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Zhang XH, Yu J, Zhao MY, Cao JH, Wu B, Xu DF. Arthroscopic M-shaped suture fixation for tibia avulsion fracture of posterior cruciate ligament: A modified technique and case series. World J Orthop 2024; 15:642-649. [PMID: 39070933 PMCID: PMC11271700 DOI: 10.5312/wjo.v15.i7.642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/03/2024] [Accepted: 06/11/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Tibial avulsion fractures of the posterior cruciate ligament (PCL) are challenging to treat and compromise knee stability and function. Traditional open surgery often requires extensive soft tissue dissection, which may increase the risk of morbidity. In response to these concerns, arthroscopic techniques have been evolving. The aim of this study was to introduce a modified arthroscopic technique utilizing an M-shaped suture fixation method for the treatment of tibial avulsion fractures of the PCL and to evaluate its outcomes through a case series. AIM To evaluate the effects of arthroscopic M-shaped suture fixation on treating tibia avulsion fractures of the PCL. METHODS We developed a modified arthroscopic M-shaped suture fixation technique for tibia avulsion fractures of the PCL. This case series included 18 patients who underwent the procedure between January 2021 and December 2022. The patients were assessed for range of motion (ROM), Lysholm score and International knee documentation committee (IKDC) score. Postoperative complications were also recorded. RESULTS The patients were followed for a mean of 13.83 ± 2.33 months. All patients showed radiographic union. At the final follow-up, all patients had full ROM and a negative posterior drawer test. The mean Lysholm score significantly improved from 45.28 ± 8.92 preoperatively to 91.83 ± 4.18 at the final follow-up (P < 0.001), and the mean IKDC score improved from 41.98 ± 6.06 preoperatively to 90.89 ± 5.32 at the final follow-up (P < 0.001). CONCLUSION The modified arthroscopic M-shaped suture fixation technique is a reliable and effective treatment for tibia avulsion fractures of the PCL, with excellent fracture healing and functional recovery.
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Affiliation(s)
- Xiao-Hui Zhang
- Department of Orthopaedic Surgery, Shaoxing Central Hospital, Shaoxing 312000, Zhejiang Province, China
- Department of Orthopaedic Surgery, The Central Hospital of Shaoxing University, Shaoxing 312000, Zhejiang Province, China
| | - Jian Yu
- Department of Orthopaedic Surgery, Shaoxing Central Hospital, Shaoxing 312000, Zhejiang Province, China
- Department of Orthopaedic Surgery, The Central Hospital of Shaoxing University, Shaoxing 312000, Zhejiang Province, China
| | - Meng-Yao Zhao
- Department of Orthopaedic Surgery, Shaoxing Central Hospital, Shaoxing 312000, Zhejiang Province, China
- Department of Orthopaedic Surgery, The Central Hospital of Shaoxing University, Shaoxing 312000, Zhejiang Province, China
| | - Jin-Hui Cao
- Department of Orthopaedic Surgery, Shaoxing Central Hospital, Shaoxing 312000, Zhejiang Province, China
- Department of Orthopaedic Surgery, The Central Hospital of Shaoxing University, Shaoxing 312000, Zhejiang Province, China
| | - Bing Wu
- Department of Orthopaedic Surgery, Shaoxing Central Hospital, Shaoxing 312000, Zhejiang Province, China
- Department of Orthopaedic Surgery, The Central Hospital of Shaoxing University, Shaoxing 312000, Zhejiang Province, China
- Central Laboratory, Shaoxing Central Hospital, Shaoxing 312000, Zhejiang Province, China
| | - Dan-Feng Xu
- Department of Orthopaedic Surgery, Shaoxing Central Hospital, Shaoxing 312000, Zhejiang Province, China
- Department of Orthopaedic Surgery, The Central Hospital of Shaoxing University, Shaoxing 312000, Zhejiang Province, China
- Central Laboratory, Shaoxing Central Hospital, Shaoxing 312000, Zhejiang Province, China
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Wang X, Zi S, Ji X, Zhu W, Cao L. A novel approach for anterior cruciate ligament tibial avulsion fracture: arthroscopic modified suture bridge fixation technique. Arch Orthop Trauma Surg 2024; 144:3167-3173. [PMID: 38904681 DOI: 10.1007/s00402-024-05365-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/05/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) tibial avulsion fracture is a rare injury, which usually happens in adults with traffic accidents or sports injuries. Surgery interventions are common treatment methods, they can restore knee function and help to return to normal life. In this study, we described an arthroscopic modified suture bridge fixation technique for ACL tibial avulsion fractures and explored the feasibility and therapeutic effects. MATERIALS AND METHODS This retrospective study reviewed data from January 2020 to May 2022. Data were collected on 18 patients (10 males and 8 females) with ACL tibial avulsion fractures and underwent arthroscopic modified suture bridge fixation technique. The study analyzed surgical data about intraoperative blood loss, operation time, hospital stay, fracture healing time, and visual analog scale (VAS). Functional evaluation of the knee joint was performed using the anterior drawer test, Lysholm knee scoring scale, International Knee Documentation Committee (IKDC), and knee range of motion (ROM). RESULTS All 18 patients were followed up between 12 and 20 months, with an average of 15.22 ± 1.96 months. The intraoperative blood loss was approximately 15-40 mL, averaging 25.78 ± 6.19 mL. The operation time was 65-85 min, with a mean of 74.89 ± 4.86 min. The hospital stay of patients was 3-5 days, with a mean of 3.89 ± 0.76 days. The mean fracture healing time was 8-12 weeks after surgery, with a mean of 9.22 ± 1.7 weeks. All incisions healed grade I without infection. There were no internal fixation failures, neurovascular injuries, and lower extremity deep venous thrombosis. The anterior drawer test was negative in all patients. At the final follow-up, the mean VAS score was 0-3, averaging 1.56 ± 0.71. The Lysholm score of the injured knee was 89-96, with an average of 92.50 ± 2.50; the IKDC score was 88-93, with an average of 90.44 ± 1.89; the knee ROM was 110-126°, with an average of 120.67° ± 4.31°. CONCLUSION Results demonstrated that the modified suture bridge fixation technique under arthroscope could provide reliable fixation and favorable clinical effects for ACL tibial avulsion fractures. This is a simple, minimally invasive, effective, and clinically applicable surgical method for ACL tibial avulsion fracture.
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Affiliation(s)
- Xiong Wang
- Department of Orthopedics, Shanghai Baoshan Luodian Hospital, No. 121, Luoxi Road, Baoshan District, Shanghai, 201908, China
| | - Shuming Zi
- Department of Orthopedics, Shanghai Baoshan Luodian Hospital, No. 121, Luoxi Road, Baoshan District, Shanghai, 201908, China
| | - Xiaoxi Ji
- Department of Sports Medicine, Huashan Hospital, Fudan University, 12 Wulumuqizhong Road, Shanghai, 200040, China
| | - Wenhui Zhu
- Department of Sports Medicine, Huashan Hospital, Fudan University, 12 Wulumuqizhong Road, Shanghai, 200040, China.
| | - Liehu Cao
- Department of Orthopedics, Shanghai Baoshan Luodian Hospital, No. 121, Luoxi Road, Baoshan District, Shanghai, 201908, China.
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Korthaus A, Hansen S, Krause M, Frosch KH. [Treatment of Injuries to the Posterior Cruciate Ligament]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:316-328. [PMID: 38834079 DOI: 10.1055/a-2091-4681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Compared to the anterior cruciate ligament injury, the rupture of the posterior cruciate Ligament (PCL) is the rarer condition. A high healing potential is attributed to the PCL in the literature, which is why conservative therapy is also considered important in addition to surgical treatment 1. Posterior cruciate ligament rupture is often associated with concomitant injuries. Among other things, up to 70% of cases are associated with accompanying injuries to the posterolateral corner 2. The detection of concomitant injuries has a significant influence on the outcome, as isolated surgical PCL stabilization does not lead to satisfactory results in these cases.
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Bouzid YB, Bassir RA, Boufettal M, Mekkaoui J, Kharmaz M, Lamrani MO, Berrada MS. Stepping into the Unknown: Unveiling the Rarity of PCL Fracture-Avulsions. Trauma Case Rep 2024; 51:101012. [PMID: 38600909 PMCID: PMC11004684 DOI: 10.1016/j.tcr.2024.101012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 04/12/2024] Open
Abstract
Tears of the posterior cruciate ligament (PCL) are rare, and avulsion fracture of the tibial attachment of the posterior cruciate ligament is even rarer. These injuries usually occur in accidents such as car crashes, causing acute pain, swelling as well as total functional impotence of the knee. Studies on the incidence of these injuries show variable results, but there appears to be an upward trend. The surgical management of PCL avulsion fracture is not clearly established, although arthroscopic techniques are becoming more popular due to their potential benefits. However, some medical centers may have limited access to these methods, thus preferring open surgery options. A case of LCP avulsion fracture in a 36-year-old female patient was reported, and surgery was successfully performed, leading to full recovery after six months with full knee mobility and posterior stability.
