PCL Avulsion Fracture Research Articles

Outcome of Posterior Cruciate Ligament Avulsion Fractures from Tibial Attachment Treated by Open Reduction and Internal Fixation

Objectives: To analyze the clinical and functional outcomes of posterior cruciate ligament avulsion fractures treated by open reduction and internal fixation from tibial attachment.Methods: This observational study was conducted at the orthopedics department of a tertiary care medical college. Forty adult patients with PCL avulsion fractures were included in this study based on predefined inclusion and exclusion criteria. All patients were treated by open reduction and internal fixation. Patients were followed up for one year. The Lysholm scale and knee society score were used to assess functional outcomes. A p-value less than 0.05 was considered to be statistically significant.Results: Overall, 34 (75 %) males and 6 (15%) females participated in this study with an M: F ratio of 1:0.17. The mean age of affected patients was 37.3 +/- 7.34 years. Out of 40 patients, 29 (72.50%) patients sustained fractures secondary to road traffic accidents, while 7 (17.50%) had sports-related injuries. There was a highly significant improvement in the Lysholm and Knee Society scores from the time of presentation to the final follow-up (P<0.0001). Only 1 (2.5%) patient developed residual joint instability as evidenced by the drawer test result.Conclusion: Patients with posterior cruciate ligament avulsion fracture treated by Open reduction and internal fixation were found to have excellent results in terms of functional outcomes.

Clinical and functional outcome of isolated posterior cruciate ligament avulsion fractures treated by open reduction and internal fixation

<p><strong>Background:</strong> PCL ligament avulsion fracture injuries constitute about 3-20% of all the knee injuries. Isolated posterior cruciate ligament injuries are uncommon and often go undiagnosed in acutely injured knees. fracture. In the long run they cause severe functional disability of the knee joint. There is no consensus concerning the optimal surgical treatment approach for these injuries. Our study was to assess the functional and clinical outcome of isolated PCL avulsion fractures with open reduction and internal fixation.</p><p><strong>Methods:</strong> This is a prospective study of 27 patients with isolated PCL avulsion fractures, done in the department of orthopaedics in RNT medical college over a 2-year period. All were treated with open reduction and internal fixation with 4 mm cannulated cancellous screw and washer. Postoperatively, patient leg was immobilized in posterior POP slab for 2 weeks, allowing toe touch weight bearing. All patients were regularly followed-up. 3 cases of post operative wound infection were detected.</p><p><strong>Results:</strong> Of the 27 patients, there were 19 males and 8 females. All the cases showed good fracture union in an average of 12 weeks post operatively. In the first 6 weeks, all of them acquired an average knee flexion of 90 degrees and by 3 months, all of them had 125 degrees of free flexion possible.2 cases showed negative posterior draw sign. The knee scoring system assessment showed 21 cases of excellent result, 4 cases of good result and 2 cases of fair result.</p><p><strong>Conclusions:</strong> Though rare, PCL avulsion fractured are to be managed properly and treated surgically. PCL tibial avulsion fractures treated through Burk and Schaffer approach with open reduction and internal fixation produces good results.</p>

"Complex PCL Avulsion and Hoffa Fractures with a Unique Posteromedial Approach: A Case Report"

"Complex PCL Avulsion and Hoffa Fractures with a Unique Posteromedial Approach: A Case Report"

THE OUTCOMES OF POSTERIOR CRUCIATE LIGAMENT TIBIAL AVULSION FIXATION WITH A SCREW USING A DUAL POSTEROMEDIAL PORTAL TECHNIQUE.

Our purpose was to evaluate the clinical results of PCL tibial avulsion fracture fixation performed with 4 mm cancellous screws using a dual posteromedial (PM) portal technique. In a prospective study, we followed 12 patients submitted to PCL tibial insertion avulsion arthroscopic fixation using dual PM portals with cancellous screws from March 2014 to Jan 2020. The proximal higher PM portal served as an instrument portal and provided an optimal trajectory for arthroscopic screw fixation of larger PCL avulsion fractures. The lower PM portal was used as a viewing portal. Significant improvements were found between the preoperative and postoperative mean Lysholm scores at six months. The preoperative IKDC score mean of 10.13 increased to 89.3 at the end of six months. Minor adverse results with this technique were: grade I on posterior sag in five knees (41.6%), temporary stiffness in two cases (16.7 %), delayed union in one patient (8.3 %), and difficulty squatting at the end of six months in one patient (8.3%). Temporary extension lag was present in two individuals (16.7%), and fixed subtle flexion deficit of 3-5 degrees occurred in one individual (8.3 %). The outcomes obtained with the proposed technique were similar to those obtained with open techniques, although mild flexion deficits and discreet posterior sag may be present in a significant number of cases. Level of Evidence II; Prospective Cohort Study .

