Tratamento cirúrgico da fratura avulsão na inserção tibial do ligamento cruzado posterior: resultado funcional

X-Shaped Knot Fixation and Double Posteromedial Portals for the Treatment of Posterior Cruciate Ligament Tibial Avulsion Fractures With Retention of the Posterior Septum

Posterior cruciate ligament (PCL) avulsion fractures at the tibial attachment site are managed using various techniques. Some surgeries involve internal fixation with an adjustable double-loop plate, anterior-to-posterior suture suspension fixation, hollow lag screw fixation, and steel wire fixation. In this case, an X-shaped knot and double posteromedial portals are used to retain the posterior septum for fixation. In this technique, we describe double posteromedial portals are used in this method. The internal joint is fixed with an X-shaped knot, and the external joint is fixed with SwiveLock, which puts the wire belt binding PCL compression bone block in a perfect tension state. This surgical technique can achieve a sound functional reduction.

Improved arthroscopic high-strength suture fixation for the treatment of posterior cruciate ligament avulsion fracture

Background: To investigate the curative effects of improved non-absorbable high-strength fixation under arthroscopy on posterior cruciate ligament (PCL) avulsion fracture. Methods: A retrospective analysis was performed on 16 cases of PCL avulsion fracture in 15 patients who underwent high-strength suture fixation under arthroscopy from December 2017 to November 2019. According to the Meyers-McKeever classification, there were 2 cases of type II and 14 cases of type III. The fracture was reduced under arthroscopy, and knotted and fixed under the anterior and medial skin of the knee joint with high-strength sutures and a button plate. Regular follow-up of the knee joint healing and stability, the range of motion and the functional recovery of affected limb was conducted. The last follow-up was completed after the button plate was taken out. The Lysholm score was used to assess the recovery situation. Results: The button plate was taken out 6-9 months (average 7.2 months) after surgery. At the last follow-up, the fractures of the 15 patients were all healed. Moreover, six patients were positive for posterior drawer test within Grade 1 and the others were negative. All patients had no knee extension limitation, and the range of knee flexion reached more than 120°, with an average of (132.4 ± 3.6)°. The average Lysholm score was (93.1 ± 4.7). There were significant differences in knee flexion angle and Lysholm score at different time points after operation, p = 0.000. Conclusion: For the treatment of PCL avulsion fracture, the optimized arthroscopic high-strength suture fixation is easy to perform and repeat, and the fixation is strong and solid. The functions of the knee joint experienced good recovery after the surgery.

Posterior cruciate ligament tibial insertion avulsion, management by open reduction and internal fixation using plate and screws through a direct posterior approach

PURPOSE

The purpose of our study was to evaluate the clinical and radiological outcomes after ORIF of PCL tibial insertion avulsion through the modified direct posterior approach using a small set plate and screws.

METHODS

Between January 2017 to September 2019, 31 patients with isolated PCL tibial insertion bony avulsion were identified. Twenty-one (68%) patients presented within one week of the injury, 8 (26%) patients presented after injury by a mean 7.5 weeks (range 3:12), and two (6%) patients presented late at 7- and 9-months after injury.

RESULTS

The mean age was 28.3 ± 6.3 years, 26 (84%) males, and 5 (16%) females. The mean operative time was 39.8 ± 7.9 min. In all patients, a one-third tubular plate was used. Fracture union was achieved in all patients after a mean 8 ± 2.1 weeks. The mean knee flexion at last follow up was 120.7° ± 4.3 with full extension in all patients. The knee Lysholm scoring was excellent in 27 (87%) patients, good in 3 (10%) patients, and fair in one (3%); the mean score was 93.4 ± 3.9. The PDT was positive in 4 patients (13%), three grade I, and one grade II. No neurovascular bundle or hardware related complications were reported. Two (6.5%) patients had a superficial wound infection with no further intervention.

CONCLUSION

Using small set plates and screws for ORIF of PCL tibial avulsion fractures through a direct posterior approach revealed good results in terms of surgical exposure, safety, radiological and clinical outcomes.

Collagen from Marine Sources and Skin Wound Healing in Animal Experimental Studies: a Systematic Review

Collagen (Col) from marine organisms has been emerging as an important alternative for commercial Col and it has been considered highly attractive by the industry. Despite the positive effects of Col from marine origin, there is still limited understanding of the effects of this natural biomaterial in the process of wound healing in animal studies. In this context, the purpose of this study was to perform a systematic review of the literature to examine the effects of Col from different marine species in the process of skin tissue healing using experimental models of skin wound. The search was carried out according to the orientations of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and the descriptors of the Medical Subject Headings (MeSH) were defined: "marine collagen," "spongin," "spongin," "skin," and "wound." A total of 42 articles were retrieved from the databases PubMed and Scopus. After the eligibility analyses, this review covers the different marine sources of Col reported in 10 different papers from the beginning of 2011 through the middle of 2019. The results were based mainly on histological analysis and it demonstrated that Col-based treatment resulted in a higher deposition of granulation tissue, stimulation of re-epitalization and neoangiogenesis and increased amount of Col of the wound, culminating in a more mature morphological aspect. In conclusion, this review demonstrates that marine Col from different species presented positive effects on the process of wound skin healing in experimental models used, demonstrating the huge potential of this biomaterial for tissue engineering proposals.

Outcome of screw post fixation of neglected posterior cruciate ligament bony avulsions

BACKGROUND

Contrary to acute posterior cruciate ligament (PCL) bony tibial avulsions, surgical management of chronic injuries is technically challenging and appears to be controversial. We sought to assess the outcome of a novel screw post augmentation technique in neglected cases.

METHODS

16 patients were followed up in a tertiary single-center retrospective study. The bony fragment was fixed using a lag screw with a spiked washer and an additional screw post through an open posterior approach. The pre- and postoperative knee range of movement (ROM), laxity, and modified Tegner-Lysholm (TL) scores were compared.

RESULTS

The median time from injury to surgery was 10 weeks (range, 3-260). The mean clinical follow-up time was 24.25 ± 9.21 months. At the final follow-up, the mean knee ROM flexion was 130° ± 11.55° with no extension lag. 3 patients had grade 1 laxity. The TL grade was predominantly excellent, and the overall median score improved from 76 preoperatively to 95 postoperatively (p < 0.0004). Bony union was achieved in all cases.

CONCLUSION

The described screw post fixation technique results in an excellent outcome for these rare injuries.

LEVEL OF EVIDENCE

Level IV, case series.