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The Journal of Bone and Joint Surgery (American) 83:698-708 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.

Arthroscopically Assisted Treatment of Avulsion Fractures of the Posterior Cruciate Ligament from the Tibia

Sung-Jae Kim, MD, Sang-Jin Shin, MD, Nam-Hong Choi, MD and Shin-Kang Cho, MD

Investigation performed at the Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
Sung-Jae Kim, MD Sang-Jin Shin, MD Shin-Kang Cho, MD Department of Orthopaedic Surgery, Yonsei University College of Medicine, C.P.O. Box 8044, 120-752, Seoul, Korea. E-mail address for S.-J. Kim: os{at}yumc.yonsei.ac.kr
Nam-Hong Choi, MD Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji Medical College, Hakae 1-Dong, Nowon-ku 280-1, Seoul, Korea
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.
A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our CD-ROM (call 781-449-9780, ext. 140, to order).

Background: The attachment of the posterior cruciate ligament to the posterior intercondylar fossa of the tibia is in a location that is difficult to access for arthroscopic surgical procedures. This report presents a variety of arthroscopically assisted reduction and fixation methods for managing avulsion fractures of the posterior cruciate ligament from the tibia.

Methods: Thirteen patients (fourteen knees) who had an avulsion fracture of the posterior cruciate ligament were treated with an arthroscopic procedure. Eleven patients underwent the operation in the acute phase (four to ten days after the injury), and two patients had delayed surgery (at nineteen and twenty months after the injury) because of nonunion. The choice of fixation method was based on the size of the avulsed fragment. Six knees that had a small bone fragment (<10 mm) with comminution were fixed with use of multiple sutures. Two knees that had a small bone fragment without comminution were fixed with 23-gauge wires. Two knees that had a medium-sized fragment (10 to 20 mm) were fixed with Kirschner wires. Four knees that had a large single fragment of bone (>20 mm) that involved the condyles were fixed with one or two cannulated screws.

Results: All patients had osseous union as determined on radiographs. Three injured knees in two patients showed limitation of motion after the operation. These patients had been immobilized for two or three months after the surgery because of concomitant fractures. The eleven patients who had undergone the operation in the acute phase, including two in whom postoperative arthrofibrosis had developed, showed no or trace posterior instability following the procedure. However, the two patients in whom the surgery had been delayed had residual grade-I posterior instability. The postoperative side-to-side differences, when measured with use of the KT-2000 arthrometer and posterior stress radiographs, showed better results in the patients in whom the surgery had been performed in the acute phase than in the patients in whom the operation had been delayed.

Conclusion: Arthroscopic procedures can be used to treat tibial avulsion fractures of the posterior cruciate ligament.


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