Treatment of avulsion fracture of posterior cruciate ligament tibial insertion by minimally invasive approach in posterior medial knee

Huihui Guo; Yao Zhao; Liang Gao; Chen Wang; Xianbo Shang; Haitao Fan; Wendan Cheng; Chang Liu

doi:10.3389/fsurg.2022.885669

Treatment of avulsion fracture of posterior cruciate ligament tibial insertion by minimally invasive approach in posterior medial knee

Front Surg. 2023 Jan 6:9:885669. doi: 10.3389/fsurg.2022.885669. eCollection 2022.

Authors

Huihui Guo^{1

2}, Yao Zhao¹, Liang Gao³, Chen Wang¹, Xianbo Shang¹, Haitao Fan⁴, Wendan Cheng¹, Chang Liu⁵

Affiliations

¹ Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
² Fuyang People's Hospital, Fuyang, China.
³ Center for Clinical Medicine, Hua Tuo Institute of Medical Innovation (HTIMI), Berlin, Germany.
⁴ Anhui Medical University, Fuyang, China.
⁵ Anhui Armed Police General Hospital, Hefei, China.

Abstract

Objective: The study aims to explore the feasibility and clinical effect of posterior minimally invasive treatment of cruciate ligament tibial avulsion fracture.

Methods: Posterior knee minimally invasive approach was used to treat avulsion fracture of posterior cruciate ligament (PCL) tibia in 15 males and 11 females. The length of the incision, intraoperative blood loss, operation time, postoperative hospital stay, residual relaxation, and fracture healing time were analyzed to evaluate the curative effect, learning curve, and advantages of the new technology. Neurovascular complications were recorded. During the postoperative follow-up, the International Knee Joint Documentation Committee (IKDC), Lysholm knee joint score, and knee joint range of motion were recorded to evaluate the function.

Results: All 26 patients were followed up for 18-24 months, with an average of 24.42 ± 5.00 months. The incision length was 3-6 cm, with an average of 4.04 ± 0.82 cm. The intraoperative blood loss was about 45-60 ml, with an average of 48.85 ± 5.88 ml. The operation time was 39-64 min, with an average of 52.46 ± 7.64 min. The postoperative hospital stay was 2-5 days, with an average of 2.73 ± 0.87 days. All incisions healed grade I without neurovascular injury. All fractures healed well with an average healing time of 9.46 ± 1.33 weeks (range, 8-12 weeks). The Lysholm score of the affected knee was 89-98 (mean, 94.12 ± 2.49) at 12-month follow-up. The IKDC score was 87-95 with an average of 91.85 ± 2.19, and the knee range of motion was 129-148° with an average of 137.08 ± 5.59°. The residual relaxation was 1-3 mm, with an average of 1.46 ± 0.65 mm.

Conclusion: This minimally invasive method provides sufficient exposure for internal fixation of PCL tibial avulsion fractures without the surgical complications associated with traditional open surgical methods. The process is safe, less invasive, and does not require a long learning curve.

Keywords: avulsion fracture; clinical effects; minimally invasive; posterior cruciate ligament; technique.

Grants and funding

This study was supported by the Hefei independent innovation policy “Borrow-transfersupplement” project (J2020Y07), Functional limb salvage of diabetic foot (2020byzd347), Masquelet technique combined with transverse bone transfer technique for the treatment of refractory Wagner III and IV diabetic foot (FY2021-027) and tibial periosteum lateral extension for Wagner III and IV diabetic foot in a multidisciplinary collaborative mode (2022xkj225). The funders had no role in the study design, data collection and analysis, in the decision to publish, or in the preparation of the manuscript.