Posteromedial Approach to Fix Posterior Cruciate Ligament Tibial Avulsion: A Backup Fixation and Case Series

Tibial avulsion fractures of PCL are common; however, the choice between open reduction internal fixation (ORIF) and arthroscopic repair of acute fractures remains controversial. We assessed the efficacy and safety of managing PCL avulsion fractures with ORIF using the posteromedial approach.

A surgical reduction technique for posterior cruciate ligament avulsion fracture in total knee arthroplasty: a comparison study

BackgroundPosterior cruciate ligament (PCL) avulsion fracture of the tibia is an uncommon but serious complication during primary cruciate-retaining total knee arthroplasty (TKA). The first objective of this report was to conduct a retrospective cohort study to investigate the incidence and potential risk factors of PCL avulsion fracture in primary cruciate-retaining TKA. The second objective was to assess the functional outcomes of the knee after reduction of PCL avulsion fracture.MethodsFrom January 2014 to January 2016, 56 patients who experienced PCL avulsion fracture of the tibia in primary cruciate-retaining TKA were included in the study group. Patients in this group underwent reduction of avulsion fracture. In this period, we selected 224 patients (control group) for comparison. Patients in this group also underwent the same TKA, but no PCL avulsion fracture occurred. The range of motion of the knee and Knee Society Scores were assessed. The Forgotten Joint Score was used to analyze the ability to forget the joint. Differences were considered statistically significant at p < 0.05.ResultsIn our series, the incidence of PCL avulsion fracture was 4.6%. There were no significant differences (p > 0.05) with regard to the preoperative or postoperative range of motion of the knee, final 4-year mean clinical score in the study and control groups 92.4 ± 2.7 and 93.6 ± 1.9, respectively, and mean functional scores of 85.1 ± 1.8 and 87.1 ± 1.2, respectively.ConclusionsThe incidence of PCL avulsion fracture of the tibia is relatively high. Older age and female gender were the two risk factors of fracture in primary cruciate-retaining TKA. Reduction of PCL avulsion fracture with a high-strength line can achieve good stability and function of the knee.

Arthroscopic reduction and internal fixation (ARIF) versus open reduction internal fixation (ORIF) to elucidate the difference for tibial side PCL avulsion fixation: a randomized controlled trial (RCT).

To compare the clinical, radiological outcomes, economic and technical differences for ORIF by cancellous screw fixation versus ARIF by double-tunnel suture fixation for displaced tibial-side PCL avulsion fractures. Forty patients with displaced tibial-sided PCL avulsions were operated upon after randomizing them into two groups (20 patients each in the open and arthroscopic group) and followed up prospectively. Assessment included duration of surgery, cost involved, pre- and post-operative functional scores, radiological assessment of union, and posterior laxity using stress radiography and complications. The mean follow-up period was 33months (27-42) (open group) and 30months (26-44) (arthroscopic group). The duration of surgery was significantly larger in the arthroscopic group (47.8 ± 17.9min) as compared to the open group (33.4 ± 10.1min). The costs involved were significantly higher in the arthroscopic group (p- 0.01). At final follow-up, knee function in the form of IKDC (International Knee Documentation Committee) evaluation (89.9 ± 4.8-open and 89.3 ± 5.9-arthroscopic) and Lysholm scores (94.2 ± 4.1-open and 94.6 ± 4.1-arthroscopic) had improved significantly with the difference (n.s.) between the two groups. The mean posterior tibial displacement was 5.7 ± 1.8mm in the open group and 6.3 ± 3.1mm in the arthroscopic group which was (n.s.). There were two non-unions and one popliteal artery injury in the arthroscopic group. Both ARIF and ORIF for PCL avulsion fractures yield good clinical and radiological outcomes. However, ORIF was better thanARIF in terms of cost, duration of surgery, and complications like non-union and iatrogenic vascular injury. II.

PELVIC RING INJURY ASSOCIATED WITH FLOATING KNEE AND IPSILATERAL POSTERIOR CRUCIATE LIGAMENT (PCL) AVULSION FRACTURE: AN EXPERIENCE

Pelvic ring injury associated with floating knee is relatively rare1. For our best acquaintance, few literatures have documented such injuries in an individual patient. The aim of this study is to validate the feasibility of damage control orthopedics (DCO).Method:A 15-years-old girl, involved in high-energy road traffic accident presented with hemodynamic instability. The pelvis was unstable with deformity in the right upper and lower extremities. Significant lacerations over forehead, right forearm and thigh present. Her radiographs proved the unstable pelvis fracture[A], multiple fractures of right lower limb with floating knee injury associated with PCL avulsion fracture[B-E], compound right ulna fracture[F], cerebral concussion, intra-abdominal injury and multiple lacerations establishing the distinctive of polytrauma.Results:The algorithm of DCO was resolute as treatment. Initial procedures of pelvic external fixation, right calcaneal traction, exploratory laparotomy, wound debridement and right long arm back-slab were done. CT pelvis and right knee performed after achieving initial fracture and hemodynamic stability. Internal fixations were applied after a period of time. The patient recovered after the DCO guided management with restoration of limb functional, and the quality of life greatly improved.Discussions:The DCO emphasizes the need to avoid further damage by the “second hit” which may originate from surgical procedures and focus on advanced life-saving supports.1 Our surgical team followed the principles of debridement and removal of the infection factors first, carried out definite surgery during the stable period. In addition to supply of the blood volume and protein, the nutritional support was emphasized.Conclusion:The DCO plays a pivotal role in the management strategies of complex pelvic ring injuries and floating knee with functional good outcome.

Comparison of outcome of tibial avulsion fracture of the posterior cruciate ligament using open reduction internal fixation by cc screw and arthroscopic suture bridge technique

Introduction: Number of operative techniques have been described with the use of lag screws, steel wires, arthroscopic tight rope fixation, arthroscopic suture bridge technique. As there is continuous advancement in newer technique, we are comparing outcome of PCL tibial avulsion fixed by two different methods open reduction internal fixation by CC screw and arthroscopic suture bridge technique. Method: The PCL tibial avulsion was approached by posterior Burks and Schaffer approach, fixed by CC screw in half of the patient and in another half, we used arthroscopic suture bridge technique. One fiber wire is used in arthroscopic technique. Results: Anatomical reduction and fixation of PCL avulsion by arthroscopic fixation is equally effective when compared with ORIF by CC screw fixation. Conclusion: The use of CC screw could be a simple and reliable technique for PCL avulsion fractures of the tibia. Patients achieved good knee function after surgery, but arthroscopic suture bridge technique of PCL avulsion fixation gives better knee function and less intraoperative complications.

POSTERO-MEDIAL APPROACH: A SAFE APPROACH TO POSTERIOR CRUCIATE LIGAMENT AVULSION FRACTURE

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)

Clinical experience with arthroscopic suture pull technique in isolated PCL avulsion injuries

Objectiveto assess twenty two cases of isolated PCL avulsion fractures from tibial insertion, arthroscopically treated with suture pull technique, and to evaluate achieved clinical outcomes in terms of radiographic laxometry (objective) and Lysholm scale (subjective). Material and methodStudy includes 22 cases operated between April 2014 and March 2017. Patients less than 18 years old, presentation after 3 weeks of injury, concomitant injury in the same limb, with open wounds or with comminuted avulsed fragment were excluded from the study. All cases were MRI proven. All arthroscopic suture fixation technique was used in all cases. Follow up was done at 3 weeks, 6 weeks, 3 months, 6 months and 12 months. Mean follow up was one year. Subjective complaints, Knee flexion, Lysholm score and stress radiographs were noted. ResultsAverage Lysholm score was 96.3. Seventeen patients had excellent results and Five had good results based on Lysholm scores. In two patients, grade 2 laxity (5–10 mm) was present on stress radiographs but there were no clinical complaints. All patients achieved osseous union and had no functional limitation. Three Patients developed arthrofibrosis initially but gained functional range later. ConclusionArthroscopic suture fixation method for PCL avulsion fracture from tibia is a good and safe method of choice for fixation.

Evaluation of Knee Joint after Open Reduction and Internal Fixation Surgery of Posterior Cruciate Ligament in Patients with Avulsion Fracture.

BACKGROUND:The posterior cruciate ligament is one of the important tissues and structures sustaining the knee joint, and its rupture or detachment may lead to joint instability or destruction.AIM:The present study aimed at investigating the Open Reduction and Internal Fixation surgery of posterior cruciate ligament and comparing it to the normal knee of the same side.METHODS:In this study, 25 patients with avulsion fracture at the PCL joint were treated with open surgery and screw fixation. The patients were followed up by Lysholm knee score for at least 12 months after surgery.RESULTS:All patients were male with an average age of 25 years over the years 2010-2018. The common mechanism of injury in these patients was motorcycle-car accident. In the study with Lysholm knee score, 21 patients (80%) obtained the good score of 60-90 while 20% of patients were placed in the fair group (30-59). The average score was 86.CONCLUSION:The obtained score of knee function questionnaire in this study had no significant difference from other similar studies, and most patients achieved a good and acceptable score after the surgery. There was no knee instability and functional impairment in the patients compared to the normal knee. Considering the clinical results after the fixation of the PCL avulsion fracture causing a significant improvement in patients, the surgery could be considered as an acceptable and effective method for treating such impairment and fracture.

