Wei DENG, Yaxing Lİ, Shizhou WU, Xi LİU, Fuguo HUANG, Hui ZHANG

Surgical treatment of posterior cruciate ligament tibial avulsion fractures using a locking compression hook plate: A case series

Objective: This study aimed to evaluate the results of surgical treatment of tibial avulsion injuries of the posterior cruciate ligament (PCL) with a 3.5-mm locking compression hook plate (LCHP). Methods: From June 2012 to June 2015, 16 consecutive patients (10 males and 6 females, mean age: 38 (range: 19-57) years) presented with isolated tibial avulsion injuries of the PCL. We used a 3.5-mm LCHP and lag screws for open reduction and internal fixation (ORIF) through the posterior medial approach. The operation time, quantity of bleeding, visual analog scale (VAS) scores, stability of posterior drawer test (PDT) results, and fracture healing time were studied to assess clinical efficacy. At the 12-month follow-up, a functional evaluation using knee range of motion (ROM) and the Lysholm knee scoring system (LKSS) was performed. Results: The data from a mean follow-up of 24.1 (range: 14-33) months from 16 patients were recorded. No neurovascular complications, incision infections, or delayed union or nonunion were observed. The mean operation time was 61.4 (range: 45-80) min. The mean quantity of bleeding was 41.6 (range: 25-66) mL. The mean bone healing time was 11.8 (range: 45-80) weeks. The mean VAS score was 1.63 (range: 0-3) after surgery. The average LKSS and ROM of the knee were 51.75±7.67 and 50.94°±10.19° before surgery and 92.75±5.46 and 127.75°±6.13° at 1 year, respectively. The outcomes were judged to be excellent for 11 patients, good for 4, and fair for 1 (excellent and good rates: 93.8% for 15/16). At the final follow-up (≥1 year), the PDT scores returned to normal.Conclusion: The results showed that 3.5-mm LCHP provided reliable fixation following ORIF of isolated PCL tibial avulsion fractures and was a safe, simple, and effective procedure. This procedure may reduce complications and improve functional recovery relative to those of other procedures.

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1. Joshi S, Bhatia C, Gondane A, Rai A, Singh S, Gupta S. Open reduction and internal fixation of isolated posterior cruciate ligament avulsion fractures: Clinical and functional outcome. Knee Surg Relat Res 2017; 29: 210-6. [Crossref]

2. Katsman A, Strauss EJ, Campbell KA, Alaia MJ. Posterior cruciate ligament avulsion fractures. Curr Rev Musculoskelet Med 2018; 11: 503-9. [Crossref]

3. Barros MA, Cervone GL, Costa AL. Surgical treatment of avulsion fractures at the tibial insertion of the posterior cruciate ligament: functional result. Rev Bras Ortop 2015; 50: 631-7. [Crossref]

4. Fanelli GC, Edson CJ. Posterior cruciate ligament injuries in trauma patients: Part II. Arthroscopy 1995; 11: 526-9. [Crossref]

5. Janousek AT, Jones DG, Clatworthy M, Higgins LD, Fu FH. Posterior cruciate ligament injuries of the knee joint. Sports Med 1999; 28: 429-41. [Crossref]

6. Giordano BD, Dehaven KE, Maloney MD. Acute femoral "peel-off" tears of the posterior cruciate ligament: technique for arthroscopic anatomical repair. Am J Orthop (Belle Mead NJ) 2011; 40: 226-32.

7. Hooper PO, 3rd, Silko C, Malcolm TL, Farrow LD. Management of posterior cruciate ligament tibial avulsion injuries: A systematic review. Am J Sports Med 2018; 46: 734-42. [Crossref]

8. Zhang X, Cai G, Xu J, Wang K. A minimally invasive postero-medial approach with suture anchors for isolated tibial avulsion fracture of the posterior cruciate ligament. Knee 2013; 20: 96-9. [Crossref]

9. Strobel MJ, Weiler A, Schulz MS, Russe K, Eichhorn HJ. Arthroscopic evaluation of articular cartilage lesions in posterior-cruciate-ligament-deficient knees. Arthroscopy 2003; 19: 262-8. [Crossref]

10. Abdallah AA, Arafa MS. Treatment of posterior cruciate ligament tibial avulsion by a minimally-invasive open posterior approach. Injury 2017; 48: 1644-9. [Crossref]

