Bony Avulsion Of Posterior Cruciate Ligament Research Articles

Treatment of Posterior Cruciate Ligament Tibial Avulsion: A New Modified Open Direct Lateral Posterior Approach.

The optimal operative technique for the treatment of the tibial-side avulsion injuries of the posterior cruciate ligament (PCL) is debatable. This study was aimed to evaluate the postoperative outcomes and complications if any after an open direct, posterolateral approach using cannulated cancellous screw fixation of a PCL tibial avulsion. From January 2016 to June 2018, 17 patients (14 males and 3 females) with PCL avulsion fraction treatment-who underwent open reduction and internal fixation using cannulated cancellous screws-were included in this prospective study. A direct posterolateral approach in the prone position was used in all cases. The Lysholm's knee score and International Knee Documentation Committee (IKDC) score were assessed preoperatively and during regular follow-up examinations for at least 1 year (12-20 months) postoperatively. All patients had fracture union and all of their knees were stable upon physical examination. No nerve or blood vessel injuries occurred. The mean Lysholm's scores and mean IKDC scores were improved significantly at the last follow-up. This study provides evidence that open direct posterolateral approach may be reliable for the treatment of tibial-sided bony PCL avulsion fractures. This approach can provide direct visualization of the posterior capsule and PCL avulsion site associated with good reduction and stable fixation, easy application of the screws directly from posterior to anteriorly without extensive soft tissue damage. Nevertheless, long-term follow-up is recommended.

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

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.

Functional outcome of bony PCL avulsions fixed with Mini open technique

Introduction: To evaluate the functional outcome in bony Posterior Cruciate Ligament (PCL) avulsion fractures treated with open reduction and internal fixation through Mini open technique. The approach is safe, and simple with a slight modification and technical tips. Material and Methods: Twenty four patients (19 males and 5 females) were included in the study. Fixation was done through a modified mini open technique using 4 mm cannulated cancellous screws. The minimum follow up considered in study was one year. Functional outcome was assessed using clinical examination, Tegner Lysholm knee score and stress radiography. Results: The mean Tegner Lysholm scores at the time of 1 year follow up was 91.66. The PCL laxity assessed clinically by posterior drawer test on stress radiography was grade I in 3 cases and nil in rest of 21 at 8 weeks follow-up. All the patients had achieved bony union of tibial avulsion fractures at the time of last follow up. Conclusion: Bony PCL avulsion fractures treated by Mini open technique with open reduction and internal fixation achieved good to excellent results and can prevent significant late onset disability.

Functional evaluation of fixation for PCL bony avulsion fractures using Burk and Schaffer’s approach

Background: Posterior cruciate ligament (PCL) is the chief posterior stabilizer of the knee In literature, surgical indications for PCL injuries treatment remains debatable, but in PCL bony avulsion, surgical reinsertion of the avulsed fragment is a recommended procedure. Objective: This study was aimed to evaluate efficacy of Burk Schaffer’s approach for fixation of tibial avulsion of PCL and to abstract the outcome of bony PCL avulsion fractures treated with cancellous screw fixation and their complications if any. Study Design: This was a prospective study conducted in 34 patients of isolated PCL avulsion fracture. Material and Methods: This study had 34 patients with age ranging from 28 to 50 yrs. It included 47.06% RTA, 26.47% sports trauma and 26.47% domestic injuries. All patients were evaluated by X-rays, MRI and CT preoperatively. Standard Burks Schaffer’s approach was used in all cases. All patients were assessed radiologically for union, Tegner Lysholm Knee Scoring Scale and IKDC score and objective PDT manual examination for a period of 2 years after surgery were done. 67.65% achieved union in 12 weeks and 26.47% achieved union by 16 weeks, Delayed union was found in 5.88% beyond 16 weeks although none needed revision or reconstruction. Average pre-operative Lysholm score of 40 improved to 88 postoperatively. Average IKDC score preoperative was 33 which meliorated to 83 after treatment. Conclusion: Improvised approach by Burk and Schaffer is safer and easier than the classical one. Open reduction and fixation with cannulated screw is one of the excellent techniques for tibial avulsion of posterior cruciate ligament (PCL). The isolated PCL avulsion fractures treated with fixation have good Lysholm and IKDC scores, although objective laxity is present in significant number of cases without subjective disability. The isolated PCL injuries have good results if managed surgically

Tibial avulsion fracture of the posterior cruciate ligament: K-wire or screw fixation? A retrospective study of 26 patients.

Although the posterior cruciate ligament (PCL) is not frequently injured, a greater understanding of its role in stabilizing the knee joint, mechanism of injury and treatment has developed. Isolated avulsion injuries constitute only a subgroup of PCL injuries, but nevertheless several operative techniques have been described for the fixation of the avulsed bony fragment. In order to investigate whether K-wire or screw fixation yields better long-term results, we examined 26 patients at an average of 10.5 years after the initial operation. Clinical examination, activity level, radiographic evaluation and instrumented measurements did not reveal any significant differences. All the patients had an excellent functional result. Thus, both K-wire and screw fixation are recommended for bony PCL avulsion injuries.