While both conservative and operative management for pcl injuries have their proponents 911. It is one of several ligaments that connect the thighbone to the shinbone. Pcl injuries are less common than anterior cruciate ligament acl injuries. Tibial avulsion fractures of pcla comparison of outcomes. Pcls avulsion fracture free download as powerpoint presentation. Pdf on aug 17, 2015, tarek boutefnouchet and others published posterior cruciate ligament avulsion injury find, read and cite all the. Posterior cruciate ligament avulsion fractures, current. Open reduction and internal fixation of isolated posterior cruciate. This mechanism makes sense because this fracture involves the non accelerating. Early surgical treatment has been regarded as necessary, but the optimal surgical technique remains unclear. An acutely torn pcl usually maintains its continuity as a single structure. With an avulsion fracture, an injury to the bone occurs near where the bone attaches to a tendon or ligament. Avulsion fractures of the posterior cruciate ligament pcl are uncommon. Stable early fixation for pcl avulsion injuries with early controlled.
Aspetar sports medicine journal pcl injury diagnosis and. Suture or screw fixations are an appropriate method with a posterior surgical approach for cases where there is a large bony fragment. The main finding of the present study was that surgical management of pcl avulsion fractures of the tibia using a toothed plate and hollow lag screw was associated with a low incidence of nonunion and knee instability, as. Posterior cruciate ligament avulsion fractures ncbi. Posterior cruciate ligament mediated avulsion fracture of. Treatment of posterior cruciate ligament avulsion fractures of the tibia using a toothed plate and hollow lag screw. Surgical treatment of avulsion fracture around joints of. Pd sagittal image showing joint effusion and altered signal of the posterior cruciate ligament.
We assessed 21 patients 16 males and 5 females, with mean age of 27. Avulsion fractures are strongly associated with disruption of the posterior cruciate ligament. The knee is an intricate joint with numerous tendinous, ligamentous, and meniscal attachments, which make it particularly vulnerable to complex injuries after. In over 90% of patients with pcl tears, the pcl measured more than 7 mm in anteroposterior diameter on sagittal t2weighted images. Research article arthroscopicassisted reduction and. The surgical management of displaced avulsion fractures will usually result in a favourable outcome. A fracture is a break or crack in a bone that often results from an injury. Avulsion fracture of the posterior cruciate ligament from its tibial insertion is a rare condition. 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 posterior. Surgical treatment of avulsion fractures of the knee pcl.
Pdf management of posterior cruciate ligament avulsion by. 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. Background femoral avulsion fracture of the posterior cruciate ligament pcl in association with meniscus tear is extremely rare in children, and similar cases are not available in the existing lit. Posterior cruciate ligament pcl avulsion fractures are a type of avulsion fracture of the knee that represent the most common isolated pcl lesion. Suture bridge fixation technique for posterior cruciate ligament. Occult posterior cruciate ligament avulsion fracture in a. The study also evaluated the effect of delay in treatment and presence of occult pcl injury on the final outcome after surgery. Avulsion fracture, internal fixation, joint instability, knee injury, posterior cruciate ligament. Posterior cruciate ligament injuries orthoinfo aaos. Surgical treatment of avulsion fractures at the tibial.
This typically involves separation of the posterior tibial insertion of the pcl to variable degrees. Posterior cruciate ligament tibial inlay reconstruction. Fracture fragments due to pcl avulsion fracture of the tibia. Surgical management of posterior cruciate ligament. Isolated injuries are less common and surgery on the pcl has seen less popularity compared with other knee ligaments. Tibial avulsion fractures of pcla comparison of outcomes between isolated, associated and missed injuries. Injury to the posterior cruciate ligament pcl is relatively rare and, if combined with avulsion fracture of the pcl insertion site, it accounts for only a small number of knee injuries. Surgical treatment of avulsion fracture of the posterior. The posterior cruciate ligament is in the back of the knee.
Avulsion fracture of the posterior cruciate ligament pcl is a relatively uncommon injury. Management of isolated posterior cruciate ligament injuries. For the indian population, the most common mode of injury is due to motor vehicle accidents and contact sports. Cruciate ligament pcl tibial avulsion fractures treated with open reduction and. The intent of this protocol is to provide the clinician with a guideline for a nonoperative rehabilitation course of a patient with an isolated posterior cruciate ligament injury. The posterior cruciate ligament pcl presents commonly with avulsion fractures of its tibial attachment. Avulsion fractures of posterior cruciate ligament pcl represent a specific form of. Current arthroscopic concepts in repairing posterior cruciate ligament tibialsided avulsions. Surgical treatment of avulsion fractures of the knee pcl tibial. Various fixation techniques have been explored with use of lag screws, steel wires, absorbable screws, suture anchors and straddle nails. Fixation of posterior cruciate ligament avulsion fractures with. Pcl avulsion fracture additional clinical motor vehicle accident with recent fixation of femur fracture.
