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

Abstract

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.

A rare case of bony avulsion of posterior cruciate ligament from its femoral attachment

“…In 2009, Lee et al 8 reported a case of a 22-year-old soldier in which imaging had revealed bony fragments and an osteochondral defect in the medial femoral condyle which on arthroscopic evaluation was found to be originated from medial femoral condyle with a connection to the PCL fiber. In 2012, Xu et al 9 reported an avulsion of the PCL from femoral origin in a 22-year-old man.…”

Analysis of pathology and activity‐related changes to the patellae of individuals from Tell Abraq

“…OCFs involve trauma to the articular surface (Schuett et al, 2015;Toritsuka, Horibe, Hiro-oka, Mitsuoka, & Nakamura, 2007). Avulsion fractures are a fairly common type of injury to the knee (Heckman & Alkire, 1984;Keshkar, Dey, & Kumar, 2014;Toritsuka et al, 2007;Xu, Chen, Shi, & Jiang, 2012) and occur as the tendons can tolerate more stress than muscle tissue (Coleman & Rodeo, 2003:216). Following Millgram's description of avulsion fractures, where the patella experiences lateral subluxation, Heckman and Alkire (1984:426-427) suggest that the bone will experience spontaneous reduction and shear off part of the bone.…”

Arthroscopic Treatment of Acute Tibial Avulsion Fracture of the Posterior Cruciate Ligament Using the TightRope Fixation Device

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