ARTHROSCOPICALLY ASSISTED TREATMENT OF ACUTE TIBIAL INSERTION AVULSION FRACTURE OF POSTERIOR CRUCIATE LIGAMENT VIA POSTEROMEDIAL INCISION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Jinbiao , DENG Bing , HUANG Gang , PAN Xianming , DENG Shaolin , LIAO Dongfa , LI Wei.

Department of Orthopedics, Chengdu Military General Hospital, Chengdu Sichuan, 610083, P.R.China. Corresponding author: LIU Jinbiao, E-mail: liujinbiao@medmail.com.cn;

Corresponding author：

Keywords：

Posterior cruciate ligament; Tibial insertion avulsion fracture; Arthroscopy; Internal fixation

DOI：

10.7507/1002-1892.20130130

Video：

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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.

Citation： LIU Jinbiao,DENG Bing,HUANG Gang,PAN Xianming,DENG Shaolin,LIAO Dongfa,LI Wei.. ARTHROSCOPICALLY ASSISTED TREATMENT OF ACUTE TIBIAL INSERTION AVULSION FRACTURE OF POSTERIOR CRUCIATE LIGAMENT VIA POSTEROMEDIAL INCISION. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(5): 591-593. doi: 10.7507/1002-1892.20130130 Copy

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2.	朱新辉, 刘巍, 严建军, 等. 交叉韧带止点骨折的微创手术治疗. 中国骨与关节损伤杂志, 2011, 26(7): 629-630.
3.	Zhang H, Hong L, Wang XS, et al. All-arthroscopic repair of acute avulsion fracture with suture anchor. Arthroscopy, 2011, 27(5): 728-734.
4.	Xu Z, Chen D, Shi D, et al. Case report: Osteochondral avulsion fracture of the posteromedial bundle of the PCL in knee hyperflexion. Clin Orthop Relat Res, 2012, 470(12): 3616-3623.
5.	Wajsfisz A, Makridis KG, Van Den Steene JY, et al. Fixation of posterior cruciate ligament avulsion fracture with the use of a suspensory fixation. Knee Surg Sports Traumatol Arthrosc, 2012, 20(5): 996-999.
6.	Sasaki SU, da Mota e Albupuerque RF, Amatuzzi MM, 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.
7.	Gui J, Wang L, Jiang Y, et al. Single-tunnel suture fixation of posterior cruciate ligament avulsion fracture. Arthroscopy, 2009, 25(1): 78-85.
8.	Horas U, Meissner SA, Heiss C, et al. Arthroscopic fixation of posterior cruciate ligament avulsion fractures: a new minimally invasive technique. Knee Surg Sports Traumatol Arthrosc, 2010, 18(6): 781-783.
9.	Yang CK, Wu CD, Chih CJ, et al. Surgical treatment of avulsion fracture of the posterior cruciate ligament and postoperative management. J Trauma Mar, 2003, 54(3): 516-519.
10.	Zhang X, Cai G, Wang K. 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.
11.	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.
12.	缪国平, 张弛, 王俊, 等. 小切口入路空心螺钉和缝线锚钉治疗后交叉韧带胫骨止点撕脱骨折的比较. 中国骨与关节外科, 2012, 5(3): 255-257.
13.	Frosch K, Proksch N, Preiss A, et al. Treatment of bony avulsions of the posterior cruciate ligament (PCL) by a minimally invasive dorsal approach. Oper Orthop Traumatol, 2012, 24(4-5): 348-353.
14.	Chen W, Tang D, Kang L. 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.
15.	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.
16.	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.
17.	狄正林, 徐荣明, 冯建翔, 等. 膝关节后侧有限切开不吸收缝线内固定治疗后交叉韧带胫骨止点骨折. 中国骨与关节损伤杂志, 2005, 20(4): 283-284.
18.	谭海涛, 江建中, 杨克勤, 等. 关节镜引导下锚钉缝线治疗后交叉韧带胫骨止点骨折. 微创医学, 2010, 5(1): 8-10.

1. Lyscholm J, Gillguist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sport Med, 1982, 10(3): 150-154.
2. 朱新辉, 刘巍, 严建军, 等. 交叉韧带止点骨折的微创手术治疗. 中国骨与关节损伤杂志, 2011, 26(7): 629-630.
3. Zhang H, Hong L, Wang XS, et al. All-arthroscopic repair of acute avulsion fracture with suture anchor. Arthroscopy, 2011, 27(5): 728-734.
4. Xu Z, Chen D, Shi D, et al. Case report: Osteochondral avulsion fracture of the posteromedial bundle of the PCL in knee hyperflexion. Clin Orthop Relat Res, 2012, 470(12): 3616-3623.
5. Wajsfisz A, Makridis KG, Van Den Steene JY, et al. Fixation of posterior cruciate ligament avulsion fracture with the use of a suspensory fixation. Knee Surg Sports Traumatol Arthrosc, 2012, 20(5): 996-999.
6. Sasaki SU, da Mota e Albupuerque RF, Amatuzzi MM, 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.
7. Gui J, Wang L, Jiang Y, et al. Single-tunnel suture fixation of posterior cruciate ligament avulsion fracture. Arthroscopy, 2009, 25(1): 78-85.
8. Horas U, Meissner SA, Heiss C, et al. Arthroscopic fixation of posterior cruciate ligament avulsion fractures: a new minimally invasive technique. Knee Surg Sports Traumatol Arthrosc, 2010, 18(6): 781-783.
9. Yang CK, Wu CD, Chih CJ, et al. Surgical treatment of avulsion fracture of the posterior cruciate ligament and postoperative management. J Trauma Mar, 2003, 54(3): 516-519.
10. Zhang X, Cai G, Wang K. 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.
11. 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.
12. 缪国平, 张弛, 王俊, 等. 小切口入路空心螺钉和缝线锚钉治疗后交叉韧带胫骨止点撕脱骨折的比较. 中国骨与关节外科, 2012, 5(3): 255-257.
13. Frosch K, Proksch N, Preiss A, et al. Treatment of bony avulsions of the posterior cruciate ligament (PCL) by a minimally invasive dorsal approach. Oper Orthop Traumatol, 2012, 24(4-5): 348-353.
14. Chen W, Tang D, Kang L. 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.
15. 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.
16. 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.
17. 狄正林, 徐荣明, 冯建翔, 等. 膝关节后侧有限切开不吸收缝线内固定治疗后交叉韧带胫骨止点骨折. 中国骨与关节损伤杂志, 2005, 20(4): 283-284.
18. 谭海涛, 江建中, 杨克勤, 等. 关节镜引导下锚钉缝线治疗后交叉韧带胫骨止点骨折. 微创医学, 2010, 5(1): 8-10.

Chinese Journal of Reparative and Reconstructive Surgery

ARTHROSCOPICALLY ASSISTED TREATMENT OF ACUTE TIBIAL INSERTION AVULSION FRACTURE OF POSTERIOR CRUCIATE LIGAMENT VIA POSTEROMEDIAL INCISION

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