ARTHROSCOPICALLY ASSISTED TREATMENT OF POSTERIOR CRUCIATE LIGAMENT AVULSION FRACTURE WITH MENISCUS POSTERIOR HORN TEAR_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIUYang , LIGang , ZHANGKeyuan , NIJiati ,  SUNXuebin

Department of Bone Disease and Sports Injury, the First Affiliated Hospital, Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China;

Corresponding author：

SUNXuebin, Email: sportsinjury@qq.com

Keywords：

Arthroscopy; Tibial eminence avulsion fracture; Posterior cruciate ligament; Meniscus

DOI：

10.7507/1002-1892.20160247

Video：

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Objective To evaluate the effectiveness of arthroscopically assisted treatment of posterior cruciate ligament (PCL) tibial eminence avulsion fractures associated with meniscus posterior horn tear. Methods Between January 2012 and December 2014, 21 patients with PCL avulsion fracture and meniscus posterior horn tear were arthroscopically treated with polyester suture and hollow screw fixation. There were 10 males (10 knees) and 11 females (11 knees), aged 14-53 years (mean, 35.7 years). The causes included sport injury in 11 cases, traffic accident injury in 9 cases, and daily life injury in 1 case. Based on the anteroposterior and lateral X-ray films, CT, and MRI, PCL avulsion fractures were diagnosed, and 2 cases had anterior cruciate ligament avulsion fractures. The results of posterior drawer test were positive in all patients, with no end point in 14 cases and with soft end point in 7 cases; all patients showed tibial sink. The preoperative International Knee Documentation Committee (IKDC) score and Lysholm score were 46.5±5.5 and 43.3±4.5 respectively. The time from injury to operation was 6-22 days (mean, 10 days). Results The operation time was 60-100 minutes (mean, 75 minutes). Primary healing of incision was obtained in all patients, without no complication of infection. The mean follow-up time was 27.4 months (range, 12-46 months). The results of posterior drawer test were negative in 19 cases, and positive in 2 cases (having hard end point). Tibial sink disappeared. At last follow-up, X-ray film showed good healing of fracture, and no displacement. The patients had no locking knee, snapping or tenderness of joint space, and the Mcmurray sign was negative; the IKDC score and Lysholm score were significantly improved to 92.0±2.5 and 92.7±2.6 respectively (t=-39.903, P=0.000; t=-43.242, P=0.000). The range of motion was normal in 20 patients (0-130°) except 1 patient having limited flexion (0-80°), whose range of motion returned to 0-120° after release. Conclusion The arthroscopic fixation technique has satisfactory results for the reduction and fixation of PCL avulsion fracture associated with meniscus posterior horn tear because of easy operation, firm fixation, and economic price.

Citation： LIU Yang, LI Gang, ZHANG Keyuan, NI Jiati, SUN Xuebin. ARTHROSCOPICALLY ASSISTED TREATMENT OF POSTERIOR CRUCIATE LIGAMENT AVULSION FRACTURE WITH MENISCUS POSTERIOR HORN TEAR. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(10): 1205-1209. doi: 10.7507/1002-1892.20160247 Copy

1.	Thornton DD, Rubin DA. Magnetic resonance imaging of the knee menisci. Semin Roentgenol, 2000, 35(3):217-230.
2.	Rochcongar G, Cucurulo T, Ameline T, et al. Meniscal survival rate after anterior cruciate ligament reconstruction. Orthop Raumatol Surg Res, 2015, 101(8 Suppl):S323-326.
3.	Feucht MJ, Bigdon S, Mehl J, et al. Risk factors for posterior lateral meniscus root tears in anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc, 2015, 23(1):140-145.
4.	吴毅, 蔡道章, 赵畅, 等. 成人前交叉韧带断裂并半月板损伤的临床研究. 中华关节外科杂志(电子版), 2015, 9(4):39-42.
5.	Feucht JM, Bigdon S, Bode G, et al. Associated tears of the lateral meniscus in anterior cruciate ligament injuries:risk factors for different tear patterns. J Orthop Surg Res, 2015, 10:34.
6.	Solayar GN, Kapoor H. PCL tibial avulsion with an associated medial meniscal tear in a child:a case report on diagnosis and management. J Pediatr Orthop B, 2012, 21(4):356-358.
7.	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.
8.	Barros MA, Cervone GL, Costa AL. Surgical treatment of avulsion fractures at the tibial insertion of the posterior cruciate ligament:functional result. Rev Bras Ortop, 2015, 50(6):631-637.
9.	陆伟, 王大平, 李顶夫, 等. 全镜下后正中入路固定后交叉韧带下止点撕脱骨折的临床研究. 中华关节外科杂志(电子版), 2010, 4(6):755-760.
10.	Mahar AT, Duncan D, Oka R, et al. Biomechanical comparison of four different fixation techniques for pediatric tibial eminence avulsion fractures. J Pediatr Orthop, 2008, 28(2):159-162.
11.	吴术红, 刘毅. 关节镜下韧带末端缝扎固定治疗后十字韧带胫骨止点骨折. 中华骨科杂志, 2011, 31(7):779-783.
12.	郭永智, 姜鑫, 张益民. 关节镜下自制缝针缝合固定后交叉韧带胫骨止点撕脱骨折. 中华创伤骨科杂志, 2010, 12(4):387-388.
13.	Jang KM, Bae JH, Kim JG, et al. Novel arthroscopic fixation method for anterior cruciate ligament tibial avulsion fracture with accompanying detachment of the anterior horn of the lateral meniscus:three-point suture fixation. Injury, 2013, 44(8):1028-1032.
14.	Cottet BS, Mortati R, Archbold P, et al. Root avulsion of the posterior horn of the medial meniscus in skeletally immature patients. Knee, 2014, 21(6):1291-1296.
15.	Lei P, Sun R, Hu Y, et al. Effect of posterior cruciate ligament rupture on the radial displacement of lateral meniscus. Clin Biomech (Bristol Avon), 2015, 30(5):448-453.
16.	Zhang AL, Miller SL, Coughlin DG, et al. Tibiofemoral contact pressures in radial tears of the meniscus treated with all-inside repair, inside-out repair and partial meniscectomy. Knee, 2015, 22(5):400-404.
17.	Bin SL, Jeong TW, Kim SJ, et al. A new arthroscopic classification of degenerative medial meniscus root tear that correlates with meniscus extrusion on magnetic resonance imaging. Knee, 2016, 23(2):246-250.
18.	Kodama Y, Furumatsu T, Fujii M, et al. Pullout repair of a medial meniscus posterior root tear using aFasT-Fix^® all-inside suture technique. Orthop Traumatol Surg Res, 2016.[Epub ahead of print].
19.	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.

