Cruciate Ligament Avulsion Fracture Research Articles

Open reduction and internal fixation of the tibial avulsion fracture of the posterior cruciate ligament: which is better, a hollow lag screw combined with a gasket or a homemade hook plate?

ObjectiveTo compare the clinical results of homemade hook plates and hollow lag screws combined with spacers in the treatment of posterior cruciate tibial ligament avulsion fractures.Materials and methodsThis was a retrospective clinical cohort study that included 64 patients with PCL tibial avulsion fractures. Thirty-two of them were fixed with a homemade hook plate (hook plate group), and 32 were fixed with a hollow lag screen combined with a gasket (hollow lag screen group). By reviewing the medical record data and follow-up results, the operation time, postoperative drainage, fracture healing time, surgical complications, knee mobility, recovery of joint function, and whether postoperative gastrocnemius muscle strength changed in the two groups were compared.ResultsAll patients had successful wound and fracture healing. No adverse events, such as bone nonunion, infection, wound haematoma, or joint stiffness, occurred in either group. There were no patients with decreased gastrocnemius muscle strength in either group. Internal fixation failure occurred in 2 cases in the hollow lag screen group but not in the hook plate group. There were no significant differences between the two groups in terms of operative time, postoperative drainage, fracture healing time, knee mobility at the last follow-up, or Lysholm score.ConclusionIt is safe and effective to use a homemade hook plate to fix PCL tibial avulsion fractures through an inverted L-shaped posterior medial approach. A homemade hook plate may have potential advantages over a hollow lag screen combined with gasket fixation.

Die pediatrische vordere Kreuzbandläsion – Eminetia intercondylaris-Fraktur

Ligamentous structures are more robust than bone. Therefore, avulsion fractures are more common in children. This principle is seen in bony avulsion fractures of the anterior cruciate ligament in children. Diagnostics include conventional radiographs as well as an MRI to evaluate further intra-articular injuries. The fracture rarely occurs; however, it usually requires arthroscopically assisted reduction and fixation. The indication is given if at least a grade II fracture is evident radiologically. The injury, as well as the surgical procedure, carries the risk of growth damage and arthrofibrosis.

Treatment of Tibial Avulsion Fracture of Posterior Cruciate Ligament by Open Reduction and Internal Fixation

Background: An avulsion fracture of posterior cruciate ligament from tibial attachment is more common in younger age group. It should be fixed otherwise it may lead to secondary changes in knee. Various techniques and approaches are available to fix posterior cruciate ligament avulsion. Different biomechanical studies have shown that, results both open and arthroscopic methods of fixation of posterior cruciate ligament avulsion by screws are comparable. The purpose of study is to evaluate functional and clinical outcome of open reduction and fixation of posterior cruciate ligament avulsion injury through posteromedial approach.
 Materials and Methods: The study enrolled 19 cases of isolated posterior cruciate ligament avulsion injury with mean age of 33.21±9.07 year. All cases were treated by open reduction and internal fixation through modified posterior approach. The patients having duration of injury more than 12 weeks were excluded. The minimum follow up duration was 12 months. Results were assessed clinically and radiologically. Final functional outcome was assessed using the Lysholm scoring for knee.
 Results: The mean duration of follow up was 14±1.85 months. All patients achieved union at 3months. At final follow up the mean range of motion was 125.42±6.37 degree (range 110 to 135 degree) without any extensor lag. The functional outcome assessed by Lysholm scoring system was excellent in 15 cases and good in 4 cases.
 Conclusion: Open reduction and internal fixation with early range of motion exercises provides good clinical outcome and stable knee.

Long‐term outcome of a combined surgical approach for repair of femoral avulsion fracture of the caudal cruciate ligament in a dog

A four-month-old male boxer dog was presented with a one-week history of acute right hindlimb lameness after an injury. Physical and radiographic examinations confirmed a femoral avulsion fracture of the caudal cruciate ligament. Surgical repair was elected using a combination of arthroscopy and arthrotomy to place a monofilament absorbable suture material through the parallel bone tunnels to reduce the avulsed bone fragment. The last follow-up examination 2.5 years postoperatively showed good to excellent limb function and mild periarticular changes.

Modified suture-bridge technique for tibial avulsion fractures of the posterior cruciate ligament: a biomechanical comparison.