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Affiliation(s)
- Yassine Ben Bouzid
- Department of Orthopaedic and Trauma Surgery, Ibn Sina University Hospital, Rabat, Morocco
| | - Rida-Allah Bassir
- Department of Orthopaedic and Trauma Surgery, Ibn Sina University Hospital, Rabat, Morocco
| | - Monsef Boufettal
- Department of Orthopaedic and Trauma Surgery, Ibn Sina University Hospital, Rabat, Morocco
| | - Jalal Mekkaoui
- Department of Orthopaedic and Trauma Surgery, Ibn Sina University Hospital, Rabat, Morocco
| | - Mohamed Kharmaz
- Department of Orthopaedic and Trauma Surgery, Ibn Sina University Hospital, Rabat, Morocco
| | - Moulay Omar Lamrani
- Department of Orthopaedic and Trauma Surgery, Ibn Sina University Hospital, Rabat, Morocco
| | - Mohamed Saleh Berrada
- Department of Orthopaedic and Trauma Surgery, Ibn Sina University Hospital, Rabat, Morocco
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Bolz NM, Ehrle A, Mählmann K, Lischer CJ. Computed tomographic imaging and surgical management of distal insertional avulsion fragments of the caudal cruciate ligament in four horses. Vet Surg 2023; 52:1228-1236. [PMID: 37702039 DOI: 10.1111/vsu.14025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE To describe cases with caudal cruciate ligament (CdCL) avulsion fragments diagnosed based on computed tomography (CT) examination and report on arthroscopic fragment removal. ANIMALS Four Warmblood horses with hindlimb lameness and osseous fragments located in the caudal medial femorotibial joint (mFTJ). STUDY DESIGN Short case series. METHODS CT and arthroscopic evaluation of the caudal mFTJ were performed. The caudal mFTJ and the insertion of the CdCL on the tibia were assessed and removal of the avulsion fragments was attempted in three horses using a cranial intercondylar approach. RESULTS The fragment was not accessible via caudomedial approaches in one horse. A cranial intercondylar approach was used in three horses, allowing removal of the intra-articular fragment in two horses, and removal of two-thirds of the proximal fragment in the last horse. Acute, profuse, arterial bleeding occurred in this horse during surgery with transient postoperative soft tissue swelling. Comorbidities included medial femoral condyle cartilage defects (3), cranial cruciate ligament lesions (2), and medial collateral ligament lesions (2). Horses were followed up for 16 months (median, range 11-28 months), at which point all were back in ridden exercise; owners' satisfaction was good. CONCLUSION CT examination confirmed the diagnosis and allowed evaluation of the stifle joint for comorbidities. A cranial intercondylar arthroscopic approach facilitated the removal of CdCL insertional avulsion fragments, although not always complete. CLINICAL SIGNIFICANCE A cranial intercondylar approach can allow access to CdCL avulsion fragments, but complications and incomplete removal remain possible.
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Affiliation(s)
- Nico Michael Bolz
- Equine Clinic, Surgery and Radiology, Freie Universität Berlin, Berlin, Germany
| | - Anna Ehrle
- Equine Clinic, Surgery and Radiology, Freie Universität Berlin, Berlin, Germany
| | - Kathrin Mählmann
- Equine Clinic, Surgery and Radiology, Freie Universität Berlin, Berlin, Germany
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Nusia J, Xu JC, Knälmann J, Sjöblom R, Kleiven S. Injury risk functions for the four primary knee ligaments. Front Bioeng Biotechnol 2023; 11:1228922. [PMID: 37860626 PMCID: PMC10582698 DOI: 10.3389/fbioe.2023.1228922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/11/2023] [Indexed: 10/21/2023] Open
Abstract
The purpose of this study was to develop injury risk functions (IRFs) for the anterior and posterior cruciate ligaments (ACL and PCL, respectively) and the medial and lateral collateral ligaments (MCL and LCL, respectively) in the knee joint. The IRFs were based on post-mortem human subjects (PMHSs). Available specimen-specific failure strains were supplemented with statistically generated failure strains (virtual values) to accommodate for unprovided detailed experimental data in the literature. The virtual values were derived from the reported mean and standard deviation in the experimental studies. All virtual and specimen-specific values were thereafter categorized into groups of static and dynamic rates, respectively, and tested for the best fitting theoretical distribution to derive a ligament-specific IRF. A total of 10 IRFs were derived (three for ACL, two for PCL, two for MCL, and three for LCL). ACL, MCL, and LCL received IRFs in both dynamic and static tensile rates, while a sufficient dataset was achieved only for dynamic rates of the PCL. The log-logistic and Weibull distributions had the best fit (p-values: >0.9, RMSE: 2.3%-4.7%) to the empirical datasets for all the ligaments. These IRFs are, to the best of the authors' knowledge, the first attempt to generate injury prediction tools based on PMHS data for the four knee ligaments. The study has summarized all the relevant literature on PHMS experimental tensile tests on the knee ligaments and utilized the available empirical data to create the IRFs. Future improvements require upcoming experiments to provide comparable testing and strain measurements. Furthermore, emphasis on a clear definition of failure and transparent reporting of each specimen-specific result is necessary.
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Affiliation(s)
- Jiota Nusia
- Department of Traffic Safety and Traffic Systems, The Swedish National Road and Transport Research Institute (VTI), Stockholm, Sweden
| | - Jia-Cheng Xu
- Department of Traffic Safety and Traffic Systems, The Swedish National Road and Transport Research Institute (VTI), Stockholm, Sweden
- Division of Neuronic Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Johan Knälmann
- Department of Strength and Crash Analysis, Scania CV AB, Södertälje, Sweden
| | - Reimert Sjöblom
- Department of Strength and Crash Analysis, Scania CV AB, Södertälje, Sweden
| | - Svein Kleiven
- Division of Neuronic Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
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Zhou Z, Wang S, Xiao J, Mao Y, Li L, Xu W, She C. The degree of fracture reduction does not compromise the clinical efficacy of arthroscopic reduction and fixation of tibial posterior cruciate ligament avulsion fractures: A retrospective study. Medicine (Baltimore) 2023; 102:e35356. [PMID: 37773785 PMCID: PMC10545087 DOI: 10.1097/md.0000000000035356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/01/2023] [Indexed: 10/01/2023] Open
Abstract
This study aimed to explore the postoperative outcomes of patients who underwent arthroscopic internal fixation with repositioning sutures for the treatment of posterior cruciate ligament (PCL) avulsion fractures with poorly reduced fracture fragments. It was hypothesized that improperly repositioned fracture fragments might not influence the postoperative clinical outcomes in patients with PCL avulsion fractures treated by arthroscopic sutures. From January 2020 to December 2021, patients admitted to our hospital with PCL avulsion fractures were evaluated. Our inclusion criteria were as follows: diagnosis of PCL avulsion fracture as Meyers & McKeever Type II or Type III; underwent arthroscopic double tunnel suture fixation; and age below 70. Of the patients meeting these criteria, data from 34 individuals were collected by a designated follow-up officer. Based on postoperative imaging, the patients were divided into 2 groups: well fracture reduction and poor fracture reduction groups. Prior to the surgery, the Lysholm score, knee mobility, and international knee documentation committee (IKDC score) were recorded for both groups. At the 3-month post-surgery mark, CT-3D reconstruction was performed. Statistical analysis was conducted on the collected data. For data that conformed to a normal distribution, the t test was applied. For data that didn't conform, we used a non-parametric test. Both groups achieved successful wound healing without encountering any adverse events, such as fracture nonunion infection. Fracture healing was observed in both groups at the 3-month postoperative mark. The average follow-up duration was 13.24 ± 6.18 months. There were no significant differences in Lysholm score, IKDC score, or knee mobility between the well- and poorly-reduced groups at the final follow-up (P > .05). Postoperatively, both groups demonstrated significant improvements in knee function compared to the preoperative scores, with statistically significant differences observed in Lysholm score, IKDC score, and knee mobility (P < .05). Arthroscopic fixation with double-tunnel sutures proved to be a highly effective treatment approach for PCL avulsion fractures, even in cases where the fractures were poorly reduced. Remarkably, there were no significant differences observed in postoperative knee function between the well- and poorly-reduced groups, indicating that both groups achieved favorable outcomes.
