Outcome of screw post fixation of neglected posterior cruciate ligament bony avulsions

Joseph, Christina Marie; Gunasekaran, Chandrasekaran; Livingston, Abel; Chelliah, Hepsy; Jepegnanam, Thilak Samuel; Boopalan, P.R.J.V.C.

doi:10.1016/j.injury.2019.02.001

Cited by 6 publications

(13 citation statements)

References 24 publications

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“… 4 , 16 Fixation of the bone fragment can be performed by using screws, toothed plates, Kirschner wires, and sutures. 8 , 11 , 15 Recently, suture fixation was used in arthroscopic surgery of PCL avulsion fractures, and good postoperative outcomes were reported. 5 , 17 Nonabsorbable suture fixation can have many advantages.…”

Section: Discussionmentioning

confidence: 99%

“…In some cases, a large fragment can be anatomically reduced and held with a screw though an open posterior approach. 8,13 When the fragment is comminuted or too small to accommodate a screw, suturing the ligament in position arthroscopically is also a good treatment option. 4,8,16 Another reason for residual knee laxity may be that the PCL had been stretched at the time of injury and that the mechanical properties of the ligament were reduced.…”

mentioning

confidence: 99%

“…8,13 When the fragment is comminuted or too small to accommodate a screw, suturing the ligament in position arthroscopically is also a good treatment option. 4,8,16 Another reason for residual knee laxity may be that the PCL had been stretched at the time of injury and that the mechanical properties of the ligament were reduced. 6,7 Some authors have reported that a certain percentage of their patients still had significant knee instability even though the bone fragment had been anatomically reduced and rigidly fixed in the treatment of PCL avulsion fractures.…”

mentioning

confidence: 99%

“…In spite of acute tibial avulsion fractures of the PCL being widely reported, 4 , 16 delayed avulsion fractures also occur because of a neglected diagnosis or the failure of nonoperative treatment. 4 , 8 Arthroscopic suture fixation for delayed PCL avulsion injuries is considered a complex orthopaedic intervention because scar conglutination and bony callus formation complicate the anatomic structure and result in avulsed fragment malreduction. 1 , 9 The purpose of the present study was to evaluate the efficacy and clinical results of arthroscopic suture fixation with autograft-enhanced reconstruction for delayed tibial avulsion fractures of the PCL.…”

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confidence: 99%

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Arthroscopic Suture Fixation With Autograft Augmentation Reconstruction for Delayed Tibial Avulsion Fractures of the Posterior Cruciate Ligament

Zhao

Chen

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: The optimal surgical treatment of delayed avulsion fractures of the posterior cruciate ligament (PCL) is still controversial. Purpose: To evaluate the clinical results of arthroscopic suture fixation of tibial avulsion fractures of the PCL with autograft augmentation reconstruction. Study Design: Case series; Level of evidence, 4. Methods: From January 2013 to February 2017, we treated 15 patients with delayed tibial avulsion fractures of the PCL arthroscopically through posteromedial and posterolateral portals. The PCL and avulsion bone fragment were fixed with No. 2 nonabsorbable FiberWire sutures that were pulled out through a single tibial bone tunnel and fixed on a small Endobutton. Concomitantly, anatomic PCL augmentation reconstruction was performed, and the graft was pulled out through the same tunnel and fixed with an interference screw. Knee stability was assessed using the posterior drawer test, and the side-to-side difference was determined using a KT-1000 arthrometer with 134 N of posterior force at 30° of knee flexion. The International Knee Documentation Committee (IKDC) 2000 subjective form and Lysholm scale were used to evaluate clinical outcomes at follow-up. Overall, 12 patients were enrolled for analysis. The mean follow-up period was 34.4 months (range, 26-49 months). Results: At the final follow-up, 2 patients encountered 10° terminal flexion limitations. All patients had negative posterior drawer test results. The KT-1000 arthrometer side-to-side difference was significantly decreased from 8.25 ± 1.96 mm preoperatively to 1.08 ± 0.86 mm at the last follow-up ( P < .001). The mean IKDC and Lysholm scores, respectively, increased from 54.67 ± 7.13 and 53.50 ± 7.90 preoperatively to 91.13 ± 3.78 and 94.25 ± 3.32 at the final follow-up ( P < .001 for both). Conclusion: Arthroscopic suture fixation with autograft augmentation reconstruction for delayed tibial avulsion fractures of the PCL showed good clinical stability and function in this study.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Arthroscopic Suture Fixation With Autograft Augmentation Reconstruction for Delayed Tibial Avulsion Fractures of the Posterior Cruciate Ligament

