Posterior cruciate ligament tibial insertion avulsion, management by open reduction and internal fixation using plate and screws through a direct posterior approach

Khalifa, Ahmed A.; Elsherif, Mohamed Eslam; El-Sherif, Essam; Refai, Omar

doi:10.1016/j.injury.2020.09.058

Cited by 13 publications

(13 citation statements)

References 25 publications

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“…Regarding the cause of injury, Ahmed et al . reported that motor vehicle accidents were the most frequent cause of injury; 23 this was the case in our study where 75% of the patients were injured in road traffic accidents. Overall, our clinical outcomes are consistent with Hooper et al ., who demonstrated that the arthroscopic group had somewhat higher subjective and objective knee outcome scores 15 …”

Section: Discussionsupporting

confidence: 52%

Arthroscopic Direct Anterior‐to‐Posterior Suture Suspension Fixation for the Treatment of Posterior Cruciate Ligament Tibial Avulsion Fracture

Tao

Yang

Tong

et al. 2022

Orthopaedic Surgery

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Objectives A posterior cruciate ligament (PCL) avulsion fracture of the tibial attachment site is a specific type of PCL injury that is difficult and unpleasant to manage. The objective of this study is to report the preliminary results of a newly developed technique: arthroscopic endobutton‐suture fixation using a single tibial tunnel. Methods From January 2016 to January 2018, 120 patients with PCL avulsion fracture who met our criteria were recruited. Sixty cases were treated by arthroscopic direct anterior‐to‐posterior suture suspension fixation (endobutton‐suture group), and 60 cases were treated by arthroscopic screw‐suture fixation (screw‐suture group). All radiographic studies were recorded. The curative effect was evaluated by the range of motion (ROM), KT‐2000, International Knee Documentation Committee (IKDC) scores, Tegner activity scale, and Lysholm scoring system. For statistical analysis the Student t‐test was used. Results The average follow‐up duration was 24 months. Findings and difficulties in surgery are the following. The lax anterior cruciate ligament is one of the diagnostic criteria. The anatomic location of PCL avulsion fractures is deep and surrounded by nerves and vessels; thus, operating through this region is difficult. After each tunnel drilling, the debris at the edge of opening needs to be cleaned to avoid obscuring the operator's vision or wearing the sutures. In endobutton‐suture group, ROM improved from 0° preoperatively to 140.0° ± 5.6° at the last follow‐up (P < 0.001). The postoperative KT‐2000 arthrometric data at 90 N were available for all patients. The IKDC score was 23.6 ± 2.6 and 91.4 ± 4.1 pre‐ and postoperatively, respectively. The Tegner score improved from 1.2 ± 0.6 to 7.3 ± 2.3 (p < 0.001). The median Lysholm knee score increased from 40.4 ± 5.2 preoperatively to 90.1 ± 10.1 postoperatively (p < 0.001). The operative time was shorter in the endobutton‐suture group (p < 0.001). The Lysholm knee score in the endobutton‐suture group was lower than that in the endobutton‐suture group (3.1 ± 1.2 vs. 4.2 ± 1.8, p < 0.01). No significant complications were noted in the study. Conclusions The arthroscopic direct anterior‐to‐posterior suture suspension fixation is a simple and reliable method that not only provides better clinical outcomes, but also fixes avulsion fragments of any size.

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Section: Discussionsupporting

confidence: 52%

Arthroscopic Direct Anterior‐to‐Posterior Suture Suspension Fixation for the Treatment of Posterior Cruciate Ligament Tibial Avulsion Fracture

Tao

Yang

Tong

et al. 2022

Orthopaedic Surgery

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“…The knee flexion was 120.7°, which allowed for full extension. The incision was large, and there was significant vascular and nerve damage in the popliteal fossa (10). Bi et al reported 15 cases of threechannel arthroscopic surgery involving autologous tendon transplantation, TightRope, and interference screw fixation.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, the length of the incision and the degree of satisfaction with the scar after the operation are obviously better than those of a traditional operation. The operation time was not obviously prolonged (10), and the operation time may be further shortened for senior orthopedic surgeons as the operation progresses. Compared with arthroscopy, the operation time was significantly reduced (38).…”

Section: Discussionmentioning

confidence: 99%

Treatment of avulsion fracture of posterior cruciate ligament tibial insertion by minimally invasive approach in posterior medial knee

Guo

Zhao²,

Gao³

et al. 2023

Front. Surg.

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ObjectiveThe study aims to explore the feasibility and clinical effect of posterior minimally invasive treatment of cruciate ligament tibial avulsion fracture.MethodsPosterior knee minimally invasive approach was used to treat avulsion fracture of posterior cruciate ligament (PCL) tibia in 15 males and 11 females. The length of the incision, intraoperative blood loss, operation time, postoperative hospital stay, residual relaxation, and fracture healing time were analyzed to evaluate the curative effect, learning curve, and advantages of the new technology. Neurovascular complications were recorded. During the postoperative follow-up, the International Knee Joint Documentation Committee (IKDC), Lysholm knee joint score, and knee joint range of motion were recorded to evaluate the function.ResultsAll 26 patients were followed up for 18–24 months, with an average of 24.42 ± 5.00 months. The incision length was 3–6 cm, with an average of 4.04 ± 0.82 cm. The intraoperative blood loss was about 45–60 ml, with an average of 48.85 ± 5.88 ml. The operation time was 39–64 min, with an average of 52.46 ± 7.64 min. The postoperative hospital stay was 2–5 days, with an average of 2.73 ± 0.87 days. All incisions healed grade I without neurovascular injury. All fractures healed well with an average healing time of 9.46 ± 1.33 weeks (range, 8–12 weeks). The Lysholm score of the affected knee was 89–98 (mean, 94.12 ± 2.49) at 12-month follow-up. The IKDC score was 87–95 with an average of 91.85 ± 2.19, and the knee range of motion was 129–148° with an average of 137.08 ± 5.59°. The residual relaxation was 1–3 mm, with an average of 1.46 ± 0.65 mm.ConclusionThis minimally invasive method provides sufficient exposure for internal fixation of PCL tibial avulsion fractures without the surgical complications associated with traditional open surgical methods. The process is safe, less invasive, and does not require a long learning curve.

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“…Repair of PCL tibial avulsion injuries is well described in the literature. 3 , 10 , 11 , 12 , 13 Classically, this involves open reduction and internal fixation using a screw-washer construct via a modified posterior approach to the knee. 3 However, given the morbidity and risks associated with this procedure, all-arthroscopic techniques have been described.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Repair of the “Tibial Avulsion Triad”—ACL Posterolateral Bundle, PCL, and Lateral Meniscus Posterior Root: The Triple Tunnel Technique

Dartus

Kahhaleh²,

Belzile³

et al. 2022

Arthroscopy Techniques

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Posterior cruciate ligament tibial insertion avulsion, management by open reduction and internal fixation using plate and screws through a direct posterior approach

Cited by 13 publications

References 25 publications

Arthroscopic Direct Anterior‐to‐Posterior Suture Suspension Fixation for the Treatment of Posterior Cruciate Ligament Tibial Avulsion Fracture

Arthroscopic Direct Anterior‐to‐Posterior Suture Suspension Fixation for the Treatment of Posterior Cruciate Ligament Tibial Avulsion Fracture

Treatment of avulsion fracture of posterior cruciate ligament tibial insertion by minimally invasive approach in posterior medial knee

Arthroscopic Repair of the “Tibial Avulsion Triad”—ACL Posterolateral Bundle, PCL, and Lateral Meniscus Posterior Root: The Triple Tunnel Technique

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