1. Thornton DD, Rubin DA. Magnetic resonance imaging of the knee menisci. Semin Roentgenol, 2000, 35(3):217-230.
2. Rochcongar G, Cucurulo T, Ameline T, et al. Meniscal survival rate after anterior cruciate ligament reconstruction. Orthop Raumatol Surg Res, 2015, 101(8 Suppl):S323-326.
3. Feucht MJ, Bigdon S, Mehl J, et al. Risk factors for posterior lateral meniscus root tears in anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc, 2015, 23(1):140-145.
4. 吴毅, 蔡道章, 赵畅, 等. 成人前交叉韧带断裂并半月板损伤的临床研究. 中华关节外科杂志(电子版), 2015, 9(4):39-42.
5. Feucht JM, Bigdon S, Bode G, et al. Associated tears of the lateral meniscus in anterior cruciate ligament injuries:risk factors for different tear patterns. J Orthop Surg Res, 2015, 10:34.
6. Solayar GN, Kapoor H. PCL tibial avulsion with an associated medial meniscal tear in a child:a case report on diagnosis and management. J Pediatr Orthop B, 2012, 21(4):356-358.
7. 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.
8. Barros MA, Cervone GL, Costa AL. Surgical treatment of avulsion fractures at the tibial insertion of the posterior cruciate ligament:functional result. Rev Bras Ortop, 2015, 50(6):631-637.
9. 陆伟, 王大平, 李顶夫, 等. 全镜下后正中入路固定后交叉韧带下止点撕脱骨折的临床研究. 中华关节外科杂志(电子版), 2010, 4(6):755-760.
10. Mahar AT, Duncan D, Oka R, et al. Biomechanical comparison of four different fixation techniques for pediatric tibial eminence avulsion fractures. J Pediatr Orthop, 2008, 28(2):159-162.
11. 吴术红, 刘毅. 关节镜下韧带末端缝扎固定治疗后十字韧带胫骨止点骨折. 中华骨科杂志, 2011, 31(7):779-783.
12. 郭永智, 姜鑫, 张益民. 关节镜下自制缝针缝合固定后交叉韧带胫骨止点撕脱骨折. 中华创伤骨科杂志, 2010, 12(4):387-388.
13. Jang KM, Bae JH, Kim JG, et al. Novel arthroscopic fixation method for anterior cruciate ligament tibial avulsion fracture with accompanying detachment of the anterior horn of the lateral meniscus:three-point suture fixation. Injury, 2013, 44(8):1028-1032.
14. Cottet BS, Mortati R, Archbold P, et al. Root avulsion of the posterior horn of the medial meniscus in skeletally immature patients. Knee, 2014, 21(6):1291-1296.
15. Lei P, Sun R, Hu Y, et al. Effect of posterior cruciate ligament rupture on the radial displacement of lateral meniscus. Clin Biomech (Bristol Avon), 2015, 30(5):448-453.
16. Zhang AL, Miller SL, Coughlin DG, et al. Tibiofemoral contact pressures in radial tears of the meniscus treated with all-inside repair, inside-out repair and partial meniscectomy. Knee, 2015, 22(5):400-404.
17. Bin SL, Jeong TW, Kim SJ, et al. A new arthroscopic classification of degenerative medial meniscus root tear that correlates with meniscus extrusion on magnetic resonance imaging. Knee, 2016, 23(2):246-250.
18. Kodama Y, Furumatsu T, Fujii M, et al. Pullout repair of a medial meniscus posterior root tear using aFasT-Fix^® all-inside suture technique. Orthop Traumatol Surg Res, 2016.[Epub ahead of print].
19. 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.

Chinese Journal of Reparative and Reconstructive Surgery

ARTHROSCOPICALLY ASSISTED TREATMENT OF POSTERIOR CRUCIATE LIGAMENT AVULSION FRACTURE WITH MENISCUS POSTERIOR HORN TEAR

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