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Mohani M, Sharath HV, Varma T. X-Sens Inertial Sensor Technology-Based Rehabilitation on a Patient With Posterior Cruciate Ligament Avulsion Fracture and Shaft of Femur Fracture: A Case Report. Cureus 2024; 16:e55217. [PMID: 38558734 PMCID: PMC10981367 DOI: 10.7759/cureus.55217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
The posterior cruciate ligament (PCL), one of the key ligaments in the knee, serves to prevent backward movement of the tibia relative to the femur. A simultaneous occurrence of a PCL avulsion fracture and a femur shaft fracture in a pediatric patient suggests a complex orthopedic injury resulting from significant trauma to the knee and thigh area. This study describes the rehabilitation process of a 12-year-old female involved in a road traffic accident, who suffered both a midshaft femur fracture and a PCL avulsion fracture. Following surgical procedures, the patient underwent a comprehensive physiotherapy regimen utilizing X-Sens inertial sensor technology. The rehabilitation plan comprised multiple stages targeting pain alleviation, muscle strengthening, flexibility exercises, gait retraining, and balance improvement. Various interventions including contrast baths, cryotherapy, patellar mobilization, isotonic and resistance exercises, and progressive gait training were integrated across different phases of the rehabilitation program. Over subsequent follow-up periods, the patient demonstrated significant enhancements in pain management, range of motion, muscle strength, functional capabilities, and gait metrics. This case report underscores the efficacy of a systematic physiotherapy strategy incorporating advanced technology in the successful recovery from intricate lower limb fractures, underscoring the importance of prompt intervention and multidisciplinary collaboration for optimal patient outcomes.
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Affiliation(s)
- Mahek Mohani
- Department of Paediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - H V Sharath
- Department of Paediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
| | - Tanvi Varma
- Department of Cardiovascular and Respiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, IND
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Gawande V, Badge A. Clinical Effectiveness of Arthroscopy-Assisted Fixation in the Treatment of Avulsed Posterior Cruciate Ligament Injuries. Cureus 2023; 15:e50152. [PMID: 38186527 PMCID: PMC10771625 DOI: 10.7759/cureus.50152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Avulsed posterior cruciate ligament (PCL) injuries are complex orthopedic challenges that require careful consideration and optimal management. Arthroscopy offers advantages, including smaller incisions, reduced soft tissue disruption, reduced postoperative pain, and improved visualization of intraarticular anatomy. Arthroscopy-assisted fixation results in superior clinical outcomes. Patient-specific factors, graft choice, and timing of surgery significantly impact outcomes. Rehabilitation is vital and requires a tailored approach to restore knee function. Biomechanically, arthroscopy-assisted fixation enhances joint stability and range of motion, reducing the risk of secondary injuries. Advancements in technology and surgical techniques further improve outcomes. Concomitant injuries and incorporation are essential considerations. Arthroscopy-assisted fixation is a recommended approach, but personalized care is crucial for successful recovery. Its precision in reattaching the PCL enhances joint stability and clinical results, aligning with outcomes seen in conventional procedures. Using biocompatible materials in fixation devices has significantly reduced the risk of allergic reactions or complications. This has allowed a faster and smoother recovery process for patients undergoing arthroscopy-assisted fixation. The incorporation of physical therapy and rehabilitation programs after surgery plays a vital role in restoring joint function and preventing muscle atrophy. The combination of advanced technology, surgical techniques, and personalized care has greatly improved the success rate of arthroscopy-assisted fixation procedures. Advancements in technology further improve patient outcomes, but each case should be individually assessed to determine the most appropriate treatment approach.
