Arthroscopy Mini-plate Fixation with the Posterior Trans-septal Portal for Treating Posterior Cruciate Ligament Tibial Avulsion Fractures

2020 ◽  
Author(s):  
Chunlei Wang ◽  
Haisen Zhang ◽  
Longjie Li ◽  
Si Chen ◽  
Chang Liu
Keyword(s):  
Posterior Cruciate Ligament ◽  
Plate Fixation ◽  
Cruciate Ligament ◽  
International Knee Documentation Committee ◽  
Fracture Site ◽  
Avulsion Fractures ◽  
Conventional Open Surgery ◽  
Mini Plate ◽  
Pcl Avulsion

Abstract Background Posterior cruciate ligament (PCL) avulsion fractures are rare and difficult to treat. The present work aimed to examine the effect of an innovative arthroscopy method for the treatment of PCL tibial avulsion fractures using mini-plate reduction and fixation through two tibial tunnels and the posterior trans-septal portal.Methods Totally 19 patients (median age, 33 years; range, 23–43 years) with PCL tibial avulsion fractures who underwent treatment with an arthroscopic suture bridge method were retrospectively assessed. Knee function pre-operation and at last follow up was assessed via Lysholm and Tegner scores. A KT-2000 arthrometer was employed for determining knee stability, the range of motion (ROM), and side-to-side differences. Plain radiography and International Knee Documentation Committee (IKDC) exams were performed for patient evaluation.Results No patient was switched to conventional open surgery due to difficult intraoperative procedures. Mean post-surgical Lysholm and Tegner scores (P < 0.001) were significantly improved in comparison with presurgical values. KT-2000 examination revealed markedly reduced side-to-side differences at last follow-up than observed preoperatively (1.2 ± 0.6 VS. 9.3 ± 2.2; P < 0.001). Radiography at the final follow up revealed solid union at the fracture site in the totality of 19 cases.Conclusions This new arthroscopy mini-plate fixation and posterior trans-septal method for posterior cruciate ligament tibial avulsion fractures resulted in good clinico-radiological outcomes, with adequate stability and fracture site healing. It could be employed to repair avulsion fragments of various sizes.Level of evidence IV

Treatment of Posterior Cruciate Ligament Tibial Avulsion: A New Modified Open Direct Lateral Posterior Approach

2020 ◽  
Author(s):  
Sohrab Keyhani ◽  
Mehran Soleymanha ◽  
Amir Salari
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
International Knee Documentation Committee ◽  
Posterolateral Approach ◽  
Avulsion Fractures ◽  
Long Term Follow Up ◽  
Lateral Posterior ◽  
Cancellous Screws ◽  
Pcl Avulsion

AbstractThe optimal operative technique for the treatment of the tibial-side avulsion injuries of the posterior cruciate ligament (PCL) is debatable. This study was aimed to evaluate the postoperative outcomes and complications if any after an open direct, posterolateral approach using cannulated cancellous screw fixation of a PCL tibial avulsion. From January 2016 to June 2018, 17 patients (14 males and 3 females) with PCL avulsion fraction treatment—who underwent open reduction and internal fixation using cannulated cancellous screws—were included in this prospective study. A direct posterolateral approach in the prone position was used in all cases. The Lysholm's knee score and International Knee Documentation Committee (IKDC) score were assessed preoperatively and during regular follow-up examinations for at least 1 year (12–20 months) postoperatively. All patients had fracture union and all of their knees were stable upon physical examination. No nerve or blood vessel injuries occurred. The mean Lysholm's scores and mean IKDC scores were improved significantly at the last follow-up. This study provides evidence that open direct posterolateral approach may be reliable for the treatment of tibial-sided bony PCL avulsion fractures. This approach can provide direct visualization of the posterior capsule and PCL avulsion site associated with good reduction and stable fixation, easy application of the screws directly from posterior to anteriorly without extensive soft tissue damage. Nevertheless, long-term follow-up is recommended.

scholarly journals Clinical outcome of arthroscopic management of isolated posterior cruciate ligament injuries

2016 ◽  
Vol 2 (4) ◽  
pp. 411
Author(s):  
Suresh Perumal ◽  
Sadem Amer ◽  
Prakash Ayyadurai ◽  
Arumugam Sivaraman
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
International Knee Documentation Committee ◽  
Hamstring Tendon ◽  
Lysholm Score ◽  
Radiographic Evaluation ◽  
Pcl Reconstruction ◽  
Avulsion Fractures ◽  
Arthroscopic Management

