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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.
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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
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2
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He J, Byrne K, Liang J, Lu A, Wu S. Posterior cruciate ligament rupture and all-epiphyseal repair with suture tape augmentation in a 5-year-old girl: a case report and review of the literature. BMC Pediatr 2023; 23:331. [PMID: 37386372 PMCID: PMC10308658 DOI: 10.1186/s12887-023-04146-3] [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: 04/07/2022] [Accepted: 06/19/2023] [Indexed: 07/01/2023] Open
Abstract
INTRODUCTION Only a few case reports regarding pediatric posterior cruciate ligament (PCL) ruptures without bone avulsion exist in the literature. The present study aims to share our experience in the diagnosis, treatment, and prognosis of a child with a proximal PCL tear. MATERIALS AND METHODS This article reports a 5-year-old female diagnosed with a proximal PCL tear. The ruptured PCL was repaired with an all-epiphyseal suture tape augmentation (STA) without evidence of growth plate violation. RESULTS The suture tape was removed under arthroscopy and revealed the PCL was re-attached at 12 months after the first surgery. And at the time of this report, 36 months after surgery, she was doing well without any problems and with negative posterior drawer test. CONCLUSIONS Pediatric PCL tear without bone avulsion is rare. However, the torn PCL was noticed healed based on an arthroscopic second-look.
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Affiliation(s)
- Jinshen He
- Department of Orthopaedic Surgery, the Third Xiangya Hospital of Central South University, Changsha, 410013 Hunan China
| | - Kevin Byrne
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213 USA
| | - Jiehui Liang
- Department of Orthopaedic Surgery, the Third Xiangya Hospital of Central South University, Changsha, 410013 Hunan China
| | - Anjie Lu
- Department of Orthopaedic Surgery, the Third Xiangya Hospital of Central South University, Changsha, 410013 Hunan China
| | - Song Wu
- Department of Orthopaedic Surgery, the Third Xiangya Hospital of Central South University, Changsha, 410013 Hunan China
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Pacull R, Bourbotte-Salmon F, Buffe-Lidove M, Cance N, Chotel F. Misdiagnosed cartilaginous PCL avulsion in young children. SICOT J 2021; 7:57. [PMID: 34797212 PMCID: PMC8603924 DOI: 10.1051/sicotj/2021052] [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: 06/19/2021] [Accepted: 10/10/2021] [Indexed: 11/14/2022] Open
Abstract
Posterior Cruciate Ligaments injuries are rare in children and usually due to bony avulsion fractures or midsubstance tears. This study focused on cartilaginous avulsions initially misdiagnosed despite of MRI assessment. Two 6-year-old boys had cartilaginous avulsion fracture injury at the femoral attachment of the PCL. One had associated medial meniscal lesion and was reinserted. The other conducted to non-union. MRI second lecture reveals an original description with nail-biting sign on cartilage surface of anterior notch, and a close PCL angle without anterior tibial translation. No bone bruise was associated. Similarly, to ACL cartilaginous tibial avulsions, PCL cartilaginous femoral avulsions are underdiagnosed. When knee hemarthrosis occurs under the age of nine, clinician and radiologist should be aware that cartilaginous avulsion of ACL and PCL also could be the main pattern of lesion.
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Affiliation(s)
- Romain Pacull
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003 Lyon, France
| | - Florian Bourbotte-Salmon
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003 Lyon, France
| | - Margaux Buffe-Lidove
- Service de Médecine Physique et de Réadaptation, Hôpital d'instruction des Armées Desgenettes, 108 Boulevard Pinel, 69003 Lyon, France
| | - Nicolas Cance
- Service de Chirurgie Orthopédique Pédiatrique, Hôpital Femme Mère Enfant de Lyon, Groupement Hospitalier Est, 59 Boulevard Pinel, 69500 Bron, France
| | - Franck Chotel
- Service de Chirurgie Orthopédique Pédiatrique, Hôpital Femme Mère Enfant de Lyon, Groupement Hospitalier Est, 59 Boulevard Pinel, 69500 Bron, France - Université Claude Benard Lyon I, 43 Bd du 11 Novembre 1918, 69100 Villeurbanne, France
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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.
