1
|
Mohani M, Sharath HV, Varma T. X-Sens Inertial Sensor Technology-Based Rehabilitation on a Patient With Posterior Cruciate Ligament Avulsion Fracture and Shaft of Femur Fracture: A Case Report. Cureus 2024; 16:e55217. [PMID: 38558734 PMCID: PMC10981367 DOI: 10.7759/cureus.55217] [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: 02/16/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
The posterior cruciate ligament (PCL), one of the key ligaments in the knee, serves to prevent backward movement of the tibia relative to the femur. A simultaneous occurrence of a PCL avulsion fracture and a femur shaft fracture in a pediatric patient suggests a complex orthopedic injury resulting from significant trauma to the knee and thigh area. This study describes the rehabilitation process of a 12-year-old female involved in a road traffic accident, who suffered both a midshaft femur fracture and a PCL avulsion fracture. Following surgical procedures, the patient underwent a comprehensive physiotherapy regimen utilizing X-Sens inertial sensor technology. The rehabilitation plan comprised multiple stages targeting pain alleviation, muscle strengthening, flexibility exercises, gait retraining, and balance improvement. Various interventions including contrast baths, cryotherapy, patellar mobilization, isotonic and resistance exercises, and progressive gait training were integrated across different phases of the rehabilitation program. Over subsequent follow-up periods, the patient demonstrated significant enhancements in pain management, range of motion, muscle strength, functional capabilities, and gait metrics. This case report underscores the efficacy of a systematic physiotherapy strategy incorporating advanced technology in the successful recovery from intricate lower limb fractures, underscoring the importance of prompt intervention and multidisciplinary collaboration for optimal patient outcomes.
Collapse
Affiliation(s)
- Mahek Mohani
- Department of Paediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - H V Sharath
- Department of Paediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Tanvi Varma
- Department of Cardiovascular and Respiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| |
Collapse
|
2
|
Folkman MJ, Mysore A, Liu RW, Gilmore A. Posterior Cruciate Ligament Injuries in Very Young Children - A Case Report and Modern Review. THE IOWA ORTHOPAEDIC JOURNAL 2024; 44:133-138. [PMID: 38919372 PMCID: PMC11195885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Background Posterior cruciate ligament (PCL) tears in young children are rare and optimal treatment is poorly described. Diagnosis may prove challenging as young children may not be able to verbalize a complete history of injury, may be difficult to examine, and plane film radiographs often appear within normal limits. Surgical treatment carries a risk of physeal arrest, but non-operative treatment may lead to recurrent instability and pain. Methods We present a case report of a fouryear- old child with a PCL avulsion off the femoral insertion who received an open reduction and internal fixation (ORIF) with combined arthroscopic synovial debridement. We performed a literature review which compared the mechanism, location, concomitant injuries, work up and management of PCL injuries in children under the age of ten compared to adolescents and adults. Results Nineteen months following surgery, physical examination revealed full knee range of motion and return to baseline function. Imaging studies confirmed there was no evidence of physeal arrest. Conclusion ORIF with arthroscopy can be an effective method to treat PCL avulsions in children under the age of 10 years. This is similar to other case reports which reported positive outcomes with ORIF in this population. Large studies are needed to best understand optimal treatment modalities for PCL injuries in very young children. Level of Evidence: IV.
Collapse
Affiliation(s)
- Matthew J. Folkman
- Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, Ohio, USA
- The University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Amog Mysore
- Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, Ohio, USA
- Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Raymond W. Liu
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Allison Gilmore
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
3
|
Chipman DE, Cirrincione PM, Mintz DN, DiFelice GS, Warren RF, Green DW. Posterior Cruciate Ligament Femoral Avulsion Fractures in Pediatric Patients: A Report of 2 Interesting Surgical Cases. JBJS Case Connect 2023; 13:01709767-202309000-00003. [PMID: 37428839 DOI: 10.2106/jbjs.cc.22.00753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
CASE This report describes 2 cases of femoral-sided posterior cruciate ligament (PCL) avulsion injuries. A 10-year-old male patient presented with a chronic nonunion of a bony PCL femoral avulsion. In addition, a 4-year-old boy presented with an acute, displaced PCL femoral avulsion off the medial femoral condyle. Both injuries were repaired using arthroscopic techniques. CONCLUSION Femoral-sided PCL avulsions are very rare in pediatric patients and have not been reported often. We hope to increase the awareness of PCL femoral avulsion injuries in pediatric patients by describing 2 unique cases.
