Open Repair of Acute Tibial Avulsion Injury of Posterior Cruciate Ligament: Clinical Outcomes and Usefulness of Preoperative 3-D CT.
10.4055/jkoa.2011.46.3.231
- Author:
Jong Hyuk PARK
1
;
Sung Il WANG
;
Ju Hong LEE
;
Hee Rack CHOI
Author Information
1. Department of Orthopedic Surgery, Chonbuk National University Medical School, Jeonju, Korea. jhlee55@chonbuk.ac.kr
- Publication Type:Original Article
- Keywords:
posterior cruciate ligament;
tibial avulsion injury;
open repair;
3D-CT
- MeSH:
Displacement (Psychology);
Follow-Up Studies;
Humans;
Joints;
Posterior Cruciate Ligament;
Range of Motion, Articular;
Sutures
- From:The Journal of the Korean Orthopaedic Association
2011;46(3):231-236
- CountryRepublic of Korea
- Language:Korean
-
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.
