Fixation of Delayed Union or Non-Union Posterior Cruciate Ligament Avulsion Fractures

Abstract

Purpose. To report the outcome of fixation for delayed union or non-union posterior cruciate ligament (PCL) avulsion fractures. Methods. Seven men and 4 women aged 24 to 35 (mean, 28) years underwent lag screw or suture fixation for non-union or delayed union of avulsion fracture of PCL tibial attachment after a mean delay of 8.6 (range, 4-14) months. Patient satisfaction was assessed using a visual analogue scale (VAS). Functional outcome was evaluated using the Lysholm scale.Results. The mean follow-up period was 17 (range, 8-36) months. The mean Lysholm score improved from 82 preoperatively to 92 at the final follow-up (p=0.34), the mean range of knee motion improved from 82º to 87º (p=0.008), and the mean VAS score for patient satisfaction improved from 4.3 to 7.4 (p=0.0004). All patients but one achieved bone union after a mean of 7.5 (range, 7-9) weeks. Functional outcome was excellent for 6 patients, good for 4, and fair for one. Posterior drawer test was positive (grade I laxity) in 3 patients whose outcome was good for 2 and fair for one. The latter had non-union after Ethibond suture repair for a communited fracture. There were no instances of wound complications or implant loosening. Conclusion. Fixation with lag screw or suture combined with bone grafting for delayed union or non-union of PCL avulsion fractures achieves acceptable functional outcome.

Avulsion fracture of the femoral attachment of the caudal cruciate ligament treated by arthroscopy in a Bernese Mountain puppy

“…In human medicine, paediatric and adolescent patients with posterior cruciate ligament tears and non-displaced avulsion fractures are often treated conservatively with good clinical outcomes (Kocher and others 2012). The surgical indications for posterior cruciate ligament reconstruction include symptomatic posterior knee instability, posterior cruciate ligament avulsion with large bony fragments or when associated with multiple ligament injuries (Veltri and others 1995, Chen 2007, Singla and others 2014). Satisfactory stability and clinical outcome after posterior cruciate ligament reconstruction have been reported in relatively large series in adults (Min and others 2011).…”

“…In human medicine, the main surgical approach includes both arthroscopy and fluoroscopy (Accadbled and others 2013) or arthroscopic-assisted fixation (Huang and others 2015). Open reduction and internal fixation is also performed routinely (Bali and others 2012, Singla and others 2014). …”

Time-sensitive ambulatory orthopaedic soft-tissue surgery paradigms during the COVID-19 pandemic

“…Arthroscopic anterior cruciate ligament (ACL) avulsion fixation within 72 hours was not associated with statistically significant improvement in Lysholm and International Knee Documentation Committee (IKDC) scores [41]. Current reviews of posterior cruciate ligament (PCL) avulsion injuries recommend fixation of bony fragments within three weeks of injury and tendinous repair within two weeks of injury [42][43][44][45].…”

Tratamento cirúrgico da fratura avulsão na inserção tibial do ligamento cruzado posterior: resultado funcional

“…A prevalência dessas continua a aumentar à medida que a população progressivamente se envolve com atividades atléticas 1 e acidentes automobilísticos. 2 A fratura avulsão é o destacamento do fragmento de osso resultado de uma tração do ligamento, tendão ou cápsula articular do seu ponto de inserção óssea. 1 Apesar de esse tipo de lesão estar aumentando, ainda são raras, segundo a literatura, especialmente as do LCP, que são ocasionalmente subdiagnosticadas.…”

“…6,7 O ligamento cruzado posterior tem atuação importante na biomecânica do joelho, desempenha papel fundamental na estabilidade da articulação por ser restritor primário da translação posterior da tíbia em relação ao fêmur. 2,[8][9][10][11] As características da fratura, como tamanho e desvio do fragmento ósseo, região acometida na tíbia e idade do paciente, são informaç ões importantes na escolha do tratamento e podem influenciar no resultado funcional.…”