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Affiliation(s)
- Vasant Gawande
- Orthopedics, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Ankit Badge
- Medicine, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
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Vishwakarma NS, Gali JC, Gali JC, LaPrade RF. THE OUTCOMES OF POSTERIOR CRUCIATE LIGAMENT TIBIAL AVULSION FIXATION WITH A SCREW USING A DUAL POSTEROMEDIAL PORTAL TECHNIQUE. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e246988. [PMID: 36506856 PMCID: PMC9721415 DOI: 10.1590/1413-785220223002e246988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/16/2021] [Indexed: 12/03/2022]
Abstract
Objectives Our purpose was to evaluate the clinical results of PCL tibial avulsion fracture fixation performed with 4 mm cancellous screws using a dual posteromedial (PM) portal technique. Methods In a prospective study, we followed 12 patients submitted to PCL tibial insertion avulsion arthroscopic fixation using dual PM portals with cancellous screws from March 2014 to Jan 2020. The proximal higher PM portal served as an instrument portal and provided an optimal trajectory for arthroscopic screw fixation of larger PCL avulsion fractures. The lower PM portal was used as a viewing portal. Results Significant improvements were found between the preoperative and postoperative mean Lysholm scores at six months. The preoperative IKDC score mean of 10.13 increased to 89.3 at the end of six months. Minor adverse results with this technique were: grade I on posterior sag in five knees (41.6%), temporary stiffness in two cases (16.7 %), delayed union in one patient (8.3 %), and difficulty squatting at the end of six months in one patient (8.3%). Temporary extension lag was present in two individuals (16.7%), and fixed subtle flexion deficit of 3-5 degrees occurred in one individual (8.3 %). Conclusion The outcomes obtained with the proposed technique were similar to those obtained with open techniques, although mild flexion deficits and discreet posterior sag may be present in a significant number of cases. Level of Evidence II; Prospective Cohort Study .
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Affiliation(s)
- Nilesh S. Vishwakarma
- MGM institute of health sciences, Department of orthopedics, New Mumbai, Maharashtra, India
| | - Julio Cesar Gali
- Universidade Católica de São Paulo, Faculty of Medical Science and Health, Department of Surgery, Sorocaba, São Paulo, Brazil
| | - Julio Cesar Gali
- Núcleo de Ortopedia e Traumatologia Esportiva, Sorocaba, São Paulo, Brazil
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Suspension button constructs restore posterior knee laxity in solid tibial avulsion of the posterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2021; 29:4163-4171. [PMID: 33675369 PMCID: PMC8595177 DOI: 10.1007/s00167-021-06510-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/17/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Dislocated tibial avulsions of the posterior cruciate ligament (PCL) require surgical intervention. Several arthroscopic strategies are options to fix the fragment and restore posterior laxity, including two types of suspension button devices: adjustable (self-locking) and rigid knotted systems. Our hypothesis was that a rigid knotted button construct has superior biomechanical properties regarding laxity restoration compared with an adjustable system. Both techniques were compared with standard screw fixation and the native PCL. METHODS Sixty porcine knees were dissected. The constructs were tested for elongation, stiffness, yield force, load to failure force, and failure mode in a material testing machine. Group N (native, intact PCL) was used as a control group. In group DB (Dogbone™), TR (Tightrope™), and S (screw), a standardized block osteotomy with the osteotomized fragment attached to the PCL was set. The DB and TR groups simulated using a suspension button system with either a rigid knotted (DB) or adjustable system (TR). These groups were compared to a screw technique (S) simulating antegrade screw fixation from posterior. RESULTS Comparing the different techniques (DB, TR, S), no significant elongation was detected; all techniques achieved a sufficient posterior laxity restoration. Significant elongation in the DB and TR group was detected compared with the native PCL (N). In contrast, screw fixation did not lead to significant elongation. The stiffness, yield load, and load to failure force did not differ significantly between the techniques. None of the techniques reached the same level of yield load and load to failure force as the intact state. CONCLUSION Arthroscopic suspension button techniques sufficiently restore the posterior laxity and gain a comparable construct strength as an open antegrade screw fixation.
