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

Gopinatth, Varun; Mameri, Enzo S.; Casanova, Felipe J.; Khan, Zeeshan A.; Jackson, Garrett R.; McCormick, Johnathon R.; Brophy, Robert H.; Knapik, Derrick M.; LaPrade, Robert F.; Chahla, Jorge

doi:10.1177/23259671231188383

Cited by 4 publications

(2 citation statements)

References 74 publications

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“…Although there is currently no consensus, we believe that PCL avulsion fractures generally require surgical intervention. Operative treatment of PCL avulsion fractures achieves a high rate of fracture union with excellent restoration of posterior tibial translation [ 14 ]. Nonsurgical treatment is reserved for nondisplaced or minimally displaced avulsions in the absence of concomitant ligament injuries.…”

Section: Discussionmentioning

confidence: 99%

Open Repair of Posterior Cruciate Ligament Tibial Bony Avulsion With Metal Anchor: A Case Report

Bonaspetti,

Tonolini,

Dib

et al. 2024

Case Reports in Orthopedics

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Introduction: The posterior cruciate ligament (PCL) is the largest and strongest intra‐articular ligament of the knee joint and the primary posterior stabilizer. PCL injuries are less frequent than other knee ligament injuries and are typically combined with meniscal and chondral injuries or in the context of multiligamentous injuries. It is critical to properly diagnose and treat these lesions in order to avoid the risk of PCL insufficiency, subsequent knee instability, and early osteoarthritis. Surgical management can vary, and the ideal fixation device is still debated. Suture anchors are an unusual mean of fixation of PCL tibial bony avulsion. We report on two patients treated with open anchor fixation for PCL tibial bony avulsion with a follow‐up of 3 years.Case Presentation: A 15‐year‐old male and a 65‐year‐old male were treated with open anchor fixation for bony tibial avulsion of the PCL. Surgical treatment was performed at 5 weeks and 3 weeks after the trauma, respectively. Diagnosis was made with an X‐ray followed by CT and MR scans. Repair was achieved by reinserting the PCL bony fragment to its posterior tibial eminence with suture anchors through an open posterior approach. Both patients recovered full knee stability and a pain‐free full range of motion (ROM) within 4 months and returned to their previous activities with a high satisfaction. The patient has been followed up for 3 years, and no complications were observed.Conclusion: PCL bony avulsions are rare, and their optimal treatment remains a significant subject of debate, particularly in the skeletally immature patient. We believe that open repair with metal anchors could be a good choice to repair PCL bony tibial avulsion in patients without concomitant intra‐articular lesions and immature growth plates or severe fragmentation.

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Section: Discussionmentioning

confidence: 99%

Open Repair of Posterior Cruciate Ligament Tibial Bony Avulsion With Metal Anchor: A Case Report

Bonaspetti,

Tonolini,

Dib

et al. 2024

Case Reports in Orthopedics

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“…While conservative management may be considered for nondisplaced avulsion fractures, surgical intervention is typically indicated for displaced fractures to re-establish joint stability and function[ 6 , 7 ]. Traditionally, open surgical techniques have been the mainstay for the fixation of tibial avulsion fractures.…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic M-shaped suture fixation for tibia avulsion fracture of posterior cruciate ligament: A modified technique and case series

Zhang,

Yu,

Zhao

et al. 2024

World J Orthop

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BACKGROUND Tibial avulsion fractures of the posterior cruciate ligament (PCL) are challenging to treat and compromise knee stability and function. Traditional open surgery often requires extensive soft tissue dissection, which may increase the risk of morbidity. In response to these concerns, arthroscopic techniques have been evolving. The aim of this study was to introduce a modified arthroscopic technique utilizing an M-shaped suture fixation method for the treatment of tibial avulsion fractures of the PCL and to evaluate its outcomes through a case series. AIM To evaluate the effects of arthroscopic M-shaped suture fixation on treating tibia avulsion fractures of the PCL. METHODS We developed a modified arthroscopic M-shaped suture fixation technique for tibia avulsion fractures of the PCL. This case series included 18 patients who underwent the procedure between January 2021 and December 2022. The patients were assessed for range of motion (ROM), Lysholm score and International knee documentation committee (IKDC) score. Postoperative complications were also recorded. RESULTS The patients were followed for a mean of 13.83 ± 2.33 months. All patients showed radiographic union. At the final follow-up, all patients had full ROM and a negative posterior drawer test. The mean Lysholm score significantly improved from 45.28 ± 8.92 preoperatively to 91.83 ± 4.18 at the final follow-up (P < 0.001), and the mean IKDC score improved from 41.98 ± 6.06 preoperatively to 90.89 ± 5.32 at the final follow-up (P < 0.001). CONCLUSION The modified arthroscopic M-shaped suture fixation technique is a reliable and effective treatment for tibia avulsion fractures of the PCL, with excellent fracture healing and functional recovery.

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Clinical efficacy of arthroscopic high-intensity suture binding combined with button plate suspension fixation in the treatment of posterior cruciate ligament tibial avulsion fractures

Zhang,

Liu,

Chen

et al. 2024

J Orthop Surg Res

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Purpose To assess the clinical efficacy of arthroscopic treatment for posterior cruciate ligament (PCL) tibial avulsion fractures using high-intensity suture binding combined with button plate suspension fixation. Methods We retrospectively analyzed clinical data from 32 patients with PCL tibial avulsion fractures treated at our hospital from July 2020 to August 2023. We recorded operation time, intraoperative and postoperative complications, and used imaging to assess fracture reduction and healing. Pain and knee function were evaluated using the Visual Analogue Scale (VAS), range of knee motion, Lysholm score, and International Knee Documentation Committee (IKDC) score. Study Design Case series; Level of evidence, 4. Results All patients were followed for 6 to 18 months, averaging 13.6 months. All incisions healed successfully without postoperative complications. X-rays taken on the first postoperative day showed satisfactory fracture reduction. Three-month post-surgery imaging confirmed healed fractures and no internal fixation failures. At the final follow-up, knee function was well recovered, with only one patient exhibiting a positive posterior drawer test of degree I. Furthermore, the mean VAS score was 0. 5 (range 0.0 to 1.0), active knee extension was 2. 2° (range 0.0 to 5.0), and active knee flexion was 137.7° (range 130.0 to 145.0). The mean Lysholm score was 91.5(range 89.3 to 94.0), and the IKDC score averaged 83.8 ± 3.7, and these outcomes showed statistically significant improvement from preoperative levels (P < 0.001). Conclusions Arthroscopic high-intensity suture binding combined with button plate suspension fixation for PCL tibial avulsion fractures offers several benefits: it is minimally invasive, results in less postoperative pain, enables earlier functional exercise, and provides satisfactory clinical outcomes with fewer complications.

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

Cited by 4 publications

References 74 publications

Open Repair of Posterior Cruciate Ligament Tibial Bony Avulsion With Metal Anchor: A Case Report

Open Repair of Posterior Cruciate Ligament Tibial Bony Avulsion With Metal Anchor: A Case Report

Arthroscopic M-shaped suture fixation for tibia avulsion fracture of posterior cruciate ligament: A modified technique and case series

Clinical efficacy of arthroscopic high-intensity suture binding combined with button plate suspension fixation in the treatment of posterior cruciate ligament tibial avulsion fractures

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