Outcome of Posterior Cruciate Ligament Avulsion Fractures from Tibial Attachment Treated by Open Reduction and Internal Fixation

Shouryashil V. Khambalkar, Tanish C. Patil, Jaydeep K. Patil, Kapil R. Ghorpade, Nagesh Naik

Abstract


Objectives: To analyze the clinical and functional outcomes of posterior cruciate ligament avulsion fractures treated by open reduction and internal fixation from tibial attachment.

Methods: This observational study was conducted at the orthopedics department of a tertiary care medical college. Forty adult patients with PCL avulsion fractures were included in this study based on predefined inclusion and exclusion criteria. All patients were treated by open reduction and internal fixation. Patients were followed up for one year. The Lysholm scale and knee society score were used to assess functional outcomes. A p-value less than 0.05 was considered to be statistically significant.

Results: Overall, 34 (75 %) males and 6 (15%) females participated in this study with an M: F ratio of 1:0.17. The mean age of affected patients was 37.3 +/- 7.34 years. Out of 40 patients, 29 (72.50%) patients sustained fractures secondary to road traffic accidents, while 7 (17.50%) had sports-related injuries. There was a highly significant improvement in the Lysholm and Knee Society scores from the time of presentation to the final follow-up (P<0.0001). Only 1 (2.5%) patient developed residual joint instability as evidenced by the drawer test result.

Conclusion: Patients with posterior cruciate ligament avulsion fracture treated by Open reduction and internal fixation were found to have excellent results in terms of functional outcomes.


Keywords


Fracture; Internal Fixation; Open Reduction; Outcome; Posterior Cruciate Ligament

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References


  1. Zlotnicki JP, Naendrup JH, Ferrer GA, Debski RE. Basic biomechanic principles of knee instability. Curr Rev Musculoskelet Med. 2016;9(2):114–22. doi:10.1007/s12178-016-9329–8.
  2. Pache S, Aman ZS, Kennedy M, Nakama GY, Moatshe G, Ziegler C, et al. Posterior cruciate ligament: current concepts review. Arch Bone Jt Surg. 2018;6(1):8–18. doi:10.22038/abjs.2017.25851.1686
  3. Pierce CM, O’Brien L, Griffin LW, Laprade RF. Posterior cruciate ligament tears: functional and postoperative rehabilitation. Knee Surg Sports Traumatol Arthrosc. 2013;21(5):1071–84. doi:10.1007/s00167-012-1970-1
  4. Ridley U, Ridley L. Imaging of the knee: Common acute presentations to general practice. Aust J Gen Pract. 2020;49(6):344–9. doi:10.31128/AJGP-10-19-5120
  5. Hooper PO 3rd, Silko C, Malcolm TL, Farrow LD. Management of posterior cruciate ligament tibial avulsion injuries: a systematic review. Am J Sports Med. 2018; 46(3):734–42. doi:10.1177/0363546517701911
  6. Sundararajan SR, Joseph JB, Ramakanth R, Jha AK, Rajasekaran S. Arthroscopic reduction and internal fixation (ARIF) versus open reduction internal fixation (ORIF) to elucidate the difference for tibial side PCL avulsion fixation: a randomized controlled trial (RCT). Knee Surg Sports Traumatol Arthrosc. 2021;29(4):1251–7. doi:10.1007/s00167-020-06144-9
  7. Simhal RK, Bovich M, Bahrun EA, Dreese JC. Postoperative rehabilitation of posterior cruciate ligament surgery: a systematic review. Sports Med Arthrosc Rev. 2021;29(2):81–7. doi:10.1097/JSA.0000000000000307
  8. Vishwakarma NS, Gali JC, Gali JC, LaPrade RF. The outcomes of posterior cruciate ligament tibial avulsion fixation with a screw using a dual posteromedial portal technique. Acta Ortop Bras. 2022;30(spe2):e246988. doi:10.1590/1413-785220223002e246988
  9. Katsman A, Strauss EJ, Campbell KA, Alaia MJ. Posterior cruciate ligament avulsion fractures. Curr Rev Musculoskelet Med. 2018;11(3):503–9. doi:10.1007/s12178-018-9491-2
  10. Culliton SE, Bryant DM, MacDonald SJ, Hibbert KM, Chesworth BM. Validity and internal consistency of the new knee society knee scoring system. Clin Orthop Relat Res. 2018;476(1):77–84. doi:10.1007/s11999.0000000000000014
  11. Tuca M, Bernal N, Luderowski E, Green DW. Tibial spine avulsion fractures: treatment update. Curr Opin Pediatr. 2019;31(1):103–111. doi:10.1097/MOP.0000000000000719
  12. Bali K, Prabhakar S, Saini U, Dhillon MS. Open reduction and internal fixation of isolated PCL fossa avulsion fractures. Knee Surg Sports Traumatol Arthrosc. 2012;20(2):315–21. doi:10.1007/s00167-011-1618-6
  13. Khatri K, Sharma V, Lakhotia D, Bhalla R, Farooque K. Posterior cruciate ligament tibial avulsion treated with open reduction and internal fixation through the burks and schaffer approach. Malays Orthop J. 2015;9(2):2–8. doi:10.5704/MOJ.1507.004.
  14. Fan N, Zheng YC, Zang L, Yang CG, Yuan S, Du P, et al. What is the impact of knee morphology on posterior cruciate ligament avulsion fracture in men and women: a case control study. BMC Musculoskelet Disord. 2021;22(1):100. doi:10.1186/s12891–021-03984-5
  15. Chen W, Luo W, Chen Z, Jiang Y. 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. doi:10.11622/smedj.2016010
  16. Owesen C, Sandven-Thrane S, Lind M, Forssblad M, Granan LP, Årøen A. Epidemiology of surgically treated posterior cruciate ligament injuries in Scandinavia. Knee Surg Sports Traumatol Arthrosc. 2017;25(8):2384–91. doi:10.1007/s00167-015-3786-2
  17. Sanders TL, Pareek A, Barrett IJ, et al. Incidence and long-term follow-up of isolated posterior cruciate ligament tears. Knee Surg Sports Traumatol Arthrosc. 2017;25(10):3017–23. doi:10.1007/s00167-016-4052-y
  18. Joshi S, Bhatia C, Gondane A, Rai A, Singh S, Gupta S. Open reduction and internal fixation of isolated posterior cruciate ligament avulsion fractures: clinical and functional outcome. Knee Surg Relat Res. 2017;29(3):210–6. doi:10.5792/ksrr.17.022
  19. Wu S, Zhang K, Fu W, Li J. Zhongguo xiu fu chong jian wai ke za zhi. 2023;37(5):572–7. doi:10.7507/1002-1892.202301061
  20. Khalifa AA, Elsherif ME, Elsherif E, Refai O. Posterior cruciate ligament tibial insertion avulsion, management by open reduction and internal fixation using plate and screws through a direct posterior approach. Injury. 2021;52(3):594–601. doi:10.1016/j.injury.2020.09.058




DOI: https://doi.org/10.15850/ijihs.v11n2.3471

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