Displaced tibial posterior cruciate ligament (PCL) avulsion fractures require surgical fixation in order to provide an adequate bone healing and to avoid a loss of posterior stability. The purpose of this study was to compare the biomechanical properties of a recently established modified suture bridge technique to a well-established transtibial pullout technique. It was hypothesized that the suture bridge technique shows lower elongation and higher load to failure force compared to a transtibial pullout fixation. Twelve fresh-frozen human cadaveric knees were biomechanically tested using an uniaxial hydrodynamic material testing system. A standardized bony avulsion fracture of the tibial PCL insertion was generated. Two different techniques were used for fixation: (A) suture bridge configuration and (B) transtibial pullout fixation. In 90° of flexion elongation, initial stiffness and failure load were determined. The suture-bridge technique resulted in a significant lower elongation (4.5 ± 2.1mm) than transtibial pullout technique (12.4 ± 3.0mm, p < 0.001). The initial stiffness at the beginning of cyclic loading was 46.9 ± 3.9N/mm in group A und 40.8 ± 9.0N/mm in group B (p = 0.194). Load to failure testing exhibited 286.8 ± 88.3N in group A and 234.3 ± 96.8N in group B (p = 0.377). The suture bridge technique provides a significant lower construct elongation during cyclic loading. But postoperative rehabilitation must respect the low construct strength of both techniques because both fixation techniques did not show a sufficient fixation strength to allow for a more aggressive rehabilitation.

Pseudarthrosis after bony avulsion fracture of the posterior cruciate ligament

Tibial bony avulsion fractures of the posterior cruciate ligament (PCL) are rare injuries and in certain cases adelayed healing or non-union can occur under conservative treatment. Presentation of the clinical result of patients with pseudarthrosis who were secondarily operated on after bony avulsion of the PCL. The study included all patients who were operated on since 2010 for reasons of delayed or non-union PCL avulsion fracture in this clinic. Standardized questionnaires and follow-up documentation, e.g. visual analog scale (VAS), International Knee Documentation Committee (IKDC), Lysholm and Tegner scores were used and a magnetic resonance imaging (MRI) monitoring of the injured knee was carried out. A total of 5patients aged from 30 to 63 years (3male, 2female) were identified with mainly persisting flexion pain and instability under conservative treatment and secondary surgery of the knee. In the follow-up of 4patients good results could be achieved (IKDC health condition 81/subjective assessment76) after minimally invasive direct screw reduction with consolidation of the fracture zone; however, there was a slight residual dorsal instability. The secondary operative treatment of pseudarthrosis of bony PCL injuries led to good clinical results. Due to the detectable residual instability the authors are of the opinion that the indications for primary osteosynthesis in the acute phase should be generously considered. This must still be corroborated in studies with larger case numbers. The indications for MRI diagnostics should be generously considered, Smoking appears to be associated with an increased risk of pseudarthrosis. Good results can be achieved with aminimally invasive posterior screw approach, even after a delay.

Management of displaced posterior cruciate ligament avulsion fractures using arthroscopic suture fixation technique versus Burks and Schaffer approach

Purpose The purpose of this study was to analyze and compare the results of management of displaced posterior cruciate ligament (PCL) avulsion fractures using cannulated screws through the Burks and Schaffer open approach versus the arthroscopic suture technique. Patients and methods Forty patients with PCL avulsion fractures were included in this randomized prospective study. Twenty patients in group A were treated using the arthroscopic suture technique, whereas 20 patients in group B underwent open reduction and internal fixation of the avulsed PCL fragment by a 4-mm cannulated screw using the Burks and Schaffer approach. The mean follow-up period was 26.75 and 28.55 months for group A and B, respectively. Functional assessment was done using the Lysholm and International Knee Documentation Committee scores. Radiographic evaluation was done by plain radiographs and computerized tomography to assess the rate and time for bone union. Clinical examination compared the regained flexion range of motion and degree of posterior laxity. Results All patients were available at the final follow-up. All patients in both groups achieved bone union at 7–10 weeks postoperative. The Lysholm and International Knee Documentation Committee scores in both groups increased significantly at the final follow-up. There was no statistically significant difference between both groups apart from the operative time for the arthroscopic group being longer than the open group and the regained flexion range in the arthroscopic group was higher than the open group. Eight (40%) patients in the arthroscopic had associated meniscal pathologies, which were treated during the arthroscopic procedure. No neurovascular, nonunion or wound complications were reported in either group. Conclusion Displaced tibial PCL avulsion fractures can be successfully managed using both the open and arthroscopic techniques. Arthroscopic management required a longer operative time than the open approach; however, the regained flexion range was better than the open technique and concomitant pathologies were managed during the arthroscopic procedure. Level of evidence: Level III; prospective comparative study.

