A rare case of bony avulsion of posterior cruciate ligament from its femoral attachment.
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ABSTRACT:
SUBMITTER: Mishra AK
PROVIDER: S-EPMC5192177 | biostudies-literature | 2016 Dec
REPOSITORIES: biostudies-literature
Publications
A rare case of bony avulsion of posterior cruciate ligament from its femoral attachment.
Mishra Anil Kumar AK Vikas Rohit R
Medical journal, Armed Forces India 20160525 Suppl 1
Similar Datasets
Project description:Medial collateral ligament (MCL) of the knee is one of the most commonly injured ligaments of the knee. Incidence of posterior cruciate ligament (PCL) injuries can vary widely. Conservative treatment has shown good clinical outcomes and relatively rapid return to play in both injuries alone. We present the case of a 38-year-old male who presented a combined MCL avulsion injury and PCL tear treated surgically. The PCL was reconstructed using the double-bundle Achilles allograft technique. Within the same surgery, a medial femoral incision was performed to reinsert the avulsion of the bone fragment rotated and distally retracted together with the MCL with bone anchors and Spike Washer. Two years after surgery, the patient enjoyed a 0/140-degree range of motion for flexion/extension. He had returned to sports and was pain-free. In conclusion, femoral avulsion of the MCL associated to PCL injury is a rare and nondescribed injury that, as opposed to most MCL isolated injuries, might benefit from early surgical reconstruction.
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Project description:It was in the early 1900s that anterior cruciate ligament (ACL) repair was first described with its resurgence in the mid-1900s. It however failed to gain popularity because of unsatisfactory early outcomes as a result of poorly selected patients. We describe a suture pullout technique of acute ACL repair in a carefully selected cohort of patients. Healing capabilities similar to that of the proximal medial collateral ligament have been shown in the proximal ACL avulsions. Adding microfracture of the lateral wall of the notch further enhances the healing environment by countering the synovial fluid environment. Acute ACL repair when performed in a carefully selected patient leads to good results and saves the patient of a reconstruction procedure.
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Project description:Humeral avulsion of the inferior glenohumeral ligament (HAGL) has recently gained more recognition as a cause of shoulder instability. Posterior HAGL lesions, being much more infrequent than anterior disruptions, have only recently been documented as a notable cause of posterior instability. We detail the treatment of a previously unreported case of a posterior HAGL variant lesion consisting of a bony avulsion with involvement of the teres minor tendon. Arthroscopic fixation was facilitated by use of a "sheathless" arthroscopic approach with a 70° arthroscope and suture anchor.
| S-EPMC3986478 | biostudies-literature
Project description:A femoral-sided avulsion fracture of the anterior cruciate ligament (ACL) is a rare and challenging condition. Most reported cases have occurred in childhood or adolescence. Many techniques of ACL repair have been reported, and in recent years, techniques in arthroscopic surgery have been developed and have become ever more popular with orthopaedic surgeons. We created a technique of arthroscopic ACL repair with suture anchor fixation for a femoral-sided ACL avulsion fracture. This technique saves the natural ACL stump. It is available for cases in which creation of a tibial tunnel is not allowed. Moreover, it does not require a skin incision for fixation on the far femoral cortex and, therefore, does not require a second operation to remove the fixation device. The arthroscopic technique also has a good cosmetic outcome.
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Project description:Posterior cruciate ligament (PCL) tibial avulsion fractures in children are extremely rare. Due to the rarity of these injuries, careful attention to the specific physical examination and imaging findings is necessary for a proper diagnosis. PCL avulsion fractures can be missed on plain radiography in skeletally immature patients. Magnetic resonance imaging should be considered if sagging or posterior drawer sign is positive after a strong hit to the anterior aspect of the lower leg. With this knowledge, clinicians can formulate treatment plans that can return patients to their original functionality while avoiding potential morbidity from misdiagnoses. We treated these patients using the suture bridge method. In children, ossification is incomplete, and they possess a lot of cartilage, so screw fixation easily destroys avulsed fragment. The suture bridge method can firmly fix the avulsed fragments, reducing the risk of damage to the bone fragment; therefore, a secondary surgery for implant removal is not needed. Arthroscopic surgery also was expected to be technically difficult in children due to the limited scope of the operation. We used open fixation because the outcome was unaffected by open surgery and arthroscopic surgery, and all patients returned to full sporting activity postoperatively.
