Effectiveness analysis of minimally invasive safe approach to knee joint for treatment of avulsion fractures of tibial insertion of posterior cruciate ligament_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANG Chongjun , CHEN Bobo , CAO Nianping ,  TIAN Ye

Department of Spine and Joint Surgery, Shengjing Hospital of China Medical University, Shenyang Liaoning, 110000, P. R. China;

Corresponding?author：

TIAN Ye, Email: tiany3@sj-hospital.org

Keywords：

Minimally invasive safe approach; avulsion fracture of tibial insertion of posterior cruciate ligament; internal fixation; open reduction

DOI：

10.7507/1002-1892.202208101

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To analyze the effectiveness of minimally invasive safe approach of the knee joint in the treatment of avulsion fractures of the tibial insertion of the posterior cruciate ligament (PCL). Methods The clinical data of 26 patients with avulsion fractures of tibial insertion of PCL treated with open reduction and internal fixation via minimally invasive safe approach of the knee joint between February 2019 and March 2022 were analyzed retrospectively. There were 18 males and 8 females with an average age of 45.5 years (range, 33-58 years). The causes of injury were traffic accident in 14 cases, falling from height in 7 cases, and sports injury in 5 cases. There were 15 cases of left knee and 11 cases of right knee. The preoperative Lysholm score of knee joint was 34.4±7.3 and the flexion range of motion of knee joint was (69±12)°. According to Meyers classification, there were 8 cases of type Ⅱ and 18 cases of type Ⅲ. The time from injury to operation ranged from 1 to 5 days, with an average of 2 days. Results The operation time was 40-70 minutes, with an average of 55 minutes; the intraoperative blood loss was 10-30 mL, with an average of 15 mL. Delayed incision healing occurred in 1 case after operation, and the incision healed after conservative treatment, and the incisions of the other patients all healed by first intention. Postoperative X-ray films showed satisfactory fracture reduction. All 26 patients were followed up 3-30 months, with an average of 22 months. No complication such as neurovascular injury, infection, and knee extension disorder occurred after operation. X-ray films at 3 months after operation showed that all fractures healed without displacement of the fracture ends; the posterior drawer test was negative. At last follow-up, the flexion range of motion of knee joint was (120±9)°, the Lysholm score was 90.7±3.8, which were significantly improved when compared with those before operation (t=16.376, P<0.001; t=47.665, P<0.001). Conclusion The minimally invasive safe approach of the knee joint for the treatment of PCL tibial insertion avulsion fractures is easy to operate, with minimal surgical trauma, safe and reliable approach, and satisfactory recovery of knee joint function after operation.

Citation： HUANG Chongjun, CHEN Bobo, CAO Nianping, TIAN Ye. Effectiveness analysis of minimally invasive safe approach to knee joint for treatment of avulsion fractures of tibial insertion of posterior cruciate ligament. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(1): 1-5. doi: 10.7507/1002-1892.202208101 Copy