Fixation of anterior cruciate ligament avulsion fractures with arthroscopic suture bridge technique

Purpose: Numerous techniques for treatment of anterior cruciate ligament (ACL) avulsion fractures have been described in literature from closed reduction to definitive fixation, both open and arthroscopically assisted fixation. The present study aims to evaluate the clinical outcome of arthroscopic suture bridge fixation technique. Methods: The present retrospective study includes 31 patients with documented ACL avulsion fractures between 2008 and 2015. They all underwent arthroscopic suture bridge fixation by the same lead operating surgeon. The inclusion criteria were a displaced ACL avulsion fracture (Meyer and McKeever Types 3 and 4), with a minimum completed follow-up of 18 months. All patients were assessed with a preoperative magnetic resonance imaging to confirm the fracture. Results: Radiographs taken postoperatively showed that all avulsed fragments reduced were maintained and healing was evident in all cases by the end of 3 months. Clinically, no symptoms of instability were called for and no signs of ACL deficiency were elicited. Range of motion measurement showed a mean extension deficit of 2° (0-4) and a mean flexion deficit of 3° (1-6) when compared with the unaffected knee. The average Lysolm knee score was 98 (96-100). Conclusion: The present study demonstrated arthroscopic suture bridge fixation as a successful surgical intervention procedure for treatment of ACL avulsion fractures.

Efficacy of Arthroscopic suture fixation technique in comminuted avulsion fractures of Anterior Cruciate Ligament

Background: Treatment of comminuted avulsion fractures of Anterior Cruciate Ligament (ACL) is challenging. Arthroscopic fixation techniques such as fixation with Screws, staples, k-wires and Sutures are described to achieve this. But in comminuted avulsion fractures of ACL(Meyers and McKeever Type IV), attempts at internal fixation with screws, staples or k-wires often becomes impossible as small fragments of avulsed bone may further shatter while fixing them with implant. Hence we decided to perform arthroscopic reduction and fixation with sutures. Aim of this study is to demonstrate efficacy and benefits of fixation of ACL avulsion fractures with arthroscopic reduction and suture fixation technique. Methods: Patients diagnosed as having comminuted avulsion fractures of ACL and treated at our institute between November 2012 to January 2015 and those who were followed up in Out Patient Department or on telephone up to January 2016 were retrospectively studied. We could trace records of 23 patients who fulfilled our inclusion, exclusion and follow up criteria. Fixation of ACL avulsion fractures was performed with arthroscopic reduction and suture fixation technique. Results: 23 patients with comminuted avulsion fracture of Anterior Cruciate Ligament were studied retrospectively. Post-operatively 17 patients had full range of motion by 8 weeks. The remaining 6 patients had a range of 50 to 1100 at the 8 week. This was improved to 50 to 1250 till 12 weeks of follow up.19 patients had a negative Lachman test postoperatively, and 4 patients had a grade I Lachman, but with a firm end point. 2 patients had deep vein thrombosis on 3rd and 5th post-operative day. These patients were treated with low molecular weight heparin injections subcutaneously for 1 week followed by oral anticoagulants and physiotherapy. At an average of 27 months' follow-up (range, 12 to 39 months), all of the patients were satisfied with their outcome and returned to their pre-injury function

Staged primary fixation of combined bicruciate traumatic avulsion fractures from tibial eminence

Avulsion fractures of cruciate ligament are relatively uncommon as most of them are intrasubstance tears. Primary surgical fixation of avulsion fractures is necessary to avoid residual laxity and preserve the native ligaments. Combined anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) avulsion fractures are even rare with very few articles being published in literature. We report a case of simultaneous traumatic avulsion of ACL and PCL from tibial eminence, which was managed by staged surgical fixation with good functional outcome.

'Rain chain' for ankle arthroscopy.

'Rain chain' for ankle arthroscopy.

Hoffa fracture associated with avulsion fracture of cruciate ligaments: Two case reports

Hoffa fracture designated as intraarticular coronal plane femoral condyle fracture are the uncommon injury in orthopaedics. Hoffa fracture associated with cruciate ligament avulsion fracture are rather rare injuries reported. We encountered 2 cases of Hoffa fracture with cruciate ligament avulsion fracture in our hospital. These cases were managed by open reduction and internal fixation of femoral condyle with 2 lag screws and screw fixation of avulsion fracture of cruciate ligament. Patients were followed up for 18 months. KOOS functional knee score was used to evaluate the outcome. Excellent result in one and good result was observed in second case regarding postoperative knee movement, weight bearing, pain and bony union.

A Posteromedial Approach to a Complex Multifragmentary Avulsion Fracture of the Posterior Cruciate Ligament: A Case Report

A Posteromedial Approach to a Complex Multifragmentary Avulsion Fracture of the Posterior Cruciate Ligament: A Case Report

Fixation of tibial bony avulsion of the posterior cruciate ligament using the posteromedial approach

