A Posterior Approach to Open Reduction and Internal Fixation of Displaced Posterior Cruciate Ligament Tibial Osseous Avulsions

Hooper, Perry O.; Bevan, Patrick J.; Silko, Christopher; Farrow, Lutul D.

doi:10.2106/jbjs.st.17.00044

Cited by 11 publications

(11 citation statements)

References 8 publications

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“…A posterior approach to open reduction and internal fixation of PCL avulsion fractures was found to be effective in fractures involving large dislocations. 2 However, this method is highly invasive with a risk of neurovascular damage. Moreover, the fixation material was difficult to remove.…”

Section: Discussionmentioning

confidence: 99%

“…Because the bone hole must be created with a 4.0-mm drill, this method is not indicated for patients with small bone fragments or crushing. Computed tomography (CT) scanning before surgery is required to assess the extent of dislocation and the size of bone fragments, as other surgical procedures may be optimal, including the pull-out technique 4 if the bone fragments are crushed, or the Burks approach 2 if the dislocation is very large ( Table 1 ).…”

Section: Indicationsmentioning

confidence: 99%

“… 1 Until recently, surgical reattachment frequently has involved posterior approaches to the fracture site. 2 These approaches, however, require large skin incisions to avoid damage to the popliteal neurovascular structures that are located immediately behind the site and are therefore difficult to remove. Arthroscopic methods, however, are both safe and less invasive than posterior repair approaches.…”

mentioning

confidence: 99%

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Arthroscopic Fixation Technique for Avulsion Fracture of the Posterior Cruciate Ligament From the Tibia

Kan¹,

Nakagawa

Hino³

et al. 2020

Arthroscopy Techniques

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This study describes an arthroscopic pullout fixation technique for small and comminuted avulsion fractures of the posterior cruciate ligament from the tibia. Intra-articular surgery required 3 arthroscopic portals, the anterolateral, anteromedial, and posteromedial portals. To simplify surgery, the posterolateral portal was omitted. A 2.4-mm K-wire was inserted through the anterior incision to the center of the bone fragment. This central guidewire was subsequently overdrilled with a 4.0-mm cannulated drill. The fixation material consisted of Pass Telos artificial ligaments inserted through the fiber loop of a fixed suspensory device such as RIGIDLOOP. The leading end of the thread of the RIGIDLOOP was pulled out through the anteromedial portal. The button of RIGIDLOOP was gradually advanced through the bone tunnel. The button was pulled out and flipped over the bony fragment. The artificial ligament was pulled distally to reduce the bony fragment, and fixed onto the tibia using a ligament button while applying anterior drawer force to the proximal tibia with the knee flexed at 90. This minimally invasive procedure was successful in treating small and comminuted avulsion fracture of the tibial attachment of the posterior cruciate ligament.

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Section: Discussionmentioning

confidence: 99%

Section: Indicationsmentioning

confidence: 99%

mentioning

confidence: 99%

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Arthroscopic Fixation Technique for Avulsion Fracture of the Posterior Cruciate Ligament From the Tibia

Kan¹,

Nakagawa

Hino³

et al. 2020

Arthroscopy Techniques

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“…14 The most common complications involve neurovascular injury resulting from access approach, loss of reduction, paresthesia, arthrofibrosis, or compression, which potentially causes pseudarthrosis and knee flexion contracture. [22][23][24] Willinger et al compared the open with an arthroscopic fracture treatment, and reported arthroscopic treatment may lead to a slightly higher subjective and objective outcome, but the rate of arthrofibrosis was slightly elevated in the arthroscopic group. 25 In this study, the bone healing was good without any neurovascular complications and knee stiffness; hence, this approach may be a safe and effective method.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Posterior Cruciate Ligament Tibial Avulsion: A New Modified Open Direct Lateral Posterior Approach

2020

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The optimal operative technique for the treatment of the tibial-side avulsion injuries of the posterior cruciate ligament (PCL) is debatable. This study was aimed to evaluate the postoperative outcomes and complications if any after an open direct, posterolateral approach using cannulated cancellous screw fixation of a PCL tibial avulsion. From January 2016 to June 2018, 17 patients (14 males and 3 females) with PCL avulsion fraction treatment—who underwent open reduction and internal fixation using cannulated cancellous screws—were included in this prospective study. A direct posterolateral approach in the prone position was used in all cases. The Lysholm's knee score and International Knee Documentation Committee (IKDC) score were assessed preoperatively and during regular follow-up examinations for at least 1 year (12–20 months) postoperatively. All patients had fracture union and all of their knees were stable upon physical examination. No nerve or blood vessel injuries occurred. The mean Lysholm's scores and mean IKDC scores were improved significantly at the last follow-up. This study provides evidence that open direct posterolateral approach may be reliable for the treatment of tibial-sided bony PCL avulsion fractures. This approach can provide direct visualization of the posterior capsule and PCL avulsion site associated with good reduction and stable fixation, easy application of the screws directly from posterior to anteriorly without extensive soft tissue damage. Nevertheless, long-term follow-up is recommended.

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“… 1 Both open and arthroscopic procedures have been reported, and similar clinical results have been obtained. 2 , 3 Regarding open procedures, the fixation is direct and simple and there is no need for the learning curve of arthroscopic surgical procedures, 4 , 5 , 6 , 7 but these procedures are invasive. The advantage of arthroscopic procedures 8 , 9 , 10 is that the fracture can be directly exposed intra-articularly and combined intra-articular lesions can be treated simultaneously, in addition to their minimally invasive nature.…”

mentioning

confidence: 99%

Arthroscopic Suture-to-Loop Fixation of Posterior Cruciate Ligament Tibial Avulsion Fracture

Tang

Zhao

2021

Arthroscopy Techniques

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Avulsion fracture of the tibial insertion of the posterior cruciate ligament (PCL) receives constant concern. Arthroscopic procedures have long been attempted because of their minimally invasive nature, and various related techniques have been reported. However, the best arthroscopic method is still being pursued. In this article, we introduce an arthroscopic suture ligation and backup adjustable-loop fixation technique for PCL tibial avulsion fracture. The critical points of this technique are proper ligation of the PCL, proper location of the 2 tibial tunnels to create pulleys for posteriorinferior reduction of the bone fragment, and additional backup suture loop fixation. Our experience indicates that this technique is efficient and relatively simple. We consider that the introduction of this technique will provide a reasonable choice in the treatment of PCL tibial avulsion fracture.

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A Posterior Approach to Open Reduction and Internal Fixation of Displaced Posterior Cruciate Ligament Tibial Osseous Avulsions

Abstract: The exact operative indications for PCL injuries remain in question, but we believe that displaced tibial avulsion injuries at the PCL attachment always require operative treatment.

Cited by 11 publications

References 8 publications

Arthroscopic Fixation Technique for Avulsion Fracture of the Posterior Cruciate Ligament From the Tibia

Arthroscopic Fixation Technique for Avulsion Fracture of the Posterior Cruciate Ligament From the Tibia

Treatment of Posterior Cruciate Ligament Tibial Avulsion: A New Modified Open Direct Lateral Posterior Approach

Arthroscopic Suture-to-Loop Fixation of Posterior Cruciate Ligament Tibial Avulsion Fracture

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