<p class="abstract"><strong>Background:</strong> Isolated posterior cruciate ligament<strong> (</strong>PCL) injuries are considered as benign and treated conservatively. But studies have shown the long term outcomes of these patients are poor. Aim of this study is to determine the functional outcomes, efficacy, and complication of isolated PCL injuries treated by arthroscopic PCL reconstruction or fixation.</p><p class="abstract"><strong>Methods:</strong> 24 patients, each with an isolated PCL injury, (17 with complete PCL tear and 7 with PCL avulsion fracture) were enrolled in this prospective study. Patients with complete tear underwent PCL reconstruction with hamstring tendon autograft and patients with displaced avulsion fractures underwent arthroscopic fixation with suture bridge technique. Average age at time of surgery was 33 years. Average time from injury to surgery was 1 month. Average follow-up period was 18 months. Patients underwent regular follow-up postoperatively with clinical and radiographic evaluation. Follow-up examinations comprised the Lysholm knee score, the International Knee Documentation Committee (IKDC) score.<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean preoperative Lysholm score for 24 knees was 41; mean postoperative Lysholm score was 90. Eighteen of 24 patients had excellent results, and 4 patients had good results and 2 patients have fare result at final assessment. IKDC ratings showed significant improvements on subsequent follow ups. In final IKDC ratings, 21 patients were assessed as normal or near normal (grade A or B).</p><p class="abstract"><strong>Conclusions:</strong> The short-term follow-up, analytical results showed good function after arthroscopic management in isolated PCL injuries. Hence we recommend surgical intervention in isolated PCL injuries.</p>

scholarly journals Arthroscopic Standard Anterior and Posteromedial Portal Posterior Cruciate Ligament Reconstruction With Remnant Preservation : 2-Year Follow-up

2020 ◽  
Vol 8 (B) ◽  
pp. 418-422
Author(s):  
Sholahuddin Rhatomy ◽  
Erwin Saspraditya ◽  
Riky Setyawan
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
International Knee Documentation Committee ◽  
Pcl Reconstruction ◽  
Remnant Preservation ◽  
Lysholm Knee Score ◽  
Ikdc Score ◽  
Grade 3 ◽  
Pcl Injury

BACKGROUND: Grade 3 posterior cruciate ligament (PCL) injury needs surgical intervention, but there is no consensus on the optimal technique in PCL reconstruction. The old technique always removes the remnant for good visualization of tunnel replacement. Recently, many studies proposed the concept of preservation of PCL remnant with achieve good visualization. AIM: The aim of the study is to evaluate PCL reconstruction with remnant preservation using the standard anterior and posteromedial portal at 2-year follow-up. METHODS: We conducted a cohort retrospective study between January 2013 and December 2015. In this study, 25 patients underwent PCL reconstruction using the standard anterior and posteromedial portal with remnant preservation. We used quadrupled hamstring autograft. The patients were assessed using the International Knee Documentation Committee (IKDC) score, Lysholm Knee Score, Modified Cincinnati Score, and knee society score (KSS) at pre-operative and 2-year post-operative. Range of motion (ROM) and complications were evaluated postoperatively. RESULTS: The mean diameter of the quadruple hamstring graft was 8 mm. Clinical outcomes enhanced significantly (p < 0.05). The average of Lysholm activity scale improved from 65.12 ± 10.48 to 94.96 ± 4.80. The IKDC score improved from 60.50 ± 15.10 to 95.60 ± 3.44. Modified Cincinnati score improved from 62. 28 ± 13.6 to 96.04 ± 1.62. The KSS also improved from 60.12 ± 18.01 to 94.88 ± 6.36. Twenty-two patients had 0–135° full ROM and three patients had 0–110° ROM. Two patients had surgical site infection but recovered with local debridement. CONCLUSION: PCL reconstruction using the standard anterior and posteromedial portal with remnant preservation at 2-year follow-up resulted in satisfactory clinical and functional outcomes.

scholarly journals An Unusual Case of Anteriorly Displaced Posterior Cruciate Ligament Tibial Attachment Avulsion Injury

2019 ◽  
Vol 7 (21) ◽  
pp. 3623-3625
Author(s):  
Pamudji Utomo ◽  
Asep Santoso ◽  
Iwan Budiwan Anwar ◽  
Tangkas SMHS Sibarani ◽  
Bintang Soetjahjo ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Unusual Case ◽  
Cruciate Ligament ◽  
Plain Radiograph ◽  
Avulsion Injury ◽  
Satisfactory Outcome ◽  
Surgical Fixation ◽  
Bony Fragment ◽  
Pcl Avulsion

