Fixation of tibial bony avulsion of the posterior cruciate ligament using the posteromedial approach

Attia, Mohamed E; Zanfaly, Amr I.

doi:10.4103/1110-1148.145299

Cited by 7 publications

(5 citation statements)

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“…These results were superior to those reported in previous studies. In a study by Attia and Zanfaly 27) among 12 patients treated using navicular screws, excellent results were obtained in 33.3%, good results in 58.3% and fair results in 8.3%. Similarly, Piedade and Mischan 28) showed excellent results in 53% and good in 47% of their cases where screws or Polyester no.…”

Section: Discussionmentioning

confidence: 96%

Open Reduction and Internal Fixation of Isolated Posterior Cruciate Ligament Avulsion Fractures: Clinical and Functional Outcome

Joshi

Bhatia

Gondane

et al. 2017

Knee Surg Relat Res

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PurposeThe posterior cruciate ligament (PCL) presents commonly with avulsion fractures of its tibial attachment. An avulsion fracture of the PCL, if not surgically fixed, may lead to secondary changes in the knee joint. Various fixation techniques have been explored with use of lag screws, steel wires, absorbable screws, suture anchors and straddle nails. The purpose of this study was to evaluate the clinical and functional outcome of open reduction and internal fixation of tibial avulsion injuries of the PCL using cannulated cancellous screws.Materials and MethodsWe performed open reduction and internal fixation using cannulated cancellous screws in 14 patients (mean age, 33.9 years) with isolated PCL avulsion injuries. Patients with a duration of injury more than 12 weeks were excluded. The minimum follow-up period was 12 months. Results were assessed radiologically and clinically. Final functional outcome was assessed using the Lysholm knee scoring system.ResultsThe average follow-up period was 13.5 months. At the final follow-up, all 14 patients achieved fracture union. The average flexion was 121.7°±9.2° with full extension achieved in all patients. Mild instability (1+) was noted in 4 patients. The Lysholm functional score was excellent in 11 patients, good in 2 patients and fair in 1 patient with an average score of 97±7.6.ConclusionsStable early fixation for PCL avulsion injuries with early controlled mobilization provided excellent to good results. However, fixation should not be discouraged for late-presenting patients because good to fair results can be achieved in such cases.

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Section: Discussionmentioning

confidence: 96%

Open Reduction and Internal Fixation of Isolated Posterior Cruciate Ligament Avulsion Fractures: Clinical and Functional Outcome

Joshi

Bhatia

Gondane

et al. 2017

Knee Surg Relat Res

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“…Additionally, this modified procedure by Attia et al. 9 has a low rate of neurovascular injury compared with Nicandri et al.’s 8 approach. Qiu et al.…”

Section: Discussionmentioning

confidence: 98%

“…Attia et al. 9 further modified the technique through changes to the posterior L incision by splitting the gastrocnemius medial head. This procedure is similar to that followed in the Trickey approach, 5 and one of its advantages is that the lateral half of the medial head can be pulled to improve exposure of more than one bony fragment or lateral extension of the bony fragment, with little tension compared with Burks and Schaffer’s approach.…”

Section: Discussionmentioning

confidence: 99%

Popliteal artery occlusion concomitant with a tibial plateau fracture and posterior cruciate ligament avulsion fracture

Lin

Chen

et al. 2019

J Int Med Res

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In acute trauma, posterior cruciate ligament (PCL) injury may occur concomitantly with a bony fracture and be easily overlooked. A popliteal artery injury associated with a tibial plateau fracture and PCL avulsion fracture is rare. Missed or delayed diagnosis of this condition leads to a high amputation rate. Therefore, close attention is required with this type of injury. The limb can be saved though early detection and immediate reconstruction of the injured artery, followed by fasciotomy. We report here a rare case of popliteal artery occlusion proximal to the surgical zone, which was diagnosed after fixation of a medial tibial plateau fracture and posterior cruciate avulsion injury. In dashboard injuries without knee dislocation, the arterial intima may be injured and become vulnerable, even with an initial ankle brachial index greater than 0.9. This can cause concomitant occlusion of the popliteal artery due to iatrogenic retraction during surgery. Therefore, a neurovascular examination should be repeated to prevent delayed-onset thrombosis. To the best of our knowledge, this is the first case of popliteal artery injury concomitant with a tibial plateau fracture and PCL avulsion owing to initial dashboard injury-related arterial intima injury, which can present with a normal ankle brachial index.

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“…Of the 12 patients included in this study, 4 (33.3%) showed excellent results, 7 (58.3%) showed good results and 1 (8.3%) showed a fair result as per Lysholm knee score. 25 Khatri Several techniques and implants have been used for reduction and fixation, according to the size and the degree of comminution of the avulsed fragment and according to the expertise of the treating surgeon. However, nowadays screw fixation has been the most common method used and has shown favorable results.…”

Section: Discussionmentioning

confidence: 99%

Surgical fixation of posterior cruciate ligament avulsion fracture from tibial attachment using cannulated cancellous screw: a clinical, radiological and functional outcome evaluation

Mondal

Das

2021

Int J Res Orthop

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Background: PCL (posterior cruciate ligament) is the main posterior stabilizer of the knee and plays a role in central axis controlling and imparting rotational stability to the knee. Injury to PCL presents commonly with avulsion fractures from its tibial attachment. An avulsion fracture of the PCL, if not surgically fixed, may lead to secondary changes in the knee joint. The aim of the study was to evaluate the clinical and functional results in patients with PCL tibial avulsion fractures treated by CC (cannulated cancellous) screw fixation.Methods: This was a prospective study conducted at a tertiary care government hospital in Kolkata, between December 2018 to July 2020 on patients who underwent CC screw fixation for post-traumatic PCL avulsion fracture from tibial site. All patients were followed up for 9 months. Lysholm knee score was used to assess the functional outcomes of the patients.Results: In a total of 10 patients, 9 (90%) patients showed excellent and 1 (10%) patient had good result during the final follow-up. 80% patients did not develop any complications. At the end of 9 months, the mean Lysholm score was 95.6. 8 (80%) patients achieved almost full knee ROM post-operatively by the end of final follow-up.Conclusions: Surgical fixation using CC screws is a simple, easy, safe and reproducible method without requiring significant expertise for achieving good stability in PCL tibial site avulsion fractures, where early intervention prevents significant late disability as it provides an excellent clinical, functional and radiographic outcome along with good joint function.

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Fixation of tibial bony avulsion of the posterior cruciate ligament using the posteromedial approach

Cited by 7 publications

References 0 publications

Open Reduction and Internal Fixation of Isolated Posterior Cruciate Ligament Avulsion Fractures: Clinical and Functional Outcome

Open Reduction and Internal Fixation of Isolated Posterior Cruciate Ligament Avulsion Fractures: Clinical and Functional Outcome

Popliteal artery occlusion concomitant with a tibial plateau fracture and posterior cruciate ligament avulsion fracture

Surgical fixation of posterior cruciate ligament avulsion fracture from tibial attachment using cannulated cancellous screw: a clinical, radiological and functional outcome evaluation

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