Pediatric Posterior Cruciate Ligament Avulsion Fracture of the Tibial Insertion: Case Report and Review of the Literature

Abstract

Background Posterior cruciate ligament (PCL) avulsion fracture of the tibial insertion is a very rare injury in children. In addition to performing an attentive clinical examination, radiologic studies are fundamental for its correct diagnosis and treatment. Its management may be either conservative or operative. So far, only a few cases treated conservatively have been reported in the pediatric population, with controversial results. Methods We prospectively collected and reviewed clinical and radiographic data of an 11-year-old boy with avulsion fracture of the tibial insertion of the PCL. In addition, we performed a systematic review of the literature available to date. Results We decided to treat the avulsion fracture in a conservative way. The patient has been followed with accurate clinical and radiological follow-up controls until complete recovery. Conclusion Posterior cruciate avulsion fracture is a very rare finding in children, and no definitive indications for its appropriate management exist. With this report, we demonstrate that these fractures can be treated conservatively in selected cases with good results, avoiding potential surgical-related complications. Study Design This is a case report (level of evidence V).

Avulsion fracture of the tibial insertion of the PCL in child – case report

“…Is well known fact that injuries to the PCL are infrequent at all ages, especially compared with those against the anterior cruciate ligament (ACL). PCL injuries generally present with immediate pain, swelling, and limitation of the range of motion [9,10]. Due to protective reflex muscle spasms and painful mobilization, appropriate knee examination is often difficult.…”

“…Although surgically treated seems to be more effective. It allows for early mobilization of the patient with shorter rehabilitation time [9,11]. When treated surgically more recent studies show successful outcomes with both the open and arthroscopic-assisted treatment [10].…”

“…Nonoperative management is based on restoration of the tibiofemoral relationship achieved where the fracture displacement is minimal. It is usually followed with immobilization and specific physical rehabilitation [9]. Nowadays there are currently a variety of surgical treatment for displaced PCL avulsion fractures.…”

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

“…This may be partly attributed to the fact that osteochondral avulsions of the PCL can be easily misdiagnosed on plain radiographs in children. In recent years, arthroscopic treatments of avulsion fractures from the tibial insertion of the PCL have been reported, but publications on the femoral avulsion of the PCL are still rare, and a “gold standard” of treatment is not yet available. This paper presented an extremely rare case of a PCL avulsion from the femoral insertion in association with a meniscus tear as well as its arthroscopic management in a child.…”

An Unusual Complex Posterolateral Osteoligamentous Injury of the Knee in an Adolescent

“…Ligament injuries of the knee in adolescents are relatively uncommon and usually present as avulsion fractures [1]. Both lateral collateral ligament (LCL) avulsion and posterior cruciate ligament (PCL) avulsion injuries are infrequent in children and adolescents [2,3]. Iliotibial band avulsion from the lateral tibial condyle is an even rarer injury in this group of patients [4].…”