Treatment of posterior cruciate ligament tibial avulsion fractures through a modified open posterior approach: Operative technique and 12- to 48-month outcomes

Gregg T. Nicandri, Eric Otto Klineberg, Christopher J. Wahl, William J. Mills

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

OBJECTIVES: To report clinical and functional outcomes following fixation of tibial posterior cruciate ligament (PCL) avulsion fractures through a modified open posterior approach when combined with a rehabilitation program emphasizing early range of motion. DESIGN: Retrospective case series. SETTING: Level I trauma center. PATIENTS: From March 4, 2000 to May 8, 2003, there were 16 cases of PCL tibial avulsion injuries presented to our institution, with 10 patients available for follow up at 12 to 48 months (mean 28 months). INTERVENTION: Fixation of tibial PCL avulsion fractures was with a lag screw and washer placed through a modified open posterior approach. Range of motion was begun on postoperative day 1. MAIN OUTCOME MEASUREMENTS: Clinical stability, range of motion, gastrocnemius muscle strength, radiographic appearance, and each patient's overall health-related quality of life (using the musculoskeletal functional assessment tool) were evaluated at final follow up. RESULTS: The average musculoskeletal functional assessment score was 14. (Musculoskeletal functional assessment scores range from 0-100, with higher scores indicating poorer function.) All patients achieved union of their fracture and had clinically stable knees at the latest follow-up. Flexion difference greater than 10 degrees (P = 0.16), extension difference greater than 2 degrees (P = 0.38), and heel raise difference more than 8 repetitions (P = 0.23) were not demonstrated in comparison to the normal side. CONCLUSIONS: Treatment of tibial PCL avulsion fractures, which includes fixation through a modified open posterior approach and early postoperative range of motion, results in healing of the fracture, good functional outcomes, stability to posterior draw testing, and does not lead to gastrocnemius weakness or significant range of motion deficits at 12 to 48 months postoperatively.

Original languageEnglish (US)
Pages (from-to)317-324
Number of pages8
JournalJournal of Orthopaedic Trauma
Volume22
Issue number5
DOIs
StatePublished - May 2008
Externally publishedYes

Fingerprint

Posterior Cruciate Ligament
Tibial Fractures
Articular Range of Motion
Therapeutics
Fracture Healing
Heel
Trauma Centers
Muscle Strength
Knee
Skeletal Muscle
Rehabilitation
Quality of Life
Avulsion Fractures
Wounds and Injuries

Keywords

  • Functional outcome
  • Posterior cruciate ligament avulsion injury
  • Rehabilitation
  • Surgical technique

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Treatment of posterior cruciate ligament tibial avulsion fractures through a modified open posterior approach : Operative technique and 12- to 48-month outcomes. / Nicandri, Gregg T.; Klineberg, Eric Otto; Wahl, Christopher J.; Mills, William J.

