Tibial avulsion fracture of the posterior cruciate ligament: K-wire or screw fixation?

Abstract

Although the posterior cruciate ligament (PCL) is not frequently injured, a greater understanding of its role in stabilizing the knee joint, mechanism of injury and treatment has developed. Isolated avulsion injuries constitute only a subgroup of PCL injuries, but nevertheless several operative techniques have been described for the fixation of the avulsed bony fragment. In order to investigate whether K-wire or screw fixation yields better long-term results, we examined 26 patients at an average of 10.5 years after the initial operation. Clinical examination, activity level, radiographic evaluation and instrumented measurements did not reveal any significant differences. All the patients had an excellent functional result. Thus, both K-wire and screw fixation are recommended for bony PCL avulsion injuries.

Pediatric PCL Insufficiency from Tibial Insertion Osteochondral Avulsions

“…In adults, injuries to the PCL typically are limited to the substance of the ligament [30]. Bony avulsions, in which an osteochondral fragment is detached from the PCL insertion site, also have been reported in adults [5,8,11,17,22,23,29,33,35,39]. In the pediatric population, PCL injuries are rare, likely as a result of the elasticity of the ligament [9,10,28].…”

Tratamento cirúrgico da fratura-avulsão da inserção tibial do L.C.P. do joelho: experiência de 21 casos

“…In a study conducted on 36 patients with bone avulsion of the PCL in its tibial insertion, Torisu (8) found that the injury was secondary to a motorcycle accident in 47% of the cases, and identified the presence of the injury on the anterior tibial surface in 47% of the patients. Seitz et al (10) retrospectively assessed 26 patients and found a similar mechanism of injury in 87% of the cases, and injury on the anterior leg surface in 100%. In our case series, 57% of the injuries were resultant from motorcycle accidents, and 17% have been caused by car accidents, while the presence of injury on the anterior leg surface was found in 62% of the cases.…”

“…Torisu (9) assessed 21 patients with avulsion fracture of the tibial insertion of PCL, affecting males in 76% of the cases. Seitz et al (10) in a retrospective study with 26 patients, reported 73% of male cases, with a mean age of 23 years. In this study, patients' ages ranged from 15 to 53 years (mean = 29 years), and 76% were males.…”

“…Many authors have emphasized that surgical reinsertion of the PCL fragment yields better results when compared to conservative treatment. Surgery enables measures such as a deeper tibial insertion site of the PCL, stiff fixation of the bone fragment, made by screws and washers, to aid PCL retensioning, and, consequently, a better clinical evolution (9,10,12,14,15) . Additionally, the time elapsed between injury and surgical procedure is an important factor that must be considered.…”

“…In this case series, in 95% of the cases, surgery was made within up to 15 days after injury, and the mean surgery time was 30 minutes. In recent years, some publications have assessed alternatives to fixate bone fragments, as well as new suggestions on how to surgically address this injury, such as reduction control under arthroscopic view (2,10,16,17) . Inoue et al (18) conducted a prospective study intending to evaluate clinical prognosis of open reduction and PCL avulsion fracture fixation.…”