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Affiliation(s)
- Zhaoxin Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Shendong Wang
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Jiazheng Xiao
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Yongtao Mao
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Liubing Li
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Wei Xu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Chang She
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
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Zhu Y, Yuan T, Cai D, Tao J, Dong J, Hu B, Qin J. Adjustable-Loop Cortical Button Fixation Results in Good Clinical Outcomes for Acute Tibial Avulsion Fracture of the Posterior Cruciate Ligament. Arthrosc Sports Med Rehabil 2023; 5:e307-e313. [PMID: 37101872 PMCID: PMC10123405 DOI: 10.1016/j.asmr.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/30/2022] [Accepted: 11/08/2022] [Indexed: 02/07/2023] Open
Abstract
Purpose To evaluate the clinical outcomes for arthroscopic treatment of acute posterior cruciate ligament (PCL) avulsion fractures with adjustable-loop cortical button fixation device. Methods Patients with PCL tibial avulsion fractures treated with an adjustable-loop cortical button fixation device between October 2019 and October 2020 were retrospectively identified. Patients with type 1 were treated using plaster fixation as a conservative treatment, whereas patients with type 2 and 3 with displacement were treated using an arthroscopic adjustable-loop cortical button. Operating time, incision recovery, complications, and postoperative fracture healing time were monitored. All patient follow-up was done at 12 months' postoperatively. Lysholm Knee Score and the International Knee Documentation Committee score were used to assess knee function. Results A total of 30 patients were included in the study (20 male/10 female; mean age 45.5 years, range 35-68 years). The mean operative time was 67.5 minutes (range: 50-90 minutes). The postoperative incision healed at stage A without complications, such as medically induced vascular nerve injury, intra-articular hematoma, or infection. All 30 patients were tracked postoperatively for 12 to 14 months, with a mean follow-up period of 12.6 months. The Lysholm knee function score was 45.93 ± 6.15 before surgery and 87.10 ± 3.71 at 12 months after surgery, and the International Knee Documentation Committee score was 19.27 ± 4.40 before surgery and 95.47 ± 1.87 at 12 months after surgery, with a statistically significant difference. Conclusions The treatment of PCL avulsion fractures with arthroscopic adjustable-loop cortical button fixation is easy to perform and shows good clinical results in our study. Level of Evidence IV, therapeutic case series.
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Affiliation(s)
| | | | | | | | | | | | - Jian Qin
- Address correspondence to Jian Qin, Sir Run Run, Hospital of Nanjing Medical University, Nanjing 211100, China.
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Sun K, Fan M. Study of double button plate and cannulated screw fixation for posterior cruciate ligament avulsion fracture. Front Surg 2023; 9:887010. [PMID: 36713664 PMCID: PMC9880984 DOI: 10.3389/fsurg.2022.887010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 10/20/2022] [Indexed: 01/15/2023] Open
Abstract
Background The posterior cruciate ligament (PCL) plays an important role in maintaining the stability of the knee joint. To date, researchers have not reached agreement on which type of fixation material should be used to treat PCL tibial avulsion fractures. The aim of this study was to investigate the effects of double button plate and cannulated screw fixation in the treatment of PCL avulsion fractures. Methods We retrospectively reviewed our database, which was collected prospectively. From January 2019 to January 2020, 46 patients with posterior cruciate ligament avulsion fractures who were treated with double button plate and cannulated screw fixation. The primary outcomes of this study were surgical complications (fixation failure/displacement, implant breakage, nonunion, infection), radiological parameters, and knee function and secondary outcomes included reoperation rates for the fixation methods and the prevalence of symptomatic hardware causing soft tissue irritation outcomes were included. Values were analysed using multiple comparisons, where P-values of 0.05 or less were considered significant. Results Double button plate fixation had significantly higher values than cannulated screw fixation. The results showed that double button plate fixation was related to greater decreases in the length of surgery, intraoperative blood loss, hospital days, full weight bearing time, and incidence of complications, as well as greater increases in postoperative range of motion and Knee Society Score function and Lysholm scores. Conclusion Compared with cannulated screw fixation, the use of double button plate fixation technology has the following advantages: less trauma, shorter operation time, convenient use of instruments and fixtures, and it does not need to be removed, thus avoiding secondary trauma. Moreover, double button plate fixation under direct vision is safe and reliable without the need for additional equipment.
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Sun C, Du R, Luo S, Chen L, Ma Q, Cai X. A New Arthroscopic Tightrope Suture-Button Fixation Procedure for Tibial Eminence Avulsion Fracture. J Knee Surg 2023; 36:132-138. [PMID: 34187070 DOI: 10.1055/s-0041-1731326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This case-series outcome study presents a new arthroscopic technique for tibial eminence avulsion fracture (TEAF) with double-tunnel using two tightrope suture buttons. From May 2017 to July 2020, we performed a new arthroscopic technique for TEAF with double tunnels, using two tightrope suture buttons on 13 patients. Clinical assessments included anterior drawer, Lachman, and pivot shift tests, the International Knee Documentation Committee (IKDC), Lysholm knee scores, visual analog scale (VAS) scores, and range of motion (ROM). An independent observer noted conditions before surgery and during the last follow-up. The patients had an average follow-up of 26.2 months, ranging from 15 to 37 months. During the last postsurgical follow-up, the anterior drawer, Lachman, and pivot shift tests were negative in all the cases. According to the IKDC, Lysholm, and VAS final scores, all patients presented a significant knee function improvement at last follow-ups compared with preoperatively. The study shows that satisfactory results about an anatomic reduction of the fragment, knee stability, function, and strength can be achieved with the new arthroscopic technique for TEAF with double tunnels using two tightrope suture buttons. This study is a therapeutic case series and its level of evidence is IV.
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Affiliation(s)
- Changjiao Sun
- Department of Orthopaedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Ruiyong Du
- Department of Orthopaedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Song Luo
- Southern Medical District of Chinese PLA General Hospital, Beijing, China
| | - Lianxu Chen
- Department of Orthopaedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Qi Ma
- Department of Orthopaedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xu Cai
- Department of Orthopaedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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Huang WT, Kang K, Wang J, Li T, Dong JT, Gao SJ. Morphological Risk Factors for Posterior Cruciate Ligament Tear and Tibial Avulsion Injuries of the Tibial Plateau and Femoral Condyle. Am J Sports Med 2023; 51:129-140. [PMID: 36476119 DOI: 10.1177/03635465221131295] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Identification of morphological risk factors associated with the knee that threaten ligaments is important for understanding injury mechanisms and prevention. However, the morphological risk factors for posterior cruciate ligament (PCL) lesions are not clearly understood. PURPOSE To investigate whether the medial tibial depth (MTD), medial and lateral posterior tibial slope, asymmetry of the medial and lateral slopes, radius of the sagittal plane medial femoral condyle, coronal tibial slope, and notch width index (NWI) were risk factors for PCL intrasubstance tearing (PCLIT) and tibial avulsion fractures (PCLAF). STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Between January 2015 and March 2022, 82 patients with isolated PCLIT, 68 patients with isolated PCLAF, and 82 controls without any ligamentous or meniscal pathologic findings as determined via physical examination and magnetic resonance imaging were included. Values were compared among the 3 groups. Logistic regression analysis was performed to confirm the risk factors. Receiver operating characteristic curves were defined for the morphological indicators and combination of risk factors. RESULTS Logistic regression analysis revealed (1) MTD, lateral minus medial posterior tibial slope, radius of the posterior circle of the medial femoral condyle, and NWI as significant independent predictors for PCLIT and (2) MTD and NWI for PCLAF. The areas under the curve combining the 4 indicators for PCLIT and noncontact PCLIT were 0.79 (95% CI, 0.72-0.86) and 0.90 (95% CI, 0.85-0.96), respectively. The area under the curve for the combination of MTD and NWI for PCLAF was 0.78 (95% CI, 0.70-0.86). CONCLUSION Decreased MTD and NWI were associated with an increased incidence of PCLIT and PCLAF. Increased asymmetry of the medial and lateral slopes and the radius of the posterior circle of the medial femoral condyle were associated with the presence of PCLIT. In addition, the model of a combination of risk factors showed good predictive ability for noncontact PCLIT. These findings may aid clinicians in identifying patients at risk for PCL lesions. Further studies are warranted for identifying the effect of these factors on biomechanical mechanisms.