Arthroscopic reattachment of tibial avulsion fractures of the posterior cruciate ligament using ABS button and tightrope (Mohandas Jagsun technique)

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Avulsion fractures of tibial insertion of the posterior cruciate ligament are rare among the knee injuries. Purpose of this study is to determine the functional outcome of arthroscopic reattachment of tibial avulsion of the Posterior cruciate ligament by ABS button (Arthrex) and tight rope.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 15 Patients with PCL avulsion fracture were included. The Inclusion criteria were: 1) Displaced avulsion fractures (type-2 and type-3). They were followed at regular intervals using IKDC score, Lysholm score and subjective questionnaire.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; All cases showed complete osseous union during follow up. All knees are stable on examination by posterior sag sign and posterior drawer test. Two patients had loss of about 10&lt;sup&gt;0 &lt;/sup&gt;flexion. According to the IKDC form assessment 13 patients classified as normal and 2 were classified as near normal.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Arthroscopic reattachment of tibial avulsion fractures of the posterior cruciate ligament using ABS button and tightrope&lt;strong&gt; &lt;/strong&gt;gives fairly good clinical outcomes. &lt;/p&gt;

Tibial avulsion fractures of pcl—A comparison of outcomes between isolated, associated and missed injuries

ObjectiveAvulsion fracture of Posterior Cruciate Ligament from its tibial insertion is not a common injury and is missed most often, particularly when associated with multiple injuries or fractures around the knee and hip. While arthroscopic fixation has a steep learning curve, open reduction and fixation remains the gold standard treatment. Paucity of literature on missed and associated PCL injuries motivated us to do this study.This study aims to compare the clinical outcomes of three groups of displaced PCL avulsion fractures viz. isolated, associated and missed injuries, treated with open reduction and internal fixation. Materials and MethodsWe prospectively analyzed 52 cases of displaced PCL avulsion fracture from tibial insertion managed at our tertiary care center from 2009 to 2015. Open reduction was done through our own modification of the Burks and Schaffer approach and fixation done using 4mm or 6.5mm partially threaded cannulated cancellous screws with washer. Missed injuries that are more than 6 weeks old were excluded. The clinical outcome was assessed using the Lysholm knee scoring scale and objective tests like looking for tibial sag and posterior drawer, at 12 months following fixation. ResultsStatistical analyses revealed predominantly excellent outcome in isolated injuries, good in associated injuries and fair to poor outcome in missed injuries. The incidence of post-operative laxity was significantly higher in case of comminuted fractures. But there was no statistically significant difference between the Lysholm scores of cases with grade I laxity and those without laxity. ConclusionThe Burks and Schaffer approach is technically simple and safe; our modification enables better reduction and easy fixation. Functional outcome of the knee is best in isolated injuries; good in associated injuries despite the presence of other fractures; fair in treated missed injuries and definitely poor in untreated cases. Identifying the tell-tale signs will help us avoid missed injuries.

Treatment of posterior cruciate ligament tibial avulsion by a minimally-invasive open posterior approach

ObjectiveTo assess the surgical technique and report the outcomes following fixation of PCL bony avulsions through mini-invasive posterior knee approach as described by Burks and Schaffer. MethodsFrom June 2012 to July 2015, 27 patients enrolled in the study (21 males and 6 females). Fixation of tibial PCL avulsion fractures was done with one or two cannulated screws, or sutures through Burks and Schaffer’s approach. The mean interval before surgery was 16days (1–70) .Patients was followed up for an average of 51 weeks. The outcome measures evaluated at final follow-up were (1) clinical stability as assessed by posterior drawer test, (2) radiologic union, (3) functional assessment by Lysholm score, and (4) gastrocnemius muscle strength as a measure of morbidity. ResultsAverage operative time was 43min. Improvement of both subjective Lysholm score (mean 93) and objective stability testing by posterior drawer test (returns to normal in 81.1% of patients) at the final follow-up. Good radiographic union at average of 5.6 weeks. No morbidity of the gastrocnemius with few complications. ConclusionsThe approach was fast and safe with excellent visualization. It allows surgeons to address other injuries in the same setting. It can be considered as a minimally-invasive open surgery without surgery-related morbidity. It is a reproducible technique that can be done at any trauma centre by surgeons with average experience. The subjective and objective results of the technique are excellent and comparable to the arthroscopic procedures that needs more specific centres with well-trained surgeons.

