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J Knee Surg 2022; 35(08): 862-867
DOI: 10.1055/s-0040-1721093
Original Article

Treatment of Posterior Cruciate Ligament Tibial Avulsion: A New Modified Open Direct Lateral Posterior Approach

Sohrab Keyhani
1   Department of Knee Surgery and Sports Medicine, Akhtar Orthopedic Training and Research Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,
Mehran Soleymanha
2   Department of Orthopedic Surgery, Poursina Hospital Orthopaedic Research Center, Guilan University of Medical Sciences, Rasht, Iran
,
Amir Salari
3   Department of Orthopedic Surgery, Poursina Hospital Orthopaedic Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Abstract

The optimal operative technique for the treatment of the tibial-side avulsion injuries of the posterior cruciate ligament (PCL) is debatable. This study was aimed to evaluate the postoperative outcomes and complications if any after an open direct, posterolateral approach using cannulated cancellous screw fixation of a PCL tibial avulsion. From January 2016 to June 2018, 17 patients (14 males and 3 females) with PCL avulsion fraction treatment—who underwent open reduction and internal fixation using cannulated cancellous screws—were included in this prospective study. A direct posterolateral approach in the prone position was used in all cases. The Lysholm's knee score and International Knee Documentation Committee (IKDC) score were assessed preoperatively and during regular follow-up examinations for at least 1 year (12–20 months) postoperatively. All patients had fracture union and all of their knees were stable upon physical examination. No nerve or blood vessel injuries occurred. The mean Lysholm's scores and mean IKDC scores were improved significantly at the last follow-up. This study provides evidence that open direct posterolateral approach may be reliable for the treatment of tibial-sided bony PCL avulsion fractures. This approach can provide direct visualization of the posterior capsule and PCL avulsion site associated with good reduction and stable fixation, easy application of the screws directly from posterior to anteriorly without extensive soft tissue damage. Nevertheless, long-term follow-up is recommended.

Keywords

posterior cruciate ligament - avulsion fractures - direct posterolateral approach

Note

This study was approved by the Poursina hospital, Guilan University of medical sciences; Iran (No. 9938). Informed consent was obtained from all individual participants included in the study.


Authors' Contributions

S.K. supported in developing the original idea and the protocol and definition of intellectual content. M.S. and A.S. provided contribution in the development of the protocol. M.S. involved in preparation of the manuscript and dedicated in drafting the manuscript.