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Affiliation(s)
- Wen-Tao Huang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Kai Kang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Juan Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Hebei Institute of Orthopaedic Research, Shijiazhuang, China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Tong Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiang-Tao Dong
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shi-Jun Gao
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Hebei Institute of Orthopaedic Research, Shijiazhuang, China
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Intercondylar notch volume in patients with posterior cruciate ligament tears and tibial avulsion injuries: a study applying computed tomography. J Orthop Surg Res 2022; 17:560. [PMID: 36550563 PMCID: PMC9784257 DOI: 10.1186/s13018-022-03451-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Two relatively common forms of injury exist in the posterior cruciate ligament (PCL) after the onset of trauma: PCL tear and tibial avulsion fracture. The mechanism for the occurrence of these different forms of injury is not known. Herein, we aimed to investigate this mechanism by comparing the intercondylar notch parameters between patients with PCL tears and those with PCL avulsion fractures of the tibial insertion. METHODS Fifty-three patients with PCL tears (37 male, 16 female: median age of 37 years: range 18-54 years) and 46 patients with avulsion fractures of tibial insertion (33 male, 13 female: median age of 33 years: range 18-55 years) were included in this study. Three-dimensional computed tomography (CT) was applied to measure the intercondylar notch width index and intercondylar notch volume. The intercondylar notch volume was simulated as the truncated-pyramid shape. Measurements of the top and bottom areas of this model were conducted on the slice containing the most proximal (S1) and most distal (S2) levels of Blumensaat's line. Femoral condyle height (h) was defined as the vertical distance between two parallel planes, and the volume was calculated as h(S1 + S2 + √(S1S2))/3. The values of S1, S2, h, notch volume, the body mass index (BMI), intercondylar notch width (NW), femoral condylar width (FW) and notch width index (NWI) were compared among the PCL tear and avulsion-fracture groups. RESULTS The results show a significant difference in the S2 and normalized intercondylar notch volumes among patients with PCL tears and tibial avulsion injuries. Patients with PCL tears have smaller S2 and intercondylar notch volumes than those with tibial avulsion. There were no significant differences between the two groups in S1 or the 2D notch measurement parameters, such as the NW, FW and NWI. In addition, logistic regression analysis revealed notch volume and body mass index (BMI) as two significant independent predictors for PCL tears. CONCLUSION Decreased intercondylar notch volume and increased BMI are associated with an increased incidence of PCL tears. The occurrence of PCL tears and tibial avulsion injuries is influenced by the femoral intercondylar notch volume, and the measurement of the notch volume could be useful for identifying patients at risk for PCL tears.
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Arthroscopic Reduction of Bicruciate Tibial Avulsion Fractures: Lever Push Technique. Arthrosc Tech 2022; 11:e1525-e1530. [PMID: 36185125 PMCID: PMC9519939 DOI: 10.1016/j.eats.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/19/2022] [Indexed: 02/03/2023] Open
Abstract
Combined anterior cruciate ligament and posterior cruciate ligament tibial avulsion fractures are rare knee injuries that are primarily seen in adults. Prompt surgical intervention is indicated for displaced fractures to restore knee stability. Arthroscopic techniques are now the preferred method for treating anterior tibial spine avulsion fractures with posterior cruciate ligament tibial avulsion fractures being treated arthroscopically or with open reduction and internal fixation methods. This Technical Note and accompanying video demonstrate an arthroscopically assisted repair of bicruciate tibial avulsion fractures using an arthroscopic lever push technique. Two sutures are passed through the anterior cruciate ligament and pulled down through two bone tunnels placed within the tibial fracture bed, and one suture is passed around the posterior cruciate ligament and pulled down through one bone tunnel passing from the anterior tibia to the tibial fracture bed. Our technique is simple and effective in reducing bicruciate tibial avulsion fractures to anatomic position.
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Kong AP, Robbins RM, Stensby JD, Wissman RD. The Lateral Knee Radiograph: A Detailed Review. J Knee Surg 2022; 35:482-490. [PMID: 35062040 DOI: 10.1055/s-0041-1741391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Initial imaging evaluation for a variety of knee pathologies often begins with a radiographic series. Depending on the specific indication, this will include at least two different projections of the knee. In most cases, these are the anteroposterior and lateral radiographs of the affected knee, and sometimes with the contralateral knee for comparison. Typically, knee pathologies visible on lateral view can also be appreciated on the anteroposterior view. However, several pathologic processes occur in anatomic locations typically obscured on other projections because of superimposed osseous structures. Examples of these pathologies include injuries involving the quadriceps or patellar tendons, avulsion fractures involving anterior or posterior structures, and many soft-tissue injuries. Knowledge of the relevant anatomy and typical pathologies typically visualized on the lateral radiograph of the knee is imperative to avoid overlooking these disease processes.
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Affiliation(s)
- Andrew P Kong
- Department of Radiology, University of Missouri System, 1 Hospital Dr., Columbia, Missouri
| | - Robert M Robbins
- Department of Radiology, University of Missouri System, 1 Hospital Dr., Columbia, Missouri
| | - James D Stensby
- Musculoskeletal Imaging Division, Department of Radiology, Faculty of Clinical Radiology, University of Missouri System, Columbia, Missouri
| | - Robert D Wissman
- Musculoskeletal Imaging Division, Department of Radiology, Faculty of Clinical Radiology, University of Missouri System, Columbia, Missouri
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Phatama KY, Lesmana A, Cendikiawan F, Pradana AS, Mustamsir E, Hidayat M. Unusual combination of posterior cruciate ligament tibial avulsion fracture and Segond fracture: A case report. Int J Surg Case Rep 2021; 86:106380. [PMID: 34509156 PMCID: PMC8437793 DOI: 10.1016/j.ijscr.2021.106380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/24/2021] [Accepted: 09/02/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction and importance Posterior cruciate ligament (PCL) avulsion fracture is an uncommon entity, but it poses significant morbidity to patient's knee and activities. A combination of PCL avulsion fracture with Segond fracture is rare and has not been described much before in known literature. In this case report, we present a rare case of a combination of these two injuries. Case presentation A 16-year-old cyclist who sustained left knee injury after a high-velocity fall while cycling. He fell with his anteromedial side of his left knee hitting the ground in flexion. After the fall, he felt excruciating pain and unable to bear weight. Examination revealed severe joint effusion, tenderness on posterior and lateral side of the left knee, no vascular injury and neurological deficit present. Radiographic examination revealed PCL avulsion fracture and Segond fracture. Five days after the injury, the avulsed PCL fragment and the lateral tibial plateau fragment were reduced and fixed with 3.5 mm cortical screw and washers. On the follow up, the patient stated that there is no pain on weightbearing position and after evaluated with Knee injury and Osteoarthritis Outcome Score (KOOS), the result is 90%. Clinical discussion Although the combination of PCL avulsion fracture and Segond fracture is rare, this pattern of injury could happen and could be considered when evaluating knee injuries. Conclusion Both fractures need to be addressed and managed adequately to restore knee stability and prevent early joint degeneration. A rare case of combination of PCL avulsion fracture with Segond fracture Segond fracture only present in 1.25% of the ACL avulsion cases PCL avulsion fracture is rare compare to intrasubstance PCL tear. No other identical case has been described or reported previously.
