Peel-off injury at the tibial attachment of the posterior cruciate ligament in children.
BACKGROUND
Careful review of the literature seldom reveals peel-off-type injuries at the tibial attachment of the posterior cruciate ligament in children.


OBJECTIVE
The purpose of this research is to describe the diagnosis and treatment of peel-off injuries at the tibial ligament-osseous junction of the posterior cruciate ligament in children.


METHODS
Case series; Level of evidence, 4.


METHODS
Between February 2001 and May 2007, 6 patients with diagnosed peel-off injuries at the tibial attachment of the posterior cruciate ligament were surgically treated. All patients were boys from 12 to 13 years of age (mean, 12.3 years). Plain radiographs were normal, but magnetic resonance imaging and arthroscopic findings revealed complete avulsion of the posterior cruciate ligament at the tibial attachment without an osseous fragment. The authors retrospectively reviewed the clinical presentations, diagnostic tests, surgical procedures, and the results of the treatment. The mean follow-up was 37.3 months (range, 25-53 months).


RESULTS
Five of the 6 patients had returned to their preinjury levels of activities. The mean side-to-side difference in posterior translation as measured with the KT-2000 arthrometer and stress radiographs was 2.3 mm (range, 0.7-5.2 mm) and 2.9 mm (range, 0.3-6.4 mm), respectively. The mean Lysholm score was 95 points (range, 90-100 points). According to the assessment with the International Knee Documentation Committee form, 2 patients were classified as A, 3 as B, and 1 as C.


CONCLUSIONS
The authors could diagnose peel-off injuries at the tibial attachment of the posterior cruciate ligament in children by careful examinations and arthroscopic surgeries. Satisfactory outcomes without any complications were obtained through the arthroscopic reattachment and fixation using multiple sutures in the case of the avulsed stump that was not split.
Arthroscopy and Joint Research Institute, Department of Orthopaedic Surgery, Yonsei University Health System, 120-752, CPO Box 8044, 250 Seongsanno, Seodaemungu, Seoul, Korea.
Sung-Jae
SJ
Kim
Seung-Bae
SB
Jo
Sul-Gee
SG
Kim
In-Seop
IS
Park
Hyeong-Pyo
HP
Kim
Sung-Hwan
SH
Kim
D000293:Adolescent; D001182:Arthroscopy / Q000379:methods*; D002648:Child; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000473:pathology / Q000601:surgery*; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D016119:Posterior Cruciate Ligament / Q000293:injuries / Q000601:surgery*; D013977:Tibia / Q000293:injuries / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome