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Fixation of posterior cruciate ligament avulsion fracture with the use of a suspensory fixation

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Posterior cruciate ligament (PCL) avulsion fractures are uncommon injuries, and their treatment, still, remains difficult. There are procedures described in the literature which are minimal invasive and use either sutures or screws to stabilize the avulsed fragment. The purpose of this study was to present an innovative arthroscopic technique using a suspensory device with specific biomechanical properties. The aim of this study was to determine whether this technique was effective in the treatment of PCL avulsion fractures and applicable in everyday clinical practice.

Methods

Two patients with an isolated posterior cruciate ligament avulsion fracture were operated under arthroscopy. The Endobutton device was used to stabilize the fracture, and a double-spike plate was used to secure the fixation. The clinical assessment of patients was made by plain radiographs, CT scan, MRI and IKDC examination form.

Results

The median operative time was 57.5 min (range 55–60). No posterior tibial sag was noticed, and the range of motion was normal. No complications were recorded, and both patients returned to their usual daily activities. Both fractures had healed at 10 months postoperatively.

Conclusions

Treatment outcomes using a suspensory device in the fixation of posterior cruciate ligament avulsion fractures are encouraging. The small size of the device makes it easy to handle, and the procedure is simple and does not require multiple sutures and bony tunnels. This technique offers sufficient compression, restores the length of posterior cruciate ligament and can fix avulsion fragments of any size.

Level of evidence

Therapeutic study, Case series with no comparison group, Level IV.

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References

  1. Chiarapattanakom P, Pakpianpairoj C, Liupolvanish P, Malungpaishrope K (2009) Isolated PCl avulsion from the tibial attachment: residual laxity and function of the knee after screw fixation. J Med Assoc Thai 92(Suppl 6):S181–S188

    PubMed  Google Scholar 

  2. Choi NH, Kim SJ (1997) Arthroscopic reduction and fixation of bony avulsion of the posterior cruciate ligament of the tibia. Arthroscopy 13(6):759–762

    Article  PubMed  CAS  Google Scholar 

  3. Conner CS, Perez BA, Morris RP et al (2010) Three femoral fixation devices for anterior cruciate ligament reconstruction: comparison of fixation on the lateral cortex versus the anterior cortex. Arthroscopy 26(6):796–807

    Article  PubMed  Google Scholar 

  4. Gui J, Wang L, Jianq Y et al (2009) Single-tunnel suture fixation of posterior cruciate ligament avulsion fracture. Arthroscopy 25(1):78–85

    Article  PubMed  Google Scholar 

  5. Horas U, Meissner SA, Heiss C, Schnettler R (2010) Arthroscopic fixation of posterior cruciate ligament avulsion fractures: a new minimally invasive technique. Knee Surg Sports Traumatol Arthrosc 18(6):781–783

    Article  PubMed  Google Scholar 

  6. Jazayeri SM, Esmaili Jah AA, Karami M (2009) A safe postero-medial approach to posterior cruciate ligament avulsion fracture. Knee Surg Sports Traumatol Arthrosc 17(3):244–247

    Article  PubMed  Google Scholar 

  7. Kim SJ, Shin SJ, Choi NH, Cho SK (2001) Arthroscopically assisted treatment of avulsion fractures of the posterior cruciate ligament from the tibia. J Bone Joint Surg Am 83-A(5):698–708

    PubMed  CAS  Google Scholar 

  8. Littlejohn SG, Geissler WB (1995) Arthroscopic repair of a posterior cruciate ligament avulsion. Arthroscopy 11(2):235–238

    Article  PubMed  CAS  Google Scholar 

  9. Loos WC, Fox JM, Blazina ME et al (1981) Acute posterior cruciate ligament injuries. Am J Sports Med 9(2):86–92

    Article  PubMed  CAS  Google Scholar 

  10. Martinez-Moreno JL, Blanco-Blanco E (1988) Avulsion fractures of the posterior cruciate ligament of the knee: an experimental percutaneous rigid fixation technique under arthroscopic control. Clin Orthop Relat Res 237:204–208

    PubMed  Google Scholar 

  11. Sasaki SU, da Mota e Albuquerque RF, Amatuzzi MM, Pereira CA (2007) Open screw fixation versus arthroscopic suture fixation of tibial posterior cruciate ligament avulsion injuries: a mechanical comparison. Arthroscopy 23(11):1226–1230

    Article  PubMed  Google Scholar 

  12. Shelbourne KD, Davis TJ, Patel DV (1999) The natural history of acute, isolated, nonoperatively treated posterior cruciate ligament injuries. A prospective study. Am J Sports Med 27(3):276–283

    PubMed  CAS  Google Scholar 

  13. Shino K, Nakata K, Mae T et al (2003) Arthroscopic fixation of tibial bony avulsion of the posterior cruciate ligament. Arthroscopy 19(2):E12

    Article  PubMed  Google Scholar 

  14. Sonin AH, Fitzgerald SW, Hoff FL et al (1995) MR imaging of the posterior cruciate ligament: normal, abnormal, and associated injury patterns. Radiographics 15(3):551–561

    PubMed  CAS  Google Scholar 

  15. Torisu T (1977) Isolated avulsion fracture of the tibial attachment of the posterior cruciate ligament. J Bone Joint Surg Am 59(1):68–72

    PubMed  CAS  Google Scholar 

  16. Trickey EL (1980) Injuries to the posterior cruciate ligament: diagnosis and treatment of early injuries and reconstruction of late instability. Clin Orthop Relat Res 147:76–81

    PubMed  Google Scholar 

  17. Zhao J, He Y, Wang J (2006) Arthroscopic treatment of acute tibial avulsion fracture of the posterior cruciate ligament with suture fixation technique through Y-shaped bone tunnels. Arthroscopy 22(2):172–181

    Article  PubMed  Google Scholar 

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The authors declare that they have no conflict of interest.

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Correspondence to Patrick Djian.

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Wajsfisz, A., Makridis, K.G., 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 20, 996–999 (2012). https://doi.org/10.1007/s00167-011-1702-y

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  • DOI: https://doi.org/10.1007/s00167-011-1702-y

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