Posteromedial Versus Direct Posterior Approach for Posterior Cruciate Ligament Reinsertion
Abstract
Avulsion fractures of the posterior cruciate ligament (PCL) are usually found in pediatric populations. This study investigated which of 2 approaches—posteromedial or direct posterior—enables easier PCL reinsertion. Ten fresh cadavers were studied using direct posterior (10 knees) and posteromedial (10 knees) approaches. In both, a guidewire was inserted into the tibial insertion of the PCL as perpendicular as possible to the coronal knee axis. Then, the angle between the guidewire and the horizontal plane of the table was measured. The mean angle of the guidewire was 8.6° (SD=7.3°) with the direct posterior approach and 36.6° (SD=14.3°) with the posteromedial approach (P=.005). The direct posterior approach allows a greater degree of freedom compared with the posteromedial approach to reach the PCL tibial insertion. [Orthopedics. 2016; 39(5):e1024–e1027.]
- 1.Bali K, Prabhakar S, Saini U, Dhillon MS. Open reduction and internal fixation of isolated PCL fossa avulsion fractures. Knee Surg Sports Traumatol Arthrosc. 2012; 20(2):315–321.
10.1007/s00167-011-1618-6 Crossref MedlineGoogle Scholar - 2.Burks RT, Schaffer JJ. A simplified approach to the tibial attachment of the posterior cruciate ligament. Clin Orthop Relat Res. 1990; 254:216–219. CrossrefGoogle Scholar
- 3.Chen CH, Chen WJ, Shih CH. Fixation of small tibial avulsion fracture of the posterior cruciate ligament using the double bundles pull-through suture method. J Trauma. 1999; 46(6):1036–1038.
10.1097/00005373-199906000-00009 Crossref MedlineGoogle Scholar - 4.Chen SY, Cheng CY, Chang SS, Arthroscopic suture fixation for avulsion fractures in the tibial attachment of the posterior cruciate ligament. Arthroscopy. 2012; 28(10):1454–1463.
10.1016/j.arthro.2012.04.141 Crossref MedlineGoogle Scholar - 5.Nicandri GT, Klineberg EO, Wahl CJ, Mills WJ. Treatment of posterior cruciate ligament tibial avulsion fractures through a modified open posterior approach: operative technique and 12- to 48-month outcomes. J Orthop Trauma. 2008; 22(5):317–324.
10.1097/BOT.0b013e31817279d1 Crossref MedlineGoogle Scholar - 6.Wajsfisz A, Makridis KG, Van Den Steene JY, Djian P. Fixation of posterior cruciate ligament avulsion fracture with the use of a suspensory fixation. Knee Surg Sports Traumatol Arthrosc. 2012; 20(5):996–999.
10.1007/s00167-011-1702-y Crossref MedlineGoogle Scholar - 7.Deehan DJ, Pinczewski LA. Arthroscopic reattachment of an avulsion fracture of the tibial insertion of the posterior cruciate ligament. Arthroscopy. 2001; 17(4):422–425.
10.1053/jars.2001.21841 Crossref MedlineGoogle Scholar - 8.Abbott LC, Carpenter WF. Surgical approaches to the knee joint. J Bone Joint Surg Am. 1945; 27:277–310. Google Scholar
- 9.Trickey EL. Injuries to the posterior cruciate ligament: diagnosis and treatment of early injuries and reconstruction of late instability. Clin Orthop Relat Res. 1980; 147:76–81. CrossrefGoogle Scholar
- 10.Meyers MH. Isolated avulsion of the tibial attachment of the posterior cruciate ligament of the knee. J Bone Joint Surg Am. 1975; 57(5):669–672. Crossref MedlineGoogle Scholar
- 11.White EA, Patel DB, Matcuk GR, Cruciate ligament avulsion fractures: anatomy, biomechanics, injury patterns, and approach to management. Emerg Radiol. 2013; 20(5):429–440.
10.1007/s10140-013-1121-0 Crossref MedlineGoogle Scholar - 12.Jazayeri SM, Esmaili Jah AA, Karami M. A safe postero-medial approach to posterior cruciate ligament avulsion fracture. Knee Surg Sports Traumatol Arthrosc. 2009; 17(3):244–247.
10.1007/s00167-008-0665-0 Crossref MedlineGoogle Scholar - 13.Ruedi TP, Buckley R, Moran CG. AO Principles of Fracture Management. 2nd ed. New York, NY: Thieme Medical Publishers; 2007. Google Scholar
