An avulsion fracture of the pcl, if not surgically fixed, may lead to secondary changes in the knee joint. Anterior arthroscopicassisted fixation of posterior cruciate ligament avulsion fractures wei huang1, xuan gong2, mishra rahul1, shukla priyanka1, changdong wang 3, xi liang1, guoliang ding4 and ning hu1 abstract background. Pdf on aug 17, 2015, tarek boutefnouchet and others published posterior cruciate ligament avulsion injury find, read and cite all the. It was diagnosed based on the history of trauma, knee pain and swelling after trauma, positive posterior drawer test and avulsion fracture shown by radiograph. Arthroscopic primary posterior cruciate ligament repair with. Treatment of tibia avulsion fracture of posterior cruciate ligament. We report a pcl mediated avulsion fracture of the lateral tibial condyle along with the tibial insertion.
Background posterior cruciate ligament pcl avulsion fracture of the tibial. Pseudoarthrosis repair of a posterior cruciate ligament. Objective avulsion fracture of posterior cruciate ligament from its tibial insertion is not a common injury and is missed most often, particularly when associated with multiple injuries or. Avulsion fracture of the posterior aspect of proximal tibia. The most common mechanism of avulsion fractures of the pcl at the tibial insertion is a dashboard injury, in which the knee is in a flexed position, and a posteriorly directed force is applied to the pretibial area. Pdf tibial avulsion fractures of pcla comparison of. Pdf posterior cruciate ligament avulsion injury researchgate. Avulsion fracture of the posterior cruciate ligament pcl is a relatively uncommon injury. The posterior cruciate ligament pcl presents commonly with avulsion fractures of its tibial attachment. A fracture is a break or crack in a bone that often results from an injury. The purpose of this technical note is to present a novel allinside arthroscopic reconstruction technique for bony tibial avulsion fractures of the posterior cruciate ligament using the. Abnormally increased signal intensity within the pcl on protondensity images is highly suggestive of pcl tear.
Management of posterior cruciate ligament tibial avulsion. Sep 21, 2015 posterior cruciate ligament avulsion injury. Tibial avulsion fractures of pcla comparison of outcomes. Primary repair of posterior cruciate ligament avulsion fracture. Posterior cruciate ligament avulsion fracture radiology. A pcl injury most commonly results in an intrasubstance tear. Avulsion fractures of the posterior cruciate ligament pcl are uncommon. Posterior cruciate ligament avulsion fractures, current. Apr, 2017 a fracture is a break or crack in a bone that often results from an injury. Pdf pediatric posterior cruciate ligament avulsion fracture of the. Sep 08, 2010 the appearance of the posterior cruciate ligament pcl was consistent with that of a pcl avulsion fracture at the tibial insertion, and the lateral tibial condyle was avulsed anterosuperiorly without disruption of the articular cartilage fig. An acutely torn pcl usually maintains its continuity as a single structure. Posterior cruciate ligament pcl avulsion fracture of the. Pdf posterior cruciate ligament avulsion from the tibia.
Pcl avulsion fracture arthroscopic fixation, a new. Pcl avulsion fracture additional clinical motor vehicle accident with recent fixation of femur fracture. Surgical treatment of avulsion fracture around joints of. Treatment of posterior cruciate ligament tibial avulsion fractures through a modified open posterior approach. He was diagnosed as acute avulsion of posterior cruciate ligament pcl. Originates from the anterolateral medial femoral condyle and inserts on the posterior. Pediatric posterior cruciate ligament avulsion fracture of the tibial. Avulsion fractures of the tibial insertion of the posterior cruciate ligament pcl have always been regarded as rare injuries. An avulsion fracture is a bone fracture which occurs when a fragment of bone tears away from the main mass of bone as a result of physical trauma. Tibialsided avulsion injuries of the posterior cruciate ligament pcl. Usually they occur when the knee is stressed and tension is placed on a ligament or tendon and it pulls off a small piece of the bone that it is attached to. Pdf download for management of posterior cruciate ligament tibial. Oct 10, 20 first time in history, pcl posterior cruciate ligament avulsion fracture was sucessfully fixed using tight rope implant by arthroscopic technique by dr. Pcl avulsion fracture from its tibial insertion is an injury which, if diagnosed early and treated with the simple orif gives spectacular results.