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Affiliation(s)
| | - Sercan Yalcin
- Cleveland Clinic Sports Medicine, Cleveland, Ohio, USA
| | | | - Paul Saluan
- Cleveland Clinic Sports Medicine, Cleveland, Ohio, USA
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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.
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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
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6
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"Multiligamentous" Injuries of the Skeletally Immature Knee: A Case Series and Literature Review. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2019; 2:e079. [PMID: 30656255 PMCID: PMC6324891 DOI: 10.5435/jaaosglobal-d-17-00079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Multiligamentous knee injuries occur rarely in the pediatric population. Few reports are available in the existing literature; furthermore, no longitudinal studies regarding the choice of treatment and long-term outcomes for this unique population have been published. To fill this knowledge gap, the literature on multiligamentous injuries of the knee in the adult population is commonly used as a guideline in clinical decision making for children and adolescents. However, the developing bone and physis are often weaker than the ligamentous structures of the knee—particularly during periods of rapid growth—and may be the first to fail in the event of injury or trauma. Bony avulsion fractures and peri-physeal fractures, rather than mid-substance ligamentous ruptures, may result. Patients with skeletal immaturity may therefore present with different patterns of multiligamentous injury after acute trauma to the knee. This article describes the clinical presentation, our treatment approach, and short-term outcomes for three pediatric patients with multiligamentous injuries of the knee and reviews the current literature relating to these uncommon injuries.
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7
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Richmond CG, Cannamela PC, Fabricant PD, Ganley TJ, Beckmann JT, Anderson AF, Shea KG. It is feasible to perform an all-epiphyseal double-bundle posterior cruciate ligament reconstruction in skeletally immature patients? A computer-aided modelling study. J ISAKOS 2018. [DOI: 10.1136/jisakos-2017-000170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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8
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Troyer S, Anchustegui NG, Richmond CG, Cannamela PC, Dingel A, Stavinoha TJ, Ganley TJ, Anderson AF, Shea KG. Avoiding tibia physeal injury during double-bundle posterior cruciate ligament reconstruction. J ISAKOS 2018. [DOI: 10.1136/jisakos-2017-000184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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9
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Sørensen OG, Faunø P, Christiansen SE, Lind M. Posterior cruciate ligament reconstruction in skeletal immature children. Knee Surg Sports Traumatol Arthrosc 2017; 25:3901-3905. [PMID: 28188335 DOI: 10.1007/s00167-016-4416-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 12/20/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Rupture of the posterior cruciate ligament (PCL) is a rare knee injury in children with open growth plates. The follow-up results of six patients with open physes treated with PCL reconstruction are presented. The objective is to evaluate the clinical outcomes of PCL reconstruction for six skeletally immature patients. METHODS Between 2006 and 2010, six skeletally immature patients were treated with PCL reconstruction. At the time of surgery, the median age was 9 years (range 6-14). The median follow-up time after surgery was 50 months (range 41-90). Outcomes were evaluated by KOOS and Tegner scores, instrumented knee laxity, and radiologic long-axis leg length measurements. RESULTS The median KOOS score at follow-up was 88 (range 26-98). The median Tegner score was 6 (range 4-7). The median side-to-side difference in laxity according to KT-1000 was 2 mm (range 1-5) at 25° of flexion and 3 mm (range 3-6) at 70° of flexion. A median side-to-side difference in flexion of 8° was found. All but one patient had returned to playing sports at follow-up. One patient's index leg had a length discrepancy of 16 mm. CONCLUSIONS PCL reconstruction resulted in fair to good clinical outcomes for skeletally immature children. Clinically relevant leg length discrepancy was found in one of the six patients examined in this study. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Ole Gade Sørensen
- Department of Sportstraumatology, University Hospital of Århus, Tage Hansens Gade 2, 8000, Århus C, Denmark.