The incidence of pcl injury varies between 1% to 44% among all knee ligament injuries 46. Operative versus conservative treatment of apophyseal. Since the pcl is strong, avulsion fractures of its attachment are common. Surgical treatment of avulsion fracture of the posterior cruciate ligament and postoperative management article in the journal of trauma 543. Chronic instability and early degenerative changes can develop as a result of delayed diagnosis. Avulsion fracture of the posterior aspect of proximal tibia. A few mechanisms of pcl injuries have been proposed on the basis of the site of damage of the pcl. Management of avulsion injury of the pcl with reattachment, injury, 25 1994, 293295. The posterior cruciate ligament pcl is an important structure that helps to maintain the stability of the knee during flexion and rotation. Anatomy, biomechanics, injury patterns, and approach to management injury to the acl or pcl of the knee most commonly involves a tear of the. Cruciate ligament pcl tibial avulsion fractures treated. A novel mis technique for posterior cruciate ligament avulsion. Joints are named for the two bones that articulate with each other.
Currently, the most common treatment used for complete restoration of pcl function after an avulsion fracture is surgery using internal fixation. Management of avulsion injury of the pcl with reattachment. Rehabilitation guidelines for posterior cruciate ligament reconstruction the knee has three jointsthe patellofemoral joint knee cap, the tibiofemoral joint and the tibiofibular joint. Posterior cruciate ligament avulsion fracture radiology. Avulsion fracture of tibial insertion of pcloperative management and outcome m ali1, p agrawal2, n katakdhond3, m arshadullah4 abstract there are controversies about the management of the pcl injuries among the orthopaedic surgeons. Painful left knee after twisted injury following a fall. Posterior approach for arthroscopic reduction and antegrade fixation of avulsion fracture of the posterior cruciate ligament from the tibia with cannulated screw and washer.
Arthroscopic bridge technique, avulsion, posterior cruciate ligament, repair tintroduction materials and methods he posterior cruciate ligament pcl is the main static stabilizer of the knee. An injury to the posterior cruciate ligament requires a powerful force. Effects of microendoscopyassisted reduction and screw fixation through a single miniincision on posterior cruciate ligament tibial avulsion fracture. Posterior cruciate ligament avulsion fractures springerlink. The most effective management of posterior cruciate ligament pcl injuries remains unclear and the natural history of untreated pcl injuries is controversial. Occult posterior cruciate ligament avulsion fracture in a paediatric patient.
Abnormally increased signal intensity within the pcl on protondensity images is highly suggestive of pcl tear. Treatment of posterior cruciate ligament avulsion fractures of the. Posterior cruciate ligament pcl injury is typically caused by direct trauma to a bent knee. This study aims to compare the clinical outcomes of three groups of displaced pcl avulsion fractures viz. Management of posterior cruciate ligament tibial avulsion injuries. Arthroscopic treatment of femoral avulsion fracture of the. An avulsion fracture of the pcl, if not surgically fixed, may lead to secondary changes in the knee joint. Originates from the anterolateral medial femoral condyle and inserts on the posterior. Vecsei, tibial avulsion fracture of the posterior cruciate ligament. Management of posterior cruciate ligament tibial avulsion. The knee resource posterior cruciate ligament injury. Inclusion criteria included englishlanguage studies involving surgical fixation strategies for pcl tibialsided bony avulsions.
Fixation of posterior cruciate ligament avulsion fractures. Arthroscopic treatment of acute tibial avulsion fracture of the. Pdf posterior cruciate ligament avulsion injury researchgate. 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. The general goals of fracture management are anatomic reduction of the fracture and protection of the soft tissue en.
Lo veterans general hospitalaipei, taipei, taiwan, china twentyeight cases ofavubion injury of the posterior cruciate ligament pcl treated by reattachment were followed up to evaluate the results. 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. The avulsion fracture of the femoral attachment from the posterior cruciate ligament pcl is quite rare, particularly in adults. On the basis of the site of damage of the pcl, hyperflexion, pretibial trauma, and hyperextension are proposed as mechanisms of pcl injuries.
Current arthroscopic concepts in repairing posterior. The posterior cruciate ligament pcl is an important stabiliser of the knee. Avulsion fracture of the head of the fibula the arcuate. 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. This keywords kneeligamentinjuries medial collateral ligament avulsion posterior cruciate ligament tear combined ligament injuries surgical repair abstract medial collateral ligament mcl of the knee is one of the most commonly injured. Pcl avulsion fracture something about radiology just. Avulsion fracture of tibial insertion of pcloperative. Pcl avulsion fracture arthroscopic fixation, a new. Open posterior approach for internal fixation of pcl. Surgical treatment of avulsion fractures of the knee pcl tibial insertion. We report a pclmediated avulsion fracture of the lateral tibial condyle along with the tibial insertion. Avulsion fracture of femoral attachment of posterior.
Management of pcl avulsion injuries with late presentationnonunion banerjee s 1, sharma pk2, singh k1 and elhence a. There are currently a variety of treatment approaches for pcl avulsion fractures, with none emerging as a goldstandard surgical. Posterior cruciate ligament tibial avulsion treated with open. Management of posterior cruciate ligament avulsion by cannulated screw.
Treatment of posterior cruciate ligament tibial avulsion fractures through a modified open. Avulsion fractures of the pelvic apophyses typically occur in adolescent athletes due to a sudden strong muscle contraction while growth plates are still open. 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. The major knowledge gap is regarding surgical fixation of pcl avulsion fractures with delayed presentationnon union.
Open reduction and internal fixation of isolated pcl fossa. On the other hand, avulsion fractures of the tibial condyle are also rare. Pcl avulsion fracture normal lateral x ray medial and lateral intercondylar eminences should overlap with each other. Injuries are often due to a blow to the knee while it is bent.
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