J Korean Fract Soc.  2018 Oct;31(4):149-153. 10.12671/jkfs.2018.31.4.149.

Avulsion Fracture of the Posterior Cruciate Ligament from Femoral Insertion Occurred in a Patient with Residual Poliomyelitis: A Case Report

• Choi W
• Kim T

• KMID: 2422896
• DOI: http://doi.org/10.12671/jkfs.2018.31.4.149

Abstract

Avulsion fracture of the posterior cruciate ligament from its femoral insertion is quite rare, particularly in adults, and the treatment guidelines have not been established. A 68-year-old female patient with residual poliomyelitis presented with an avulsion fracture of the femoral insertion of the posterior cruciate ligament after a falling accident and was treated with arthroscopic headless compression screw fixation and pull-out suture of the avulsed ligament. We report this case with a relevant discussion of this type of injury.

Keyword

Posterior cruciate ligament; Femoral insertion; Avulsion fracture; Residual poliomyelitis; Arthroscopy; Headless compression screw; Pull-out suture

MeSH Terms

Accidental Falls
Adult
Aged
Arthroscopy
Female
Humans
Ligaments
Poliomyelitis*
Posterior Cruciate Ligament*
Sutures

Figure

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  Fig. 1 Anteroposterior (A) and lateral (B) radiographs of the left knee showing a bony fragment (arrows) in the femur intercondylar notch area.

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  Fig. 2 Axial (A) and sagittal (B) computed tomography images of the left knee showing a comminuted fracture (white arrows) located at the inner aspect of the intercondylar notch at the lateral side of the medial femoral condyle. (C) Three-dimensional reconstruction of a computed tomography image shows a fracture located at the femoral insertion of the posterior cruciate ligament (black arrow).

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  Fig. 3 Sagittal fat-suppressed T2-weighted magnetic resonance image of the left knee showing an avulsion fracture of the posterior cruciate ligament (arrow). Increased bone marrow signal on inferior part of the patella (arrowhead) and increased joint effusion (asterisk) are also observed.

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  Fig. 4 Posterior drawer test of the left knee performed under anesthesia showing the starting point (A) and posterior displacement (B) of the tibia after a force was applied suggestive of posterior cruciate ligament insufficiency.

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  Fig. 5 Intraoperative arthroscopic findings of the left knee. (A) Avulsion fracture of the femur medial condyle was observed, and it was connected to the posterior cruciate ligament (arrow). (B) After fixation of the fragment using a headless compression screw (arrow), the avulsed posterior cruciate ligament is sutured for pull-out fixation. (C) Tension of the posterior cruciate ligament was confirmed using the arthroscopic probe after the fixation.

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  Fig. 6 Postoperative anteroposterior (A) and lateral (B) radiographs of the left knee. A headless compression screw was inserted in the medial femoral condyle and a cancellous screw with a washer was inserted into the metaphysis of the femur for post-tie fixation of the pull-out sutures.

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