Surgical Technique: When to Arthroscopically Repair the Torn Posterior Cruciate Ligament

DiFelice, Gregory S.; Lissy, Micah; Haynes, Paul T.

doi:10.1007/s11999-011-2034-4

Cited by 36 publications

(35 citation statements)

References 34 publications

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“…If surgery is delayed, it is inevitable that the PCL will be treated with autograft or allograft reconstruction, as delay results in obscuration of tissue planes and loss of tissue integrity with ligament retraction. 1,[6][7][8][9] However, if early surgical intervention is planned (within 3 weeks from the time of injury) then primary repair of the PCL can be achieved [10][11][12] and has demonstrated positive clinical outcomes comparable with reconstruction. 13,14 In MLKI, PCL disruption occurs most frequently at the femoral insertion or midsubstance of the ligament, although distal injury typically involves an attached osseous fragment related to either avulsion or coexistent tibial plateau fracture.…”

Section: Introductionmentioning

confidence: 99%

The Value of Accurate Magnetic Resonance Characterization of Posterior Cruciate Ligament Tears in the Setting of Multiligament Knee Injury: Imaging Features Predictive of Early Repair vs Reconstruction

Goiney

Porrino

Twaddle

et al. 2016

Current Problems in Diagnostic Radiology

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Section: Introductionmentioning

confidence: 99%

The Value of Accurate Magnetic Resonance Characterization of Posterior Cruciate Ligament Tears in the Setting of Multiligament Knee Injury: Imaging Features Predictive of Early Repair vs Reconstruction

Goiney

Porrino

Twaddle

et al. 2016

Current Problems in Diagnostic Radiology

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“…Finally, Difelice et al 9 in 2012 reported on 3 patients with PCL peel-off injuries; they performed a PCL repair passing Bunnell-type stitches into the substance of the ligament and then passed the sutures through drill holes into the femoral footprint and tied them over a bony bridge.…”

Section: Discussionmentioning

confidence: 99%

“…3 Arthroscopic repair of femoral avulsion and peel-off lesions of the PCL has been reported. [4][5][6][7][8][9] In most of these articles, a transosseous repair with sutures passed through 2 bone tunnels into the medial femoral condyle was described.…”

mentioning

confidence: 99%

Arthroscopic Repair of “Peel-Off” Lesion of the Posterior Cruciate Ligament at the Femoral Condyle

Rosso

Bisicchia

Amendola

2014

Arthroscopy Techniques

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Posterior cruciate ligament (PCL) injuries are uncommon, and most occur in association with other lesions. The treatment of PCL injuries remains controversial; in addition, PCL injuries have been documented to have a propensity to heal. In the literature several different patterns of PCL injury have been described including midsubstance tears/injuries, tibial bony avulsions, femoral bony avulsions, and femoral "peel-off" injuries. A peel-off injury is a complete or incomplete soft-tissue disruption of the PCL at its femoral attachment site without associated bony avulsion. In recent years arthroscopic repair of femoral avulsion and peel-off lesions of the PCL has been reported. In most of these articles, a transosseous repair with sutures passed through 2 bone tunnels into the medial femoral condyle has been described. We present a case of a femoral PCL avulsion in a 20-year-old collegiate football player with an associated medial collateral ligament injury, and we report about a novel technique for PCL repair using 2 No. 2 FiberWire sutures and two 2.9-mm PushLock anchors (Arthrex) to secure tensioning the ligament at its footprint. P osterior cruciate ligament (PCL) injuries are uncommon: the estimated incidence ranges from 3% to 37% of all the ligamentous injuries. Isolated PCL lesions are rare, and they have been documented to have the propensity to heal.1,2 In the literature several different patterns of PCL injury have been described including midsubstance injuries, tibial bony avulsions, femoral avulsion with bony fragments, and femoral "peel-off" injuries, with the last 2 types being less common.3 Arthroscopic repair of femoral avulsion and peel-off lesions of the PCL has been reported. [4][5][6][7][8][9] In most of these articles, a transosseous repair with sutures passed through 2 bone tunnels into the medial femoral condyle was described.We present a case of a femoral peel-off lesion of the PCL in a 20-year-old collegiate football player with an associated medial collateral ligament (MCL) injury, and we report about a novel technique for PCL repair using 2 No. 2 FiberWire sutures and two 2.9-mm PushLock anchors (Arthrex, Naples, FL) to secure the ligament at the footprint. Case Report and Surgical TechniqueA 20-year-old male collegiate football player (body mass index, 34.67 kg/m 2 ) presented to us the day after a right knee injury during a football game. His right knee buckled into valgus when a second player fell onto him. He was not able to walk and complained about medial pain on the right knee. The physical examination of the right lower limb showed intact neurovascular status, full extension of the knee joint, and passive flexion only to approximately 45 . The ligament examination was difficult because of swelling and limitation of motion, but there was complete laxity at full extension and at 30 with a 3þ valgus stress test. The posterior drawer test was positive with grade 1 for posterior sag, and the anterior drawer test had a normal endpoint on testing. The patient had local tende...

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“…Schenck et al [28] found that midsubstance tears occur at a low strain rate and avulsion ''stripping'' injuries from the femoral side occur at a high strain rate in hyperextension in a cadaveric knee. In several reports, avulsion of the PCL was called a ''peel off lesion'' that occurs through Sharpey's fibers and can have small fragments of bone attached to the PCL [7,10,25]. Patients 1 through 3 (Table 1) may be considered to have massive peel off lesions.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Osteochondral Avulsion Fracture of the Posteromedial Bundle of the PCL in Knee Hyperflexion

Chen

Shi

Jiang

2012

Clinical Orthopaedics &Amp; Related Research

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Background Injury of the PCL of the knee in adults usually results in rupture rather than avulsion fracture and avulsions usually occur at the tibial insertion. Case Description We report an avulsion of the PCL with a femoral origin in a 22-year-old man who was injured by hyperflexion of the knee and was treated with arthroscopy. There were two parts in the partial osteochondral avulsion fracture of the PCL posteromedial (PM) bundle. One part was fixed with polydioxanone suture through drill holes and the other was removed. The fracture healed after 3 months and the knee was stable. At 11 months postoperatively the patient had returned to full-time work without pain or restrictions. The Lysholm II knee score was 95 points. Physical examination showed a negative posterior drawer sign. Literature Review We identified four other reported cases of PCL femoral origin avulsion fractures in adults. The subjects were 20 to 25 years old in four of five reports, including our patient. Three of the five patients had involvement of only the lateral cortex of the medial femoral condyle whereas two other patients including our patient, had an osteochondral fracture. The mechanism of PCL avulsion seems to be similar to that of a PCL rupture. Purposes and Clinical Relevance The hyperflexion injury may result in injury of the PM bundle of the PCL. Our case and one other in the literature suggest such avulsions need not involve the entire PCL.

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Surgical Technique: When to Arthroscopically Repair the Torn Posterior Cruciate Ligament

Cited by 36 publications

References 34 publications

The Value of Accurate Magnetic Resonance Characterization of Posterior Cruciate Ligament Tears in the Setting of Multiligament Knee Injury: Imaging Features Predictive of Early Repair vs Reconstruction

The Value of Accurate Magnetic Resonance Characterization of Posterior Cruciate Ligament Tears in the Setting of Multiligament Knee Injury: Imaging Features Predictive of Early Repair vs Reconstruction

Arthroscopic Repair of “Peel-Off” Lesion of the Posterior Cruciate Ligament at the Femoral Condyle

Case Report: Osteochondral Avulsion Fracture of the Posteromedial Bundle of the PCL in Knee Hyperflexion

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