Background Tibial avulsion fractures of the posterior cruciate ligament are not infrequent. Controversies exist between fixation of the fragments and their reconstruction in patients with small bony fragments. This prospective study was undertaken to study the results after fixation of the fragments using a lag screw. Objective This study was designed to evaluate the efficacy of the treatment of posterior cruciate ligament avulsion fractures using the posteromedial approach and fixation with navicular screws. Study design This was a prospective study conducted in 12 patients treated by fixation with navicular screws through the posteromedial approach. Patients and methods From June 2008 to March 2010, 12 patients with acute posterior cruciate ligament avulsion fracture of the tibial attachment were treated surgically at Zagazig University Hospital and Health Insurance Hospital. Nine patients were male and three were female. Navicular screw fixation was used in all 12 patients in avulsed bony fragments, with washers in eight patients and no washers in four patients. Results All the avulsion fractures achieved union at an average of 10-14 weeks. All patients had severe posterior instability (>10 mm) preoperatively. After union of the fracture, no case suffered severe instability. Patients were followed up for an average of 7.58 months (range 6-12 months). Of the 12 patients included in this study, four (33.3%) showed excellent results, seven (58.3%) showed good results, and one (8.3%) showed a fair result. Conclusion The treatment of avulsion fracture of the posterior cruciate ligament by open reduction through the posteromedial approach and internal fixation using partially threaded screws gives very good functional and radiological results. The dissection involved is minimal and risk to the neurovascular structures is negligible.

A novel approach to fix an avulsion fracture of posterior cruciate ligament from the tibia when associated with a type C distal femoral fracture and a Hoffa fracture: a case report

Isolated avulsion fractures of the posterior cruciate ligament (PCL) from the tibia are uncommon. Further rare, are its association with a type C distal femoral fracture and a Hoffa fracture. Arthroscopic and open methods have been described to treat the tibial avulsion of PCL. We report a novel approach to repair the tibial avulsion of PCL when associated with a type c distal femoral fracture and a Hoffa fracture. We are not aware of any similar reports in the literature.

Treatment of posterior cruciate avulsion fractures using Burks and Schaffer’s approach: case series of 18 patients with 12-month follow-up

Objectives To report clinical and functional outcomes following fixation of tibial posterior cruciate ligament (PCL) avulsion fractures through Burks and Schaffer’s approach when combined with a rehabilitation programme, which emphasizes early range of motion.

Fracture avulsion du ligament croisé postérieur chez l’enfant : prise en charge chirurgicale. À propos d’un cas

Avulsion fracture of the posterior cruciate ligament (PCL) is a less frequent injury in children than in adults. Directed by a meticulous clinical examination, magnetic resonance imaging confirms the diagnosis. Surgical treatment provides good functional results in the majority of cases. We report a case of avulsion fracture of the PCL treated with a standard Twinfix surgical anchor.

Posterior cruciate ligament mediated avulsion fracture of the lateral tibial condyle: a case report

Avulsion fractures of the posterior cruciate ligament (PCL) are uncommon. On the basis of the site of damage of the PCL, hyperflexion, pretibial trauma, and hyperextension are proposed as mechanisms of PCL injuries. On the other hand, avulsion fractures of the tibial condyle are also rare. We report a PCL-mediated avulsion fracture of the lateral tibial condyle along with the tibial insertion of the PCL by extension-distraction force on the knee that has not been previously described in any study. This rare case may imply that application of an extension-distraction force to the PCL cause the avulsion fracture.

Comparison of the Surgical Treatment Results of Avulsion Fracture of the Anterior Cruciate Ligament between Children and Adults

목 적: 소아와 성인에서 전방십자인대 견열 골절의 수술적 결과를 비교하였다. 대상 및 방법:전방십자인대견열 골절로수술 받고 1 년이상 추시가가능하였던 40예 (소아 1 8, 성인 22)를 대상으로하였다. 골절은 Modif ied Meyers & McK eever 분류를 하였다. 임상적으로 관절운동범위, L ys ho lm k n ee (L K ) 점수, L ac hm an 검사, P ivo t-S h if t 검사, 대퇴사두근 위축을 비교하였으며, 방사선적으로 T e lo s R 기기를 이용하여 안정성을 평가하였다. 결 과:골절 형태는 소아군에서 2형이 8예, 3형 1 0예였으며, 성인군에서는 2, 3, 4형이 각각 2, 1 5, 5예 있었다. L K 점수는 소아와 성인군에서 99. 3점, 89. 5점으로 두 군 간에 유의한 차이를 보였다 (p<0. 05). 동반손상이 있는 경우와 골절형태가 복잡할수록 낮은 L K 점수를 보였고, 관절운동범위, L ac hm an 검사 및 P ivo t-S h if t 검사상 유의한 차이는 없었다. T e lo s R 기기를 이용한 전방 전위 정도는 평균 2. 0 m m , 2. 5 m m 로 유의한 차이는 없었다. 결 론:전방십자인대 견열골절의수술적 치료결과는소아군에서 좀더 좋은결과를 보였는데, 이는 소아군이성인군에 비해 2형골절

Femoral avulsion fracture of the anterior cruciate ligament in an 11-year-old girl

Femoral avulsion fracture of the anterior cruciate ligament in an 11-year-old girl