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Kan H, Nakagawa S, Hino M, Komaki S, Arai Y, Inoue H, Takahashi K. Arthroscopic Fixation Technique for Avulsion Fracture of the Posterior Cruciate Ligament From the Tibia. Arthrosc Tech 2020; 9:e1819-e1824. [PMID: 33294346 PMCID: PMC7695752 DOI: 10.1016/j.eats.2020.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/06/2020] [Indexed: 02/03/2023] Open
Abstract
This study describes an arthroscopic pullout fixation technique for small and comminuted avulsion fractures of the posterior cruciate ligament from the tibia. Intra-articular surgery required 3 arthroscopic portals, the anterolateral, anteromedial, and posteromedial portals. To simplify surgery, the posterolateral portal was omitted. A 2.4-mm K-wire was inserted through the anterior incision to the center of the bone fragment. This central guidewire was subsequently overdrilled with a 4.0-mm cannulated drill. The fixation material consisted of Pass Telos artificial ligaments inserted through the fiber loop of a fixed suspensory device such as RIGIDLOOP. The leading end of the thread of the RIGIDLOOP was pulled out through the anteromedial portal. The button of RIGIDLOOP was gradually advanced through the bone tunnel. The button was pulled out and flipped over the bony fragment. The artificial ligament was pulled distally to reduce the bony fragment, and fixed onto the tibia using a ligament button while applying anterior drawer force to the proximal tibia with the knee flexed at 90°. This minimally invasive procedure was successful in treating small and comminuted avulsion fracture of the tibial attachment of the posterior cruciate ligament.
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Affiliation(s)
- Hiroyuki Kan
- Department of Orthopaedics, Kyoto Interdisciplinary Institute Hospital of Community Medicine, Kyoto, Japan
| | - Shuji Nakagawa
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Manabu Hino
- Department of Orthopaedics, Kyoto Interdisciplinary Institute Hospital of Community Medicine, Kyoto, Japan
| | - Shintaro Komaki
- Department of Orthopaedics, Kyoto Interdisciplinary Institute Hospital of Community Medicine, Kyoto, Japan
| | - Yuji Arai
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan,Address correspondence to Yuji Arai, M.D., Ph.D., Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Hiroaki Inoue
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Mhaskar VA. Arthroscopic Transseptal Single-Tunnel Posterior Cruciate Ligament Refixation. Arthrosc Tech 2020; 9:e1635-e1644. [PMID: 33294320 PMCID: PMC7695555 DOI: 10.1016/j.eats.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/09/2020] [Indexed: 02/03/2023] Open
Abstract
Posterior cruciate ligament avulsions are relatively rare and often go undiagnosed. However, they need to be fixed to restore knee biomechanics. Fixation techniques vary from open to arthroscopic with comparable results. Arthroscopic techniques are less invasive; however, they are technically demanding. This Technical Note describes one such relatively low-cost arthroscopic suture tape pull-out technique using both an anterior and transseptal portals to fix the posterior cruciate ligament avulsion fragment.
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Affiliation(s)
- Vikram Arun Mhaskar
- Department of Orthopaedics, Max Smart Super Speciality Hospital, Saket, New Delhi, India,Knee & Shoulder Clinic, New Delhi, India,Address correspondence to Vikram Arun Mhaskar, M.S., M.Ch., Department of Orthopaedics, Max Smart Super Speciality Hospital, Saket, New Delhi, India.
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Forkel P, Imhoff AB, Achtnich A, Willinger L. [All-arthroscopic fixation of tibial posterior cruciate ligament avulsion fractures with a suture-button technique]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 32:236-247. [PMID: 31492968 DOI: 10.1007/s00064-019-00626-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To restore the posterior stability of the knee after a tibial posterior cruciate ligament (PCL) avulsion with a suture-button construct. INDICATIONS Acute solid and monofragment bony avulsion of the tibial PCL insertion. CONTRAINDICATIONS Chronic condition of avulsion fractures or posterior instability, multifragment avulsions, thin bone pieces, advanced knee osteoarthritis, high-grade soft tissue injury, infection. SURGICAL TECHNIQUE Supine position, all-arthroscopic treatment via posteromedial and posterolateral portal, arthroscopic visualization and fracture reduction, transtibial drilling with a cannulated 2.4 mm drill, reduction of the fragment via FiberTape™ and Dog Bone. Knotting of the tapes against an additional Dog Bone at the anterior aspect of the tibia. Intraoperative x‑ray. POSTOPERATIVE MANAGEMENT Knee extension brace with posterior tibial support for 6 weeks, 20 kg partial weight-bearing and restricted flexion up to 90° for 6 weeks, physiotherapy in prone position from the first postoperative day. Full weight bearing after x‑ray and clinical control after 6 weeks. RESULTS Since 2016 eight tibial PCL avulsions were treated. In 6 patients a suture-bridge technique via a mini-open approach was performed due to a small or comminuted fracture fragment. In 2 patients an all-arthroscopic technique was performed. No complications. The all-arthroscopic technique requires a solid fragment and enables the surgeon to treat additional pathologies. In general, the arthroscopic technique makes the open posterior approach unnecessary. The arthroscopic techniques achieve slightly higher objective and subjective values compared to the open procedure, despite a higher rate of arthrofibrosis.