| S-EPMC9051890 | biostudies-literature
Project description:Avulsion fracture of the tibial insertion of the posterior cruciate ligament (PCL) receives constant concern. Arthroscopic procedures have long been attempted because of their minimally invasive nature, and various related techniques have been reported. However, the best arthroscopic method is still being pursued. In this article, we introduce an arthroscopic suture ligation and backup adjustable-loop fixation technique for PCL tibial avulsion fracture. The critical points of this technique are proper ligation of the PCL, proper location of the 2 tibial tunnels to create pulleys for posterior-inferior reduction of the bone fragment, and additional backup suture loop fixation. Our experience indicates that this technique is efficient and relatively simple. We consider that the introduction of this technique will provide a reasonable choice in the treatment of PCL tibial avulsion fracture.
| S-EPMC8252814 | biostudies-literature
Project description:The posterior cruciate ligament surgery invariably demands adequate posterior compartment visualisation and instrumentation. The addition of posteromedial (PM) portal during posterior cruciate ligament (PCL) surgeries remains essential. The further addition of one more proximal posteromedial (PM) portal further enhances the instrumentation including suture passage in the substance of PCL or screws insertion and more so obviates the need for trans-septal and posterolateral (PL) portals. This additional PM portal is created in the safe zone under direct visualisation utilising outside-in technique and is spaced to prevent crowding of instrument with arthroscope. The proximal higher PM portal serves as instrument portal and provides optimal trajectory for even arthroscopic screw fixation of PCL avulsion fractures.
| S-EPMC8556587 | biostudies-literature
Project description:Multiple ligament injury is associated with high instability; hence, it is necessary to restore stability through application of a reliable treatment strategy. We report our experiences in handling a case of ruptured anterior cruciate ligament (ACL) complicated by chronic bony avulsion of the posterior cruciate ligament (PCL). Favourable results were obtained as a result of ACR reconstruction following a new method for tensioning of the chronic tibial bony avulsion of PCL as a postero-medial bundle and augmentation by PCL anterolateral bundle reconstruction. Favourable posterior stability could be restored through application of this new technique incorporating post-reconstruction PCL reinforcement.
| S-EPMC6275229 | biostudies-literature
Project description:Posterior cruciate ligament (PCL) ruptures are uncommonly seen in knee ligament injuries. Cconservative treatment is often suitable for isolated tears with mild-to-moderate posterior knee laxity (grades I or II). However, surgical intervention is indicated for symptomatic grade III or multiligament knee injuries. PCL reconstruction has experienced continuous development due to the progress made in arthroscopic techniques and instruments. Abnormal positioning and tensioning of the femoral button result in multiple complications such as residual laxity, loss of quadriceps muscle strength, and joint stiffness. In this Technical Note, we describe direct arthroscopic visualization of the femoral button deployment in PCL reconstruction technique, and we discuss its importance to prevent complications related to button malposition.
| S-EPMC11258917 | biostudies-literature
Project description:Background Posterior cruciate ligament (PCL) avulsion fracture of the tibial insertion is a very rare injury in children. In addition to performing an attentive clinical examination, radiologic studies are fundamental for its correct diagnosis and treatment. Its management may be either conservative or operative. So far, only a few cases treated conservatively have been reported in the pediatric population, with controversial results. Methods We prospectively collected and reviewed clinical and radiographic data of an 11-year-old boy with avulsion fracture of the tibial insertion of the PCL. In addition, we performed a systematic review of the literature available to date. Results We decided to treat the avulsion fracture in a conservative way. The patient has been followed with accurate clinical and radiological follow-up controls until complete recovery. Conclusion Posterior cruciate avulsion fracture is a very rare finding in children, and no definitive indications for its appropriate management exist. With this report, we demonstrate that these fractures can be treated conservatively in selected cases with good results, avoiding potential surgical-related complications. Study Design This is a case report (level of evidence V).
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