| | - Peter Faunø
- Department of Sportstraumatology, University Hospital of Århus, Tage Hansens Gade 2, 8000, Århus C, Denmark
| | - Svend Erik Christiansen
- Department of Sportstraumatology, University Hospital of Århus, Tage Hansens Gade 2, 8000, Århus C, Denmark
| | - Martin Lind
- Department of Sportstraumatology, University Hospital of Århus, Tage Hansens Gade 2, 8000, Århus C, Denmark
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10
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Hurni Y, De Rosa V, Gonzalez JG, Mendoza-Sagaon M, Hamitaga F, Pellanda G. Pediatric Posterior Cruciate Ligament Avulsion Fracture of the Tibial Insertion: Case Report and Review of the Literature. Surg J (N Y) 2017; 3:e134-e138. [PMID: 28840195 PMCID: PMC5565699 DOI: 10.1055/s-0037-1605364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 07/06/2017] [Indexed: 12/26/2022] Open
Abstract
Background
Posterior cruciate ligament (PCL) avulsion fracture of the tibial insertion is a very rare injury in children. In addition to performing an attentive clinical examination, radiologic studies are fundamental for its correct diagnosis and treatment. Its management may be either conservative or operative. So far, only a few cases treated conservatively have been reported in the pediatric population, with controversial results.
Methods
We prospectively collected and reviewed clinical and radiographic data of an 11-year-old boy with avulsion fracture of the tibial insertion of the PCL. In addition, we performed a systematic review of the literature available to date.
Results
We decided to treat the avulsion fracture in a conservative way. The patient has been followed with accurate clinical and radiological follow-up controls until complete recovery.
Conclusion
Posterior cruciate avulsion fracture is a very rare finding in children, and no definitive indications for its appropriate management exist. With this report, we demonstrate that these fractures can be treated conservatively in selected cases with good results, avoiding potential surgical-related complications.
Study Design
This is a case report (level of evidence V).
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Affiliation(s)
- Yannick Hurni
- Department of Pediatric Surgery, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | - Vincenzo De Rosa
- Department of Pediatric Surgery, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | - Jorge Gabriel Gonzalez
- Department of Pediatric Surgery, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | - Mario Mendoza-Sagaon
- Department of Pediatric Surgery, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | - Flurim Hamitaga
- Department of Pediatric Surgery, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | - Giorgia Pellanda
- Department of Pediatric Surgery, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
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Shea KG, Grimm NL, Nichols FR, Jacobs JC. Volumetric Damage to the Femoral Physis During Double-Bundle Posterior Cruciate Ligament Reconstruction: A Magnetic Resonance Imaging Computer Modeling Study. Arthroscopy 2015; 31:1102-7. [PMID: 25771426 DOI: 10.1016/j.arthro.2015.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 01/01/2015] [Accepted: 01/16/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to use computer models to evaluate the volume of femoral physeal disruption in double-bundle posterior cruciate ligament (PCL) reconstruction in patients with open physes. METHODS Ten skeletally immature patients (6 girls and 4 boys) were selected for this study. The magnetic resonance imaging scans of each patient were converted into a 3-dimensional model using computer-aided design/computer-aided manufacturing software. The software allowed the users to differentiate the epiphyseal, physeal, and metaphyseal tissues. This allowed for quantification of volume removed of each tissue type. Furthermore, we used the 3-dimensional models to simulate an anatomic double-bundle technique using 6-, 7-, 8-, and 9-mm-diameter tunnels. The software method reflects an inside-out drilling technique. RESULTS For drill holes of all diameters, the posteromedial tunnels exited the knee inferior to the physis, thus avoiding physeal damage. In contrast, all the anterolateral tunnels perforated the physis. The results for the percent of total physis removed are as follows: 6-mm tunnel, 1.79% ± 0.99%; 7-mm tunnel, 2.23% ± 1.19%; 8-mm tunnel, 3.00% ± 1.54%; and 9-mm tunnel, 3.84% ± 1.73%. CONCLUSIONS This computer modeling simulation of double-bundle PCL reconstruction in skeletally immature knees found that the posteromedial tunnel avoided disruption of the distal femoral physis. In contrast, the anterolateral tunnel did disrupt the physis with all drill hole sizes (6 to 9 mm), but all had a less than 4% volume of total physis removed. CLINICAL RELEVANCE A clear understanding of the drill hole position may reduce the volume of physeal injury during double-bundle PCL reconstruction. This study shows that physeal disruption of less than the experimental 7% threshold that has been shown to cause physeal arrest may not cause arrest, but this is still speculative.
