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KMID : 0361620110460030231
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Journal of the Korean Orthopaedic Association
2011 Volume.46 No. 3 p.231 ~ p.236
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Open Repair of Acute Tibial Avulsion Injury of Posterior Cruciate Ligament - Clinical Outcomes and Usefulness of Preoperative 3-D CT -
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Park Jong-Hyuk
Wang Sung-Il
Lee Ju-Hong
Choi Hee-Lack
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Abstract
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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.
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KEYWORD
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posterior cruciate ligament, tibial avulsion injury, open repair, 3D-CT
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