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Affiliation(s)
- Philipp Forkel
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - Andreas B Imhoff
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Andrea Achtnich
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Lukas Willinger
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland
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Outcomes of posterior cruciate ligament tibial avulsion treated with staple fixation: stress TELOS X-ray evaluation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:883-891. [DOI: 10.1007/s00590-019-02371-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/04/2019] [Indexed: 12/17/2022]
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Song JG, Nha KW, Lee SW. Open Posterior Approach versus Arthroscopic Suture Fixation for Displaced Posterior Cruciate Ligament Avulsion Fractures: Systematic Review. Knee Surg Relat Res 2018; 30:275-283. [PMID: 30466249 PMCID: PMC6254874 DOI: 10.5792/ksrr.17.073] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 02/28/2018] [Accepted: 05/27/2018] [Indexed: 12/23/2022] Open
Abstract
Purpose To compare the clinical outcomes between the open posterior approach and arthroscopic suture fixation for displaced posterior cruciate ligament (PCL) avulsion fractures. Methods A literature search was performed on MEDLINE, EMBASE, and the Cochrane Library databases. The inclusion criteria were as follows: papers written in English on displaced PCL avulsion fractures, clinical trial(s) with clear description of surgical technique, adult subjects, a follow-up longer than 12 months and modified Coleman methodology score (CMS) more than 60 points. Results Twelve studies were included with a mean CMS value of 72.4 (standard deviation, 7.6). Overall, 134 patients underwent the open posterior approach with a minimum 12-month follow-up, and 174 patients underwent arthroscopic suture fixation. At final follow-up, the range of Lysholm score was 85-100 for the open approach and 80-100 for the arthroscopic approach. Patients who were rated as normal or nearly normal in the International Knee Documentation Committee subjective knee assessment were 92%-100% for the open approach and 90%-100% for the arthroscopic approach. The range of side-to-side difference was 0-5 mm for both approaches. Conclusions Both arthroscopic and open methods for the treatment of PCL tibial-side avulsion injuries resulted in comparably good clinical outcomes, radiological healing, and stable knees.
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Affiliation(s)
- Jae-Gwang Song
- Department of Orthopedic Surgery, Suncheon Joongang Hospital, Suncheon, Korea
| | - Kyung-Wook Nha
- Department of Orthopedic Surgery, Ilsan Paik Hospital, College of Medicine, Inje University College of Medicine, Goyang, Korea
| | - Se-Won Lee
- Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Abstract
PURPOSE OF REVIEW The purposes of this review are to (1) discuss the epidemiology and workup of the rare posterior cruciate ligament (PCL) avulsion fracture, (2) review the indications for nonoperative and operative management of patients with PCL avulsion fractures, (3) examine surgical outcomes in this patient population, and (4) discuss the authors' preferred management algorithm and surgical approach. RECENT FINDINGS In accordance with the rarity of these injuries, the literature is sparse regarding surgical outcomes. Many of these injuries are in the setting of a multi-ligamentous injury. Most authors suggest that displaced PCL avulsion fractures should undergo operative fixation and current data suggests excellent outcomes when treating these patients with either open or arthroscopic fixation, with a low complication rate. PCL avulsion fractures, although rare, should undergo fixation when displacement is present. Current studies report successful outcomes and a low complication rate.
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Affiliation(s)
- Anna Katsman
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Eric J Strauss
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Kirk A Campbell
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Michael J Alaia
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY, USA.
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Are Arthroscopic PCL Avulsion Fixation and its Long Learning Curve Morally Justified When Other Surgical Approaches are Valid? An Ethical Issue in Surgical Research. JOURNAL OF ORTHOPEDIC AND SPINE TRAUMA 2017. [DOI: 10.5812/jost.60943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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