While the arthroscopic group had somewhat higher subjective and objective knee outcome scores, it demonstrated a slightly higher rate of arthrofibrosis. A pseudoarthrosis repair of a 4yearold bony avulsion fracture of the pcl. Currently, the most common treatment used for complete restoration of pcl function after. Pcl injuries are less common than anterior cruciate ligament acl injuries. In literature, knee ligament injuries constitute a frequent topic in a. Surgical treatment of avulsion fractures of the knee pcl tibial. Because bone heals so well, avulsions are frequently reattached. Therefore, there are several activities that should be avoided early postoperatively with a pcl. The patient we presented here was admitted to receive treatment in june 2017, whose knee injury resulted in avulsion fractures at three sites, the femoral attachment of the pcl, the tibial insertion of the anterior cruciate ligament acl, and the. An avulsion is when a small piece of bone is detached with the ligament. Another patient with associated acetabulum fracture treated with plating 3. Pcl avulsion fracture something about radiology just. Pcl injuries usually happen when the tibia shin bone is pushed backwards at the knee. An avulsion fracture around the knee can be from several areas.
Posterior cruciate ligament injuries orthoinfo aaos. Management if instability is minimal a pcl rupture may be managed conservatively with a rehabilitation program. Lo veterans general hospitalaipei, taipei, taiwan, china twentyeight cases ofavubion injury of the posterior cruciate ligament pcl treated by reattachment were followed up to evaluate the results. Undiagnosed avulsion fractures can have serious sequelae.
Pdf arthroscopic suture fixation for avulsion fractures in the. Avulsion fractures of the posterior cruciate ligament pcl are uncommon. Displaced tibial posterior cruciate ligament pcl avulsion fractures require surgical fixation in order to provide an adequate bone healing and to avoid a loss of posterior stability. Posterior cruciate ligament pcl avulsion fractures are a type of avulsion fracture of the knee that represent the most common isolated pcl lesion. Discussion the posterior cruciate ligament pcl is the stronger of the two cruciate ligaments and is the primary restraint for posterior tibial translation during knee flexion 1. Usually they occur when the knee is stressed and tension is placed on a ligament or tendon and it pulls off a small piece of the bone that it is attached to. Isolated pcl disruption most commonly occurs as avulsion at its tibial insertion as opposed to its femoral origin or as a midsubstance tear.
Surgical treatments for pcl avulsion fractures of the tibia include arthroscopic repair as. Posterior cruciate ligament pcl tears are uncommon injuries, and posterior cruciate ligament avulsion fractures are an extremely rare variant of this injury. This can occur at the ligament by the application of forces external to the body such as a fall or pull or at the tendon by a muscular contraction that is stronger than the forces holding the bone together. The posterior cruciate ligament pcl is an important stabiliser of the knee. Posterior cruciate ligament avulsion from the tibia. Patellar fractures comprise 1% of the fractures in adults 1. The posterior cruciate ligament is in the back of the knee. Posterior cruciate ligament avulsion fractures ncbi. In patients with displaced tibialsided pcl avulsion fractures treated operatively, surgical approaches render similar outcomes and risks. Posterior cruciate ligament pcl disruption occurs in up to 20% of all knee liga ment.
Posterior cruciate ligament avulsion fracture in children. Management of posterior cruciate ligament tibial avulsion injuries. Posterior cruciate ligament tibial avulsion fracture blue arrow. Avulsion fracture of the posterior aspect of proximal tibia. Posterior cruciate ligament mediated avulsion fracture of. Xrays are commonly taken to rule out an avulsion fracture where bone has been pulled away from the top of the tibia with the ligament rupture. The pcl reconstruction rehabilitation is unique in that extreme knee flexion places a higher amount of stress on the newly reconstructed pcl. The early repair of the involved corner gives the best long. Often manifests radiographically as a tiny osseous fragment located adjacent to the expected attachment site of a ligament or tendon, although sometimes large avulsed fragments may. Since the pcl is strong, avulsion fractures of its attachment are common. The leg is brought into a figure 4 position, with the knee flexed to 90 degrees and the bump repositioned under the lateral ankle. A mri scan may be required to confirm a pcl rupture. This video showcases the open reduction and internal fixation of both an avulsed pcl tibial insertion and mcl femoral attachment in a patient with. A fracture is a break or crack in a bone that often results from an injury.
Injury to the posterior cruciate ligament pcl is relatively rare and, if combined with avulsion fracture of the pcl insertion site, it accounts for only a small number of knee injuries. Pcl avulsion fracture from its tibial insertion is an injury which, if diagnosed early and treated with the simple orif gives spectacular results. Avulsion injuries of the posterior cruciate ligament of the knee are relatively infrequent. To report clinical and functional outcomes following fixation of tibial avulsion fractures of posterior cruciate ligament pcl using spring plate through a modified open posterior approach. A pseudoarthrosis repair of a 4yearold bony avulsion fracture of the pcl using a minimally invasive technique, screw fixation, and bone grafting is reported. Simultaneous posterolateral and posteromedial portals were used to insert ligament sutures 23 gauge wire or multiple sutures or screw fixation. The posterior cruciate ligament pcl avulsion fracture from its tibial insertion is a rare condition. Allarthroscopic treatment of tibial avulsion fractures of. This typically involves separation of the posterior tibial insertion of the pcl to variable degrees. Pdf posterior cruciate ligament avulsion from the tibia.
Allarthroscopic posterior cruciate ligament distal reattachment. Surgical management of posterior cruciate ligament. A b figure 5 the tunnels were established at femoral attachment to tighten pcl. Most authors recommend primary operative repair, but there have been only a few series with documented results. Joint instability, posterior cruciate ligament, rehabilitation, functional outcome introduction posterior cruciate ligament pcl is the stronger of the two cruciate ligaments of knee and is a constraint to posterior dislocation of the knee in 90 degrees of flexion 1. This mechanism makes sense because this fracture involves the non accelerating.
Occult posterior cruciate ligament avulsion fracture in a paediatric patient. The patient is positioned supine, to facilitate arthroscopic examination. An avulsion fracture is a bone fracture which occurs when a fragment of bone tears away from the main mass of bone as a result of physical trauma. A retrospective, nonrandomized study of arthroscopically assisted pclavulsion reattachments in patients 14 knees are described. Management of posterior cruciate ligament tibial avulsion.
Fracture fragments due to pcl avulsion fracture of the tibia. On the other hand, avulsion fractures of the tibial condyle are also rare. Treatment of posterior cruciate ligament tibial avulsion. They may occur with anterior cruciate ligament acl or posterior cruciate ligament pcl tears, or injuries to the stabilizing structures of the. Isolated injuries are less common and surgery on the pcl has seen less popularity compared with other knee ligaments. Avulsion fracture of femoral attachment of posterior. Pcl avulsion fracture joseph junewick, md facr 07032010 history teenager with unstable knee.
Common structures involved are the acl, mcl, tibial tubercle, femoral epicondyle, patella, ect. A few mechanisms of pcl injuries have been proposed on the basis of the site of damage of the pcl. Damage to pcl either due to bony avulsion or intrasubstance rupture. Avulsion fractures to the tibial attachment of the posterior cruciate ligament. Pcl avulsion fracture arthroscopic fixation, a new. Pseudoarthrosis repair of a posterior cruciate ligament.
Pcl avulsion fracture normal lateral x ray medial and lateral intercondylar eminences should overlap with each other. Information from its description page there is shown below. Treatment of posterior cruciate ligament avulsion fractures of the. Clinical outcomes achieved at the objective evaluation suggest that this injury should be interpreted not only as a purely bone injury, but also as a boneligament injury. In contrast to the aclmcl injury pattern reconstruct acl and rom brace for mcl 4. We report a pclmediated avulsion fracture of the lateral tibial condyle.
Evaluation of the pcl is notoriously difficult both clinically and arthroscopically. Twentythree patients with an isolated avulsion type injury of the pcl were operated on in our department during the last 15 years. When it is avulsed, this results in posterior subluxation of the tibia, wherein an. Suture bridge fixation technique for posterior cruciate ligament avulsion fracture article pdf available in clinics in orthopedic surgery 74. We present the case of a 23yearold man with patellar fracture and avulsion fracture of the tibial pcl attachment after sustaining a direct contact injury. Joints are named for the two bones that articulate with each other.
With an avulsion fracture, an injury to the bone occurs near where. Despite the further technical advent in refixation of avulsion fractures, the reported failure rate of current approaches remains high and the optimal surgical technique has not been elucidated yet. Pseudoarthrosis repair of a posterior cruciate ligament avulsion. There was a good functional result following minimally invasive pseudoarthrosis repair of a. Tibial avulsion fractures of pcla comparison of outcomes. Most people think of the tibiofemoral joint when thinking of the knee.