Publication History

Received: 01 April 2020

Accepted: 05 October 2020

Article published online:
25 November 2020

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Chen CH. Surgical treatment of posterior cruciate ligament injury. Chang Gung Med J 2007; 30 (06) 480-492
    PubMedGoogle Scholar
  • 2 Hooper III PO, Silko C, Malcolm TL, Farrow LD. Management of posterior cruciate ligament tibial avulsion injuries: a systematic review. Am J Sports Med 2018; 46 (03) 734-742
    CrossrefPubMedGoogle Scholar
  • 3 Katsman A, Strauss EJ, Campbell KA, Alaia MJ. Posterior cruciate ligament avulsion fractures. Curr Rev Musculoskelet Med 2018; 11 (03) 503-509
    CrossrefPubMedGoogle Scholar
  • 4 Montgomery SR, Johnson JS, McAllister DR, Petrigliano FA. Surgical management of PCL injuries: indications, techniques, and outcomes. Curr Rev Musculoskelet Med 2013; 6 (02) 115-123
    CrossrefPubMedGoogle Scholar
  • 5 Gavaskar AS, Karthik B, Gopalan H, Srinivasan P, Tummala NC. A novel MIS technique for posterior cruciate ligament avulsion fractures. Knee 2017; 24 (04) 890-896
    CrossrefPubMedGoogle Scholar
  • 6 Ambra LF, Franciozi CE, Werneck LG. et al. Posteromedial Versus Direct Posterior Approach for Posterior Cruciate Ligament Reinsertion. Orthopedics 2016; 39 (05) e1024-e1027
    CrossrefPubMedGoogle Scholar
  • 7 Nimmagadda R, Hu X, Xiang T. Direct linear posterior approach for posterior column tibial plateau fracture with T plate application. J Sci 2017; 7 (03) 130-134
    PubMedGoogle Scholar
  • 8 Abdallah AA, Arafa MS. Treatment of posterior cruciate ligament tibial avulsion by a minimally-invasive open posterior approach. Injury 2017; 48 (07) 1644-1649
    CrossrefPubMedGoogle Scholar
  • 9 Lobenhoffer P, Gerich T, Bertram T, Lattermann C, Pohlemann T, Tscheme H. [Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures]. Unfallchirurg 1997; 100 (12) 957-967
    CrossrefPubMedGoogle Scholar
  • 10 Sabat D, Jain A, Kumar V. Displaced posterior cruciate ligament avulsion fractures: a retrospective comparative study between open posterior approach and arthroscopic single-tunnel suture fixation. Arthroscopy 2016; 32 (01) 44-53
    CrossrefPubMedGoogle Scholar
  • 11 Pardiwala DN, Agrawal D, Patil V, Saini U, Dhawal P. Paper 133: comparison of open versus arthroscopic fixation for isolated pcl tibial bony avulsions: a prospective randomized study with minimum 2 year follow-up. Arthroscopy 2012; 28: e413-e414
    CrossrefPubMedGoogle Scholar
  • 12 Zhu W, Lu W, Cui J. et al. Treatment of tibia avulsion fracture of posterior cruciate ligament with high-strength suture fixation under arthroscopy. Eur J Trauma Emerg Surg 2017; 43 (01) 137-143
    CrossrefPubMedGoogle Scholar
  • 13 Gwinner C, Kopf S, Hoburg A, Haas NP, Jung TM. Arthroscopic treatment of acute tibial avulsion fracture of the posterior cruciate ligament using the tightrope fixation device. Arthrosc Tech 2014; 3 (03) e377-e382
    CrossrefPubMedGoogle Scholar
  • 14 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 (01) 39-44
    CrossrefPubMedGoogle Scholar
  • 15 Lee KW, Yang DS, Lee GS, Choy WS. Suture bridge fixation technique for posterior cruciate ligament avulsion fracture. Clin Orthop Surg 2015; 7 (04) 505-508
    CrossrefPubMedGoogle Scholar
  • 16 Sun HQ, Ren YJ, Zhang YQ. Treatment of posterior cruciate ligament avulsion fracture with pressurized staples. Chi J Orthop Trauma 2011; 13: 1189-1190
    PubMedGoogle Scholar
  • 17 Mirzashahi B, Najafi A, Mansouri P, Farzan M. A new modified open posterior approach for the fixation of posterior cruciate ligament tibial avulsion fractures. Trauma Mon 2016; 22 (05) e36958
    PubMedGoogle Scholar
  • 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 (03) 210-216
    CrossrefPubMedGoogle Scholar
  • 19 Ozdemir G, Yilmaz B, Oztermeli A. Open reduction and internal fixation of the isolated tibial lateral plateau posterior fracture using direct posterior split gastrocnemius approach. Case Rep Surg 2015; 2015: 530578
    PubMedGoogle Scholar
  • 20 Huang CM, Fan HQ, Wang JX. Short term outcomes of arthroscopically assisted treatment for posterior cruciate ligament avulsion fracture. Orthop J China 2009; 17: 272-275
    PubMedGoogle Scholar
  • 21 Fu YP, Hang CM, Fam HQ. Treatment of posterior cruciate ligament avulsion fracture using anchor system combined with cannulated screw. J Pract Orthop 2011; 17: 73-74
    PubMedGoogle Scholar
  • 22 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 (02) 315-321
    CrossrefPubMedGoogle Scholar
  • 23 Nicandri GT, Klineberg EO, Wahl CJ, Mills WJ. Treatment of posterior cruciate ligament tibial avulsion fractures through a modified open posterior approach: operative technique and 12- to 48-month outcomes. J Orthop Trauma 2008; 22 (05) 317-324
    CrossrefPubMedGoogle Scholar
  • 24 Hooper III PO, Bevan PJ, Silko C, Farrow LD. A posterior approach to open reduction and internal fixation of displaced posterior cruciate ligament tibial osseous avulsions. JBJS Essential Surg Tech 2018; 8 (01) e6
    CrossrefPubMedGoogle Scholar
  • 25 Willinger L, Imhoff AB, Schmitt A, Forkel P. [Fixation of bony avulsions of the posterior cruciate ligament by a suture-bridge™ technique]. Oper Orthop Traumatol 2019; 31 (01) 3-11
    PubMedGoogle Scholar