BACKGROUND: Avulsion injury to the tibial attachment of posterior cruciate ligament (PCL) is frequently occur. The purpose of this report is to highlight an unusual variation of PCL avulsion injury. CASE PRESENTATION: A 24-year-old female was suffered a motorcycle accident 1 day before admission. The patient complained of severe right knee pain. Plain radiograph and CT-scan revealed an anteriorly displaced tibial attachment PCL avulsion fracture. Open surgical fixation was done to the patient. A satisfactory outcome was observed until the final 1-year follow-up. CONCLUSIONS: The bony fragment of the tibial attachment of posterior cruciate ligament avulsion injury can be displaced to the anterior compartment of the knee. Concomitant injury to other knee structures should be suspected when finding this case. Special consideration is also needed during the management of this unusual case.

scholarly journals Arthroscopic reattachment of tibial avulsion fractures of the posterior cruciate ligament using ABS button and tightrope (Mohandas Jagsun technique)

2018 ◽  
Vol 5 (1) ◽  
pp. 167
Author(s):  
Jagadeesh P. C. ◽  
Sampath Kumar Vallabhaneni ◽  
Prathish Rao Vennamaneni ◽  
Musthafa Bhathia
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Avulsion Fractures ◽  
Osseous Union ◽  
Tight Rope ◽  
Ikdc Score ◽  
Type 3

<p class="abstract"><strong>Background:</strong> Avulsion fractures of tibial insertion of the posterior cruciate ligament are rare among the knee injuries. Purpose of this study is to determine the functional outcome of arthroscopic reattachment of tibial avulsion of the Posterior cruciate ligament by ABS button (Arthrex) and tight rope.</p><p class="abstract"><strong>Methods:</strong> 15 Patients with PCL avulsion fracture were included. The Inclusion criteria were: 1) Displaced avulsion fractures (type-2 and type-3). They were followed at regular intervals using IKDC score, Lysholm score and subjective questionnaire.<strong></strong></p><p class="abstract"><strong>Results:</strong> All cases showed complete osseous union during follow up. All knees are stable on examination by posterior sag sign and posterior drawer test. Two patients had loss of about 10<sup>0 </sup>flexion. According to the IKDC form assessment 13 patients classified as normal and 2 were classified as near normal.</p><p><strong>Conclusions:</strong> Arthroscopic reattachment of tibial avulsion fractures of the posterior cruciate ligament using ABS button and tightrope<strong> </strong>gives fairly good clinical outcomes. </p>

scholarly journals Surgical fixation of posterior cruciate ligament avulsion fracture from tibial attachment using cannulated cancellous screw: a clinical, radiological and functional outcome evaluation

2021 ◽  
Author(s):  
Aniruddha Mondal ◽  
Ayon Das
Keyword(s):  
Posterior Cruciate Ligament ◽  
Avulsion Fracture ◽  
Screw Fixation ◽  
Cruciate Ligament ◽  
Tertiary Care ◽  
Outcome Evaluation ◽  
Cancellous Screw ◽  
Avulsion Fractures ◽  
Surgical Fixation

<p class="abstract"><strong>Background:</strong> PCL (posterior cruciate ligament) is the main posterior stabilizer of the knee and plays a role in central axis controlling and imparting rotational stability to the knee. Injury to PCL presents commonly with avulsion fractures from its tibial attachment. An avulsion fracture of the PCL, if not surgically fixed, may lead to secondary changes in the knee joint. The aim of the study was to evaluate the clinical and functional results in patients with PCL tibial avulsion fractures treated by CC (cannulated cancellous) screw fixation.</p><p class="abstract"><strong>Methods:</strong> This was a prospective study conducted at a tertiary care government hospital in Kolkata, between December 2018 to July 2020 on patients who underwent CC screw fixation for post-traumatic PCL avulsion fracture from tibial site. All patients were followed up for 9 months. Lysholm knee score was used to assess the functional outcomes of the patients.<strong></strong></p><p class="abstract"><strong>Results:</strong> In a total of 10 patients, 9 (90%) patients showed excellent and 1 (10%) patient had good result during the final follow-up. 80% patients did not develop any complications. At the end of 9 months, the mean Lysholm score was 95.6. 8 (80%) patients achieved almost full knee ROM post-operatively by the end of final follow-up.</p><p class="abstract"><strong>Conclusions:</strong> Surgical fixation using CC screws is a simple, easy, safe and reproducible method without requiring significant expertise for achieving good stability in PCL tibial site avulsion fractures, where early intervention prevents significant late disability as it provides an excellent clinical, functional and radiographic outcome along with good joint function.</p><p> </p>

scholarly journals Management of posterior cruciate ligament avulsion by cannulated screw fixation

2013 ◽  
Vol 34 (3) ◽  
pp. 28-31 ◽  
Author(s):  
A Lamichhane ◽  
DP Mahara
Keyword(s):  
Posterior Cruciate Ligament ◽  
Screw Fixation ◽  
Cruciate Ligament ◽  
Preoperative Evaluation ◽  
Cannulated Screw ◽  
Rotational Stability ◽  
Institute Of Medicine ◽  
Range Of Movement ◽  
Pcl Avulsion