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Affiliation(s)
- Krisna Yuarno Phatama
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya-RSUD Dr. Saiful Anwar, Malang, East Java, Indonesia.
| | - Albert Lesmana
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya-RSUD Dr. Saiful Anwar, Malang, East Java, Indonesia
| | - Felix Cendikiawan
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya-RSUD Dr. Saiful Anwar, Malang, East Java, Indonesia
| | - Ananto Satya Pradana
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya-RSUD Dr. Saiful Anwar, Malang, East Java, Indonesia
| | - Edi Mustamsir
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya-RSUD Dr. Saiful Anwar, Malang, East Java, Indonesia
| | - Mohamad Hidayat
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya-RSUD Dr. Saiful Anwar, Malang, East Java, Indonesia
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Zhao D, Zhong J, Zhao B, Li Y, Shen D, Gui S, Hu W, Liu C, Qian D, Li J. Clinical outcomes of acute displaced posterior cruciate ligament tibial avulsion fracture: A retrospective comparative study between the arthroscopic suture and EndoButton fixation techniques. Orthop Traumatol Surg Res 2021; 107:102798. [PMID: 33340707 DOI: 10.1016/j.otsr.2020.102798] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/29/2020] [Accepted: 10/06/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Tibial avulsion fracture of the posterior cruciate ligament is not rare in the clinic. Arthroscopic treatment is increasingly accepted, but the choice of fixation has been debated. This study aims to compare the clinical outcomes of suture and EndoButton fixation under arthroscopy for acute displaced posterior cruciate ligament avulsion fractures. METHODS A total 68 of 83 PCL tibial avulsion fracture cases from 2009 to 2016 were retrospectively reviewed. Some patients received arthroscopic suture initially, and later the others received arthroscopic EndoButton fixation. Associated lesions were treated if present. The Lysholm and International Knee Documentation Committee (IKDC) scores, KT-1000 arthrometry and plain radiography were evaluated at follow-up. The assessment data at two years of follow-up were used for comparing the two different fixation groups. RESULTS The follow-up time of 63 patients was more than 2 years. In total, 32 of the 63 patients were in the suture group, and 31 were in the EndoButton group. At two years of follow-up, knee function according to the Lysholm score was a mean of 92.5 with a 95% confidence interval [CI] of 89.45 to 96.40 in the suture group and a mean of 93.5 with a 95% CI of 90.52 to 97.28 in the EndoButton group (P=.785). More than 90% of patients in both groups rated their knee function as normal or nearly normal on IKDC subjective evaluation. KT-1000 arthrometry showed that there was no difference between the two groups, with 0 to 3mm of laxity in 91% of the cases in the suture group versus 90% of cases in the EndoButton group. All patients achieved bony healing within 3 months. No significant complications were noted in the study. CONCLUSIONS Both the arthroscopic suture and EndoButton fixation methods for acute displaced posterior cruciate ligament avulsion fractures resulted in comparably good clinical outcomes, radiologic healing, and stable knees at mid-term follow-up. LEVEL OF EVIDENCE III; retrospective comparative study.
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Affiliation(s)
- Daohong Zhao
- Department of Orthopaedics, The Second Affiliated Hospital of Kunming Medical University, No374, dianmian road, Kunming, China.
| | - Jia Zhong
- Department of Orthopaedics, The People Hospital of XiShuangBanNa State, China
| | - Bo Zhao
- Department of Orthopaedics, The Second People Hospital of BaoShan city, China
| | - Yan Li
- Department of Orthopaedics, The People Hospital of DeHong State, China
| | - Duo Shen
- Department of Orthopaedics, The People Hospital of LongChuan County, China
| | - Shiqiang Gui
- Department of Orthopaedics, The People Hospital of WeiXin County, China
| | - Weiping Hu
- Department of Orthopaedics, The People Hospital of ZhenXiong County, China
| | - Chao Liu
- Department of Orthopaedics, The People Hospital of ZhenXiong County, China
| | - Donggang Qian
- Department of Orthopaedics, The TianQi Hospital of Second Affiliated Hospital of Kunming Medical University. China
| | - Jinghua Li
- Department of Orthopaedics, The Bone Trauma Special Hospital of LiJingHua, China
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Fan N, Zheng YC, Zang L, Yang CG, Yuan S, Du P, Liu YM, Zhao Q, Wang JW. What is the impact of knee morphology on posterior cruciate ligament avulsion fracture in men and women: a case control study. BMC Musculoskelet Disord 2021; 22:100. [PMID: 33478440 PMCID: PMC7819342 DOI: 10.1186/s12891-021-03984-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 01/19/2021] [Indexed: 01/11/2023] Open
Abstract
Background Several studies on the relationship between morphological parameters and traumatic diseases of the knee have already been conducted. However, few studies focused on the association between knee morphology and posterior cruciate ligament (PCL) avulsion fracture in adults. The objective of this study was to evaluate the impact of knee morphology on PCL avulsion fracture. Methods 76 patients (comprised 40 men and 36 women) with PCL avulsion fracture and 76 age- and sex-matched controls without PCL avulsion fracture were studied from 2012 to 2020. MRI measurements of the knee were acquired in the sagittal, coronal, and axial planes. The assessed measurements including intercondylar notch width index, coronal tibial slope, and medial/lateral posterior tibial slopes were compared between men and women, and between case and control groups respectively using independent sample t-tests. In addition, binary logistic regression analyses were used to identify independent risk factors of PCL avulsion fracture. Results Except notch width index (coronal) (p = 0.003) in the case groups, there was no statistical difference in the assessed measurements including notch width index (axial), coronal tibial slope, medial posterior tibial slope, and lateral posterior tibial slope between men and women in the case and control groups (p > 0.05). When female patients were analyzed, the notch width index (coronal) was significantly smaller (p = 0.0004), the medial posterior tibial slope (p = 0.018) and the lateral posterior tibial slope (p = 0.033) were significantly higher in the case group. The binary logistic regression analysis showed that the notch width index (coronal) (B = -0.347, OR = 0.707, p = 0.003) was found to be an independent factor of PCL avulsion fracture. However, none of the assessed measurements was found to have a statistical difference between the case and control groups in men (p > 0.05). Conclusions Notch width index (coronal), medial posterior tibial slope, and lateral posterior tibial slope were found to affect PCL avulsion fracture in women, but no such measurements affected the PCL avulsion fracture in men. Furthermore, a smaller notch width index (coronal) in women was found to be a risk factor in PCL avulsion fracture.
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Affiliation(s)
- Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yong-Chen Zheng
- Department of Orthopedics, Beijing Shunyi District Hospital, Beijing, China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
| | - Cheng-Gang Yang
- Department of Orthopedics, Beijing Shunyi District Hospital, Beijing, China.
| | - Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Peng Du
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yan-Mei Liu
- Department of Orthopedics, Beijing Shunyi District Hospital, Beijing, China
| | - Qing Zhao
- Department of Orthopedics, Beijing Shunyi District Hospital, Beijing, China
| | - Jin-Wei Wang
- Department of Orthopedics, Beijing Shunyi District Hospital, Beijing, China
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周 鹏, 刘 俊, 徐 杨, 魏 代, 邓 翔, 李 忠. [Early effectiveness of minimally invasive open reduction and internal fixation versus arthroscopic double-tunnel suture fixation for tibial avulsion fracture of posterior cruciate ligament]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:707-712. [PMID: 32538560 PMCID: PMC8171530 DOI: 10.7507/1002-1892.201911049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/10/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the early effectiveness of minimally invasive open reduction and internal fixation via posterior median approach versus arthroscopic double-tunnel suture fixation in treatment of tibial avulsion fracture of the posterior cruciate ligament (PCL). METHODS A clinical data of 31 patients with the tibial avulsion fracture of the PCL and met the criteria between January 2015 and January 2019 was retrospectively analyzed. Nineteen patients (group A) were treated with open reduction and internal fixation with cannulated screw via posterior median approach. The other 12 patients (group B) were treated with arthroscopic double-tunnel suture fixation technique. There was no significant difference between the two groups ( P>0.05) in the gender, age, side of effected limb, the injury cause, the time from injury to operation, the combined meniscus injury, Meyers & McKeever classification and preoperative Lysholm score, Tegner score, International Knee Documentation Committee (IKDC) score, and the difference of tibial posterior displacement between bilateral knees. The operation time, postoperative complications, fracture healing, and the difference of tibial posterior displacement between bilateral knees, Lysholm score, Tegner score, and IKDC score were recorded. RESULTS Group B spent significantly longer operation time than group A ( t=7.347, P=0.000). No postoperative complication occurred in group B, and 1 patient in group A had a screw breakage. All patients were followed up 6-36 months (mean, 22 months). X-ray films showed that all fractures healed at 3 months after operation. At last follow-up, there was no significant difference in the patients with normal knee range of motion between the two groups ( P=0.510). At last follow-up, the difference of tibial posterior displacement between bilateral knees, Lysholm score, Tegner score, and IKDC score in the two groups were superior to those before operation ( P<0.05); while there was no significant difference between the two groups ( P>0.05). CONCLUSION For the tibial avulsion fracture of PCL, the minimally invasive open reduction and internal fixation and arthroscopic double-tunnel suture fixation can obtain similar early effectiveness. However, arthroscopic surgery has the advantages of being able to simultaneously deal with intra-articular combined injuries, avoiding internal fixator complications, and eliminating the need for secondary operation.
