title: Treatment of posterior cruciate ligament tibial avulsion fractures through a modified open posterior approach: operative technique and 12- to 48-month outcomes.
abstract: OBJECTIVE
  To report clinical and functional outcomes following fixation of tibial posterior cruciate ligament (PCL) avulsion fractures through a modified open posterior approach when combined with a rehabilitation program emphasizing early range of motion.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  From March 4, 2000 to May 8, 2003, there were 16 cases of PCL tibial avulsion injuries presented to our institution, with 10 patients available for follow up at 12 to 48 months (mean 28 months).
  
  
  METHODS
  Fixation of tibial PCL avulsion fractures was with a lag screw and washer placed through a modified open posterior approach. Range of motion was begun on postoperative day 1.
  
  
  METHODS
  Clinical stability, range of motion, gastrocnemius muscle strength, radiographic appearance, and each patient's overall health-related quality of life (using the musculoskeletal functional assessment tool) were evaluated at final follow up.
  
  
  RESULTS
  The average musculoskeletal functional assessment score was 14. (Musculoskeletal functional assessment scores range from 0-100, with higher scores indicating poorer function.) All patients achieved union of their fracture and had clinically stable knees at the latest follow-up. Flexion difference greater than 10 degrees (P = 0.16), extension difference greater than 2 degrees (P = 0.38), and heel raise difference more than 8 repetitions (P = 0.23) were not demonstrated in comparison to the normal side.
  
  
  CONCLUSIONS
  Treatment of tibial PCL avulsion fractures, which includes fixation through a modified open posterior approach and early postoperative range of motion, results in healing of the fracture, good functional outcomes, stability to posterior draw testing, and does not lead to gastrocnemius weakness or significant range of motion deficits at 12 to 48 months postoperatively.
authors.affiliation: Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA 98105, USA. nicandri@u.washington.edu
authors.forename: Gregg T
authors.initials: GT
authors.lastname: Nicandri
authors.forename: Eric O
authors.initials: EO
authors.lastname: Klineberg
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Wahl
authors.forename: William J
authors.initials: WJ
authors.lastname: Mills
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D016119:Posterior Cruciate Ligament / Q000293:injuries* / Q000601:surgery*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome