MINIMALLY INVASIVE TREATMENT OF POSTERIOR CRUCIATE LIGAMENT AVULSION FRACTURE IN A FLOPPY LATERAL POSITION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZHAOJunchao ¹ , WANGHao ²

1. Department of Orthopedics, Tianjin Hospital, Tianjin, 300211, P. R. China;
2. Department of Orthopedics, Affiliated Hospital of Logistics University of Chinese People's Armed Police Force;

Corresponding author：

ZHAOJunchao, Email: tjorzjc@163.com

Keywords：

Posterior cruciate ligament; Avulsion fracture; Floppy lateral position; Arthroscopy; Approach

DOI：

10.7507/1002-1892.20160218

Video：

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Objective To conclude the effectiveness of arthroscopy combined with Burks and SchaVer's approach in the treatment of posterior cruciate ligament (PCL) avulsion fractures in a floppy lateral position. Methods Between May 2010 and March 2014, 21 patients with PCL avulsion fractures were treated. There were 13 males and 8 females, aged 21 to 62 years (mean, 39.1 years). The causes included traffic accident injury in 10 cases, sports injury in 5 cases, and falling injury from height in 6 cases. The time from injury to hospital was 1-6 days (mean, 2.5 days). The results of posterior drawer test were all positive, and the results of anterior drawer test and lateral stress test were all negative. The Lysholm score was 28.0±5.5 before operation. And the American Orthopaedic Foot and Ankle Society (IKDC) score was 46.2±7.6 before operation. According to Meyer standards for fractures classification, 11 cases were rated as type II and 10 cases as type III. Arthroscopy was used to inspect and treat the intra-articular lesions, then avulsion fracture was fixed by Burks and SchaVer's approach in lateral position. Postoperative functional exercises were performed. Results Primary healing of incision was obtained, without nerve and vascular injury or joint infection. All patients were followed up 18-36 months (mean, 27.2 months). The X-ray films of the knee joint showed good fractures reduction and healing at 3 months after operation. The results of posterior drawer test and reverse Lachman test were negative. The knee range of motion was recovered to normal level. At last follow-up, the Lysholm score of the knee joint was significantly improved to 90.9±1.4 from preoperative one (t=54.584, P=0.000), and the IKDC score was significantly increased to 90.5±5.3 from preoperative one (t=15.638, P=0.000), including 19 cases of grade A and 2 cases of grade B. Conclusion A combination of arthroscopy and Burks and SchaVer's approach for the treatment of PCL avulsion fractures in a floppy lateral position has the advantages of minimal invasion and safe approach, short operative time, and early postoperative rehabilitation exercises, so it can provide satisfactory function recovery of the knee joint.

Citation： ZHAOJunchao, WANGHao. MINIMALLY INVASIVE TREATMENT OF POSTERIOR CRUCIATE LIGAMENT AVULSION FRACTURE IN A FLOPPY LATERAL POSITION. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(9): 1072-1075. doi: 10.7507/1002-1892.20160218 Copy

