Outcome of Isolated PCL Tibial Avulsion Fractures Treated with Cannulated Cancellous Screw Fixation
Abstract
Background: The posterior cruciate ligament (PCL) presents commonly as avulsion fractures from the tibial attachment site. Isolated tears of the PCL can be caused by a fall on the flexed knee or dashboard injury in road traffic accident. Such a mechanism (the upper tibia driven posteriorly with the knee flexed) may produce PCL disruption as the only clinically detectable instability. For the PCL avulsion fractures fixation, there are various methods available like closed reduction and internal fixation (CRIF), open reduction and internal fixation (ORIF), and arthroscopic fixation. This study was performed to assess the result of PCL avulsion fracture managed with ORIF with cannulated cancellous screw.
Methods: We performed ORIF using cannulated cancellous screws with the posterior approach in 11 patients with isolated PCL tibial avulsion injuries. The minimum follow-up period was 6 months. The results were assessed radiologically and clinically. The spectrum of outcomes following PCL tibial avulsion fracture were measure using the Lysholm knee scoring system and range of motion (ROM) of the knee joint.
Results: 63.6, 27.3, and 9.1 percent of the cases had excellent, good, and moderate fracture healing, respectively.
Conclusion: PCL tibial avulsion fractures managed with open reduction with cannulated cancellous screw fixation yields good functional outcome with less complications.
2. Butler DL, Noyes FR, Grood ES. Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. J Bone Joint Surg Am. 1980;62(2):259-70. [PubMed: 7358757].
3. Shino K, Nakata K, Mae T, Yamada Y, Shiozaki Y, Toritsuka Y.
Arthroscopic fixation of tibial bony avulsion of the posterior cruciate ligament. Arthroscopy. 2003;19(2):E12. doi: 10.1053/jars.2003.50062. [PubMed: 12579141].
4. Meyers MH. Isolated avulsion of the tibial attachment of the posterior cruciate ligament of the knee. J Bone Joint Surg Am. 1975;57(5):669-72. [PubMed: 1150710].
5. Hughston JC, Bowden JA, Andrews JR, Norwood LA. Acute tears of the posterior cruciate ligament. Results of operative treatment. J Bone Joint Surg Am. 1980;62(3):438-50. [PubMed: 7364815].
6. Torisu T. Isolated avulsion fracture of the tibial attachment of the posterior cruciate ligament. J Bone Joint Surg Am. 1977;59(1):68-72. Retrieved from. [PubMed: 833178].
7. Bali K, Prabhakar S, Saini U, Dhillon MS. Open reduction and internal fixation of isolated PCL fossa avulsion fractures. Knee Surg Sports Traumatol Arthrosc. 2012;20(2):315-21. doi:
10.1007/s00167-011-1618-6. [PubMed: 21761230].
8. Banerjee S, Sharma PK, Singh K, Elhence A. Is it too late to Fix Now? Management of PCL avulsion injuries with late presentation/non-union. Nov Tech Arthritis Bone Res. 2021;1(4):1-5
9. Deehan DJ, Pinczewski LA. Arthroscopic reattachment of an avulsion fracture of the tibial insertion of the posterior cruciate ligament. Arthroscopy. 2001;17(4):422-5. doi: 10.1053/jars.2001.21841. [PubMed: 11288019].
10. Ingle M, Bhalotia A, Chandele V, Gade S, Koichade M. Functional outcome of bony PCL avulsions fixed with Mini open technique. Int J Orthop Sci. 2017;3(1):81-4. dOI:10.22271/ortho.2017.v3.i1b.14.
11. Espejo-Baena A, Lopez-Arevalo R, Urbano V, Montanez E, Martin F. Arthroscopic repair of the posterior cruciate ligament: Two
techniques. Arthroscopy. 2000;16(6):656-60. doi: 10.1053/jars.2000.4626.
12. Seitz H, Schlenz I, Pajenda G, Vecsei V. Tibial avulsion fracture of the posterior cruciate ligament: K-wire or screw fixation? A retrospective study of 26 patients. Arch Orthop Trauma Surg. 1997;116(5):275-8. doi: 10.1007/BF00390052. [PubMed: 9177803].
13. Piedade S, Mischan M. Surgical treatment of avulsion fractures of the knee PCL tibial insertion: Experience with 21 cases. Acta Ortop Brasi. 2006;15(5):272-5. doi: doi.org/10.1590/S1413-78522007000500008.
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Issue | Vol 8, No 1 (2022) | |
Section | Research Articles | |
DOI | https://doi.org/10.18502/jost.v8i1.9040 | |
Keywords | ||
Avulsion Fracture Fracture Fixation Knee Posterior Cruciate Ligament |
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