1.	White EA, Patel DB, Matcuk GR, et al. Cruciate ligament avulsion fractures: anatomy, biomechanics, injury patterns, and approach to management. Emerg Radiol, 2013, 20(5): 429-440.
2.	Katsman A, Strauss EJ, Campbell KA, et al. Posterior cruciate ligament avulsion fractures. Curr Rev Musculoskelet Med, 2018, 11(3): 503-509.
3.	Hooper PO, Silko C, Malcolm TL, et al. Management of posterior cruciate ligament tibial avulsion injuries: A systematic review. Am J Sports Med, 2018, 46(3): 734-742.
4.	Song JG, Nha KW, Lee SW. Open posterior approach versus arthroscopic suture fixation for displaced posterior cruciate ligament avulsion fractures: Systematic review. Knee Surg Relat Res, 2018, 30(4): 275-283.
5.	Joshi S, Bhatia C, Gondane A, et al. Open reduction and internal fixation of isolated posterior cruciate ligament avulsion fractures: Clinical and functional outcome. Knee Surg Relat Res, 2017, 29(3): 210-216.
6.	Khatri K, Sharma V, Lakhotia D, et al. Posterior cruciate ligament tibial avulsion treated with open reduction and internal fixation through the burks and schaffer approach. Malays Orthop J, 2015, 9(2): 2-8.
7.	Khalifa AA, Elsherif ME, Elsherif E, et al. Posterior cruciate ligament tibial insertion avulsion, management by open reduction and internal fixation using plate and screws through a direct posterior approach. Injury, 2021, 52(3): 594-601.
8.	Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg (Am), 1970, 52(8): 1677-1684.
9.	Rhee SJ, Jang JH, Choi YY, et al. Arthroscopic reduction of posterior cruciate ligament tibial avulsion fracture using two cross-linked pull-out sutures: A surgical technique and case series. Injury, 2019, 50(3): 804-810.
10.	Zhu W, Lu W, Cui J, et al. Treatment of tibia avulsion fracture of posterior cruciate ligament with high-strength suture fixation under arthroscopy. Eur J Trauma Emerg Surg, 2017, 43(1): 137-143.
11.	Zheng W, Hou W, Zhang Z, et al. Results of arthroscopic treatment of acute posterior cruciate ligament avulsion fractures with suspensory fixation. Arthroscopy, 2021, 37(6): 1872-1880.
12.	Wajsfisz A, Makridis KG, Van Den Steene JY, et al. Fixation of posterior cruciate ligament avulsion fracture with the use of a suspensory fixation. Knee Surg Sports Traumatol Arthrosc, 2012, 20(5): 996-999.
13.	Jazayeri SM, Esmaili Jah AA, Karami M. A safe postero-medial approach to posterior cruciate ligament avulsion fracture. Knee Surg Sports Traumatol Arthrosc, 2009, 17(3): 244-247.
14.	Kan H, Nakagawa S, Hino M, et al. Arthroscopic fixation technique for avulsion fracture of the posterior cruciate ligament from the tibia. Arthrosc Tech, 2020, 9(11): e1819-e1824.
15.	Hooper PO, Bevan PJ, Silko C, et al. A posterior approach to open reduction and internal fixation of displaced posterior cruciate ligament tibial osseous avulsions. JBJS Essent Surg Tech, 2018, 8(1): e6. doi: 10.2106/JBJS.ST.17.00044.
16.	Chen LB, Wang H, Tie K, et al. Arthroscopic fixation of an avulsion fracture of the tibia involving the posterior cruciate ligament: a modified technique in a series of 22 cases. Bone Joint J, 2015, 97-B(9): 1220-1225.
17.	吳市春, 徐偉華, 林文祥, 等. 關節鏡下縫線橋技術與常規雙隧道縫線技術治療后交叉韌帶止點撕脫骨折的早期療效比較. 中國修復重建外科雜志, 2021, 35(7): 829-835.
18.	Zhao D, Zhong J, Zhao B, et al. 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(2): 102798. doi: 10.1016/j.otsr.2020.102798.
19.	周鵬, 劉俊才, 徐楊博, 等. 小切口切開復位內固定與關節鏡下雙隧道縫線固定治療后交叉韌帶脛骨止點撕脫骨折的早期療效比較. 中國修復重建外科雜志, 2020, 34(6): 707-712.
20.	Sundararajan SR, Joseph JB, Ramakanth R, et al. Arthroscopic reduction and internal fixation (ARIF) versus open reduction internal fixation (ORIF) to elucidate the difference for tibial side PCL avulsion fixation: a randomized controlled trial (RCT). Knee Surg Sports Traumatol Arthrosc, 2021, 29(4): 1251-1257.
21.	Keyhani S, Soleymanha M, Salari A. Treatment of posterior cruciate ligament tibial avulsion: A new modified open direct lateral posterior approach. J Knee Surg, 2022, 35(8): 862-867.

1. White EA, Patel DB, Matcuk GR, et al. Cruciate ligament avulsion fractures: anatomy, biomechanics, injury patterns, and approach to management. Emerg Radiol, 2013, 20(5): 429-440.
2. Katsman A, Strauss EJ, Campbell KA, et al. Posterior cruciate ligament avulsion fractures. Curr Rev Musculoskelet Med, 2018, 11(3): 503-509.
3. Hooper PO, Silko C, Malcolm TL, et al. Management of posterior cruciate ligament tibial avulsion injuries: A systematic review. Am J Sports Med, 2018, 46(3): 734-742.
4. Song JG, Nha KW, Lee SW. Open posterior approach versus arthroscopic suture fixation for displaced posterior cruciate ligament avulsion fractures: Systematic review. Knee Surg Relat Res, 2018, 30(4): 275-283.
5. Joshi S, Bhatia C, Gondane A, et al. Open reduction and internal fixation of isolated posterior cruciate ligament avulsion fractures: Clinical and functional outcome. Knee Surg Relat Res, 2017, 29(3): 210-216.
6. Khatri K, Sharma V, Lakhotia D, et al. Posterior cruciate ligament tibial avulsion treated with open reduction and internal fixation through the burks and schaffer approach. Malays Orthop J, 2015, 9(2): 2-8.
7. Khalifa AA, Elsherif ME, Elsherif E, et al. Posterior cruciate ligament tibial insertion avulsion, management by open reduction and internal fixation using plate and screws through a direct posterior approach. Injury, 2021, 52(3): 594-601.
8. Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg (Am), 1970, 52(8): 1677-1684.
9. Rhee SJ, Jang JH, Choi YY, et al. Arthroscopic reduction of posterior cruciate ligament tibial avulsion fracture using two cross-linked pull-out sutures: A surgical technique and case series. Injury, 2019, 50(3): 804-810.
10. Zhu W, Lu W, Cui J, et al. Treatment of tibia avulsion fracture of posterior cruciate ligament with high-strength suture fixation under arthroscopy. Eur J Trauma Emerg Surg, 2017, 43(1): 137-143.
11. Zheng W, Hou W, Zhang Z, et al. Results of arthroscopic treatment of acute posterior cruciate ligament avulsion fractures with suspensory fixation. Arthroscopy, 2021, 37(6): 1872-1880.
12. Wajsfisz A, Makridis KG, Van Den Steene JY, et al. Fixation of posterior cruciate ligament avulsion fracture with the use of a suspensory fixation. Knee Surg Sports Traumatol Arthrosc, 2012, 20(5): 996-999.
13. Jazayeri SM, Esmaili Jah AA, Karami M. A safe postero-medial approach to posterior cruciate ligament avulsion fracture. Knee Surg Sports Traumatol Arthrosc, 2009, 17(3): 244-247.
14. Kan H, Nakagawa S, Hino M, et al. Arthroscopic fixation technique for avulsion fracture of the posterior cruciate ligament from the tibia. Arthrosc Tech, 2020, 9(11): e1819-e1824.
15. Hooper PO, Bevan PJ, Silko C, et al. A posterior approach to open reduction and internal fixation of displaced posterior cruciate ligament tibial osseous avulsions. JBJS Essent Surg Tech, 2018, 8(1): e6. doi: 10.2106/JBJS.ST.17.00044.
16. Chen LB, Wang H, Tie K, et al. Arthroscopic fixation of an avulsion fracture of the tibia involving the posterior cruciate ligament: a modified technique in a series of 22 cases. Bone Joint J, 2015, 97-B(9): 1220-1225.
17. 吳市春, 徐偉華, 林文祥, 等. 關節鏡下縫線橋技術與常規雙隧道縫線技術治療后交叉韌帶止點撕脫骨折的早期療效比較. 中國修復重建外科雜志, 2021, 35(7): 829-835.
18. Zhao D, Zhong J, Zhao B, et al. 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(2): 102798. doi: 10.1016/j.otsr.2020.102798.
19. 周鵬, 劉俊才, 徐楊博, 等. 小切口切開復位內固定與關節鏡下雙隧道縫線固定治療后交叉韌帶脛骨止點撕脫骨折的早期療效比較. 中國修復重建外科雜志, 2020, 34(6): 707-712.
20. Sundararajan SR, Joseph JB, Ramakanth R, et al. Arthroscopic reduction and internal fixation (ARIF) versus open reduction internal fixation (ORIF) to elucidate the difference for tibial side PCL avulsion fixation: a randomized controlled trial (RCT). Knee Surg Sports Traumatol Arthrosc, 2021, 29(4): 1251-1257.
21. Keyhani S, Soleymanha M, Salari A. Treatment of posterior cruciate ligament tibial avulsion: A new modified open direct lateral posterior approach. J Knee Surg, 2022, 35(8): 862-867.

Next Article
Research progress in etiology and clinical diagnosis and treatment of scaphotrapeziotrapezoid osteoarthritis

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness analysis of minimally invasive safe approach to knee joint for treatment of avulsion fractures of tibial insertion of posterior cruciate ligament

Abstract Full text Figures/Tables Video References Cited by

Next Article

Format

Content