1.	Bali K, Prabhakar S, Saini U, et al. Open reduction and internal fixation of isolated PCL fossa avulsion fractures. Knee Surg Sports Traumatol Arthrosc, 2012, 20(2):315-321.
2.	Logan M, Williams A, Lavene J, et al. The effect of posterior cruciate ligament deficiency on knee kinerllatics. Am J Sports Med, 2004, 32(8):1915-1922.
3.	Nicandri GT, Klineberg EO, Wahl CJ, et al. Treatment of posterior cruciate ligament tibial avulsion fractures through a modified openposterior approach:operative technique and 12-to 48-month outcomes. J Orthop Trauma, 2008, 22(5):317-324.
4.	White EA, Patel DB, Matcuk GR, et al. Cruciate ligament avulsion fractures:anatomy, biomechanics, injury patterns, and approach to management. Emerg Radiol, 2013, 20(5):429-440.
5.	Chen SY, Cheng CY, Chang SS, et al. Arthroscopic suture fixation for avulsion fractures in the tibial attachment of the posterior cruciate ligament. Arthroscopy, 2012, 28(10):1454-1463.
6.	Chen W, Tang D, Kang L, et al. Effects of microendoscopy-assisted reduction and screw fixation through a single mini-incision on posterior cruciate ligament tibial avulsion fracture. Arch Orthop Trauma Surg, 2012, 132(4):429-435.
7.	Gwinner C, Kopf S, Hoburg A, et al. Arthroscopic treatment of acute tibial avulsion fracture of the posterior cruciate ligament using the TightRope fixation device. Arthrosc Tech, 2014, 3(3):e377-382.
8.	Huang W, Gong X, Rahul M, et al. Anterior arthroscopic-assisted fixation of posterior cruciate ligament avulsion fractures. Eur J Med Res, 2015, 20:88.
9.	Gwinner C, Hoburg A, Wilde S, et al. All-arthroscopic treatment of tibial avulsion fractures of the posterior cruciate ligament. GMS Interdiscip Plast Reconstr Surg DGPW, 2016.[Epub ahead of print].
10.	Hoogervorst P, Gardeniers JW, Moret-Wever S, et al. Pseudo-arthrosis repair of a posterior cruciate ligament avulsion fracture. Knee Surg Sports Traumatol Arthrosc, 2010, 18(11):1612-1616.
11.	Zhang X, Cai G, Xu J, et al. A minimally invasive postero-medial approach with suture anchors for isolated tibial avulsion fracture of the posterior cruciate ligament. Knee, 2013, 20(2):96-99.
12.	ChenW, Luo W, Chen Z, et al. Treatment of posterior cruciate ligament avulsion fractures of the tibia using a toothed plate and hollow lag screw. Singapore Med J, 2016, 57(1):39-44.
13.	Sasaki SU, da Mota e Albuquerque RF, et al. Open screw fixation versus arthroscopic suture fixation of tibial posterior cruciate ligament avulsion injuries:a mechanical comparison. Arthroscopy, 2007, 23(11):1226-1230.
14.	Jazayeri SM, Esmaili Jah AA, Karami M. A safe postero-medial approach to posterior cruciate ligament avulsion fracture. Knee Surg Sports Traumatol Arthrosc, 2009, 17(3):244-247.
15.	Kim SJ, Shin SJ, Cho SK, et al. Arthroscopic suture fixation for bony avulsion of the posterior ligament. Arthroscopy, 2001, 17(7):776-780.
16.	Gui J, Wang L, Jiang Y, et al. Single-tunnel fixation of posterior cruciate ligament avulsion fracture. Arthroscopy, 2009, 25(1):78-85.
17.	Zhang H, Hong L, Wang XS, et al. All-arthroscopic repair of arcuate avulsion fracture with suture anchor. Arthroscopy, 2011, 27(5):728-734.
18.	Feucht MJ, Salzmann GM, Pestka JM, et al. Simultaneous avulsion fracture of the posterior medial and posterior lateral meniscus root:a case report and review of the literature. Arch Orthop Trauma Surg, 2014, 134(4):509-514.
19.	Al-Ahaideb A. Posterior cruciate ligament avulsion fracture in children:a case report with long-term follow-up and comprehensive literature review. Eur J Orthop Surg Traumatol, 2013, 23 Suppl 2:257-260.
20.	Singla R, Devgan A, Gogna P, et al. Fixation of delayed union or non-union posterior cruciate ligament avulsion fractures. J Orthop Surg (Hong Kong), 2014, 22(1):70-74.
21.
22.	Veselko M, Saciri V. Posterior approach for arthroscopic eduction and antegrade fixation of avulsion fracture of the posterior cruciate ligament from the tibia with cannulated screw and washer. Arthroscopy, 2003, 19(8):916-921.
23.	Shino K, Nakata K, Mae T, et al. Arthroscopic fixation of tibial bony avulsion of the posterior cruciate ligament. Arthroscopy, 2003, 19(2):E12.

