PMC8313341_01
Coronal (a) and sagittal (b) X-ray on admission to the Emergency Department.
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fig1
The radiograph (X-ray) and computed tomography scan (CT scan) showed a displaced avulsion fracture of the PCL tibial attachment, a displaced avulsion fracture of the LCL femoral attachment and a comminuted fracture of the inferior pole of the patella (Figures 1 and 2).
Coronal (a, d), axial (b), and sagittal (c) CT scan on admission to the Emergency Department.
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fig2
The radiograph (X-ray) and computed tomography scan (CT scan) showed a displaced avulsion fracture of the PCL tibial attachment, a displaced avulsion fracture of the LCL femoral attachment and a comminuted fracture of the inferior pole of the patella (Figures 1 and 2).
MRI (fat-saturated T2-weighted) lateral view showing a displaced avulsion fracture of PCL at tibial attachment.
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fig3
The PCL tibial avulsion fracture was better characterized by magnetic resonance imaging (MRI) (Figure 3).
Arthroscopic portals used during the procedure (two standard anterior and two accessory posterior).
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Insertion of K-wires to the PCL tibial footprint controlled by fluoroscopy.
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A 2.5 cm longitudinal incision was made just medial to the tibial tubercule, and two parallel 2.5 mm K-wires were inserted through the tibial PCL guide to the medial and lateral borders of the tibial footprint, respectively (Figure 5).
MRI (T2-weighted) axial view - schematic representation of each suture (yellow and blue lines) crossing the posterior part of the base of the PCL and exiting the contralateral tunnel (a). Arthroscopic posteromedial view - interlaced suture configuration for PCL avulsion fracture (b).
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Each suture crossed the posterior part of the ligament, passed the loop, and pulled to the outside through the contralateral tunnel, creating an interlaced suture configuration (Figure 6).
Coronal (a) and sagittal (b) intraoperative X-ray showing the final reduction and fixation of PCL and LCL avulsion fractures.
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Two percutaneous screws (4.0 mm) were inserted and fixed the fragment (Figure 7).
Coronal (a, b), sagittal (c), and axial (d) control CT scan after 3 months postoperative with evidence of fracture healing.
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fig8
Three months after surgery, the avulsion fractures of PCL and LCL and the patella fracture were healed (Figure 8).