In two cases, there was associated head injury and definitive fixation was staged. With an avulsion fracture, an injury to the bone occurs near where the bone attaches to a tendon or ligament. We report a pcl mediated avulsion fracture of the lateral tibial condyle along with the tibial insertion. Posterior cruciate ligament pcl injuries account for nearly 20% of knee injuries 1. Often manifests radiographically as a tiny osseous fragment located adjacent to the expected attachment site of a ligament or tendon, although sometimes large avulsed fragments may. Fixation of posterior cruciate ligament avulsion fractures. This video showcases the open reduction and internal fixation of both an avulsed pcl tibial insertion and mcl femoral attachment in a patient with a multiligamentous knee injury.
Anatomy, biomechanics, injury patterns, and approach to management injury to the acl or pcl of the knee most commonly involves a tear of the. Posterior cruciate ligament tibial avulsion treated with open. Pcl avulsion fracture additional clinical motor vehicle accident with recent fixation of femur fracture. There is an avulsion fracture of the pcl type 1 at its insertion on the posterior tibial eminence, most likely secondary to an impact of the tibia on the cars dash. Related injuries, which include entrapment of softtissue structures, intraarticular fracture extension, and intraarticular loose bodies, can complicate or alter therapy. Current arthroscopic concepts in repairing posterior cruciate. Apr, 2017 a fracture is a break or crack in a bone that often results from an injury.
Open posterior approach for internal fixation of pcl tibial. We report a pclmediated avulsion fracture of the lateral tibial condyle along with the tibial insertion. Oct 21, 2014 although avulsion fractures of the pediatric knee are uncommon, they are important injuries to recognize because they are frequently associated with adjacent softtissue and osteocartilaginous abnormalities. Despite the further technical advent in refixation of avulsion fractures, the reported failure rate of current approaches remains high. Allarthroscopic treatment of tibial avulsion fractures of. Most people think of the tibiofemoral joint when thinking of the knee. Sep 21, 2015 bone fragment fracture with the attachment of the pcl can be divided into three types. Many of these injuries are in the setting of a multiligamentous injury. Avoid greater than 900 of knee flexion for the first 6 weeks po st injury. The posterior cruciate ligament pcl avulsion fracture from its tibial insertion is a rare condition. Painful left knee after twisted injury following a fall.
Avulsion fracture of femoral attachment of posterior cruciate. The posterior cruciate ligament pcl is an important stabiliser of the knee. Pcl avulsion fracture arthroscopic fixation, a new. Posterior cruciate ligament avulsion fractures springerlink. Management of posterior cruciate ligament tibial avulsion. B the fragment is reduced using a tibial pcl guide by arthroscopic visualization. Evaluation of the pcl is notoriously difficult both clinically and arthroscopically.
Pcl avulsion fracture normal lateral x ray medial and lateral intercondylar eminences should overlap with each other. A few mechanisms of pcl injures have been proposed on the basis of the site of damage of the pcl. Isometric knee, hip and ankle exercises were started immediately. Introduction avulsion fractures of the posterior cruciate ligament pcl are uncommon. Of the 60 patients, 19 cases were avulsion fractures of posterior cruciate ligament pcl at the tibial insertion, 6 cases were avulsion fracture of the humeral medial epicondyle, 8 cases were avulsion fractures of the humeral greater tuberosity, 6 cases were lateral malleolus avulsion fractures, 17 cases were ulna olecranon avulsion fractures. Knees posterior cruciate ligament pcl injuries account for about 20% of all knee ligament injuries, remaining prevalent among males and young adults 2. Standing flexion weightbearing views are mandatory, especially for chronic injuries, to evaluate for medial compart. Displaced posterior cruciate ligament avulsion fractures. Surgical treatment of avulsion fractures of the knee pcl. Pcl injuries can be treated with primary repair, which has the advantages of preserving the native tissue, maintaining proprioception, and minimal invasive surgery when compared with reconstruction surgery.
To report clinical and functional outcomes following fixation of tibial avulsion fractures of posterior cruciate ligament pcl using spring plate through a modified open posterior approach. Cruciate ligament pcl tibial avulsion fractures treated with open reduction. Avulsion fracture of the posterior aspect of proximal tibia. Arthroscopic primary posterior cruciate ligament repair with. Journal of orthopaedic surgery and research posterior cruciate ligament mediated avulsion fracture of the lateral tibial condyle.
Open posterior approach for internal fixation of pcl. Clinical outcomes achieved at the objective evaluation suggest that this injury should be interpreted not only as a purely bone injury, but also as a boneligament injury. Research article arthroscopicassisted reduction and. Tibial avulsion fractures of pcla comparison of outcomes. A fracture is a break or crack in a bone that often results from an injury. However with increased patient awareness and improved diagnostic procedures. Posterior knee pain may mean the patient is progressing too qulckly guidelines. Sep 10, 2015 preoperative axial a, b, sagittal c, and coronal d magnetic resonance imaging sequences showing the posterior cruciate ligament tibialsided avulsion fracture of patient 1. On the other hand, avulsion fractures of the tibial condyle are also rare.
Pd sagittal image showing joint effusion and altered signal of the posterior cruciate ligament. An avulsion fracture around the knee can be from several areas. A enface view of tibial head with dislocated pcl avulsion fracture. Pcl rupture with involvement of an osteochondral sleeve. Bony avulsion fracture of the posterior cruciate ligament constitutes 340% of all acute knee joint injuries of which 35% are displaced nonsurgical treatment of displaced pcl avulsion fractures have a high incidence rate of nonunion or malunion and can cause loss of ligament function, leading to further knee instability and traumatic arthritis. Torisu, isolated avulsion fracture of the tibial attachment of the posterior cruciate ligament, j bone joint surg am, 59 1977, 6872. Pcl injuries may lead to instability that allows the tibia to move in the. Posterior cruciate ligament pcl avulsion fractures are a type of avulsion fracture of the knee that represent the most common isolated pcl lesion. Arthroscopic treatment of acute tibial avulsion fracture.