Outcome of Isolated PCL Avulsion Fractures Treated with Cancellous Screw Fixation

Outcome of Isolated PCL Avulsion Fractures Treated with Cancellous Screw Fixation

Clinical outcome of arthroscopic management of isolated posterior cruciate ligament injuries

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Isolated posterior cruciate ligament&lt;strong&gt; (&lt;/strong&gt;PCL) injuries are considered as benign and treated conservatively. But studies have shown the long term outcomes of these patients are poor. Aim of this study is to determine the functional outcomes, efficacy, and complication of isolated PCL injuries treated by arthroscopic PCL reconstruction or fixation.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 24 patients, each with an isolated PCL injury, (17 with complete PCL tear and 7 with PCL avulsion fracture) were enrolled in this prospective study. Patients with complete tear underwent PCL reconstruction with hamstring tendon autograft and patients with displaced avulsion fractures underwent arthroscopic fixation with suture bridge technique. Average age at time of surgery was 33 years. Average time from injury to surgery was 1 month. Average follow-up period was 18 months. Patients underwent regular follow-up postoperatively with clinical and radiographic evaluation. Follow-up examinations comprised the Lysholm knee score, the International Knee Documentation Committee (IKDC) score.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Mean preoperative Lysholm score for 24 knees was 41; mean postoperative Lysholm score was 90. Eighteen of 24 patients had excellent results, and 4 patients had good results and 2 patients have fare result at final assessment. IKDC ratings showed significant improvements on subsequent follow ups. In final IKDC ratings, 21 patients were assessed as normal or near normal (grade A or B).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The short-term follow-up, analytical results showed good function after arthroscopic management in isolated PCL injuries. Hence we recommend surgical intervention in isolated PCL injuries.&lt;/p&gt;

Isolated PCL and ACL Avulsion Fractures of the Knee

Objectives:Isolated combined PCL and ACL avulsion fractures is a rare condition. A 40 year old woman had both PCL and ACL avulsion fracture due to a car accident. These fractures often have a subtle appearance at conventional radiography. Advanced imaging modalities, particularly CT and MRI are helpful to diagnose correctly and define the extent of damage. The aim of the study was point out this rare injury. We diagnosed this patient who had both PCL and ACL avulsion fractures. In the literature only a few case have been reported. We think that these fractures may be missed in the Emergency Department. If a patient is brought to the ED with high-velocity trauma, careful evaluation of bone and soft tissues followed by advanced imaging modalities should be performed.Methods:The PCL avulsion fracture was fixed with a cancellous screw via posterior approach and ACL avulsion fracture was fixed with arthroscopically assisted pull-out sutures 10 days after the traumatic event. The knee was immobilized in 20° flexion. Isometric knee, hip and ankle exercises were started immediately. Six weeks later after the operation active range of motion exercises and partial weight-bearing were allowed. In the third month full weight bearing was allowed and full range of motion was achieved.Results:Both PCL and ACL avulsion fractures healed uneventfully.Conclusion:Although knee injuries are frequent, simultaneous PCL and ACL avulsion fractures are rare . The clinician should have a high index of suspicion for these injuries. Careful physical examination and radiological imaging, especially magnetic resonance imagination is helpful in the diagnosis. Early surgical repair and appropriate rehabilitation are the keys to a good outcome in these injuries.

Results of open reduction and internal fixation in neglected PCL avulsion fracture with MCL insufficient knee – a case report and review of literature

Results of open reduction and internal fixation in neglected PCL avulsion fracture with MCL insufficient knee – a case report and review of literature

Pseudo-arthrosis repair of a posterior cruciate ligament avulsion fracture

A pseudo-arthrosis repair of a 4-year-old bony avulsion fracture of the PCL using a minimally invasive technique, screw fixation, and bone grafting is reported. The case presented seems to be rather unique due to the fragment size and the approach for pseudo-arthrosis repair. There was a good functional result following minimally invasive pseudo-arthrosis repair of a posterior cruciate ligament avulsion fracture. There are no previous reports of similar pseudo-arthrosis repairs, and other authors report good results of delayed refixation of PCL avulsion fractures. Therefore, refixation and pseudo-arthrosis repair should be considered as a viable treatment.