Newcomb Nicholas, Curtis William, Kurnik Christopher, Wharton Matthew, Treme Gehron, Shultz Christopher
The University of New Mexico, Albuquerque, New Mexico, USA.
Video J Sports Med. 2024 May 7;4(3):26350254231212930. doi: 10.1177/26350254231212930. eCollection 2024 May-Jun.
Tibial avulsion of the posterior cruciate ligament (PCL) often requires operative fixation, which frequently results in successful outcomes if identified acutely. Open or arthroscopic techniques are most commonly used.
Primary surgical indications for open fixation include acute tibial avulsion of the PCL. Secondary indications include grade 2 to grade 3 posterior drawer test and radiographic posterior subluxation of the tibia. Ideally, the joint space and articular cartilage should be well preserved.
In the simplified approach initially described by Burks and Schaffer, the patient is placed prone, and an inverted L-shaped incision is made over the posteromedial corner of the knee. A plane is developed between the medial head of the gastrocnemius and the semimembranosus down to the knee joint capsule. The gastrocnemius is retracted laterally to protect neurovascular structures and a vertical capsulotomy is performed. The tibial attachment of the PCL is reduced and held with K (Kirschner) wires and then fixated with screw and washer.
Six months post operation, our patient achieved full active and passive range of motion with a stable posterior drawer test. He returned to work without difficulty. Multiple studies have shown success with open PCL fixation and decreased rates of arthrofibrosis when compared with arthroscopic approach. In this case, the patient did not develop arthrofibrosis.
DISCUSSION/CONCLUSION: PCL tibial avulsions can be safely treated with an open approach. Contrary to other ligaments that favor reconstruction over repair, PCL avulsions may be better treated with early repair, so it is important to avoid delay in intervention. The most common complication in both open and arthroscopic approaches is arthrofibrosis, which is less common in the open approach. Early range of motion is encouraged to prevent arthrofibrosis.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
后交叉韧带（PCL）胫骨撕脱伤通常需要手术固定，如果能在急性期确诊，手术常常能取得成功的结果。最常用的是开放或关节镜技术。
开放固定的主要手术适应症包括PCL急性胫骨撕脱伤。次要适应症包括2级至3级后抽屉试验阳性以及胫骨影像学后脱位。理想情况下，关节间隙和关节软骨应得到良好保留。
在最初由伯克斯和谢弗描述的简化方法中，患者取俯卧位，在膝关节后内侧角做一个倒L形切口。在腓肠肌内侧头和半膜肌之间形成一个平面直至膝关节囊。将腓肠肌向外侧牵拉以保护神经血管结构，然后进行垂直的关节囊切开术。PCL的胫骨附着点复位并用克氏针固定，然后用螺钉和垫圈固定。
术后6个月，我们的患者实现了完全的主动和被动活动范围，后抽屉试验稳定。他顺利重返工作岗位。多项研究表明，与关节镜手术相比，开放PCL固定术取得了成功，关节纤维化发生率降低。在这个病例中，患者没有发生关节纤维化。
讨论/结论：PCL胫骨撕脱伤可以通过开放手术安全治疗。与其他倾向于重建而非修复的韧带不同，PCL撕脱伤早期修复可能效果更好，因此避免干预延迟很重要。开放和关节镜手术中最常见的并发症都是关节纤维化，在开放手术中这种情况不太常见。鼓励早期进行活动范围训练以预防关节纤维化。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本提交的出版物包含患者的豁免声明或其他书面批准形式。