Pcl avulsion fracture although injuries of the pcl are less common than those of its anterior counterpart, the chronic instability and early degenerative changes that arise from delayed diagnosis of this injury are just as debilitating. Rehabilitation guidelines for posterior cruciate ligament. For the indian population, the most common mode of injury is due to motor vehicle accidents and contact sports. Oct 10, 20 first time in history, pcl posterior cruciate ligament avulsion fracture was sucessfully fixed using tight rope implant by arthroscopic technique by dr. Pcl avulsion fracture something about radiology just for.
Pcl avulsion fracture from its tibial insertion is an injury which, if diagnosed early and treated with the simple orif gives spectacular results. An avulsion fracture involves the detachment of a bone fragment from the pulling away of a ligament, tendon, or joint capsule from its point of attachment on a bone. Pdf on aug 17, 2015, tarek boutefnouchet and others published posterior cruciate ligament avulsion injury find, read and cite all the. This typically involves the separation of the posterior tibial insertion of the pcl to variable d. Originates from the anterolateral medial femoral condyle and inserts on the posterior. Treatment of posterior cruciate ligament avulsion fractures of the. Isolated pcl and acl avulsion fractures of the knee.
Posterior cruciate ligament mediated avulsion fracture of the. Avulsion fractures of the posterior cruciate ligament pcl are uncommon. Posterior cruciate ligament mediated avulsion fracture of. Avulsion fractures of posterior cruciate ligament pcl represent a specific form of pcl injuries. Joints are named for the two bones that articulate with each other. Pdf suture bridge fixation technique for posterior. In this study 4 cases with pcl avulsion injuries were operated upon after a mean 14.
Suture bridge fixation technique for posterior cruciate ligament. This typically involves the separation of the posterior tibial insertion of the pcl to variable degrees. 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. Isolated posterior cruciate ligament pcl injuries are relatively rare and pcl injuries most commonly occur in the setting of multiligamentous knee injuries. Avulsion fractures of the pelvic apophyses typically occur in adolescent athletes due to a sudden strong muscle contraction while growth plates are still open. Nov 10, 2015 pcl avulsion fracture normal lateral x ray medial and lateral intercondylar eminences should overlap with each other. This typically involves separation of the posterior tibial insertion of the pcl to variable degrees. Most authors suggest that displaced pcl avulsion fractures should undergo. The pcl avulsion fracture was fixed with a cancellous screw via posterior approach and acl avulsion fracture was fixed with arthroscopically assisted pullout sutures 10 days after the traumatic event. Protocol for nonoperative treatment of pcl tears precautions.
Pdf tibial avulsion fractures of pcla comparison of outcomes. Surgical treatment of avulsion fracture around joints of. Pdf posterior cruciate ligament avulsion from the tibia. Operative versus conservative treatment of apophyseal.
Pdf posterior cruciate ligament avulsion injury researchgate. Pcl injuries with a tibialsided avulsion were the result of motor vehicle accidents in 68. Isolated injuries are less common and surgery on the pcl has seen less popularity compared with other knee ligaments. Usually they occur when the knee is stressed and tension is placed on a ligament or tendon and it pulls off a small piece of the bone that it is attached to. Rehabilitation guidelines for posterior cruciate ligament reconstruction the knee has three jointsthe patellofemoral joint knee cap, the tibiofemoral joint and the tibiofibular joint. The incidence of this subset of injury had increased over the past few years, introduction avulsion fracture of the posterior cruciate ligament pcl is a relatively uncommon injury. Pcl function after an avulsion fracture is surgery using internal fixation. Posterior cruciate ligament pcl avulsion fracture of the tibial insertion is a very rare injury in children.
Damage to pcl either due to bony avulsion or intrasubstance rupture. The patient we presented here was admitted to receive treatment in june 2017, whose knee injury resulted in avulsion fractures at three sites, the femoral attachment of the pcl, the tibial insertion of the anterior cruciate ligament acl, and the femoral. Pediatric posterior cruciate ligament avulsion fracture of the tibial. Pdf objective avulsion fracture of posterior cruciate ligament from its tibial insertion is not a common injury and is missed most often.
Avulsion fracture of femoral attachment of posterior. Arthroscopic treatment of acute tibial avulsion fracture of. If greater than 900 of knee flexion is performed, this must be done with an anterior drawer force to prevent posterior subluxatlon. Cruciate ligament avulsion fractures sciencedirect. Avulsion fractures of the pediatric knee springerlink. The avulsion fracture of the femoral attachment from the posterior cruciate ligament pcl is quite rare, particularly in adults. Posterior cruciate ligament avulsion fractures ncbi. This mechanism makes sense because this fracture involves the non accelerating. Pcl avulsion fracture, preferably within the first.
Research article arthroscopicassisted reduction and fixation. Posterior cruciate ligament avulsion fracture radiology. Joint instability, posterior cruciate ligament, rehabilitation, functional outcome introduction posterior cruciate ligament pcl is the stronger of the two cruciate ligaments of knee and is a constraint to posterior dislocation of the knee in 90 degrees of flexion 1. Chronic instability and early degenerative changes can develop as a result of delayed diagnosis.