Tibial avulsion fracture of the posterior cruciate ligament. The study also evaluated the effect of delay in treatment and presence of occult pcl injury on the final outcome after surgery. This typically involves the separation of the posterior tibial insertion of the pcl to variable d. 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 injuries with a tibialsided avulsion were the result of motor vehicle accidents in 68. Pd sagittal image showing joint effusion and altered signal of the posterior cruciate ligament. Fixation of posterior cruciate ligament avulsion fractures. Treatment of acute avulsion of posterior cruciate ligament of left. Apr, 2017 a fracture is a break or crack in a bone that often results from an injury. The appearance of the posterior cruciate ligament pcl was consistent with that of a pcl avulsion fracture at the tibial insertion, and the lateral tibial condyle was avulsed anterosuperiorly without disruption of the articular cartilage fig. Management of posterior cruciate ligament tibial avulsion injuries. Segond fracture is probably the best known and most discussed avulsion fracture of the knee. 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.
Isolated pcl and acl avulsion fractures of the knee. 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. For some years, studies on the posterior cruciate ligament pcl have shared researchers attention. The avulsion fracture of the femoral attachment from the posterior cruciate ligament pcl is quite rare, particularly in adults.
Pdf background posterior cruciate ligament pcl avulsion fracture of the tibial insertion is a very rare injury in children. With an avulsion fracture, an injury to the bone occurs near where the bone attaches to a tendon or ligament. Operative versus conservative treatment of apophyseal. Open reduction and internal fixation of isolated posterior. After a month of treatment, the pcl avulsion fracture got healed without any. Abnormally increased signal intensity within the pcl on protondensity images is highly suggestive of pcl tear.
An avulsion fracture of the pcl, if not surgically fixed, may lead to secondary changes in the knee joint. 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. Apr 19, 2017 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. The posterior cruciate ligament pcl presents commonly with avulsion fractures of its tibial attachment. The purpose of this technical note is to present a novel allinside arthroscopic reconstruction technique for bony tibial avulsion fractures of the posterior cruciate ligament using the. Pseudoarthrosis repair of a posterior cruciate ligament. Treatment of tibia avulsion fracture of posterior cruciate ligament. An avulsion fracture is a bone fracture which occurs when a fragment of bone tears away from the main mass of bone as a result of physical trauma. Surgical methods with stable fixation for treating avulsion fractures at the tibial insertion of the.
Pcl avulsion fracture arthroscopic fixation, a new. Open posterior approach for internal fixation of pcl tibial. Conclusion posterior cruciate avulsion fracture is a very rare finding in. Posterior cruciate ligament pcl avulsion fracture of the. Pdf posterior cruciate ligament avulsion injury researchgate. An acutely torn pcl usually maintains its continuity as a single structure. Posterior cruciate ligament mediated avulsion fracture of the. Pdf tibial avulsion fractures of pcla comparison of. The most common mechanism of avulsion fractures of the pcl at the tibial insertion is a dashboard injury, in which the knee is in a flexed position, and a posteriorly directed force is applied to the pretibial area. In over 90% of patients with pcl tears, the pcl measured more than 7 mm in anteroposterior diameter on sagittal t2weighted images. Arthroscopic treatment of acute tibial avulsion fracture of. On the other hand, avulsion fractures of the tibial condyle are also rare. The posterior cruciate ligament pcl is an important stabiliser of the knee. Evaluation of the pcl is notoriously difficult both clinically and arthroscopically.
An avulsion fracture around the knee can be from several areas. On the basis of the site of damage of the pcl, hyperflexion, pretibial trauma, and hyperextension are proposed as mechanisms of pcl injuries. Various fixation techniques have been explored with use of lag screws, steel. We report the case of a pseudoarthrosis repair of a 4yearold bony avulsion fracture of the pcl using a minimally invasive technique, screw.
Background posterior cruciate ligament pcl avulsion fracture of the tibial. He was treated with siddha varmam therapy and traditional bone setting. Avulsion fractures of the tibial insertion of the posterior cruciate ligament pcl have always been. This typically involves separation of the posterior tibial insertion of the pcl to variable degrees. Arthroscopic primary posterior cruciate ligament repair with. Sep 08, 2010 the appearance of the posterior cruciate ligament pcl was consistent with that of a pcl avulsion fracture at the tibial insertion, and the lateral tibial condyle was avulsed anterosuperiorly without disruption of the articular cartilage fig. Sep 21, 2015 posterior cruciate ligament avulsion injury. A pcl injury most commonly results in an intrasubstance tear. Posterior cruciate ligament avulsion fracture radiology. Posterior cruciate ligament avulsion fractures ncbi.
Management of posterior cruciate ligament tibial avulsion. Tibial avulsion fractures of pcla comparison of outcomes. Pcls avulsion fracture free download as powerpoint presentation. 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. We report a pcl mediated avulsion fracture of the lateral tibial condyle along with the tibial insertion. Pdf download for management of posterior cruciate ligament tibial. This was a prospective study conducted in 34 patients of isolated pcl avulsion fracture. In patients with displaced tibialsided pcl avulsion fractures treated. He was diagnosed as acute avulsion of posterior cruciate ligament pcl. It was diagnosed based on the history of trauma, knee pain and swelling after trauma, positive posterior drawer test and avulsion fracture shown by radiograph. Comminuted tibial end bony avulsion of posterior cruciate ligament pcl is a. The most common surgical procedure for pcl avulsion fractures is internal fixation.