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Affiliation(s)
- 鹏 周
- 西南医科大学附属医院骨与关节外科(四川泸州 646000)Department of Orthopaedics and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - 俊才 刘
- 西南医科大学附属医院骨与关节外科(四川泸州 646000)Department of Orthopaedics and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - 杨博 徐
- 西南医科大学附属医院骨与关节外科(四川泸州 646000)Department of Orthopaedics and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - 代清 魏
- 西南医科大学附属医院骨与关节外科(四川泸州 646000)Department of Orthopaedics and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - 翔天 邓
- 西南医科大学附属医院骨与关节外科(四川泸州 646000)Department of Orthopaedics and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
- 南开大学医学院(天津 300071)School of Medicine, Nankai University, Tianjin, 300071, P.R.China
| | - 忠 李
- 西南医科大学附属医院骨与关节外科(四川泸州 646000)Department of Orthopaedics and Joint Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
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19
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Brandsma ASE, Goedhart LM, van Raaij JJ. An avulsion fracture of the anterior cruciate ligament attachment to the lateral femoral condyle in an elderly patient: a rare finding. J Surg Case Rep 2020; 2020:rjaa054. [PMID: 32280438 PMCID: PMC7135847 DOI: 10.1093/jscr/rjaa054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 11/13/2022] Open
Abstract
An anterior cruciate ligament (ACL) rupture is a common injury. The ACL usually tears in its mid-substance, an avulsion fracture of the ACL mostly occurs at the tibial attachment. In few cases, an avulsion fracture occurs proximally from the ACL attachment to the lateral femoral condyle. This is a rare finding, especially in elderly patients. We report a case of an avulsion fracture of the ACL attachment to the lateral femoral condyle after a traumatic injury in a 60-year-old female. Injury was not recognized during initial assessment, but was later detected during knee arthroscopy because of persisting mechanical complaints with catching of the knee. This emphasizes the importance of a thorough physical examination and magnetic resonance imaging. As rare as this condition is, it is important for the orthopaedic surgeon in treating these patients to include femoral end avulsion injuries of the ACL in the differential diagnosis.
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Affiliation(s)
- ASE Brandsma
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - LM Goedhart
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - JJ van Raaij
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands
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20
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Dung TT, Du HG, Long NH, Son LM, Thanh DX, Son DN, Tuyen NT, Minh DV, Phương NH, Nam VT, Hieu PT, Thanh MN. Arthroscopic fixation of ACL avulsion fracture in the saint pault hospital: A review of treatment outcomes: Cohort study. Ann Med Surg (Lond) 2019; 48:91-94. [PMID: 31737267 PMCID: PMC6849137 DOI: 10.1016/j.amsu.2019.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/04/2019] [Indexed: 11/28/2022] Open
Abstract
Background The purpose of this research is to evaluate the results of arthroscopic suture fixation with fiber wires used as treatment for ACL avulsion fracture, and to determine how effective such a technique is when it comes to restoring of knee function. Materials and methods This prospective study involves 28 patients, who underwent arthroscopic fixation of displaced ACL avulsion fractures at Saint Paul Hospital (Hanoi) from January 2014 to March 2018. Results The first three weeks were not marked with any abnormalities associated with post-operative sutures and hematomas, infectious complications were not detected either. Post-operative displacement of fracture fragments did not take place among the patients involved in the study. At the 3-month follow-up, the average IKDC score was 90.7 (range: 76–100), and the average Lysholm score was 93.6 (range 82–100). The percentage of excellent scores was 42.9% (12 patients), good scores accounted for 50% (14 patients), while fair/poor scores accounted for 3.6% each (1 patient on each score). The percentage of excellent/good scores was 92.9% in total. Conclusion This study shows that ACL avulsion fracture can be treated effectively by arthroscopic suture fixation with fiber wires. In fact, this technique may restore knee function and stability. Evaluating the results of arthoscopic suture fixation with fiber wires used as treatment for ACL avulsion fracture. The study involves 28 patients. The ACL avulsion fracture can be treated effectively by arthoscopic suture fixation with fiber wires. It may restore knee function and stabiity.
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Affiliation(s)
- Tran Trung Dung
- Hanoi Medical University, Viet Nam.,Saint Paul University Hospital, USA.,Hanoi Medical University Hospital, Viet Nam
| | - Hoang Gia Du
- Hanoi Medical University, Viet Nam.,Bachmai University Hospital, Viet Nam
| | - Nguyen Hoang Long
- Hanoi Medical University, Viet Nam.,Vietduc University Hospital, Viet Nam
| | - Le Manh Son
- Hanoi Medical University, Viet Nam.,Vietduc University Hospital, Viet Nam
| | - Dao Xuan Thanh
- Hanoi Medical University, Viet Nam.,Bachmai University Hospital, Viet Nam
| | - Dinh Ngoc Son
- Hanoi Medical University, Viet Nam.,Vietduc University Hospital, Viet Nam
| | | | - Do Van Minh
- Hanoi Medical University, Viet Nam.,Hanoi Medical University Hospital, Viet Nam
| | - Nguyen Huy Phương
- Hanoi Medical University, Viet Nam.,Saint Paul University Hospital, USA
| | - Vu Tu Nam
- Hanoi Medical University, Viet Nam.,Saint Paul University Hospital, USA
| | - Pham Trung Hieu
- Hanoi Medical University, Viet Nam.,Saint Paul University Hospital, USA
| | - Ma Ngoc Thanh
- Hanoi Medical University, Viet Nam.,Hanoi Medical University Hospital, Viet Nam
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21
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Dung TT, Du HG, Long NH, Son LM, Thanh DX, Son DN, Tuyen NT, Van Minh D, Phương NH, Nam VT, Hieu PT, Thanh MN. Arthroscopic fixation of ACL avulsion fracture in the Saint Paul Hospital: a review of treatment outcomes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1485-1491. [PMID: 31236684 DOI: 10.1007/s00590-019-02466-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/06/2019] [Indexed: 11/26/2022]
Abstract
The purpose of this research is to evaluate the results of arthroscopic suture fixation with fiber wires used as treatment for ACL avulsion fracture, and to determine how effective such a technique is when it comes to restoring of knee function. This prospective study involves 28 patients, who underwent arthroscopic fixation of displaced ACL avulsion fractures at Saint Paul Hospital (Hanoi) from January 2014 to March 2018. The first 3 weeks were not marked with any abnormalities associated with postoperative sutures and hematomas; infectious complications were not detected either. Postoperative displacement of fracture fragments did not take place among the patients involved in the study. At the 3-month follow-up, the average IKDC score was 90.7 (range 76-100), and the average Lysholm score was 93.6 (range 82-100). The percentage of excellent scores was 42.9% (12 patients), good scores accounted for 50% (14 patients), while fair/poor scores accounted for 3.6% each (one patient on each score). The percentage of excellent/good scores was 92.9% in total. This study shows that ACL avulsion fracture can be treated effectively by arthroscopic suture fixation with fiber wires. In fact, this technique may restore knee function and stability.
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Affiliation(s)
- Tran Trung Dung
- Hanoi Medical University, Hanoi, Vietnam.
- Saint Paul University Hospital, Surigao City, Philippines.
- Hanoi Medical University Hospital, Hanoi, Vietnam.
| | - Hoang Gia Du
- Hanoi Medical University, Hanoi, Vietnam
- Bachmai University Hospital, Hanoi, Vietnam
| | - Nguyen Hoang Long
- Hanoi Medical University, Hanoi, Vietnam
- Vietduc University Hospital, Hanoi, Vietnam
| | - Le Manh Son
- Hanoi Medical University, Hanoi, Vietnam
- Vietduc University Hospital, Hanoi, Vietnam
| | - Dao Xuan Thanh
- Hanoi Medical University, Hanoi, Vietnam
- Bachmai University Hospital, Hanoi, Vietnam
| | - Dinh Ngoc Son
- Hanoi Medical University, Hanoi, Vietnam
- Vietduc University Hospital, Hanoi, Vietnam
| | - Nguyen Trung Tuyen
- Hanoi Medical University, Hanoi, Vietnam
- Saint Paul University Hospital, Surigao City, Philippines
| | - Do Van Minh
- Hanoi Medical University, Hanoi, Vietnam
- Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Nguyen Huy Phương
- Hanoi Medical University, Hanoi, Vietnam
- Saint Paul University Hospital, Surigao City, Philippines
| | - Vu Tu Nam
- Hanoi Medical University, Hanoi, Vietnam
- Saint Paul University Hospital, Surigao City, Philippines
| | - Pham Trung Hieu
- Hanoi Medical University, Hanoi, Vietnam
- Saint Paul University Hospital, Surigao City, Philippines
| | - Ma Ngoc Thanh
- Hanoi Medical University, Hanoi, Vietnam
- Hanoi Medical University Hospital, Hanoi, Vietnam
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Porrino J, Wang A, Kani K, Kweon CY, Gee A. Preoperative MRI for the Multiligament Knee Injury: What the Surgeon Needs to Know. Curr Probl Diagn Radiol 2019; 49:188-198. [PMID: 30824164 DOI: 10.1067/j.cpradiol.2019.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 02/06/2019] [Indexed: 01/13/2023]
Abstract
The multiligament knee injury is devastating and potentially limb threatening. Preoperative magnetic resonance imaging for the evaluation of the multiligament knee injury is an invaluable clinical tool, and when the radiologist is familiar with how certain injury patterns influence management, optimal outcomes can be achieved. We provide a detailed description of the relationship between salient imaging features of the multiligament knee injury, focusing on the preoperative magnetic resonance imaging, and their influence on clinical decision-making.
