All-Arthroscopic Posterior Cruciate Ligament Distal Reattachment With Extracortical Fixation

Hermanowicz, Krzysztof; Góralczyk, Adrian; Danowska, Kinga; Gałązka, Dariusz; LaPrade, Robert F.; Malinowski, Konrad

doi:10.1016/j.eats.2019.07.019

Cited by 4 publications

(3 citation statements)

References 18 publications

(21 reference statements)

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“…Open reduction and internal fixation of the avulsed fragment remains the preferred method [7, 10, 18]; however, several arthroscopic techniques have also been introduced. The clinical outcome scores after surgery reported in previous studies were generally satisfactory [3–6, 14, 22]. Yoon et al showed that the STSD after arthroscopic PCL avulsion fracture fixation, as revealed by arthrometry, was 3.0 ± 1.2 mm [22].…”

Section: Discussionmentioning

confidence: 89%

“…The patients in the present study showed good clinical outcomes and sustained active lifestyles despite some residual posterior instability. Thus, any surgery to treat acute PCL avulsion fractures should yield outcomes that are significantly superior to those in the present study, given the inevitable morbidity and expense of open or arthroscopic fracture fixation [6, 12, 15, 16]. In the PCL avulsion fracture group, the optimal cut‐off value for the amount of fracture displacement in PCL avulsion fracture that could be used to predict failure of non‐operative treatment was 6.7 mm; thus, non‐operative treatment should be preferred in such patients.…”

Section: Discussionmentioning

confidence: 99%

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The amount of displacement can determine non-operative treatment in posterior cruciate ligament avulsion fracture

Yoon

Kim

Park

2020

Knee Surg Sports Traumatol Arthrosc

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Purpose It is generally agreed that surgical treatment is warranted for acute posterior cruciate ligament (PCL) avulsion fracture with displacement. However, the amount of displacement that warrants surgical treatment has not been deined. The purpose of this study was to determine the optimal cut-of value for displacement of posterior cruciate ligament avulsion fracture in determining non-operative treatment and to compare the results of non-operative treatment in acute isolated PCL avulsion fractures with non-operative treatment of acute PCL injury. Methods Between 2007 and 2017, 30 consecutive patients with acute isolated PCL avulsion fractures and 70 consecutive patients with acute isolated PCL injuries, all of whom underwent non-operative treatment (cast immobilization with > 2 years of follow-up) were retrospectively analyzed. Clinical scores including the International Knee Documentation Committee subjective score, Lysholm score, and Tegner activity score, as well as side-to-side diferences on stress radiographs, were compared between the PCL avulsion fracture and PCL injury groups at the inal follow-up. The failure rates of non-operative treatment were also compared. The predictive value of the amount of fracture displacement for successful non-operative treatment was calculated using area under the receiver operating characteristic curve (AUROC). The optimal cut-of of the amount of fracture displacement to determine non-operative treatment was based on the maximal sum of sensitivity and speciicity. ResultsThe two groups exhibited comparable clinical scores and mean side-to-side diferences on stress radiographs. There were 5 (16.6%) failures of non-operative treatment in the PCL avulsion fracture group and 19 (27.1%) failures in the PCL injury group. (n.s) There was a signiicant positive correlation between the amount of initial avulsion fracture displacement and side-to-side diference in posterior stress radiographs at inal follow up (P < 0.001). The optimal cut-of value for the amount of fracture displacement in PCL avulsion fracture to predict failure of non-operative treatment was 6.7 mm (AUROC = 1.0). ConclusionThe outcomes of non-operative treatment of acute isolated PCL avulsion fractures were comparable to those of patients with acute isolated PCL injuries. Acute PCL avulsion injuries with displacement of less than 6.7 mm should be considered for non-operative treatment. Level of evidence IV.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

The amount of displacement can determine non-operative treatment in posterior cruciate ligament avulsion fracture

Yoon

Kim

Park

2020

Knee Surg Sports Traumatol Arthrosc

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“…Compared with arthroscopy, the operation time was significantly reduced (38). As with other surgical approaches, after operation, IKDC score, Lysholm score, knee joint mobility, and residual relaxation were significantly improved (31,39).…”

Section: Discussionmentioning

confidence: 97%

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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Arthroscopic management of avulsion fractures of the tibial attachment of the posterior cruciate ligament: A novel technique and mid-term outcomes

Seifeldin,

Abdel-Kader,

Abdel Meguid

et al. 2023

Journal of Clinical Orthopaedics and Trauma

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All-Arthroscopic Posterior Cruciate Ligament Distal Reattachment With Extracortical Fixation

Cited by 4 publications

References 18 publications

The amount of displacement can determine non-operative treatment in posterior cruciate ligament avulsion fracture

The amount of displacement can determine non-operative treatment in posterior cruciate ligament avulsion fracture

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

Arthroscopic management of avulsion fractures of the tibial attachment of the posterior cruciate ligament: A novel technique and mid-term outcomes

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