Knee central pivot bicruciate avulsion and proximal anterior cruciate ligament tear primary repair: A rare case report

Abstract

The knee is susceptible to complex injuries after trauma including fractures, multiple ligamentous lesions and avulsions due to its numerous tendinous, ligamentous and meniscal attachments. The authors describe a rare case of a 33-year-old male patient with a trauma of the right knee following a motorcycle accident, who sustained avulsion of both femoral and tibial insertion sites of anterior cruciate ligament and avulsion of tibial insertion of posterior cruciate ligament without other associated ligament lesions. The patient underwent a clinical-anamnestic and imaging evaluation to identify the lesions. Knee X-rays showed a tibial avulsion of anterior and posterior cruciate ligaments confirmed by CT scan, classified as type 3b according to Meyers and Mckeever. The authors decided for a surgical management: reduction and internal fixation of anterior and posterior cruciate ligament tibial bone fragments and repair of anterior cruciate ligament femoral avulsion using suture pull-out technique. The patient has been followed, with accurate clinical and radiological follow up controls, for 12 months and showed excellent clinical outcomes using Tegner-Lysholm Knee Score (95/100 points) and good range of motion and knee stability.

Clinical outcomes and return to sport after single-stage revision anterior cruciate ligament reconstruction by bone-patellar tendon autograft combined with lateral extra-articular tenodesis

“…Over the last decade, the anterior cruciate ligament reconstruction (ACLR) has become an increasingly common orthopedic procedure, for the growing number of injuries in pivoting sports, other athletic activities and not only [ 1 – 3 ]. Despite the improvements in surgical techniques, the ACLR failure rate continues to increase, ranging between 0 and 25% [ 4 , 5 ].…”

Arthroscopic Reduction of Bicruciate Tibial Avulsion Fractures: Lever Push Technique

“…They are primarily documented in adults after high-energy impacts, such as two-wheeler vehicle accidents and falls from a height. [1][2][3][4][5] Hyperextension of the knee from such injuries places strain on both the ACL insertion in the tibial spine and the PCL insertion in the posterior aspect of the tibial plateau and is a common mechanism of injury for adult ACL and PCL avulsion fractures. 6 Similar to stand-alone cruciate ligament tibial avulsion fractures, BTAFs present with knee pain with weight bearing, antalgic gait, painful range of motion, and instability.…”

“…They are primarily documented in adults after high-energy impacts, such as two-wheeler vehicle accidents and falls from a height. 1 , 2 , 3 , 4 , 5 Hyperextension of the knee from such injuries places strain on both the ACL insertion in the tibial spine and the PCL insertion in the posterior aspect of the tibial plateau and is a common mechanism of injury for adult ACL and PCL avulsion fractures. 6 …”