11. Chen W, Luo W, Chen Z, Jiang Y. Treatment of posterior cruciate ligament avulsion fractures of the tibia using a toothed plate and hollow lag screw. Singapore Med J 2016; 57: 39-44. [Crossref]

12. Gavaskar AS, Karthik B, Gopalan H, Srinivasan P, Tummala NC. A novel MIS technique for posterior cruciate ligament avulsion fractures. Knee 2017; 24: 890-6. [Crossref]

13. Seitz H, Schlenz I, Pajenda G, Vecsei V. Tibial avulsion fracture of the posterior cruciate ligament: K-wire or screw fixation? A retrospective study of 26 patients. Arch Orthop Trauma Surg 1997; 116: 275-8. [Crossref]

14. Torisu T. Isolated avulsion fracture of the tibial attachment of the posterior cruciate ligament. J Bone Joint Surg Am 1977; 59: 68-72. [Crossref]

15. Bali K, Prabhakar S, Saini U, Dhillon MS. Open reduction and internal fixation of isolated PCL fossa avulsion fractures. Knee Surg Sports Traumatol Arthrosc 2012; 20: 315-21. [Crossref]

16. Huang TW, Hsu KY, Cheng CY, et al. Arthroscopic suture fixation of tibial eminence avulsion fractures. Arthroscopy 2008; 24: 1232-8. [Crossref]

17. Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 1982; 10: 150-4. [Crossref]

18. Schulz MS, Russe K, Weiler A, Eichhorn HJ, Strobel MJ. Epidemiology of posterior cruciate ligament injuries. Arch Orthop Trauma Surg 2003; 123: 186-91. [Crossref]

19. Singla R, Devgan A, Gogna P, Batra A. Fixation of delayed union or non-union posterior cruciate ligament avulsion fractures. J Orthop Surg (Hong Kong) 2014; 22: 70-4. [Crossref]

20. Wagner FC, Konstantinidis L, Hohloch N, Hohloch L, Suedkamp NP, Reising K. Biomechanical evaluation of two innovative locking implants for comminuted olecranon fractures under high-cycle loading conditions. Injury 2015; 46: 985-9. [Crossref]

21. Nunez FA, Jr., Li Z, Campbell D, Nunez FA, Sr. Distal ulna hook plate: Angular stable implant for fixation of distal ulna. J Wrist Surg 2013; 2: 87-92. [Crossref]

22. Nunez FA, Jr., Barnwell J, Li Z, Nunez FA, Sr. Metaphyseal ulnar shortening osteotomy for the treatment of ulnocarpal abutment syndrome using distal ulna hook plate: case series. J Hand Surg Am 2012; 37: 1574-9. [Crossref]

23. Zhenhua F, Waizy H, Ming X, Wusheng K. Lateral malleolus hook plate for comminuted Weber A and B fractures: A retrospective study. Indian J Orthop 2013; 47: 364-9. [Crossref]

24. Xie L, Guo X, Zhang SJ, Fang ZH. Locking compression plate distal ulna hook plate fixation versus intramedullary screw fixation for displaced avulsion fifth Metatarsal Base fractures: A comparative retrospective cohort study. BMC Musculoskelet Disord 2017; 18: 405. [Crossref]

25. Kim JB, Song IS, Park BS, Ahn CH, Kim CU. Comparison of the outcomes between headless cannulated screw fixation and fixation using a locking compression distal ulna hook plate in fracture of fifth metatarsal base. J Foot Ankle Surg 2017; 56: 713-7. [Crossref]

26. Lee SK, Park JS, Choy WS: Locking compression plate distal ulna hook plate as alternative fixation for fifth metatarsal base fracture. J Foot Ankle Surg 2014; 53: 522-8. [Crossref]

27. Yastrebov O, Lobenhoffer P. Refixation of tibial bony avulsions of the posterior cruciate ligament with a hook plate. Oper Orthop Traumatol 2010; 22: 347-53. [Crossref]

28. Li L, Tian W. Displaced avulsion fractures of the posterior cruciate ligament: Treated by stellate steel plate fixation. Indian J Orthop 2015; 49: 171-5. [Crossref]

29. Yin QD, Rui YJ, Wu YW, et al. Surgical treatment of avulsion fracture around joints of extremities using hook plate fixation. BMC Musculoskelet Disord 2019; 20: 200. [Crossref]