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Affiliation(s)
- Kevin G Shea
- St. Luke's Sports Medicine, St. Children's Hospital, Boise, Idaho, U.S.A.; Department of Orthopedics, University of Utah, Salt Lake City, Utah, U.S.A
| | - Nathan L Grimm
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Francesca R Nichols
- University of Utah School of Medicine, University of Utah, Salt Lake City, Utah, U.S.A
| | - John C Jacobs
- University of Utah School of Medicine, University of Utah, Salt Lake City, Utah, U.S.A..
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All inside transtibial arthroscopic posterior cruciate ligament reconstruction in skeletally immature: surgical technique and a case report. Orthop Traumatol Surg Res 2013; 99:361-5. [PMID: 23510633 DOI: 10.1016/j.otsr.2012.11.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 10/09/2012] [Accepted: 11/21/2012] [Indexed: 02/02/2023]
Abstract
UNLABELLED Posterior cruciate ligament (PCL) tears are rare in children and may cause posterior instability of the knee. We present an original reconstruction technique. An 11-year-old boy sustained a PCL rupture. Despite initial immobilization followed by physiotherapy, he could not resume his previous sporting activities at the pre-injury level and complained of anterior knee pain. We performed an arthroscopic PCL reconstruction using a single bundle four-strand hamstring autograft. The femoral tunnel was drilled through the epiphysis and the tibial tunnel went through the physis under both arthroscopic and fluoroscopic control. The graft was secured using absorbable interference screws. At 2 years follow-up, the patient was asymptomatic and resumed sports at the same level as before the injury. Clinical examination was normal. There was no sign of growth disturbance. PCL injury is extremely rare in children. This original technique seemed appropriate in a symptomatic patient. LEVEL OF EVIDENCE IV.
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13
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Solayar GN, Kapoor H. PCL tibial avulsion with an associated medial meniscal tear in a child: a case report on diagnosis and management. J Pediatr Orthop B 2012; 21:356-8. [PMID: 21460735 DOI: 10.1097/bpb.0b013e328346252f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Posterior cruciate ligament (PCL) injuries from tibial avulsions are rare in the paediatric setting. One would need a high index of suspicion as clinical examination may be difficult, especially in the early period. Magnetic resonance imaging is an excellent diagnostic modality for this condition and other associated injuries within the knee. We report a rare case in which the patient had a PCL avulsion off the tibial insertion site with an associated posterior horn medial meniscal tear off the posterior capsule. He was treated through open reduction and internal fixation of the avulsed fragment with suture repair of the meniscal tear. We emphasize the importance of diagnosing and managing associated intra-articular injuries when dealing with the rare condition of PCL tibial avulsion in the paediatric setting.
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Affiliation(s)
- Gandhi Nathan Solayar
- Department of Orthopaedics, Waterford Regional Hospital, Ardkeen, County Waterford, Ireland.
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14
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Bovid KM, Salata MJ, Vander Have KL, Sekiya JK. Arthroscopic posterior cruciate ligament reconstruction in a skeletally immature patient: a new technique with case report. Arthroscopy 2010; 26:563-70. [PMID: 20362839 DOI: 10.1016/j.arthro.2010.01.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 01/19/2010] [Accepted: 01/27/2010] [Indexed: 02/02/2023]
Abstract
Pediatric intrasubstance posterior cruciate ligament (PCL) injuries are rare but present a significant treatment challenge. Untreated instability may lead to further knee injury, including meniscal or chondral damage. Surgical intervention risks damage to the physis, growth arrest, and angular deformity. We present the case of a skeletally immature 11-year-old boy with a high-grade intrasubstance PCL injury reconstructed using an all-arthroscopic tibial inlay technique modified to minimize risk of physeal injury. The femoral tunnels were placed entirely within the epiphysis, and the tibial physis was minimally crossed with a small drill hole and suture material. At 17 months' follow up, the patient had returned to full activity, including sports. He had a grade 1 posterior drawer and no posterior sag. Radiographs showed no degenerative changes. Both the proximal tibial and distal femoral physes were widely patent with no angular deformity. The patient had a 1-cm leg length discrepancy, with the operative limb being longer. This technical note with a case report describes a novel physeal-sparing reconstruction of the PCL in a pediatric patient with open physes.
