Skip to main content

Advertisement

SpringerLink
Log in

Effects of microendoscopy-assisted reduction and screw fixation through a single mini-incision on posterior cruciate ligament tibial avulsion fracture

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

There are various surgical approaches for the treatment of posterior cruciate ligament (PCL) injury-associated tibial fracture avulsion, including arthroscopy-assisted surgery and open posterior surgery. However, none of these treatments are perfect. We have established a simple procedure with microendoscopy-assisted reduction and cannulated screw fixation for the treatment of this disease through a single mini-incision. In this study, we delineated the effects of this surgical approach for patients with PCL tibial avulsion fracture.

Patients and methods

We retrospectively reviewed 24 patients with acute PCL tibial avulsion fracture treated via this method from 2004 to 2008. All the patients were implanted with cannulated screws (AO/ASIF, 3.5, 4.0 or 4.5 mm in diameter, 3–4 mm in length) for fixation by microendoscopy. The posterior drawer test (PDT) and KT-2000 arthrometer examination were performed to evaluate knee stability. The Lysholm knee scoring scale and the International Knee Documentation Committee (IKDC) scoring scale were used to assess knee function. Types and rates of complications and radiographic follow-up were reviewed for all cases.

Results

23 of 24 cases achieved knee stability by PDT and KT-2000 examination. The Lysholm’s score was improved from 43.8 ± 4.6 to 95.3 ± 3.8. The IKDC evaluation demonstrated an improved function in 17 cases with grade A, 6 with grade B, and 1 with grade C. No relevant complications were experienced by any patient.

Conclusions

Increased stability, functional improvement, and few complications were observed in patients of PCL injury-associated tibial fracture avulsion treated with the microendoscopy-assisted reduction and cannulated screw fixation through a single mini-incision.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. Carson EW, Deng XH, Allen A, Wickiewicz T, Warren RF (2007) Evaluation of in situ graft forces of a 2-bundle tibial inlay posterior cruciate ligament reconstruction at various flexion angles. Arthroscopy 23(5):488–495

    Article  PubMed  Google Scholar 

  2. Chen CH, Chen WJ, Shih CH (1999) Fixation of small tibial avulsion fracture of the posterior cruciate ligament using the double bundles pullthrough suture method. J Trauma 46:1036–1038

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  4. Daniel DM, Malcom LL, Losse G, Stone ML, Sachs R, Burks R (1985) Instrumented measurement of anterior laxity of the knee. J Bone Joint Surg Am 67:720–726

    PubMed  CAS  Google Scholar 

  5. Deehan DJ, Pinczewski LA (2001) Arthroscopic reattachment of an avulsion fracture of the tibial insertion of the posterior cruciate ligament. Arthroscopy 17:422–425

    Article  PubMed  CAS  Google Scholar 

  6. Dhillon MS, Singh HP, Nagi ON (2003) Posterior cruciate ligament avulsion from the tibia: fixation by a posteromedial approach. Acta Orthop Belg 69:162–167

    PubMed  CAS  Google Scholar 

  7. Irrgang JJ, Anderson AF, Boland AL (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29:600–613

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  9. Jung YB, Jung HJ, Tae SK, Lee YS, Yang DL (2006) Tensioning of remnant posterior cruciate ligament and reconstruction of anterolateral bundle in chronic posterior cruciate ligament injury. Arthroscopy 22(3):329–338

    Article  PubMed  Google Scholar 

  10. Kashani FO, Mazloumi M, Ariamanesh A (2007) Fixation of tibial avulsion fractures of the posterior cruciate ligament using pull through suture and malleolar screw. J Res Med Sci 12(1):24–27

    Google Scholar 

  11. 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 83:698–708

    PubMed  Google Scholar 

  12. Kocher MS, Foreman ES, Micheli LJ (2003) Laxity and functional outcome after arthroscopic reduction and internal fixation of displaced tibial spine fractures in children. Arthroscopy 19:1085–1090

    Article  PubMed  Google Scholar 

  13. Kocher MS, Micheil LJ, Gerbino P, Hresko MT (2003) Tibial eminence fractures in children: prevalence of meniscal entrapment. Sports Med 31:404–407

    Google Scholar 

  14. Nicandri GT, Klineberg EO, Wahl CJ, Mills WJ (2008) Treatment of posterior cruciate ligament tibial avulsion fractures through a modified open posterior approach: operative technique and 12- to 48-month outcomes. J Orthop Trauma 22:317–324

    Article  PubMed  Google Scholar 

  15. Little john SG, Geissler WB (1995) Arthroscopic repair of a posterior cruciate ligament avulsion. Arthroscopy 11:235–238

    Article  CAS  Google Scholar 

  16. Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10:150–154

    Article  PubMed  CAS  Google Scholar 

  17. Masayuki I, Kazunori Y, Eiji K, Saito K, Ishibe M (2004) Primary repair of posterior cruciate ligament avulsion fracture: the effect of occult injury in the midsubstance on postoperative instability. Am J Sports Med 32:1230–1237

    Article  Google Scholar 

  18. Meyers MH (1975) Isolated avulsion of the tibial attachment of the posterior cruciate ligament of the knee. J Bone Joint Surg Am 57:669–672

    PubMed  CAS  Google Scholar 

  19. 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 23:1226–1230

    Article  PubMed  Google Scholar 

  20. Senekovic V, Veselko M (2003) Anterograde arthroscopic fixation of avulsion fractures of the tibial eminence with a cannulated screw: five-year results. Arthroscopy 19:54–61

    PubMed  Google Scholar 

  21. Torisu T (1979) Avulsion fracture of the tibial attachment of the posterior cruciate ligament: indications and results of delayed repairs. Clin Orthop 143:107–114

    PubMed  Google Scholar 

  22. Valis P, Repko M, Krbec M, Nýdrle M, Chaloupka R (2008) Surgical management of posterior cruciate ligament avulsion fracture. Acta Chir Orthop Traumatol Cech 75(1):34–39

    PubMed  CAS  Google Scholar 

  23. Veselko M, Saciri V (2003) Posterior approach for arthroscopic reduction and antegrade fixation of avulsion fracture of the posterior cruciate ligament from the tibia with cannulated screw and washer. Arthroscopy 19:916–921

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank Dr. Li Tian-fang and Dr. Holz Jonathan for help in completing this article. This work was supported in part by the Nanjing Military Medical Technology Innovation Project during the 11th Five-Year Plan Period of China (08MA077) to L.K.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Southeast Hospital of Xiamen University, Zhangzhou, 363000, Fujian, China

    Wei Chen, Liangqi Kang, Zhenqi Ding, Mo Sha & Jiayuan Hong

  2. Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China

    Dezhi Tang

Authors
  1. Wei Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dezhi Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Liangqi Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhenqi Ding
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mo Sha
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jiayuan Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Liangqi Kang.

Additional information

W. Chen and D. Tang contributed equally to this article.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chen, W., Tang, D., Kang, L. et al. Effects of microendoscopy-assisted reduction and screw fixation through a single mini-incision on posterior cruciate ligament tibial avulsion fracture. Arch Orthop Trauma Surg 132, 429–435 (2012). https://doi.org/10.1007/s00402-011-1426-y

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-011-1426-y

Keywords

Search

Navigation