1. Bali K, Prabhakar S, Saini U, et al. Open reduction and internal fixation of isolated PCL fossa avulsion fractures. Knee Surg Sports Traumatol Arthrosc, 2012, 20(2):315-321.
2. Logan M, Williams A, Lavene J, et al. The effect of posterior cruciate ligament deficiency on knee kinerllatics. Am J Sports Med, 2004, 32(8):1915-1922.
3. Nicandri GT, Klineberg EO, Wahl CJ, et al. Treatment of posterior cruciate ligament tibial avulsion fractures through a modified openposterior approach:operative technique and 12-to 48-month outcomes. J Orthop Trauma, 2008, 22(5):317-324.
4. White EA, Patel DB, Matcuk GR, et al. Cruciate ligament avulsion fractures:anatomy, biomechanics, injury patterns, and approach to management. Emerg Radiol, 2013, 20(5):429-440.
5. Chen SY, Cheng CY, Chang SS, et al. Arthroscopic suture fixation for avulsion fractures in the tibial attachment of the posterior cruciate ligament. Arthroscopy, 2012, 28(10):1454-1463.
6. Chen W, Tang D, Kang L, et al. Effects of microendoscopy-assisted reduction and screw fixation through a single mini-incision on posterior cruciate ligament tibial avulsion fracture. Arch Orthop Trauma Surg, 2012, 132(4):429-435.
7. Gwinner C, Kopf S, Hoburg A, et al. Arthroscopic treatment of acute tibial avulsion fracture of the posterior cruciate ligament using the TightRope fixation device. Arthrosc Tech, 2014, 3(3):e377-382.
8. Huang W, Gong X, Rahul M, et al. Anterior arthroscopic-assisted fixation of posterior cruciate ligament avulsion fractures. Eur J Med Res, 2015, 20:88.
9. Gwinner C, Hoburg A, Wilde S, et al. All-arthroscopic treatment of tibial avulsion fractures of the posterior cruciate ligament. GMS Interdiscip Plast Reconstr Surg DGPW, 2016.[Epub ahead of print].
10. Hoogervorst P, Gardeniers JW, Moret-Wever S, et al. Pseudo-arthrosis repair of a posterior cruciate ligament avulsion fracture. Knee Surg Sports Traumatol Arthrosc, 2010, 18(11):1612-1616.
11. Zhang X, Cai G, Xu J, et al. A minimally invasive postero-medial approach with suture anchors for isolated tibial avulsion fracture of the posterior cruciate ligament. Knee, 2013, 20(2):96-99.
12. ChenW, Luo W, Chen Z, et al. Treatment of posterior cruciate ligament avulsion fractures of the tibia using a toothed plate and hollow lag screw. Singapore Med J, 2016, 57(1):39-44.
13. Sasaki SU, da Mota e Albuquerque RF, et al. Open screw fixation versus arthroscopic suture fixation of tibial posterior cruciate ligament avulsion injuries:a mechanical comparison. Arthroscopy, 2007, 23(11):1226-1230.
14. Jazayeri SM, Esmaili Jah AA, Karami M. A safe postero-medial approach to posterior cruciate ligament avulsion fracture. Knee Surg Sports Traumatol Arthrosc, 2009, 17(3):244-247.
15. Kim SJ, Shin SJ, Cho SK, et al. Arthroscopic suture fixation for bony avulsion of the posterior ligament. Arthroscopy, 2001, 17(7):776-780.
16. Gui J, Wang L, Jiang Y, et al. Single-tunnel fixation of posterior cruciate ligament avulsion fracture. Arthroscopy, 2009, 25(1):78-85.
17. Zhang H, Hong L, Wang XS, et al. All-arthroscopic repair of arcuate avulsion fracture with suture anchor. Arthroscopy, 2011, 27(5):728-734.
18. Feucht MJ, Salzmann GM, Pestka JM, et al. Simultaneous avulsion fracture of the posterior medial and posterior lateral meniscus root:a case report and review of the literature. Arch Orthop Trauma Surg, 2014, 134(4):509-514.
19. Al-Ahaideb A. Posterior cruciate ligament avulsion fracture in children:a case report with long-term follow-up and comprehensive literature review. Eur J Orthop Surg Traumatol, 2013, 23 Suppl 2:257-260.
20. Singla R, Devgan A, Gogna P, et al. Fixation of delayed union or non-union posterior cruciate ligament avulsion fractures. J Orthop Surg (Hong Kong), 2014, 22(1):70-74.
21.
22. Veselko M, Saciri V. Posterior approach for arthroscopic eduction and antegrade fixation of avulsion fracture of the posterior cruciate ligament from the tibia with cannulated screw and washer. Arthroscopy, 2003, 19(8):916-921.
23. Shino K, Nakata K, Mae T, et al. Arthroscopic fixation of tibial bony avulsion of the posterior cruciate ligament. Arthroscopy, 2003, 19(2):E12.

Chinese Journal of Reparative and Reconstructive Surgery

MINIMALLY INVASIVE TREATMENT OF POSTERIOR CRUCIATE LIGAMENT AVULSION FRACTURE IN A FLOPPY LATERAL POSITION

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