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Affiliation(s)
- Jack Porrino
- Yale Radiology and Biomedical Imaging, New Haven, CT 06520.
| | - Annie Wang
- Yale Radiology and Biomedical Imaging, New Haven, CT 06520.
| | - Kimia Kani
- Department of Radiology, University of Maryland School of Medicine, Baltimore, MD 21201.
| | - Christopher Y Kweon
- University of Washington, Department of Orthopaedics & Sports Medicine, Seattle, WA 98195.
| | - Albert Gee
- University of Washington, Department of Orthopaedics & Sports Medicine, Seattle, WA 98195.
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Yao X, Xu Y, Yuan J, Lv B, Fu X, Wang L, Yang S, Meng S. Classification of tibia plateau fracture according to the "four-column and nine-segment". Injury 2018; 49:2275-2283. [PMID: 30270010 DOI: 10.1016/j.injury.2018.09.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/31/2018] [Accepted: 09/09/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE The existing classification systems of tibial plateau fracture (TPF) are suboptimal for clinical use and academic communication. A more comprehensive and universal classification system with the capability to analyze all patterns of TPF is urgently required to guide the clinical practice. This study aimed to analyze the incidence and fracture characteristics of TPF using a computed tomography-based "four-column and nine-segment" classification. METHODS According to the differentiated morphological characteristics, tibial plateau and proximal fibula were divided into four columns, which were subdivided into nine segments. Tibia plateau injury index (TPII) was innovatively introduced to represent the extent of injury. A total of 698 consecutive adult patients with 704 affected knees were included (377 females, 321 males, mean age 51.6 ± 12.9 years). Fracture mapping was retrospectively analyzed according to the new-style classification system based on the CT imaging. RESULTS 371 (53.2%) left knees and 321 (46.0%) right knees were injured solely and 6 (0.9%) cases sustained bilateral injuries. The rates of one-column, two-column, three-column and all-four-column injuries were 30.5%, 31.5%, 28.0% and 9.9%, respectively. On average, 2.2 ± 1.0 columns and 3.6 ± 2.1 segments were involved, the mean TPII was 5.7 ± 3.0. The rates of mild, moderate and severe comminuted fractures were 50.0%, 37.5% and 12.5%. The most frequently affected columns were lateral column (572, 81.3%) and intermedial column (524, 74.4%), and the less frequently involved columns were the medial column (219, 31.1%) and fibular column (218, 31.0%). The most frequently affected segments were the posterolateral segment (465, 66.1%), anterolateral segment (453, 64.3%) and posteromedian segment (379, 53.8%). The least frequently involved segment was tubercle segment (85, 12.1%). CONCLUSIONS The novel "four-column and nine-segment" classification will be a beneficial classification system for clinical diagnosis, statistical analysis and prognostic judgment of tibial plateau fractures.
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Affiliation(s)
- Xiang Yao
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Yong Xu
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Jishan Yuan
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Bin Lv
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Xingli Fu
- Jiangsu University Health Science Center, Zhenjiang, Jiangsu Province, China
| | - Lei Wang
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Shengquan Yang
- Department of Orthopaedics, The No.1 People's Hospital of Yancheng, Yancheng, Jiangsu Province, China
| | - Sheng Meng
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu Province, China.
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Abstract
PURPOSE OF REVIEW The purposes of this review are to (1) discuss the epidemiology and workup of the rare posterior cruciate ligament (PCL) avulsion fracture, (2) review the indications for nonoperative and operative management of patients with PCL avulsion fractures, (3) examine surgical outcomes in this patient population, and (4) discuss the authors' preferred management algorithm and surgical approach. RECENT FINDINGS In accordance with the rarity of these injuries, the literature is sparse regarding surgical outcomes. Many of these injuries are in the setting of a multi-ligamentous injury. Most authors suggest that displaced PCL avulsion fractures should undergo operative fixation and current data suggests excellent outcomes when treating these patients with either open or arthroscopic fixation, with a low complication rate. PCL avulsion fractures, although rare, should undergo fixation when displacement is present. Current studies report successful outcomes and a low complication rate.
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Affiliation(s)
- Anna Katsman
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Eric J Strauss
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Kirk A Campbell
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Michael J Alaia
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY, USA.
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25
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Yoon JR, Park CD, Lee DH. Arthroscopic suture bridge fixation technique with multiple crossover ties for posterior cruciate ligament tibial avulsion fracture. Knee Surg Sports Traumatol Arthrosc 2018; 26:912-918. [PMID: 27681893 DOI: 10.1007/s00167-016-4339-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/22/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE This study examined the clinical outcomes of a newly developed technique, arthroscopic suture bridge fixation with crossover ties of PCL tibial avulsion fracture using two tibial tunnels and a posterior trans-septal portal. METHODS Records were reviewed of 18 patients (median age 33.5 years, range 13-55 years) with PCL tibial avulsion fractures treated with an arthroscopic suture bridge technique. Knee function before surgery and at last follow-up was evaluated by Lysholm and Tegner scores. A KT-2000 arthrometer was used to evaluate knee stability, and fracture union was assessed by plain radiographs. RESULTS Mean postoperative Lysholm (P < 0.001) and Tegner (P = 0.011) scores showed significant improvements compared with preoperative scores. Arthrometry showed that the mean side-to-side difference improved significantly, from 7.8 ± 0.8 mm preoperatively to 3 ± 1.2 mm postoperatively (P = 0.012). Radiographic evaluation showed solid union at the fracture site in all 18 patients at last follow-up. CONCLUSION This new arthroscopic double-tunnel pull-out suture bridge fixation with multiple crossover ties and posterior trans-septal technique for PCL tibial avulsion fracture yielded good clinico-radiological outcomes, including satisfactory stability and fracture site healing. This technique can be a useful treatment option for PCL tibial avulsion fracture even with small comminuted fracture due to compression by the unique crossover configuration mesh of multiple fixation sutures. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jung-Ro Yoon
- Department of Orthopedic Surgery, Seoul Veterans Hospital, Seoul, South Korea
| | - Chan-Deok Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 135-710, South Korea
| | - Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 135-710, South Korea.
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26
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Lombardo-Torre M, Espejo-Reina A, García-Gutiérrez G, Espejo-Baena A, Espejo-Reina MJ. Arthroscopic Treatment of Concurrent Avulsion Fracture of Anterior and Posterior Cruciate Ligament with Suspension Device. J Orthop Case Rep 2018; 8:81-85. [PMID: 30167421 PMCID: PMC6114203 DOI: 10.13107/jocr.2250-0685.1062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Simultaneous avulsion fractures of the insertion of both cruciate ligaments of the knee are extremely uncommon lesions and their treatment remains difficult. The purpose of this paper is to show an arthroscopic repair technique of simultaneous tibial avulsion fracture of both cruciate ligaments of the knee such by using an adjustable length suspension device. CASE REPORT A 25-year-oldmale patient was treated by arthroscopic reduction and fixation of both bony avulsion of cruciate ligaments of the knee with a sliding and adjustable length suspension device (ZipTight, Biomet, Warsaw, IN, USA). There were no post-operative complications appeared. At 18-month follow-up, the patient was conducting normal life, free of symptoms. At clinical examination, Lachman, anterior drawer, pivot shift, posterior drawer, and reverse pivot shift tests were negative. Range of motion was 130° flexion, presenting a slight 5° of extension deficit. The International Knee Documentation Committee score was 83.80 points. Lysholm scale was 85 points. CONCLUSION The described repair technique is able to provide stable fixation of bone fragments in the face of early fracture consolidation, as well as minimizing potential complications and surgical time.
