Department of Orthopedic Surgery, Kyung-Hee University Hospital, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
Department of Orthopedic Surgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.
Knee Surg Sports Traumatol Arthrosc. 2021 Apr;29(4):1269-1275. doi: 10.1007/s00167-020-06175-2. Epub 2020 Jul 25.
It is generally agreed that surgical treatment is warranted for acute posterior cruciate ligament (PCL) avulsion fracture with displacement. However, the amount of displacement that warrants surgical treatment has not been defined. The purpose of this study was to determine the optimal cut-off value for displacement of posterior cruciate ligament avulsion fracture in determining non-operative treatment and to compare the results of non-operative treatment in acute isolated PCL avulsion fractures with non-operative treatment of acute PCL injury.
Between 2007 and 2017, 30 consecutive patients with acute isolated PCL avulsion fractures and 70 consecutive patients with acute isolated PCL injuries, all of whom underwent non-operative treatment (cast immobilization with > 2 years of follow-up) were retrospectively analyzed. Clinical scores including the International Knee Documentation Committee subjective score, Lysholm score, and Tegner activity score, as well as side-to-side differences on stress radiographs, were compared between the PCL avulsion fracture and PCL injury groups at the final follow-up. The failure rates of non-operative treatment were also compared. The predictive value of the amount of fracture displacement for successful non-operative treatment was calculated using area under the receiver operating characteristic curve (AUROC). The optimal cut-off of the amount of fracture displacement to determine non-operative treatment was based on the maximal sum of sensitivity and specificity.
The two groups exhibited comparable clinical scores and mean side-to-side differences on stress radiographs. There were 5 (16.6%) failures of non-operative treatment in the PCL avulsion fracture group and 19 (27.1%) failures in the PCL injury group. (n.s) There was a significant positive correlation between the amount of initial avulsion fracture displacement and side-to-side difference in posterior stress radiographs at final follow up (P < 0.001). The optimal cut-off value for the amount of fracture displacement in PCL avulsion fracture to predict failure of non-operative treatment was 6.7 mm (AUROC = 1.0).
The outcomes of non-operative treatment of acute isolated PCL avulsion fractures were comparable to those of patients with acute isolated PCL injuries. Acute PCL avulsion injuries with displacement of less than 6.7 mm should be considered for non-operative treatment.
IV.
对于有移位的急性后交叉韧带（PCL）撕脱骨折，一般认为需要手术治疗。然而，需要手术治疗的移位量尚未确定。本研究的目的是确定后交叉韧带撕脱骨折位移的最佳截断值，以确定非手术治疗，并比较急性孤立性 PCL 撕脱骨折的非手术治疗结果与急性 PCL 损伤的非手术治疗结果。
回顾性分析 2007 年至 2017 年期间连续 30 例急性孤立性 PCL 撕脱骨折和 70 例急性孤立性 PCL 损伤患者，所有患者均接受非手术治疗（石膏固定，随访时间超过 2 年）。在最终随访时，比较 PCL 撕脱骨折组和 PCL 损伤组的临床评分，包括国际膝关节文献委员会主观评分、Lysholm 评分和 Tegner 活动评分，以及应力位 X 线片的侧别差异。还比较了非手术治疗的失败率。使用受试者工作特征曲线（ROC）下面积（AUROC）计算骨折位移量对非手术治疗成功的预测价值。基于最大灵敏度和特异性之和，确定骨折位移量的最佳截断值来确定非手术治疗。
两组的临床评分和应力位 X 线片的侧别差异均相似。PCL 撕脱骨折组有 5 例（16.6%）非手术治疗失败，PCL 损伤组有 19 例（27.1%）失败（n.s）。初始撕脱骨折位移量与最终随访时后向应力位 X 线片侧别差异之间存在显著正相关（P < 0.001）。预测 PCL 撕脱骨折非手术治疗失败的骨折位移最佳截断值为 6.7mm（AUROC=1.0）。
急性孤立性 PCL 撕脱骨折非手术治疗的结果与急性孤立性 PCL 损伤患者的结果相当。对于小于 6.7mm 位移的急性 PCL 撕脱损伤，应考虑非手术治疗。
IV。
