Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2015 Oct 29;20:88.
doi: 10.1186/s40001-015-0177-6.

Anterior Arthroscopic-Assisted Fixation of Posterior Cruciate Ligament Avulsion Fractures

Affiliations
Free PMC article
Clinical Trial

Anterior Arthroscopic-Assisted Fixation of Posterior Cruciate Ligament Avulsion Fractures

Wei Huang et al. Eur J Med Res. .
Free PMC article

Abstract

Background: Avulsion fractures of the tibial insertion of the posterior cruciate ligament (PCL) have always been regarded as rare injuries. The tibial attachment of the PCL is located in an area, which is difficult to access.

Hypothesis: To verify the effects of anterior arthroscopic fixation of PCL avulsion fractures.

Methods: 18 patients with PCL avulsion fracture were included. The inclusion criteria were: (1) the fracture fragment size was greater than 20 mm; (2) surgery in the acute phase of fractures (<3 weeks). The intervention was anterior arthroscopic fixation of fractures. Outcome variables included posterior laxity assessment with KT2000 arthrometer, posterior sag sign, the quadriceps activation test, the reverse Lachman, posterior stress X-rays, range of motion, and the IKDC form assessment.

Results: Complete osseous union showed in all cases during the follow-up (24-49 months). The posterior laxity assessment demonstrated slight posterior tibia translation (<5 mm) on the femur in 1 patient at 89 N and in 2 at maximal testing. All were stable on the posterior sag sign, the quadriceps activation test, the reverse Lachman and posterior stress X-rays. Two had loss of flexion of about 10° (grade B). Others showed a full range of knee motion. According to the IKDC form assessment, 16 patients were classified as grade A and 2 were classified as grade B. 16 of 18 patients were absolutely pain free, and there was general satisfaction on pain questionnaire. All the patients returned to their pre-injury knee function. No revision surgery was performed.

Conclusions: The anterior arthroscopic-assisted fixation guided with a tibial PCL guide is a simple and feasible alternative for treating PCL avulsion fractures when the fragment size is larger than 20 mm.

Figures

Fig. 1
Fig. 1
PCL avulsion fracture of a 26-year-old male was fixed anteriorly under arthroscopy with one partially threaded cannulated screws. a, b X-ray and CT showed the tibial intercondylar eminence fracture. c MRI showed the tibial intercondylar eminence fracture of PCL insertion. eg The tibial PCL guide (Acufex) was used to secure the fracture fragment and guide one kirschner wire. d, h The position of one partially threaded cannulated screw was confirmed under image intensifier and X-ray examination after operation. Arrow pointed the fracture
Fig. 2
Fig. 2
PCL avulsion fracture of a 32-year-old female was fixed anteriorly under arthroscopy with two partially threaded cannulated screws. a, b X-ray and CT showed the tibial intercondylar eminence fracture. c, d MRI confirmed the fragment size and displacement of the PCL avulsion fracture. Fragment involved the medial and lateral tibial plates. e, f Standard knee arthroscopy was performed with anterolateral and anteromedial portals using a 30° 4.0 mm arthroscope. The tibial PCL guide (acufex) and the probe were used to secure the fracture fragment and guide kirschner wires. gi The position of two partially threaded cannulated screws was confirmed under image intensifier and X-ray examination after operation. Arrow pointed the fracture

Similar articles

See all similar articles

Cited by 4 articles

References

    1. Ogawa H, Sumi H, Shimizu K. Posterior cruciate ligament mediated avulsion fracture of the lateral tibial condyle: a case report. J Orthop Surg Res. 2010;5:67. doi: 10.1186/1749-799X-5-67. - DOI - PMC - PubMed
    1. Yang CK, Wu CD, Chih CJ, Wei KY, Su CC, Tsuang YH. Surgical treatment of avulsion fracture of the posterior cruciate ligament and postoperative management. J Trauma. 2003;54(3):516–519. doi: 10.1097/01.TA.0000047048.37775.32. - DOI - PubMed
    1. Wajsfisz A, Makridis KG, Van Den Steene JY, Djian P. Fixation of posterior cruciate ligament avulsion fracture with the use of a suspensory fixation. Knee Surg Sports Traumatol Arthrosc. 2012;20(5):996–999. doi: 10.1007/s00167-011-1702-y. - DOI - PubMed
    1. Mariani PP, Becker R, Rihn J, Margheritini F. Surgical treatment of posterior cruciate ligament and posterolateral corner injuries. An anatomical, biomechanical and clinical review. Knee. 2003;10(4):311–324. doi: 10.1016/S0968-0160(02)00141-2. - DOI - PubMed
    1. Hoogervorst P, Gardeniers JW, Moret-Wever S, van Kampen A. Pseudo-arthrosis repair of a posterior cruciate ligament avulsion fracture. Knee Surg Sports Traumatol Arthrosc. 2010;18(11):1612–1616. doi: 10.1007/s00167-010-1114-4. - DOI - PMC - PubMed

Publication types

Feedback