In: Journal of Orthopaedic Trauma, Vol. 22, No. 5, 05.2008, p. 317-324.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVES: To report clinical and functional outcomes following fixation of tibial posterior cruciate ligament (PCL) avulsion fractures through a modified open posterior approach when combined with a rehabilitation program emphasizing early range of motion. DESIGN: Retrospective case series. SETTING: Level I trauma center. PATIENTS: From March 4, 2000 to May 8, 2003, there were 16 cases of PCL tibial avulsion injuries presented to our institution, with 10 patients available for follow up at 12 to 48 months (mean 28 months). INTERVENTION: Fixation of tibial PCL avulsion fractures was with a lag screw and washer placed through a modified open posterior approach. Range of motion was begun on postoperative day 1. MAIN OUTCOME MEASUREMENTS: Clinical stability, range of motion, gastrocnemius muscle strength, radiographic appearance, and each patient's overall health-related quality of life (using the musculoskeletal functional assessment tool) were evaluated at final follow up. RESULTS: The average musculoskeletal functional assessment score was 14. (Musculoskeletal functional assessment scores range from 0-100, with higher scores indicating poorer function.) All patients achieved union of their fracture and had clinically stable knees at the latest follow-up. Flexion difference greater than 10 degrees (P = 0.16), extension difference greater than 2 degrees (P = 0.38), and heel raise difference more than 8 repetitions (P = 0.23) were not demonstrated in comparison to the normal side. CONCLUSIONS: Treatment of tibial PCL avulsion fractures, which includes fixation through a modified open posterior approach and early postoperative range of motion, results in healing of the fracture, good functional outcomes, stability to posterior draw testing, and does not lead to gastrocnemius weakness or significant range of motion deficits at 12 to 48 months postoperatively.",
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N2 - OBJECTIVES: To report clinical and functional outcomes following fixation of tibial posterior cruciate ligament (PCL) avulsion fractures through a modified open posterior approach when combined with a rehabilitation program emphasizing early range of motion. DESIGN: Retrospective case series. SETTING: Level I trauma center. PATIENTS: From March 4, 2000 to May 8, 2003, there were 16 cases of PCL tibial avulsion injuries presented to our institution, with 10 patients available for follow up at 12 to 48 months (mean 28 months). INTERVENTION: Fixation of tibial PCL avulsion fractures was with a lag screw and washer placed through a modified open posterior approach. Range of motion was begun on postoperative day 1. MAIN OUTCOME MEASUREMENTS: Clinical stability, range of motion, gastrocnemius muscle strength, radiographic appearance, and each patient's overall health-related quality of life (using the musculoskeletal functional assessment tool) were evaluated at final follow up. RESULTS: The average musculoskeletal functional assessment score was 14. (Musculoskeletal functional assessment scores range from 0-100, with higher scores indicating poorer function.) All patients achieved union of their fracture and had clinically stable knees at the latest follow-up. Flexion difference greater than 10 degrees (P = 0.16), extension difference greater than 2 degrees (P = 0.38), and heel raise difference more than 8 repetitions (P = 0.23) were not demonstrated in comparison to the normal side. CONCLUSIONS: Treatment of tibial PCL avulsion fractures, which includes fixation through a modified open posterior approach and early postoperative range of motion, results in healing of the fracture, good functional outcomes, stability to posterior draw testing, and does not lead to gastrocnemius weakness or significant range of motion deficits at 12 to 48 months postoperatively.

AB - OBJECTIVES: To report clinical and functional outcomes following fixation of tibial posterior cruciate ligament (PCL) avulsion fractures through a modified open posterior approach when combined with a rehabilitation program emphasizing early range of motion. DESIGN: Retrospective case series. SETTING: Level I trauma center. PATIENTS: From March 4, 2000 to May 8, 2003, there were 16 cases of PCL tibial avulsion injuries presented to our institution, with 10 patients available for follow up at 12 to 48 months (mean 28 months). INTERVENTION: Fixation of tibial PCL avulsion fractures was with a lag screw and washer placed through a modified open posterior approach. Range of motion was begun on postoperative day 1. MAIN OUTCOME MEASUREMENTS: Clinical stability, range of motion, gastrocnemius muscle strength, radiographic appearance, and each patient's overall health-related quality of life (using the musculoskeletal functional assessment tool) were evaluated at final follow up. RESULTS: The average musculoskeletal functional assessment score was 14. (Musculoskeletal functional assessment scores range from 0-100, with higher scores indicating poorer function.) All patients achieved union of their fracture and had clinically stable knees at the latest follow-up. Flexion difference greater than 10 degrees (P = 0.16), extension difference greater than 2 degrees (P = 0.38), and heel raise difference more than 8 repetitions (P = 0.23) were not demonstrated in comparison to the normal side. CONCLUSIONS: Treatment of tibial PCL avulsion fractures, which includes fixation through a modified open posterior approach and early postoperative range of motion, results in healing of the fracture, good functional outcomes, stability to posterior draw testing, and does not lead to gastrocnemius weakness or significant range of motion deficits at 12 to 48 months postoperatively.

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