Arthroscopic Treatment of Femoral Avulsion Fracture of the Posterior Cruciate Ligament in Association with Meniscus Tear

Abstract

Background: Femoral avulsion fracture of the posterior cruciate ligament (PCL) in association with meniscus tear is extremely rare in children, and similar cases are not available in the existing literature. Case presentation:In this paper, we present a case of a 9-year-old boy treated by an arthroscopic repair technique using two transfemoral tunnels sparing the epiphyseal plate for 8-shaped suture fixation of femoral avulsion fracture of the PCL and using the Fastfix repair system for a meniscus tear. At 3-month postoperative, the boy showed satisfactory recovery with a full range of motion of the right knee and normal muscular strength, and no complications were observed after operation. The patient had been followed up for 24 months and his final assessment demonstrated stable painless knee with excellent functional outcome. In view of this, we suggest that the "figure-of-eight" suture technique using two transfemoral tunnels sparing the epiphyseal plate can be considered a new choice for the treatment of the PCL femoral attachment avulsion, especially in skeletally immature patients. In addition, six similar cases were found in a comprehensive literature review targeting femoral avulsion fracture of the PCL. According to the relevant findings and cases studies, we proposed a new classification named "Xiangya" which might facilitate future clinical decision making.

Arthroscopic Primary Repair of the Posterior Cruciate Ligament

“…Zhao et al recently presented the case of 9-year-old patient treated with primary PCL repair. 38 At 2-year follow-up, the patient was satisfied with his operated knee, and physical examination showed a negative posterior drawer test and full ROM. The postoperative Lysholm's score was 85.…”

Investigative study of the potentialities of noble applications for the Brazilian calcium sulfate α-hemihydrate

“…For Kwon et al (2016), plaster is an almost exclusive material for the development of dental models for prosthetic and orthodontic rehabilitation or for the analysis of temple and jaw joints. Following this line of applications in the health area, case studies involving the use of plaster as an inorganic material associated with special therapy techniques aimed at correcting anatomical deformities in the treatment of orthopedic injuries, such as pseudoarthrosis, can also be mentioned, for bone grafts and for making a provisional nasal prosthesis for the treatment of recovery from a geriatric oncological rhinectomy (Rosen et al 2019;Chang et al 2020;Chen et al 2020;Zhao et al 2020).…”

Posterior Cruciate Ligament Femoral Avulsion Fractures in Pediatric Patients

“…Various treatment methods were used in these different cases depending on the timing of presentation and various concomitant injuries, including meniscus tears, popliteal artery damage, and hip dislocation. [9][10][11][12][13] This case report describes the diagnosis and treatment course of 2 male patients with PCL femoral avulsion fractures. Institutional review board approval was obtained for this report.…”

“…Various treatment methods were used in these different cases depending on the timing of presentation and various concomitant injuries, including meniscus tears, popliteal artery damage, and hip dislocation. 9-13…”

“…5 In patients younger than 14 years, most PCL femoral avulsions described are cartilaginous, and several have been reported in children aged 3 to 7 years 7,8 . Five bony femoral avulsion fractures are reported in the literature; however, they were in patients 8 years or older, and their mechanisms of injury were typically secondary to high-energy trauma [9][10][11][12][13] . Various treatment methods were used in these different cases depending on the timing of presentation and various concomitant injuries, including meniscus tears, popliteal artery damage, and hip dislocation.…”