structure in knee joint as it is one of the major knee stabilizers which acts by limiting the posterior tibial translation[1]. Clinical examination included posterior drawer test and radiological assessment was done with anteroposterior and lateral radiographs of knee. All patients functional outcome were assessed using knee society score on follow-ups from 20 cases, 13 cases had score > 80 while 7 cases had score between 6080(due to moderate pain while walking and climbing stairs). In all patients flexion of knee was possible of average 100 degrees (range 90-110 degrees) and they were able to walk, climb up stairs, sit, squat and do daily activity postoperatively. They were subjected to radiograph both AP and Lateral view of knee joint taken. No neurovascular complications occurred while performing procedure with this approach
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