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27
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Frings J, Akoto R, Müller G, Frosch KH. Knöcherne Ausrisse des hinteren Kreuzbandes. ARTHROSKOPIE 2018. [DOI: 10.1007/s00142-017-0162-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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28
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Ambra LFM, Franciozi CES, Werneck LGM, de Queiroz AAB, Yamada RK, Granata GSM, Debieux P, Luzo MVM. Posteromedial Versus Direct Posterior Approach for Posterior Cruciate Ligament Reinsertion. Orthopedics 2016; 39:e1024-7. [PMID: 27398782 DOI: 10.3928/01477447-20160623-15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 09/24/2015] [Indexed: 02/03/2023]
Abstract
Avulsion fractures of the posterior cruciate ligament (PCL) are usually found in pediatric populations. This study investigated which of 2 approaches-posteromedial or direct posterior-enables easier PCL reinsertion. Ten fresh cadavers were studied using direct posterior (10 knees) and posteromedial (10 knees) approaches. In both, a guidewire was inserted into the tibial insertion of the PCL as perpendicular as possible to the coronal knee axis. Then, the angle between the guidewire and the horizontal plane of the table was measured. The mean angle of the guidewire was 8.6° (SD=7.3°) with the direct posterior approach and 36.6° (SD=14.3°) with the posteromedial approach (P=.005). The direct posterior approach allows a greater degree of freedom compared with the posteromedial approach to reach the PCL tibial insertion. [Orthopedics. 2016; 39(5):e1024-e1027.].
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29
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Gwinner C, Hoburg A, Wilde S, Schatka I, Krapohl BD, Jung TM. All-arthroscopic treatment of tibial avulsion fractures of the posterior cruciate ligament. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2016; 5:Doc02. [PMID: 26816668 PMCID: PMC4717297 DOI: 10.3205/iprs000081] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: The posterior cruciate ligament (PCL) avulsion fracture from its tibial insertion is a rare condition. Despite the further technical advent in refixation of avulsion fractures, the reported failure rate of current approaches remains high and the optimal surgical technique has not been elucidated yet. The purpose of the current study is to present an all-inside arthroscopic reconstruction technique for bony tibial avulsion fractures of the PCL and initial clinical outcomes. Methods: Patients underwent a thorough clinical and radiological examination of both knees at 3, 6, 12, 18, and if possible also at 24 months. Clinical evaluation included subjective and objective IKDC 2000, Lysholm score, and KOOS score. Radiographic imaging studies included CT scans for assessment of osseous integration and anatomic reduction of the bony avulsion. In addition to that posterior stress radiographs of both knees using the Telos device (Arthrex, Naples, USA) were conducted to measure posterior tibial translation. Results: A total of four patients (1 female, 3 male; ø 38 (± 18) years), who underwent arthroscopic refixation of a PCL avulsion fracture using the Tight Rope device were enrolled in this study. Mean follow up was 22 [18–24] months. The mean subjective IKDC was 72.6% (± 9.9%). Regarding the objective IKDC three patients accounted for grade A, one patient for grade C. The Lysholm score yielded 82 (± 6.9) points. The KOOS score reached 75% (± 13%; symptoms 76%, pain 81%, function 76%, sports 66%, QoL 64%). All patients showed complete osseous integration and anatomic reduction of the bony avulsion. The mean posterior tibial translation at final follow up was 2.8 [0–7] mm. Conclusions: All-arthroscopic treatment of tibial avulsion fractures of the posterior cruciate ligament provides satisfactory clinical results in a preliminary patient cohort. It is a reproducible technique, which minimizes soft tissue damage and obviates a second surgery for hardware removal. Further clinical studies with larger patient cohorts and a control group are needed to further confirm these preliminary results.
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Affiliation(s)
- Clemens Gwinner
- Center for Musculoskeletal Surgery, Charité - Medical University of Berlin, Germany
| | - Arnd Hoburg
- Center for Musculoskeletal Surgery, Charité - Medical University of Berlin, Germany
| | - Sophie Wilde
- Center for Musculoskeletal Surgery, Charité - Medical University of Berlin, Germany
| | - Imke Schatka
- Institute for Radiology and Nuclear Medicine, Charité - Medical University of Berlin, Germany
| | - Björn Dirk Krapohl
- Department of Plastic and Hand Surgery, St. Marien-Krankenhaus Berlin, Germany
| | - Tobias M Jung
- Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Germany
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30
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Barros MA, Cervone GLDF, Costa ALS. Surgical treatment of avulsion fractures at the tibial insertion of the posterior cruciate ligament: functional result. Rev Bras Ortop 2015; 50:631-7. [PMID: 27218073 PMCID: PMC4867919 DOI: 10.1016/j.rboe.2015.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/14/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To objectively and subjectively evaluate the functional result from before to after surgery among patients with a diagnosis of an isolated avulsion fracture of the posterior cruciate ligament who were treated surgically. METHOD Five patients were evaluated by means of reviewing the medical files, applying the Lysholm questionnaire, physical examination and radiological examination. For the statistical analysis, a significance level of 0.10 and 95% confidence interval were used. RESULTS According to the Lysholm criteria, all the patients were classified as poor (<64 points) before the operation and evolved to a mean of 96 points six months after the operation. We observed that 100% of the posterior drawer cases became negative, taking values less than 5 mm to be negative. CONCLUSION Surgical methods with stable fixation for treating avulsion fractures at the tibial insertion of the posterior cruciate ligament produce acceptable functional results from the surgical and radiological points of view, with a significance level of 0.042.
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31
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Barros MA, Cervone GLDF, Costa ALS. Tratamento cirúrgico da fratura avulsão na inserção tibial do ligamento cruzado posterior: resultado funcional. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2015.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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32
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Boutsiadis A, Karataglis D, Agathangelidis F, Ditsios K, Papadopoulos P. Arthroscopic 4-point suture fixation of anterior cruciate ligament tibial avulsion fractures. Arthrosc Tech 2014; 3:e683-7. [PMID: 25685674 PMCID: PMC4314561 DOI: 10.1016/j.eats.2014.08.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 08/26/2014] [Indexed: 02/03/2023] Open
Abstract
Tibial eminence avulsion fractures are rare injuries occurring mainly in adolescents and young adults. When necessary, regardless of patient age, anatomic reduction and stable internal fixation are mandatory for fracture healing and accurate restoration of normal knee biomechanics. Various arthroscopically assisted fixation methods with sutures, anchors, wires, or screws have been described but can be technically demanding, thus elongating operative times. The purpose of this article is to present a technical variation of arthroscopic suture fixation of anterior cruciate ligament avulsion fractures. Using thoracic drain needles over 2.4-mm anterior cruciate ligament tibial guidewires, we recommend the safe and easy creation of four 2.9-mm tibial tunnels at different angles and at specific points. This technique uses thoracic drain needles as suture passage cannulas and offers 4-point fixation stability, avoiding potential complications of bony bridge fracture and tunnel connection.
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Affiliation(s)
- Achilleas Boutsiadis
- First Orthopaedic Department, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Thessaloniki, Greece,Address correspondence to Achilleas Boutsiadis, M.D., First Orthopaedic Department, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, 14 Kapetan Gkoni, Stavroupoli, Thessaloniki, Greece, 56430.
| | - Dimitrios Karataglis
- Department of Orthopaedics, General Clinic, Blue Cross, Euromedica, Thessaloniki, Greece
| | - Filon Agathangelidis
- First Orthopaedic Department, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Thessaloniki, Greece
| | - Konstantinos Ditsios
- First Orthopaedic Department, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Thessaloniki, Greece
| | - Pericles Papadopoulos
- First Orthopaedic Department, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Thessaloniki, Greece
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Vairis A, Petousis M, Vidakis N, Kandyla B, Tsainis AM. Evaluation of a posterior cruciate ligament deficient human knee joint finite element model. QSCIENCE CONNECT 2014. [DOI: 10.5339/connect.2014.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Achilles Vairis
- 1Mechanical Engineering Department, Technological Education Institute of Crete, Estavromenos, 71004, Heraklion, Crete, Greece
| | - Markos Petousis
- 1Mechanical Engineering Department, Technological Education Institute of Crete, Estavromenos, 71004, Heraklion, Crete, Greece
| | - Nectarios Vidakis
- 1Mechanical Engineering Department, Technological Education Institute of Crete, Estavromenos, 71004, Heraklion, Crete, Greece
| | - Betina Kandyla
- 2National Organization for Primary Health Care, Athens, Greece
| | - Andreas-Marios Tsainis
- 1Mechanical Engineering Department, Technological Education Institute of Crete, Estavromenos, 71004, Heraklion, Crete, Greece
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