Abstract
PurposeThe aim of the present study was to describe epidemiology, management and outcome of pediatric and adolescent patients with posterior cruciate ligament (PCL) injuries.MethodsSixteen patients of less than 18 years of age with 7 PCL avulsion fractures and 9 PCL tears were included over a 10-year period. Trauma mechanism, additional injuries and treatment methods were analyzed. Follow-up examination included range of motion and ability to perform squats. Pedi-IKDC and Lysholm score were obtained and posterior shift was measured in kneeling view radiographs and compared to the contralateral side. Patients were grouped into pediatric patients with open physes at the time surgery and adolescent patients with closing or closed physes. In case of open physes, growth disturbances were assessed.ResultsSix of the treated patients (median age 12.5 years, range 10–13) had open physes at time of surgery. Five of those sustained avulsion fractures and treatment consisted of open reduction and screw fixation in four cases and graft reconstruction in one case. One patient sustained a PCL tear and underwent graft reconstruction. Follow-up at a median of 71.5 months (range 62–100) did not reveal any growth disturbances. Median Pedi-IKDC was 71.9 (range 51.7–92.1), median Lysholm score was 81.5 (range 66–88) and median posterior shift difference was 2.5 mm (range 0–11). The remaining 10 patients (median age 16 years, range 14–17) had closing/closed physis at the time of operation. Two patients presented with avulsion fractures treated with open reduction and screw fixation and 8 patients sustained PCL tears treated with graft reconstruction. At a median follow-up of 69.5 months (range 11–112), median Pedi-IKDC was 86.8 (range 36.8–97.7), median Lysholm score was 84.0 (range 45–95) and median posterior shift difference was 4 mm (range 0–15).ConclusionsIn our small number of pediatric patients with PCL injuries, open reduction and epiphyseal screw fixation of displaced avulsed fractures and steep tunnel drilling in case of PCL reconstruction did not cause growth disturbances. Nevertheless, long-term functional impairment should be expected and close follow-up has to be recommended.Level of evidenceTherapeutic, Level IV.
Highlights
Posttraumatic lesions of the posterior cruciate ligament (PCL) are rarer than those of the anterior cruciate ligament (ACL) [17]
Patients were grouped into pediatric patients with open physes at the time surgery and adolescent patients with closing or closed physes
Open reduction and screw fixation was performed in cases of displaced avulsion fractures and was achieved with retention stiches, controlled radiologically and maintained with one or two K-wires, depending on the size of the displaced fragment. 3 mm cannulated screws were inserted
Summary
Posttraumatic lesions of the posterior cruciate ligament (PCL) are rarer than those of the anterior cruciate ligament (ACL) [17]. The incidence of PCL lesions has been reported with a great variability ranging from 1 to 44% of all knee injuries [21]. Patients with PCL lesions are older than those with ACL injuries [16]. PCL lesions are uncommonly diagnosed in pediatric and adolescent patients [22]. Typical mechanisms causing PCL lesions include hyperextension or hyper-flexion of the knee and posterior displacement of the tibia in relation to the femur while the knee is flexed (“dashboard injury”) [14]. In the majority of cases, PCL lesions are caused by a high-energy trauma resulting in concomitant damages to other structures of the knee (in about two-thirds of PCL cases) and to other body regions (in 92.5% of PCL cases) [16]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