The posterior cruciate ligament pcl is an important stabiliser of the knee. Open posterior approach for internal fixation of pcl tibial. Avulsion fractures of the tibial insertion of the posterior cruciate ligament pcl have always been. Treatment of acute avulsion of posterior cruciate ligament of left. An avulsion fracture around the knee can be from several areas. He was treated with siddha varmam therapy and traditional bone setting. Posterior cruciate ligament avulsion fractures ncbi. To the authors knowledge, there is no report of pseudoarthrosis repair of a pcl avulsion fracture. Common structures involved are the acl, mcl, tibial tubercle, femoral epicondyle, patella, ect. Management of posterior cruciate ligament tibial avulsion injuries.
Posterior cruciate ligament mediated avulsion fracture of the. There is an avulsion fracture of the pcl type 1 at its insertion on the posterior tibial eminence, most likely secondary to an impact of the tibia on the cars dash. Apr 19, 2017 avulsion fractures of the pelvic apophyses typically occur in adolescent athletes due to a sudden strong muscle contraction while growth plates are still open. In patients with displaced tibialsided pcl avulsion fractures treated. Isolated pcl and acl avulsion fractures of the knee. It is a reproducible technique, which minimizes soft tissue damage and obviates a second surgery for hardware removal. Ishibeprimary repair of posterior cruciate ligament avulsion fracture. The avulsion fracture of the femoral attachment from the posterior cruciate ligament pcl is quite rare, particularly in adults. Anterior arthroscopicassisted fixation of posterior cruciate. Pd sagittal image showing joint effusion and altered signal of the posterior cruciate ligament. Comminuted tibial end bony avulsion of posterior cruciate ligament pcl is a. Various fixation techniques have been explored with use of lag screws, steel. Pdf suture bridge fixation technique for posterior.
Tibial avulsion fractures of pcl a comparison of outcomes between isolated, associated and missed injuries. May 10, 2019 of the 60 patients, 19 cases were avulsion fractures of posterior cruciate ligament pcl at the tibial insertion, 6 cases were avulsion fracture of the humeral medial epicondyle, 8 cases were avulsion fractures of the humeral greater tuberosity, 6 cases were lateral malleolus avulsion fractures, 17 cases were ulna olecranon avulsion fractures. Allarthroscopic treatment of tibial avulsion fractures of the posterior cruciate ligament provides satisfactory clinical results in a preliminary patient cohort. On the basis of the site of damage of the pcl, hyperflexion, pretibial trauma, and hyperextension are proposed as mechanisms of pcl injuries. Originally described by the french surgeon paul segond in 1879 after a series of cadaveric experiments, 1, this fracture involves cortical avulsion of the tibial insertion of the middle third of the lateral capsular ligament, 2. The pcl avulsion fracture was fixed with a cancellous screw via posterior approach and acl avulsion fracture was fixed with arthroscopically assisted pullout sutures 10 days after the traumatic event. In over 90% of patients with pcl tears, the pcl measured more than 7 mm in anteroposterior diameter on sagittal t2weighted images. Treatment of acute avulsion of posterior cruciate ligament of. Suture bridge fixation technique for posterior cruciate ligament avulsion fracture. Arthroscopic treatment of acute tibial avulsion fracture of. Clinical outcomes achieved at the objective evaluation suggest that this injury should be interpreted not only as a purely bone injury, but also as a boneligament injury. Conclusion posterior cruciate avulsion fracture is a very rare finding in. A few mechanisms of pcl injuries have been proposed on the basis of the site of damage of the pcl.
This was a prospective study conducted in 34 patients of isolated pcl avulsion fracture. Pcl injuries with a tibialsided avulsion were the result of motor vehicle accidents in 68. Operative versus conservative treatment of apophyseal. The study also evaluated the effect of delay in treatment and presence of occult pcl injury on the final outcome after surgery. The patient we presented here was admitted to receive treatment in june 2017, whose knee injury resulted in avulsion fractures at three sites, the femoral attachment of the pcl, the tibial insertion of the anterior cruciate ligament acl, and the femoral. Chronic instability and early degenerative changes can develop as a result of delayed diagnosis. The appearance of the posterior cruciate ligament pcl was consistent with that of a pcl avulsion fracture at the tibial insertion, and the lateral tibial condyle was avulsed anterosuperiorly without disruption of the articular cartilage fig. Open reduction and internal fixation of isolated posterior.
