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Review
. 2018 Sep;11(3):503-509.
doi: 10.1007/s12178-018-9491-2.

Posterior Cruciate Ligament Avulsion Fractures

Anna Katsman  1 , Eric J Strauss  1 , Kirk A Campbell  1 , Michael J Alaia  2
Affiliations
Review

Posterior Cruciate Ligament Avulsion Fractures

Anna Katsman et al. Curr Rev Musculoskelet Med. 2018 Sep.

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.

Keywords: Avulsion fracture; PCL facet; Posterior cruciate ligament (PCL).

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Conflict of interest statement

Conflict of Interest

All authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
a, b AP and lateral images of a 25-year-old male status post motorcycle accident. This patient sustained a comminuted, displaced PCL facet fracture with nondisplaced fibular head fracture and a nondisplaced inferior pole patella fracture with intact extensor mechanism
Fig. 2
Fig. 2
Sagittal T1-weighted image showing a PCL facet fracture with PCL clearly attached to the displaced fragment
Fig. 3
Fig. 3
CT sagittal cut showing comminuted, displaced PCL avulsion fracture. The proximal fragment is attached to the PCL. The distal fragment is attached to the medial meniscus root. A non-absorbable suture was placed into the meniscus root and the suture placed into a knotless anchor on the posterior tibial cortex. The PCL fragment was ultimately secured with a screw and washer
Fig. 4
Fig. 4
Open posterior approach for reduction of PCL avulsion fracture through an extensile approach (proximal is to the left and medial is on the bottom of the page). Please note the use of the retractor to pull the medial gastrocnemius laterally, protecting the neurovascular bundle. The screw and washer can be seen in the fragment just next to the retractor
Fig. 5
Fig. 5
Fluoroscopic postoperative image showing anatomic reduction of PCL facet fracture using a screw and washer
See this image and copyright information in PMC

References

    1. • Hooper PO. Management of posterior cruciate ligament tibial avulsion injuries: a systematic review. Am J Sports Med. Most complete and upto date systematic review of outcomes of open and arthroscopic approaches to PCL avulsion fractures. This paper eveluates 28 studies from 1975 to the date of publication. They conclude that similar outcomes are achieved with both techniques. Arthroscopic approach allows for treament of concomitant intraarticular pathology.
    1. Barros MA. Surgical treatment of avulsion fractures at the tibial insertion of the posterior cruciate ligament: functional result. Rev Bras Ortop (English ed.). 50(6):631–7. - PMC - PubMed
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