Objective To investigate the effectiveness of arthroscopically assisted treatment of acute tibial insertion avulsion fracture of the posterior cruciate ligament (PCL) via posteromedial incision. Methods Between January 2010 and January 2012, 22 patients with acute tibial insertion avulsion of the PCL underwent arthroscopic reduction and fixation via posteromedial incision. There were 14 males and 8 females with an average age of 32 years (range, 18-48 years). The injury causes included traffic accident injury in 14 cases, sport injury in 4 cases, and falling injury in 4 cases. The disease duration ranged from 7 to 16 days (mean, 10 days). Of 22 patient, 14 had simple PCL injury, 6 had PCL injury with meniscus injury, and 2 with cartilage injury. The results of posterior drawer test were positive in all patients. The preoperative Lysholm score was 51.1 ± 3.4. Results All incisions healed by first intention without infection, deep venous thrombosis of lower limbs, or vessel and nerve injuries. All patients were followed up 12-24 months (mean, 18.4 months). X-ray films showed that all fractures healed with the healing time of 2-4 months (mean, 3 months). The Lysholm score was improved to 96.0 ± 2.2 at 6 months after operation, showing significant difference when compared with preoperative score (t=43.020, P=0.000). Conclusion Arthroscopically assisted treatment of acute tibial insertion avulsion fracture of the PCL via posteromedial incision is a safe, easy, and effective method.
ObjectiveTo observe the anatomical morphology of the tibial insertion of the anterior cruciate ligament (ACL) in Chinese adults so as to offer theoretical guidance for ACL reconstruction and meniscus transplantation. MethodsFifteen adult cadaveric knees (8 left knees and 7 right knees) were dissected, including 10 males and 5 females, with an age ranged from 25 to 47 years (mean, 32.4 years). All knees were generally observed through standard medial parapatellar approaches, then the ACL midsubstance and the tibial insertion (direct and indirect insertions) were anatomically measured. ResultsIn all specimens, the ACL was flat with a lot of fine fibers. The anteromedial bundle and posterolateral bundle could be observed in 13 of 15 knees. However, no obvious bundles were found in 2 knees. The arc-shaped tibial direct insertion started at the medial tibial eminence and ended at the anterior horn of the lateral meniscus. The width of the arc was (11.2±2.4) mm; the thickness was (3.0±0.3) mm; and the cross-sectional area was (28.8±7.8) mm2. And the left-right diameter of the whole insertion was (9.5±1.8) mm; anteroposterior diameter was (11.9±0.6) mm; and the cross-sectional area was (117.8±12.5) mm2. The width of the anterior horn of lateral meniscus was (12.3±2.0) mm. The anterior horn of lateral meniscus was surrounded by arc-shaped direct insertion in the middle, and its fibers were partly intertwined with indirect insertion of ACL. ConclusionAnatomical ACL reconstruction may therefore require a arc-shaped tibial footprint. There are overlap covering relationship between the attachment location of anterior horn of the lateral meniscus and tibial insertion of ACL. It should pay more attention to protecting tibial insertion of ACL in lateral meniscus transplantation.