The amount of displacement can determine non-operative treatment in posterior cruciate ligament avulsion fracture

Abstract

Purpose It is generally agreed that surgical treatment is warranted for acute posterior cruciate ligament (PCL) avulsion fracture with displacement. However, the amount of displacement that warrants surgical treatment has not been deined. The purpose of this study was to determine the optimal cut-of value for displacement of posterior cruciate ligament avulsion fracture in determining non-operative treatment and to compare the results of non-operative treatment in acute isolated PCL avulsion fractures with non-operative treatment of acute PCL injury. Methods Between 2007 and 2017, 30 consecutive patients with acute isolated PCL avulsion fractures and 70 consecutive patients with acute isolated PCL injuries, all of whom underwent non-operative treatment (cast immobilization with > 2 years of follow-up) were retrospectively analyzed. Clinical scores including the International Knee Documentation Committee subjective score, Lysholm score, and Tegner activity score, as well as side-to-side diferences on stress radiographs, were compared between the PCL avulsion fracture and PCL injury groups at the inal follow-up. The failure rates of non-operative treatment were also compared. The predictive value of the amount of fracture displacement for successful non-operative treatment was calculated using area under the receiver operating characteristic curve (AUROC). The optimal cut-of of the amount of fracture displacement to determine non-operative treatment was based on the maximal sum of sensitivity and speciicity. ResultsThe two groups exhibited comparable clinical scores and mean side-to-side diferences on stress radiographs. There were 5 (16.6%) failures of non-operative treatment in the PCL avulsion fracture group and 19 (27.1%) failures in the PCL injury group. (n.s) There was a signiicant positive correlation between the amount of initial avulsion fracture displacement and side-to-side diference in posterior stress radiographs at inal follow up (P < 0.001). The optimal cut-of value for the amount of fracture displacement in PCL avulsion fracture to predict failure of non-operative treatment was 6.7 mm (AUROC = 1.0). ConclusionThe outcomes of non-operative treatment of acute isolated PCL avulsion fractures were comparable to those of patients with acute isolated PCL injuries. Acute PCL avulsion injuries with displacement of less than 6.7 mm should be considered for non-operative treatment. Level of evidence IV.

Arthroscopic Suture-to-Loop Fixation of Posterior Cruciate Ligament Tibial Avulsion Fracture

“…Posterior cruciate ligament (PCL) avulsion fracture is a special kind of PCL injury and needs to be surgically addressed when the displacement or joint instability is severe. 1 Both open and arthroscopic procedures have been reported, and similar clinical results have been obtained. 2 , 3 Regarding open procedures, the fixation is direct and simple and there is no need for the learning curve of arthroscopic surgical procedures, 4 , 5 , 6 , 7 but these procedures are invasive.…”

Treatment of avulsion fracture of posterior cruciate ligament tibial insertion by minimally invasive approach in posterior medial knee

“…Zhao et al believed that nonsurgical treatment can be successfully used for fractures with displacement less than 5 mm (22). Yoon et al found that conservative treatment could achieve satisfactory results when the displacement of a simple PCL avulsion fracture was less than 6.7 mm (18). Although these conservative treatments have achieved good results, there are many complications in the late stages of the conservative treatment of displaced PCL tibial avulsion fractures, which are easy to lead to knee instability, severe mobility limitation, and knee degeneration.…”

Homemade pin-hook for surgical treatment of posterior cruciate ligament avulsion fractures

“…According to the commonly used Meyers-McKeever system, conservative therapy can yield good outcomes in individuals with Meyers-McKeever type I fractures, but type II and III fractures are typically treated surgically. Some scholars conclude that acute PCL avulsion injuries with displacements of less than 6.7 mm should be considered for nonoperative treatment [11]. Other researchers found that surgery can help restore the tension of the PCL and obtain a better prognosis than nonsurgical treatment.…”