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Abstract
Purpose
To evaluate the clinical outcome of open repair of acute tibial posterior cruciate ligament (PCL) tibial avulsion injury using the posteromedial approach, and to examine the usefulness of pre-operative 3D-computed tomography (CT) imaging.
Materials and Methods
From July 2004 onwards, among the 33 patients with acute tibial avulsion injury of the PCL, 22 patients were available for a 1-year follow-up. Patients underwent internal fixation using screws, pullout sutures or staples through the posteromedial approach. Clinical evaluations were performed using the posterior drawer test, posterior drawer stress x-ray, range of motion and Tegner score. In addition, size of the fragment, visibility, comminution, displacement and presence of extension were studied and were compared to the pre-operative X-ray and 3D-CT imaging.
Results
Four cases demonstrated 10-degree restriction in flexion and 1 case demonstrated 10-degree restriction in extension compared to the unaffected side. Except for the 2 cases which had Grade I posterior instability on the posterior drawer test, the results of the post-operative joint stability were negative and the posterior drawer stress X-ray using the Telos device showed an average of 0.57±0.4 mm. Like the average pre-operative Tegner score of 6.7±0.9, the Tegner score was restored to 6.2±0.7 (p>0.05) at the last follow-up. 3D-CT showed an improved accuracy in visibility (55.6%), comminution (50%) and displacement (44.4%) compared to the simple X-ray.
Conclusion
The acute tibial avulsion injury treated with the appropriate internal fixation through the posteromedial approach based on the fracture size demonstrated exellent outcomes. The pre-operative 3D-CT was useful for identifying the fracture pattern and choosing the appropriate internal fixation.
Figures and Tables
Figure 1
A 33-year-old woman with a knee injury sustained during a fall. (A) AP and lateral radiographs of the knee revealed mildly displaced avulsed fragment, but not determined the degree of comminution. (B) A 3D-CT image of the knee definitely showed comminution and displacement of avulsed fragment. (C) Fixation of avulsed tibial fragment of PCL with a pull out suture and staple and lastest follow up stress view using Telos device.
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