Pd sagittal image showing joint effusion and altered signal of the posterior cruciate ligament. Case report transverse patellar fracture with avulsion fracture of. Open posterior approach for internal fixation of pcl. The avulsion fracture of the femoral attachment from the posterior cruciate ligament pcl is quite rare, particularly in adults. Rehabilitation guidelines for posterior cruciate ligament reconstruction the knee has three jointsthe patellofemoral joint knee cap, the tibiofemoral joint and the tibiofibular joint. Diagnosis pcl avulsion fracture additional clinical motor vehicle accident with recent fixation of femur fracture.
Bony avulsion fracture of the posterior cruciate ligament constitutes 340% of all acute knee joint injuries of which 35% are displaced nonsurgical treatment of displaced pcl avulsion fractures have a high incidence rate of nonunion or malunion and can cause loss of ligament function, leading to further knee instability and traumatic arthritis. There is an avulsion fracture of the pcl type 1 at its insertion on the posterior tibial eminence, most likely secondary to an impact of the tibia on the cars dash. The most common mechanism of avulsion fractures of the pcl at the tibial insertion is a dashboard injury, in which the knee is in a flexed position, and a posteriorly. Chronic instability and early degenerative changes can develop as a result of delayed diagnosis. Avulsion fracture of the posterior cruciate ligament pcl is a relatively uncommon injury. Posterior cruciate ligament avulsion fracture radiology. Tackle first and then acl same sitting or second sitting 3. Tibial avulsion of pcl the pcl tibial avulsion is approached similarly to tibial inlay reconstruction. Injuries are often due to a blow to the knee while it is bent. Avulsion fractures of the posterior cruciate ligament pcl are a rare, but serious, knee pathology.
October 2014 this video describes arthroscopic technique for pullout repair of pcl avulsion with small bony fragment. A pcl injury most commonly results in an intrasubstance tear. An avulsion fracture involves the detachment of a bone fragment from the pulling away of a ligament, tendon, or joint capsule from its point of attachment on a bone. Painful left knee after twisted injury following a fall. To report clinical and functional outcomes following fixation of tibial posterior cruciate ligament pcl avulsion fractures through a modified open posterior approach when combined with a rehabilitation program emphasizing early range of motion.
The most common mechanism of avulsion fractures of the pcl at the tibial insertion is a dashboard injury, in which the knee is in a flexed position, and a posteriorly directed force is applied to the pretibial area. Management of avulsion injury of the pcl with reattachment. Pdf on aug 17, 2015, tarek boutefnouchet and others published posterior cruciate ligament avulsion injury find, read and cite all the. On the basis of the site of damage of the pcl, hyperflexion, pretibial trauma, and hyperextension are proposed as mechanisms of pcl injuries. An injury to the posterior cruciate ligament requires a powerful force. Originates from the anterolateral medial femoral condyle and inserts on the posterior. It is one of several ligaments that connect the thighbone to the shinbone. Clinical examination in children can be difficult as they are often irritable and uncooperative. This keywords kneeligamentinjuries medial collateral ligament avulsion posterior cruciate ligament tear combined ligament injuries surgical repair abstract medial collateral ligament mcl of the knee is one of the most commonly injured. The case presented seems to be rather unique due to the fragment size and the approach for pseudoarthrosis repair. Occult posterior cruciate ligament avulsion fracture in a. Surgical treatment of avulsion fractures of the knee pcl.
Rehabilitation guidelines for posterior cruciate ligament. Posterior cruciate ligament tibial avulsion treated with. Arthroscopic pullout repair of pcl avulsion vumedi. Pcl function after an avulsion fracture is surgery using internal fixation. Pdf posterior cruciate ligament avulsion injury researchgate. Isolated avulsion fracture of the tibial attachment of the. For the indian population, the most common mode of injury is due to motor vehicle accidents and contact sports. Surgical treatment of avulsion fractures at the tibial. Pdf suture bridge fixation technique for posterior. Case report transverse patellar fracture with avulsion. Figure 6 twomonth followup, xray indicated good reduction. Fixation of posterior cruciate ligament avulsion fractures.
668 385 99 1587 859 1181 996 518 749 29 8 1343 949 402 798 333 1012 364 1366 405 1480 373 463 463 1489 1346 842 1331