Isolated posterior cruciate ligament pcl injuries are relatively rare and pcl injuries most commonly occur in the setting of multiligamentous knee injuries. Although the posterior cruciate ligament pcl is not frequently injured, a greater understanding of its role in stabilizing the knee joint, mechanism of injury and treatment has developed. This typically involves the separation of the posterior tibial insertion of the pcl to variable d. This video showcases the open reduction and internal fixation of both an avulsed pcl tibial insertion and mcl femoral attachment in a patient with a multiligamentous knee injury. Tibial avulsion fracture of the posterior cruciate ligament. Pdf posterior cruciate ligament reconstruction augmentation. To report clinical and functional outcomes following fixation of tibial avulsion fractures of posterior cruciate ligament pcl using spring plate through a modified open posterior approach. Nov 10, 2015 pcl avulsion fracture normal lateral x ray medial and lateral intercondylar eminences should overlap with each other. This study had 34 patients with age ranging from 28 to 50 yrs.
Jul 15, 2011 the study was aimed to share the experience of managing posterior cruciate ligament pcl avulsion fractures of tibia with open reduction and internal fixation orif. Open reduction and internal fixation of isolated pcl fossa. For some years, studies on the posterior cruciate ligament pcl have shared researchers attention. With an avulsion fracture, an injury to the bone occurs near where the bone attaches to a tendon or ligament. For the indian population, the most common mode of injury is due to motor vehicle accidents and contact sports. This mechanism makes sense because this fracture involves the non accelerating. Fixation of posterior cruciate ligament avulsion fractures. We report the case of a pseudoarthrosis repair of a 4yearold bony avulsion fracture of the pcl using a minimally invasive technique, screw. Painful left knee after twisted injury following a fall. Posterior cruciate ligament mediated avulsion fracture of. Avulsion fracture of femoral attachment of posterior cruciate.
This can occur at the ligament by the application of forces external to the body such as a fall or pull or at the tendon by a muscular contraction that is stronger than the forces holding the bone together. Segond fracture is probably the best known and most discussed avulsion fracture of the knee. Pcls avulsion fracture free download as powerpoint presentation. After a month of treatment, the pcl avulsion fracture got healed without any. Surgical treatment of avulsion fractures of the knee pcl.
Feb 11, 2016 repair of bony avulsion of pcl if the posterior cruciate ligament is avulsed from the tibia and the repair is to be done through a medial approach, dissect the posterior skin and subcutaneous tissue as a single layer to the posteromedial corner and, with the knee flexed to 90 degrees, retract the medial head of the gastrocnemius and the. The most common surgical procedure for pcl avulsion fractures is internal fixation. Isolated avulsion injuries constitute only a subgroup of pcl injuries, but nevertheless several operative techniques have been described for the fixation of. Pcl avulsion fracture something about radiology just for. Pdf background posterior cruciate ligament pcl avulsion fracture of the tibial insertion is a very rare injury in children. Posterior cruciate ligament pcl avulsion fractures are a type of avulsion fracture of the knee that represent the most common isolated pcl lesion. Avulsion fracture of the posterior cruciate ligament from its tibial insertion is a rare condition. This typically involves separation of the posterior tibial insertion of the pcl to variable degrees. Surgical methods with stable fixation for treating avulsion fractures at the tibial insertion of the.
Anterior arthroscopicassisted fixation of posterior cruciate ligament. Allarthroscopic treatment of tibial avulsion fractures of. Treatment of tibia avulsion fracture of posterior cruciate ligament with highstrength suture fixation under arthroscopy. On the other hand, avulsion fractures of the tibial condyle are also rare. Effects of microendoscopyassisted reduction and screw fixation through a single miniincision on posterior cruciate ligament tibial avulsion fracture. Isometric knee, hip and ankle exercises were started immediately. The appearance of the posterior cruciate ligament pcl was consistent with that of a pcl avulsion fracture at the tibial insertion, and the figure 1 initial anteroposterior and lateral radiographs of the knee, showing fractures of the lateral tibial condyle a and the posterior intercondylar prominence b. Pcl injuries can be treated with primary repair, which has the advantages of preserving the native tissue, maintaining proprioception, and minimal invasive surgery when compared with reconstruction surgery. Evaluation of the pcl is notoriously difficult both clinically and arthroscopically. Surgical treatment of avulsion fractures at the tibial insertion of the.
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