Introduction: Posterior cruciate ligament (PCL) is the main posterior stabilizer of the knee. The PCL also plays a role as a central axis controlling and imparting rotational stability to the knee. The most effective management of posterior cruciate ligament (PCL) injuries remains unclear and the natural history of untreated PCL injuries is controversial. The need for surgical repair of displaced bony PCL avulsions is less controversial. Here we present repair of PCL avulsion by screw fixation. Methods: There were total of 18 patients (Male 12 and Female 6) operated for isolated PCL avulsion from tibia during the period from 2002 to 2010. Preoperative evaluation was done clinically and radiologically .MRI was advised for suspected other ligaments and meniscal injuries. Patients with other ligaments and meniscal injury were not included in this series. All cases operated by simplified approach described by Burks and Schaffer. Avulsed fragment was reduced and xed with 4 mm a cannulated screw. Evaluation of the patients were done clinically, radilologically and using functional scale of Tegner-Lysholm. Results: Out of 18 patients, 12 patients were male and 6 patients were female. Average age of the patients was 29yrs (range 18-47 yrs). Average period of follow up was 31 months (ranging 12 - 52 m). Range of movement was found full in all patients at the last follow up. Grade 1-2 laxity was found in 8 patients but subjectively they were not aware of the laxity. Average Lysholm score was 91 (range 87-97). Conclusion: Improvised approach by Burk and Schaffer is safer and easier than the classical one. Open reduction and fixation with cannulated screw is one of the excellent techniques for tibial avulsion of posterior cruciate ligament. DOI: http://dx.doi.org/10.3126/joim.v34i3.8914 Journal of Institute of Medicine, December, 2012; 34:28-31

scholarly journals Arthroscopic Standard Anterior and Posteromedial Portal Posterior Cruciate Ligament Reconstruction With Remnant Preservation: 2-Year Follow-up

2019 ◽  
Vol 12 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Sholahuddin Rhatomy ◽  
Erwin Saspraditya ◽  
Riky Setyawan
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
International Knee Documentation Committee ◽  
Pcl Reconstruction ◽  
Remnant Preservation ◽  
Lysholm Knee Score ◽  
Ikdc Score ◽  
Grade 3 ◽  
Pcl Injury

Background: Grade 3 Posterior Cruciate Ligament (PCL) injury needs surgical intervention, but there is no consensus on the optimal technique in PCL reconstruction. The old technique always removes the remnant for good visualization of tunnel replacement. Recently, many studies proposed the concept of the preservation of PCL remnant with achieving good visualization. The aim of the study is to evaluate PCL reconstruction with remnant preservation using the standard anterior and posteromedial portal at 2-years follow-up. Methods: We conducted a cohort retrospective study between January 2013 to December 2015. In this study, 25 patients underwent PCL reconstruction using standard anterior and posteromedial portal with remnant preservation. We used quadrupled hamstring autograft. The patients were assessed using the International Knee Documentation Committee (IKDC) score, Lysholm knee score, Modified Cincinnati Score, and Knee Society Score (KSS) at pre-operative and 2-years post-operative. Range of Motion (ROM) and complication were evaluated post-operatively. Results: The mean diameter of the quadruple hamstring graft was 8 mm. Clinical outcomes enhanced significantly (p<0.05). The average Lysholm activity scale improved from 65.12 ± 10.48 to 94.96 ± 4.80. The International Knee Documentation Committee (IKDC) score improved from 60.50 ± 15.10 to 95.60 ± 3.44. The Modified Cincinnati Score improved from 62. 28 ± 13.6 to 96,04 ± 1.62. The KSS also improved from 60.12 ± 18.01 to 94.88 ± 6.36. 22 patients had 0-135° full ROM and 3 patients had 0-110° ROM. Two patients had surgical site infection but recovered with local debridement. Conclusion: PCL reconstruction using standard anterior and posteromedial portal with remnant preservation at 2 years follow up resulted in satisfactory clinical and functional outcomes.

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

2020 ◽  
Vol 8 (8) ◽  
pp. 232596712094404
Author(s):  
Mingguang Bi ◽  
Chen Zhao ◽  
Jihang Chen ◽  
Zheping Hong ◽  
Zhen Wang ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Case Series ◽  
Suture Fixation ◽  
Level Of Evidence ◽  
Avulsion Fractures ◽  
Posterior Drawer ◽  
Kt 1000 ◽  
The Mean

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.

Sign in / Sign up

Export Citation Format

Share Document