Bonaspetti Giovanni, Tonolini Stefano, Dib Giovanni, Piovani Alessia
Department of Orthopaedics and Trauma Surgery Clinical Institute S. Anna GSD-Istituto Clinico S. Anna GSD, Via del Franzone 31 25127, Brescia, Italy.
Department of Orthopaedics and Trauma Surgery University of Brescia School of Medicine, Viale Europa 11 25123, Brescia, Italy.
Case Rep Orthop. 2024 Jul 9;2024:3137345. doi: 10.1155/2024/3137345. eCollection 2024.
The posterior cruciate ligament (PCL) is the largest and strongest intra-articular ligament of the knee joint and the primary posterior stabilizer. PCL injuries are less frequent than other knee ligament injuries and are typically combined with meniscal and chondral injuries or in the context of multiligamentous injuries. It is critical to properly diagnose and treat these lesions in order to avoid the risk of PCL insufficiency, subsequent knee instability, and early osteoarthritis. Surgical management can vary, and the ideal fixation device is still debated. Suture anchors are an unusual mean of fixation of PCL tibial bony avulsion. We report on two patients treated with open anchor fixation for PCL tibial bony avulsion with a follow-up of 3 years. A 15-year-old male and a 65-year-old male were treated with open anchor fixation for bony tibial avulsion of the PCL. Surgical treatment was performed at 5 weeks and 3 weeks after the trauma, respectively. Diagnosis was made with an X-ray followed by CT and MR scans. Repair was achieved by reinserting the PCL bony fragment to its posterior tibial eminence with suture anchors through an open posterior approach. Both patients recovered full knee stability and a pain-free full range of motion (ROM) within 4 months and returned to their previous activities with a high satisfaction. The patient has been followed up for 3 years, and no complications were observed. PCL bony avulsions are rare, and their optimal treatment remains a significant subject of debate, particularly in the skeletally immature patient. We believe that open repair with metal anchors could be a good choice to repair PCL bony tibial avulsion in patients without concomitant intra-articular lesions and immature growth plates or severe fragmentation.
后交叉韧带（PCL）是膝关节内最大且最强壮的韧带，也是主要的后向稳定结构。PCL损伤比其他膝关节韧带损伤少见，通常与半月板和软骨损伤合并存在，或发生于多韧带损伤的情况下。正确诊断和治疗这些损伤对于避免PCL功能不全、继发膝关节不稳定以及早期骨关节炎的风险至关重要。手术治疗方式各异，理想的固定装置仍存在争议。缝线锚钉是PCL胫骨骨撕脱固定的一种特殊方式。我们报告了2例采用开放锚钉固定治疗PCL胫骨骨撕脱的患者，随访3年。1例15岁男性和1例65岁男性接受了PCL胫骨骨撕脱的开放锚钉固定治疗。手术分别在创伤后5周和3周进行。通过X线检查，随后进行CT和磁共振成像扫描做出诊断。通过开放后入路，使用缝线锚钉将PCL骨块重新植入胫骨后髁，实现修复。2例患者均在4个月内恢复了膝关节的完全稳定性，且无痛地获得了全范围活动度（ROM），并以高度满意度恢复了先前的活动。对患者进行了3年随访，未观察到并发症。PCL骨撕脱罕见，其最佳治疗方法仍是一个重要的争议话题，尤其是在骨骼未成熟的患者中。我们认为，对于没有合并关节内病变、生长板未成熟或严重骨折碎片的患者，采用金属锚钉进行开放修复可能是修复PCL胫骨骨撕脱的一个不错选择。
