Abstract
Background: The open reduction with internal fixation is an effective approach for treatment of avulsion fracture of posterior cruciate ligament. The previously used internal fixation materials including hollow screws, absorbable screw, tension bands and sutures have great defects such as insufficient fixation strength, susceptibility to re-fracture, etc. Stellate steel plate is novel material for internal fixation which has unique gear-like structure design. We used stellate steel plate for treatment of displaced avulsion fractures of posterior cruciate ligament in this study.
Materials and Methods: 14 patients (9 men, 5 women; aged, 19–35 years; mean age, 28 years)with displaced avulsion fractures of the tibial insertion of the posterior cruciate ligament were retrospectively analyzed between June 2009 and June 2011. The mean duration from injury to the operation was 8.3 days (range 6–15 days). All the patients were treated with open reduction and internal fixation of a stellate steel plate (DePuy, Raynham, MA 02767, USA). The Lysholm-Tegner knee function score criteria were used to analyze results.
Results: The mean followup was 24.6 months (range 18–32 months). After 6 months, all the fractures healed and knee joint activity was normal, with no knee stiffness or instability. The Lysholm-Tegner scores were 97.1 ± 1.7 points at the final followup.
Conclusion: Owing to its unique gear structure, the stellate steel plate design can effectively fix an avulsion fracture block and it is a simple operation with short postoperative rehabilitation time and firm fixation.
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References
Kim YM, Lee CA, Matava MJ. Clinical results of arthroscopic single-bundle transtibial posterior cruciate ligament reconstruction: A systematic review. Am J Sports Med 2011;39:425–34.
Torisu T. Isolated avulsion fracture of the tibial attachment of the posterior cruciate ligament. J Bone Joint Surg Am 1977;59:68–72.
Montgomery SR, Johnson JS, McAllister DR, Petrigliano FA. Surgical management of PCL injuries: Indications, techniques, and outcomes. Curr Rev Musculoskelet Med 2013;6:115–23.
Chen SY, Cheng CY, Chang SS, Tsai MC, Chiu CH, Chen AC, et al. Arthroscopic suture fixation for avulsion fractures in the tibial attachment of the posterior cruciate ligament. Arthroscopy 2012;28:1454–63.
Bali K, Prabhakar S, Saini U, Dhillon MS. Open reduction and internal fixation of isolated PCL fossa avulsion fractures. Knee Surg Sports Traumatol Arthrosc 2012;20:315–21.
Yang CK, Wu CD, Chih CJ, Wei KY, Su CC, Tsuang YH. Surgical treatment of avulsion fracture of the posterior cruciate ligament and postoperative management. J Trauma 2003;54:516–9.
Burks RT, Schaffer JJ. A simplified approach to the tibial attachment of the posterior cruciate ligament. Clin Orthop Relat Res 1990;254:216–9.
Briggs KK, Kocher MS, Rodkey WG, Steadman JR. Reliability, validity, and responsiveness of the Lysholm knee score and Tegner activity scale for patients with meniscal injury of the knee. J Bone Joint Surg Am 2006;88:698–705.
Van Dommelen BA, Fowler PJ. Anatomy of the posterior cruciate ligament. A review. Am J Sports Med 1989;17:24–9.
Girgis FG, Marshall JL, Monajem A. The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop Relat Res 1975;106:216–31.
Harner CD, Xerogeanes JW, Livesay GA, Carlin GJ, Smith BA, Kusayama T, et al. The human posterior cruciate ligament complex: An interdisciplinary study. Ligament morphology and biomechanical evaluation. Am J Sports Med 1995;23:736–45.
Voos JE, Mauro CS, Wente T, Warren RF, Wickiewicz TL. Posterior cruciate ligament: Anatomy, biomechanics, and outcomes. Am J Sports Med 2012;40:222–31.
Rosenthal MD, Rainey CE, Tognoni A, Worms R. Evaluation and management of posterior cruciate ligament injuries. Phys Ther Sport 2012;13:196–208.
Fanelli GC, Beck JD, Edson CJ. Current concepts review: The posterior cruciate ligament. J Knee Surg 2010;23:61–72.
Schulz MS, Russe K, Weiler A, Eichhorn HJ, Strobel MJ. Epidemiology of posterior cruciate ligament injuries. Arch Orthop Trauma Surg 2003;123:186–91.
Cosgarea AJ, Jay PR. Posterior cruciate ligament injuries: Evaluation and management. J Am Acad Orthop Surg 2001;9:297–307.
Nicandri GT, Klineberg EO, Wahl CJ, Mills WJ. 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 2008;22:317–24.
Zhang X, Cai G, Xu J, Wang K. A minimally invasive postero-medial approach with suture anchors for isolated tibial avulsion fracture of the posterior cruciate ligament. Knee 2013;20:96–9.
Sasaki SU, da Mota e Albuquerque RF, Amatuzzi MM, Pereira CA. Open screw fixation versus arthroscopic suture fixation of tibial posterior cruciate ligament avulsion injuries: A mechanical comparison. Arthroscopy 2007;23:1226–30.
Wajsfisz A, Makridis KG, Van Den Steene JY, Djian P. Fixation of posterior cruciate ligament avulsion fracture with the use of a suspensory fixation. Knee Surg Sports Traumatol Arthrosc 2012;20:996–9.
Fabbriciani C, Mulas PD, Ziranu F, Deriu L, Zarelli D, Milano G. Mechanical analysis of fixation methods for anterior cruciate ligament reconstruction with hamstring tendon graft. An experimental study in sheep knees. Knee 2005;12:135–8.
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Li, L., Tian, W. Displaced avulsion fractures of the posterior cruciate ligament: Treated by stellate steel plate fixation. IJOO 49, 171–175 (2015). https://doi.org/10.4103/0019-5413.152454
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DOI: https://doi.org/10.4103/0019-5413.152454