Zhao

Chen

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…Although no complication was reported, the prong on the staple, with a length of 22 mm, might further damage the osteoporotic bone. The design of spikes on the washer has been applied in treatment of various kinds of soft tissue injury, such as posterior cruciate ligament bony avulsions, conoid ligament disruptions 22,23 . Biomechanical studies demonstrated spiked metal washer provided secure fixations and allowed normal microcirculation of tissues beneath the washer for the reattachment of avulsed ligaments 17 .…”

Section: Effects On Repairing MCL Insufficiency By Using the Screw Anmentioning

confidence: 99%

Management of Medial Collateral Ligament Insufficiency During Total Knee Arthroplasty with a Screw and Rectangular Spiked Washer: A Case Series of 14 Patients

Sun

et al. 2020

Orthopaedic Surgery

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Objective: To describe the technique of primary repair of medial collateral ligament (MCL) insufficiency using a screw and rectangular spiked washer in a case series of 14 patients. Methods: Fourteen patients undergoing MCL repair by a screw and rectangular spiked washer during TKA between March 2018 and March 2019 were retrospectively reviewed. Among them, half injuries were avulsion of the femoral origin, and the other half were MCL laxity. There were 12 women and two men included in the study, with an average age of 63.6 years (range, 49-79 years) at the time of surgery. This series were followed up with a focus on range of motion (ROM), coronal alignment, Hospital for Special Surgery (HSS) knee scores, their subjective sense of joint instability, and related complications. At the last follow-up, function of the MCL was assessed by manually applying a valgus stress to the knee at both 0 and 30 of knee flexion. Results: The mean follow-up time for all patients was 15.6 months (range, 13-20 months). Repair of the MCL was successful in all patients. ROM improved from a mean of 70.7 ± 35.1 before surgery to 103.9 ± 6.8 at latest follow-up (P = 0.001). All patients were able to perform a half squat easily, but none were able to do full squatting. The mean preoperative HSS score was 43.6 ± 13.4 and increased to a mean of 85.6 ± 3.8 postoperatively (P < 0.001). The femorotibial angle improved from a mean of −3.22 ± 9.47 before surgery to a mean of 5.16 ± 3.14 at the final follow-up (P = 0.006). At the time of final follow-up, no patient required revision and manipulation under anesthesia following the index arthroplasty. No radiolucencies or migration were observed in association with the knee prostheses. No displacement of the screw and rectangular spiked washer was found. There were no clinical complications. No patient reported subjective instability of the knee. Upon physical examination, no patient was found to have laxity in the coronal plane in either 30 of flexion or full extension. Conclusions: The screw and rectangular spiked washer is a simple and effective method for treating MCL sufficiency in TKA, and a study with a larger cohort and extended follow-up is requisite to claim its role in preventing coronal instability and component failure.

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Arthroscopic Suture to Loop Fixation of PCL Tibial Avulsion Fracture

Zhao¹,

Tang²

2022

Minimally Invasive Functional Reconstruction of the Knee

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Outcome of screw post fixation of neglected posterior cruciate ligament bony avulsions

Cited by 6 publications

References 24 publications

Arthroscopic Suture Fixation With Autograft Augmentation Reconstruction for Delayed Tibial Avulsion Fractures of the Posterior Cruciate Ligament

Arthroscopic Suture Fixation With Autograft Augmentation Reconstruction for Delayed Tibial Avulsion Fractures of the Posterior Cruciate Ligament

Management of Medial Collateral Ligament Insufficiency During Total Knee Arthroplasty with a Screw and Rectangular Spiked Washer: A Case Series of 14 Patients

Arthroscopic Suture to Loop Fixation of PCL Tibial Avulsion Fracture

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