- •Neglected PCL bony avulsion injuries are rare.
- •The challenge with neglected cases is that the PCL is retracted and fibrosed.
- •Intra-articular release of the contracted ligament, burr hole drilling of the fracture bed, combined with the screw post fixation technique can achieve good results.
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.
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.
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.
The described screw post fixation technique results in an excellent outcome for these rare injuries.
Level of evidence
Level IV, case series.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Injury
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Epidemiology of posterior cruciate ligament injuries.Arch Orthop Trauma Surg. 2003; 123: 186-191https://doi.org/10.1007/s00402-002-0471-y
- Long-term outcomes following single-bundle transtibial arthroscopic posterior cruciate ligament reconstruction.Int Orthop. 2013; 37: 337-343https://doi.org/10.1007/s00264-012-1609-3
- Open reduction and internal fixation of isolated PCL fossa avulsion fractures.Knee Surg Sports Traumatol Arthrosc. 2012; 20: 315-321https://doi.org/10.1007/s00167-011-1618-6
- Management of posterior cruciate ligament tibial avulsion injuries: a systematic review.Am J Sports Med. 2017; 363546517701911https://doi.org/10.1177/0363546517701911
- Surgical treatment of avulsion fracture of the posterior cruciate ligament and postoperative management.J Trauma. 2003; 54: 516-519https://doi.org/10.1097/01.TA.0000047048.37775.32
- Treatment of posterior cruciate ligament avulsion fractures of the tibia using a toothed plate and hollow lag screw.Singapore Med J. 2016; 57: 39-44https://doi.org/10.11622/smedj.2016010
- Surgical Treatment of Avulsion Fractures of The Knee Pcl Tibial Insertion: Experience With 21 Cases [tratamento Cirúrgico Da Fratura-avulsão Da Inserção Tibial Do L.c.p. Do Joelho: Experiência De 21 Casos].Scopus, 2007
- Outcome of isolated PCL avulsion fractures treated with cancellous screw fixation.2017Http://AimdrjournalCom/Pdf/Vol3Issue1/OR4_OA_NileshPdf
- Surgical treatment of avulsion fractures at the tibial insertion of the posterior cruciate ligament: functional result.Rev Bras Ortop. 2015; 50: 631-637https://doi.org/10.1016/j.rboe.2015.09.005
- Fixation of delayed union or non-union posterior cruciate ligament avulsion fractures.J Orthop Surg Hong Kong. 2014; 22: 70-74https://doi.org/10.1177/230949901402200118
- Posterior cruciate ligament avulsion from the tibia: fixation by a posteromedial approach.Acta Orthop Belg. 2003; 69: 162-167
- Diagnostic evaluation of posterior cruciate ligament injuries.Knee Surg Sports Traumatol Arthrosc. 2003; 11: 282-288https://doi.org/10.1007/s00167-003-0409-0
- Concomitant posterior cruciate ligament injuries with direct injury-related patellar fractures.Arch Orthop Trauma Surg. 2016; 136: 779-784https://doi.org/10.1007/s00402-016-2449-1
- The nonoperative treatment of acute, isolated (partial or complete) posterior cruciate ligament-deficient knees: an intermediate-term follow-up study.HSS J Musculoskelet J Hosp Spec Surg. 2007; 3: 137-146https://doi.org/10.1007/s11420-007-9058-z
- Comparison of surgical repair or reconstruction of the cruciate ligaments versus nonsurgical treatment in patients with traumatic knee dislocations.Am J Sports Med. 2002; 30: 718-727https://doi.org/10.1177/03635465020300051601
- Acute tears of the posterior cruciate ligament. Results of operative treatment.J Bone Joint Surg Am. 1980; 62: 438-450
- Treatment of posterior cruciate ligament tibial avulsion fractures through a modified open posterior approach: operative technique and 12- to 48-month outcomes.J Orthop Trauma. 2008; 22: 317-324https://doi.org/10.1097/BOT.0b013e31817279d1
- Avulsion fracture of the tibial attachment of the posterior cruciate ligament. Indications and results of delayed repair.Clin Orthop. 1979; : 107-114
- Current concepts review: the posterior cruciate ligament.J Knee Surg. 2010; 23: 61-72
- Surgical management of PCL injuries: indications, techniques, and outcomes.Curr Rev Musculoskelet Med. 2013; 6: 115-123https://doi.org/10.1007/s12178-013-9162-2
- The accuracy of magnetic resonance imaging in diagnosing chronic posterior cruciate ligament injury.Knee. 2004; 11: 265-270https://doi.org/10.1016/j.knee.2003.11.005
- Rating systems in the evaluation of knee ligament injuries.Clin Orthop. 1985; : 43-49
- Posterior instability of the knee near extension. A clinical and stress radiographic analysis of acute injuries of the posterior cruciate ligament.J Bone Joint Surg Br. 1990; 72: 225-230
- Delayed surgical treatment for tibial avulsion fracture of the posterior cruciate ligament in children.Knee Surg Sports Traumatol Arthrosc. 2016; 24: 754-759https://doi.org/10.1007/s00167-015-3929-5
- Functional evaluation of fixation for PCL bony avulsion fractures using Burk and Schaffer’s approach.Int J Orthop Sci. 2017; 3: 735-739
- A novel MIS technique for posterior cruciate ligament avulsion fractures.Knee. 2017; 24: 890-896https://doi.org/10.1016/j.knee.2017.03.014
- Current arthroscopic concepts in repairing posterior cruciate ligament tibial-sided avulsions.Orthopedics. 2015; 38: 563-569https://doi.org/10.3928/01477447-20150902-06
- Posterior cruciate ligament tibial avulsion treated with open reduction and internal fixation through the burks and schaffer approach.Malays Orthop J. 2015; 9: 2-8https://doi.org/10.5704/MOJ.1507.004
- Delayed detection of clinically significant posterior cruciate ligament injury after peri-articular fracture around the knee of 448 patients.Arch Orthop Trauma Surg. 2012; 132: 1741-1746https://doi.org/10.1007/s00402-012-1605-5
- Reliability, validity, and responsiveness of the Lysholm knee scale for various chondral disorders of the knee.J Bone Joint Surg Am. 2004; 86-A: 1139-1145
Published online: February 01, 2019
© 2019 Elsevier Ltd. All rights reserved.