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First published on May 18, 2004, doi:10.1177/0363546503262201
This version was published on July 1, 2004
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The American Journal of Sports Medicine 32:1230-1237 (2004)
© 2004 American Orthopaedic Society for Sports Medicine

Primary Repair of Posterior Cruciate Ligament Avulsion Fracture

The Effect of Occult Injury in the Midsubstance on Postoperative Instability

Masayuki Inoue, MD, PhD*,{dagger}, Kazunori Yasuda, MD, PhD{ddagger}, Eiji Kondo, MD{ddagger}, Katsutoshi Saito, MD{dagger} and Motomi Ishibe, MD, PhD{dagger}

From the {dagger} NTT East Japan Sapporo Hospital, Sapporo, Japan, and {ddagger} Hokkaido University School of Medicine, Sapporo, Japan

* Address correspondence to Masayuki Inoue, S-1, W15, Chu-o-ku, Sapporo, Japan 060-0061 (e-mail: inomasa{at}rose.ocn.ne.jp).

Background: In the posterior cruciate ligament avulsion fracture, posterior instability cannot be completely restored by the anatomical reduction and fixation of an avulsed fragment.

Hypothesis: The occult midsubstance injury inside the posterior cruciate ligament may affect the residual posterior instability after anatomical reduction and internal fixation of the avulsed fragment.

Study Design: Prospective comparative clinical study.

Methods: Thirty-one patients were followed for a period of 2 to 8 years. Based on magnetic resonance images taken immediately after the injury, these patients were divided into 2 groups, the occult injury group (group O, 15 knees) and the uninjured group (group N, 16 knees).

Results: The side-to-side difference of the posterior knee instability was 3.2 mm in group O and 3.0 mm in group N. Approximately 60% of the knees examined showed mild posterior instability in both groups. There were no significant differences found between the 2 groups.

Conclusion: The occult posterior cruciate ligament midsubstance injury does not significantly affect postoperative posterior instability of the knee. This fact did not support the hypothesis that has been commonly considered thus far.

Clinical Relevance: It is not necessary for orthopaedic surgeons to be overly apprehensive about occult midsubstance injury in the treatment of posterior cruciate ligament avulsion fracture.

Key Words: posterior cruciate ligament (PCL) • avulsion fracture • occult injury • posterior instability • clinical result






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