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

Abstract

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.

Posterior Cruciate Ligament Avulsion Fractures

“…Most commonly, as a result of a motor vehicle accidents and especially motorcycle injuries, a dashboard injury occurs when a posterior directed force is applied to the proximal tibia when the knee is flexed. Therefore, PCL avulsion fractures are more frequently reported in China, India, and other countries where motorcycle transportation is more prevalent [7]. The second most frequent mechanism is sportsrelated trauma, in which the mechanism is knee hyperextension [1•].…”

“…The wide range noted in the reported incidence can be attributed to variable clinical presentations, including asymptomatic PCL injury [6]. Despite the low incidence of PCL injuries, resulting instability and early degenerative changes can be debilitating to patients, which are mostly young males [7]. Although there are many case series published on the management and outcomes of PCL avulsion fractures, no optimal surgical management has been suggested.…”

Arthroscopic reattachment of tibial avulsion fractures of the posterior cruciate ligament using ABS button and tightrope (Mohandas Jagsun technique)

“…Various open or arthroscopic techniques have been described in the literature regarding fixation of PCL avulsion injuries by using lag screws, steel wires, absorbable screws, suture bridge, suture anchors and tightrope, but no one technique has been considered a gold standard. 8,9 In this study we are present our experience with fixation using ABS button (Arthrex) and tightrope. It has a wide surface area to achieve compression at fracture site.…”

The Effects of Korean Medicine Treatment on Posterior Cruciate Ligament Avulsion Fracture: A Case Report

“…Zhu et al [6] reported the merits of high-strength suture fixation under arthroscopy for 18 cases of PCL avulsion injury, all of which were successful. Joshi et al [7] reported improvement in 14 cases of PCL avulsion fractures after performing open reduction and an internal fix, but this treatment is limited to patients with fractures that have just occurred and is not recommended for patients presenting to clinic late.…”