Tibial avulsion fractures of the posterior cruciate ligament treated with open reduction and screw fixation; mid-term results.
Schmidt-Hebbel A. (Chile)
Schmidt-Hebbel A. (Chile)
ESSKA Academy. Schmidt-Hebbel A. May 9, 2018; 209804; P17-1156 Topic: Open Surgery
Andrés Schmidt-Hebbel
Andrés Schmidt-Hebbel
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Objectives: To report mid-term clinical, radiographic and functional outcomes following fixation of posterior cruciate ligament (PCL) tibial avulsion fractures treated with cannulated screws through an open posterior approach.

Methods: Design: Retrospective case series. Setting: Level I trauma center. Patients: From August 2010 to April 2017, 32 cases of PCL tibial avulsion fractures were admitted in our institution. Patients with acute fractures (< 4 weeks), displacement >2mm on Radiography (X-ray) or Computerized tomography (CT scan) in isolation or with combined knee lesions were included. Patients older than 65 years, bilateral, concomitant vascular or neurological injuries, and less than 6 months follow-up were excluded. Twenty patients with a mean age of 41 years (32-61)met the inclusion criteria. High velocity motor vehicle accidents were responsible for all cases, and 53% of the patients had at least one concomitant knee lesion. Primary outcomes: Clinical stability was assessed through (1) posterior drawer test and (2) Comparative single kneeling stress X-ray. Secondary outcomes: (3) Radiographic union. (4) Lysholm and Tegner activity scales and (5) complicactions. Statistical analysis was performed with Stata SE/12.0 using the Wilcoxon Mann-Whitney test and two sample T-test.

Results: The mean follow up time was 36 months (6-82). Clinical stability (0 or grade I posterior drawer) was reestablished in 93% of the patients. Side to side difference using single kneeling stress X-ray was < 2mm in 12 patients, 2-5mm in 4 and >5mm in 4 patients (0.1-6.8). All fractures showed radiograhic union. Mean Lysholm score improved significantly from preoperative 29.06 (Standard Deviation SD 11.4) to 85.17 (SD 7.6) at final follow up (p<0.0001). Postoperative Tegner activity scale (4 SD 0.7) did no vary significantly (P=0.361) compared to the preinjury score (4.2 SD1.0). Four patients developed postoperative deep vein thrombosis and 3 patients with arthrofibrosis required mobilization under anesthesia.

Conclusions: Fixation of displaced tibial sided PCL avulsion fractures with cannulated screws through a posterior approach restores clinical and radiological stability and has excellent union rates. Functional results are good at mid-term despite high rates of postoperative complicactions.

PCL tibial, avulsion fracture, fixation, screw
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