For the indian population, the most common mode of injury is due to motor vehicle accidents and contact sports. Pdf on aug 17, 2015, tarek boutefnouchet and others published posterior cruciate ligament avulsion injury find, read and cite all the. Pcl avulsion fracture from its tibial insertion is an injury which, if diagnosed early and treated with the simple orif gives spectacular results. To the authors knowledge, there is no report of pseudoarthrosis repair of a pcl avulsion fracture. Avulsion fractures of the posterior cruciate ligament pcl are uncommon. Anterior arthroscopicassisted fixation of posterior cruciate ligament avulsion fractures wei huang1, xuan gong2, mishra rahul1, shukla priyanka1, changdong wang 3, xi liang1, guoliang ding4 and ning hu1 abstract background. Posterior cruciate ligament mediated avulsion fracture of. Originates from the anterolateral medial femoral condyle and inserts on the posterior. Although the posterior cruciate ligament pcl is not frequently injured, a greater understanding of its role in stabilizing the knee joint, mechanism of injury and treatment has developed. Avulsion fracture of the posterior aspect of proximal tibia. 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.
Surgical treatment of avulsion fractures of the knee pcl. Objective avulsion fracture of posterior cruciate ligament from its tibial insertion is not a common injury and is missed most often, particularly when associated with multiple injuries or. Allarthroscopic treatment of tibial avulsion fractures of the posterior cruciate ligament provides satisfactory clinical results in a preliminary patient cohort. Early surgical treatment has been regarded as necessary, but the optimal surgical technique remains unclear. 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. Tibial avulsion fractures of pcl a comparison of outcomes between isolated, associated and missed injuries.
Avulsion fracture of the posterior cruciate ligament pcl is a relatively uncommon injury. Surgical treatment of avulsion fracture around joints of. Pdf posterior cruciate ligament avulsion from the tibia. Isometric knee, hip and ankle exercises were started immediately. Open reduction and internal fixation of isolated pcl fossa.
Posterior cruciate ligament avulsion fractures, current. Suture bridge fixation technique for posterior cruciate ligament avulsion fracture. Isolated avulsion injuries constitute only a subgroup of pcl injuries, but nevertheless several operative techniques have been described for the fixation of. Allarthroscopic treatment of tibial avulsion fractures of.
Avulsion fractures of the tibial insertion of the posterior cruciate ligament pcl have always been regarded as rare injuries. Anterior arthroscopicassisted fixation of posterior cruciate. Surgical treatment of avulsion fractures at the tibial insertion of the. Treatment of acute avulsion of posterior cruciate ligament of. Pediatric posterior cruciate ligament avulsion fracture of the tibial. Pdf suture bridge fixation technique for posterior. A few mechanisms of pcl injuries have been proposed on the basis of the site of damage of the pcl. Painful left knee after twisted injury following a fall. Chronic instability and early degenerative changes can develop as a result of delayed diagnosis. Treatment of posterior cruciate ligament tibial avulsion fractures through a modified open posterior approach. Pcl avulsion fracture additional clinical motor vehicle accident with recent fixation of femur fracture. Posterior cruciate ligament pcl avulsion fractures are a type of avulsion fracture of the knee that represent the most common isolated pcl lesion. Avulsion fracture of femoral attachment of posterior cruciate.
Ishibeprimary repair of posterior cruciate ligament avulsion fracture. May 10, 2019 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. Treatment of tibia avulsion fracture of posterior cruciate ligament with highstrength suture fixation under arthroscopy. Tibialsided avulsion injuries of the posterior cruciate ligament pcl. It is a reproducible technique, which minimizes soft tissue damage and obviates a second surgery for hardware removal. Isolated posterior cruciate ligament pcl injuries are relatively rare and pcl injuries most commonly occur in the setting of multiligamentous knee injuries. Jul 15, 2011 the study was aimed to share the experience of managing posterior cruciate ligament pcl avulsion fractures of tibia with open reduction and internal fixation orif. 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. Pcl avulsion fracture something about radiology just for.
Avulsion fracture of the posterior cruciate ligament from its tibial insertion is a rare condition. Anterior arthroscopicassisted fixation of posterior cruciate ligament. Originally described by the french surgeon paul segond in 1879 after a series of cadaveric experiments, 1, this fracture involves cortical avulsion of the tibial insertion of the middle third of the lateral capsular ligament, 2. Feb 11, 2016 repair of bony avulsion of pcl if the posterior cruciate ligament is avulsed from the tibia and the repair is to be done through a medial approach, dissect the posterior skin and subcutaneous tissue as a single layer to the posteromedial corner and, with the knee flexed to 90 degrees, retract the medial head of the gastrocnemius and the. This study had 34 patients with age ranging from 28 to 50 yrs. 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. Pdf pediatric posterior cruciate ligament avulsion fracture of the. The appearance of the posterior cruciate ligament pcl was consistent with that of a pcl avulsion fracture at the tibial insertion, and the figure 1 initial anteroposterior and lateral radiographs of the knee, showing fractures of the lateral tibial condyle a and the posterior intercondylar prominence b. Common structures involved are the acl, mcl, tibial tubercle, femoral epicondyle, patella, ect. A fracture is a break or crack in a bone that often results from an injury. Effects of microendoscopyassisted reduction and screw fixation through a single miniincision on posterior cruciate ligament tibial avulsion fracture. Primary repair of posterior cruciate ligament avulsion fracture.
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