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The amount of displacement can determine non-operative treatment in posterior cruciate ligament avulsion fracture

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

It is generally agreed that surgical treatment is warranted for acute posterior cruciate ligament (PCL) avulsion fracture with displacement. However, the amount of displacement that warrants surgical treatment has not been defined. The purpose of this study was to determine the optimal cut-off value for displacement of posterior cruciate ligament avulsion fracture in determining non-operative treatment and to compare the results of non-operative treatment in acute isolated PCL avulsion fractures with non-operative treatment of acute PCL injury.

Methods

Between 2007 and 2017, 30 consecutive patients with acute isolated PCL avulsion fractures and 70 consecutive patients with acute isolated PCL injuries, all of whom underwent non-operative treatment (cast immobilization with > 2 years of follow-up) were retrospectively analyzed. Clinical scores including the International Knee Documentation Committee subjective score, Lysholm score, and Tegner activity score, as well as side-to-side differences on stress radiographs, were compared between the PCL avulsion fracture and PCL injury groups at the final follow-up. The failure rates of non-operative treatment were also compared. The predictive value of the amount of fracture displacement for successful non-operative treatment was calculated using area under the receiver operating characteristic curve (AUROC). The optimal cut-off of the amount of fracture displacement to determine non-operative treatment was based on the maximal sum of sensitivity and specificity.

Results

The two groups exhibited comparable clinical scores and mean side-to-side differences on stress radiographs. There were 5 (16.6%) failures of non-operative treatment in the PCL avulsion fracture group and 19 (27.1%) failures in the PCL injury group. (n.s) There was a significant positive correlation between the amount of initial avulsion fracture displacement and side-to-side difference in posterior stress radiographs at final follow up (P < 0.001). The optimal cut-off value for the amount of fracture displacement in PCL avulsion fracture to predict failure of non-operative treatment was 6.7 mm (AUROC = 1.0).

Conclusion

The outcomes of non-operative treatment of acute isolated PCL avulsion fractures were comparable to those of patients with acute isolated PCL injuries. Acute PCL avulsion injuries with displacement of less than 6.7 mm should be considered for non-operative treatment.

Level of evidence

IV.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Kyung-Hee University Hospital, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea

    Kyoung Ho Yoon & Jae-Young Park

  2. Department of Orthopedic Surgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea

    Sang-Gyun Kim

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  1. Kyoung Ho Yoon
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  2. Sang-Gyun Kim
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Correspondence to Jae-Young Park.

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The authors declare that they have no competing interests.

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No outside funding or financial support was received to undertake this study.

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Ethical approval was obtained from the Kyung Hee University Hospital Institutional Review Board (KHUH 2019-08-014) prior to the start of the study.

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Formal consent was not required for this retrospective study.

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Yoon, K.H., Kim, SG. & Park, JY. The amount of displacement can determine non-operative treatment in posterior cruciate ligament avulsion fracture. Knee Surg Sports Traumatol Arthrosc 29, 1269–1275 (2021). https://doi.org/10.1007/s00167-020-06175-2

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  • DOI: https://doi.org/10.1007/s00167-020-06175-2

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