2017 ISAKOS Biennial Congress ePoster #1807

 

Evaluation of Posterior Instability after Open Reduction and Internal Fixation of PCL Tibial Avulsion Fractures

Francesco Giron, MD, PhD, Firenze ITALY
Luca Giannini, MD, Florence ITALY
Michele Losco, MD, PhD, Firenze ITALY
Roberto Buzzi, MD, Florence, ITALY

SOD Traumatologia e Ortopedia Generale, AOU Careggi, Firenze, Firenze, ITALY

FDA Status Not Applicable

Summary

In case of PCL tibial avulsion fracture, ORIF trough a Burk’s and Schaffer approach is a viable option to treat these type injuries in most of the cases.

Abstract

Objectives: In past years many arthroscopic and open techniques have been described to treat tibial avulsion fracture of the PCL, but only few studies have investigated postoperative knee stability. The purpose of this study was to prospectively evaluate knee stability after an open reduction and internal fixation (ORIF) of a posterior cruciate ligament (PCL) tibial avulsion fracture treated trough a Burk’s and Schaffer approach.

Methods

Nineteen patients (14 males and 5 females) with an avulsion fracture of tibial insertion of PCL who underwent ORIF in our hospital between 2007 and 2015 were included. The mean age was 42 years (range 17–75). All preoperative data were collected from clinical record. Eight patients have an associated lesion: three fractures of the posterior acetabular wall, three fractures of the femoral diaphysis, one distal tibial fracture and one patellar fracture. Sixteen patients were treated acutely (< 3 weeks) while three have a chronic injury. Preoperatively, the diagnosis was performed using standard X-rays and CT scan evaluation. The clinical outcome assessment was performed using the International Knee Documentation Committee form and the Knee Injury and Osteoarthritis Outcome Score. The posterior tibial drawer was investigated with a KT-1000 arthrometer and stress X-rays with Telos device at 90° of knee flexion after 6 months from surgery. The patients were then evaluated annually.

Results

All patients were review at an average follow-up of 30 months (range 6–47 months). Radiologic assessment showed fracture union in all patients. At the last follow-up, the mean IKDC score was 68, the subscales of KOOS form were respectively 77, 79, 86, 58 and 68. The objective IKDC final scores showed 10 patients graded as ‘‘normal’’, 8 patients graded as ‘‘nearly normal’’ and 1 patient graded as ‘‘abnormal’’. The mean tibial posterior translation measured with KT-1000 was 2 mm (range 0–6). Stress radiographs performed with Telos showed an average posterior tibial translation of 2.7 mm (range 0,1 – 9,8). We found a SSD >5 mm in a patients with a chronic injury. There were no statistically significant differences in the outcomes between acutely treated patients and patients with delayed surgery.

Discussion

In our series ORIF trough Burk’s and Schaffer approach was able to restore the posterior stability with a good outcome in most cases. An abnormal tibial posterior drawer (ssd>5mm) was found in 1 patient who have had a delayed operation (>4 weeks). These results are in line with those reported by other authors who identify chronic lesion as a risk factor for persistent instability.

Conclusions

In our opinion ORIF in case of PCL tibial avulsion fracture is a viable option to treat these type injuries in most of the cases.