Conservative management of posterior cruciate ligament avulsion with a large bony fragment: a prospective cohort study

Abstract

Background: Internal fixation is the standard choice for treatment of posterior cruciate ligament (PCL) avulsion with a large bony fragment. However, it is not without complication. This study investigated PCL avulsions with large bony fragments to determine if conservative management resulted in acceptable outcomes. Methods: In a prospective cohort study, the outcome of conservative management of PCL avulsion with large bony fragment was evaluated in 40 patients. The inclusion criteria were a fracture size of more than 20 mm and a displacement of less than 2 mm. The outcomes were evaluated after 12 mo and included the evaluation knee range of motion and scoring of the modified Lysholm questionnaire and the International Knee Documentation Committee. Knee instability was checked by the drawer test and confirmed by stress radiography. Results: The mean patient age was 36.9±16.1 yr. The mean final knee range of motion (ROM) was 125.6±8.2 degrees. The mean Lysholm score was 92.3±6.1 points. Accordingly, the excellent, good, and fair results were observed in 29 (72.5%), eight (20%), and three (7.5%) patients, respectively. The mean International Knee Documentation Committee score of the patients was 94.2±5.3 points. Postoperative instability was seen in two patients. Nonunion was observed in two other patients. The size of the bony fragment was 30 and 32 mm in patients with nonunion. Conclusions: Conservative management of the PCL avulsion with a large bony fragment could result in acceptable outcome. However, application of this technique needs further characterization, particularly with respect to the size of bony fragment. Level of Evidence: Level II.

Systematic Review and Meta-analysis of Clinical Outcomes After Management of Posterior Cruciate Ligament Tibial Avulsion Fractures

“…Patients undergoing open surgery were most commonly treated using screw and washer fixation (48.2%, 405/841 patients), whereas patients who underwent arthroscopic surgery were treated most commonly using transtibial pull-out fixation (94.3%, 402/426 patients) ( Table 1 ). All patients treated nonoperatively 3 , 40 , 64 , 71 underwent a period of immobilization via casting ranging from 4 weeks 64 to 8 weeks, 40 often followed by a hinged brace 3 , 71 and ROM exercises 64 , 71 until patients achieved full flexion and full weightbearing.…”

“…A total of 1440 patients, 75% (1083/1440) of whom were men, were included in this systematic review and metaanalysis (Table 1 1). All patients treated nonoperatively 3,40,64,71 underwent a period of immobilization via casting ranging from 4 weeks 64 to 8 weeks, 40 often followed by a hinged brace 3,71 and ROM exercises 64,71 until patients achieved full flexion and full weightbearing.…”