Collapse
Affiliation(s)
- Danielle E Chipman
- Department of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Peter M Cirrincione
- Department of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Douglas N Mintz
- Department of Radiology, Hospital for Special Surgery, New York, New York
| | - Gregory S DiFelice
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Russell F Warren
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Daniel W Green
- Department of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| |
Collapse
|
4
|
Scarcella MJ, Yalcin S, Scarcella NR, Saluan P, Farrow LD. Outcomes of Pediatric Posterior Cruciate Ligament Reconstruction: A Systematic Review. Orthop J Sports Med 2021; 9:23259671211032539. [PMID: 34604428 PMCID: PMC8485165 DOI: 10.1177/23259671211032539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background Little has been reported in the literature regarding surgical treatment of posterior cruciate ligament (PCL) injuries in pediatric patients. Purpose/Hypothesis The purpose was to evaluate presentation, injury pattern, outcomes, and complications of surgically managed PCL injuries in pediatric patients. It was hypothesized that pediatric patients would have good patient-reported outcomes and no significant radiographic changes or complications. Study Design Systematic review; Level of evidence, 4. Methods A literature search was performed using PubMed, Medline, EMBASE, Scopus, and Cochrane databases between 1975 and December 16, 2019. Search terms included "posterior cruciate ligament," "peel-off injury," "avulsion," "PCL," "pediatric," "skeletally immature," and "adolescent." Included were studies on pediatric patients with PCL injuries managed operatively. Exclusion criteria included case reports, studies not reporting clinical results, reviews, abstract or conference papers, or papers not in the English language. Quality assessment was performed on all included studies using the MINORS (Methodological Index for Non-Randomized Studies) criteria. Results Four articles comprising 43 knees in 42 patients met the criteria and were included. Motor vehicle accidents were the most common mechanism of injury (39.5%; n = 17/43), followed by sports-related injuries (35%; n = 15/43). All studies commented on tear pattern, with the following distribution: 42% (n = 18/43) midsubstance tears, 37% (n = 16/43) tibial avulsions, and 21% (n = 9/43) femoral avulsions. Overall, good patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score and Pediatric International Knee Documentation Committee, Tegner, and Lysholm scores) and return to activity, as well as satisfactory posterior stability (KT-1000 arthrometer, posterior drawer test, and kneeling radiographs) and range of motion, were reported. There was no significant leg-length discrepancy or angular deformity reported. Arthrofibrosis was reported in 7% of postoperative knees and was the most commonly reported complication. Osteoarthritis was reported in 21% (n = 9/43) of knees. The average MINORS score was 7 (range, 6-8) for noncomparative studies and 10 for comparative studies. Conclusion Good patient-reported outcomes and return to activity can be obtained using repair or reconstruction. This evidence was limited by the quality of the included studies and overall small sample size; however, this review serves as a baseline for futures studies on PCL repair/reconstruction in pediatric patients.
Collapse
Affiliation(s)
| | - Sercan Yalcin
- Cleveland Clinic Sports Medicine, Cleveland, Ohio, USA
| | | | - Paul Saluan
- Cleveland Clinic Sports Medicine, Cleveland, Ohio, USA
| | | |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Sodavarapu P, Kumar D, Guduru A, Rathod PM. An Unusual Complex Posterolateral Osteoligamentous Injury of the Knee in an Adolescent. Cureus 2020; 12:e7532. [PMID: 32377480 PMCID: PMC7198076 DOI: 10.7759/cureus.7532] [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] [Indexed: 12/02/2022] Open
Abstract
We present an unusual and complex case of a 16-year-old adolescent male who injured his right knee and sustained combined avulsion injuries of posterior cruciate ligament (PCL) at the tibial insertion site, iliotibial band at lateral tibial condyle, and lateral collateral ligament (LCL) at femoral insertion site akin to osteoligamentous posterolateral corner injury. Anatomical reduction of the femoral LCL avulsion fragment was performed and fixed with a two 4-mm partially threaded cancellous screw. Iliotibial band avulsion was buttressed using Ellis t-plate and fixed with two 4-mm partially threaded cancellous screws. PCL avulsion fracture was conservatively treated owing to minimal displacement. At one-year follow-up, the patient was pain free with a range of motion of 0 to 150 degrees of flexion and had a pain free knee with no instability. Posterolateral corner injury in the patient was very significant as it involved LCL avulsion and iliotibial band avulsion, both of which are part of the posterolateral structures of the knee and also involve the growth plate. Fixation of the avulsion of Gerdy's tubercle with the buttress plate helps to provide additional stability to counteract the deforming forces of the iliotibial band. LCL is also the major stabilizer against varus forces, and hence fixation is required for stability while preventing growth disturbance. PCL avulsion can be treated conservatively in those patients where the fragment is undisplaced or minimally displaced. A good outcome can be achieved in skeletally immature patients who have osteoligamentous posterolateral corner injuries with associated avulsion fractures by using appropriate anatomical reduction and surgical fixation.
Collapse
Affiliation(s)
- Praveen Sodavarapu
- Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Deepak Kumar
- Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Aditya Guduru
- Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Pratik M Rathod
- Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| |
Collapse
|
7
|
Zhao X, Kuang SD, Su C, Xiao WF, Lei GH, Gao SG. Arthroscopic Treatment of Femoral Avulsion Fracture of the Posterior Cruciate Ligament in Association with Meniscus Tear. Orthop Surg 2020; 12:692-697. [PMID: 32157830 PMCID: PMC7189033 DOI: 10.1111/os.12636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/09/2020] [Accepted: 01/21/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Femoral avulsion fracture of the posterior cruciate ligament (PCL) in association with meniscus tear is extremely rare in children, and similar cases are not available in the existing literature. CASE PRESENTATION In this paper, we present a case of a 9-year-old boy treated by an arthroscopic repair technique using two transfemoral tunnels sparing the epiphyseal plate for 8-shaped suture fixation of femoral avulsion fracture of the PCL and using the Fastfix repair system for a meniscus tear. At 3-month postoperative, the boy showed satisfactory recovery with a full range of motion of the right knee and normal muscular strength, and no complications were observed after operation. The patient had been followed up for 24 months and his final assessment demonstrated stable painless knee with excellent functional outcome. In view of this, we suggest that the "figure-of-eight" suture technique using two transfemoral tunnels sparing the epiphyseal plate can be considered a new choice for the treatment of the PCL femoral attachment avulsion, especially in skeletally immature patients. In addition, six similar cases were found in a comprehensive literature review targeting femoral avulsion fracture of the PCL. According to the relevant findings and cases studies, we proposed a new classification named "Xiangya" which might facilitate future clinical decision making.
Collapse
Affiliation(s)
- Xin Zhao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Shi-da Kuang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Chao Su
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Wen-Feng Xiao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Guang-Hua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Center for Clinical Technology and Research of Joint Surgery of Hunan Province, Changsha, China
| | - Shu-Guang Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Center for Clinical Technology and Research of Joint Surgery of Hunan Province, Changsha, China
| |
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|