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Affiliation(s)
- Karen M Bovid
- MedSport-Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan 48106-0391, USA
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15
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Mid-substance tear of the anterior and posterior cruciate ligaments in children: a report of three patients. Knee Surg Sports Traumatol Arthrosc 2009; 17:964-7. [PMID: 19421738 DOI: 10.1007/s00167-009-0806-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Accepted: 04/03/2009] [Indexed: 10/20/2022]
Abstract
We report one case of mid-substance injury of the posterior cruciate ligament and two cases of mid-substance injuries of the anterior cruciate ligament in children. Surgical repair with augmentation using the iliotibial band was performed on these patients without the use of transphyseal drill holes. A small strip of the iliotibial band was sutured onto the end of the cruciate ligament stump to augment the remnant. At the most recent follow-up examinations, conducted 5-11 years after surgery, no restriction or discomfort in daily and sport activities was reported, and acceptable levels of function in the injured knees were noted in all patients.
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16
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Anderson AF, N. Anderson AC. Posterior Cruciate and Posterolateral Ligament Reconstruction in an Adolescent with Open Physes. J Bone Joint Surg Am 2007. [DOI: 10.2106/00004623-200707000-00026] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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17
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Shen HC, Yang JJ, Chang JH, Wang SJ. Surgical treatment of injury of the posterior cruciate ligament and posterolateral instability in the knee of a 5-year-old child: a case report. Am J Sports Med 2007; 35:831-4. [PMID: 17244904 DOI: 10.1177/0363546506295081] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Hsain-Chung Shen
- Department of Orthopedic Surgery, Tri-Service General Hospital, Neihu, Taipei, Taiwan
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Hesse E, Bastian L, Zeichen J, Pertschy S, Bosch U, Krettek C. Femoral avulsion fracture of the posterior cruciate ligament in association with a rupture of the popliteal artery in a 9-year-old boy: a case report. Knee Surg Sports Traumatol Arthrosc 2006; 14:335-9. [PMID: 15947912 DOI: 10.1007/s00167-005-0677-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2004] [Accepted: 03/20/2005] [Indexed: 02/01/2023]
Abstract
Ruptures of the posterior cruciate ligament (PCL) and especially proximal bony avulsion fractures in children are very rare. This in combination with a rupture of the popliteal artery is extremely rare. Thus, an exact incidence is not available from the literature. Overall, these injuries are severe and often lead to chronic knee instability. We report a case of a 9-year-old boy who suffered a traumatic displacement of the left knee with a rupture of the popliteal artery. Prior to transfer to our department, he was treated by a saphenous vein bypass graft and by a transfixation of the knee using two oblique percutaneous pins. We performed magnetic resonance imaging (MRI) scan of the knee which revealed a femoral avulsion fracture of the PCL. Other ligaments and menisci were intact. A transosseous femoral fixation using non-absorbable stitches was carried out. A 1-year follow-up after surgery demonstrates intact peripheral perfusion and sensation, straight axes of both legs and a physiological gait. Minimal differences of the length and circumference of both legs could be measured. The posterior laxity (Lachman-test) was about 5/8 mm (right/left knee) and 2/5 mm (right/left knee) in 90 degrees flexion. The range of motion (extension/flexion) was 5/0/140 degrees -/5/100 degrees (right-left knee). Intact cruciate ligaments were confirmed by MRI. Minimal experience exists in treatment of combined injuries to the PCL and the popliteal artery in children.
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Affiliation(s)
- E Hesse
- Department of Trauma Surgery, Hannover Medical School, Carl Neuberg Strasse 1, 30625, Hannover, Germany.
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