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Arthroscopically Assisted Treatment of Avulsion Fractures of the Posterior Cruciate Ligament from the Tibia by Sung-Jae Kim, Sang-Jin Shin, Nam-Hong Choi,

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Presentation on theme: "Arthroscopically Assisted Treatment of Avulsion Fractures of the Posterior Cruciate Ligament from the Tibia by Sung-Jae Kim, Sang-Jin Shin, Nam-Hong Choi,"— Presentation transcript:

1 Arthroscopically Assisted Treatment of Avulsion Fractures of the Posterior Cruciate Ligament from the Tibia by Sung-Jae Kim, Sang-Jin Shin, Nam-Hong Choi, and Shin-Kang Cho J Bone Joint Surg Am Volume 83(5):698-708 May 1, 2001 ©2001 by The Journal of Bone and Joint Surgery, Inc.

2 Posterior view of a right knee. Sung-Jae Kim et al. J Bone Joint Surg Am 2001;83:698-708 ©2001 by The Journal of Bone and Joint Surgery, Inc.

3 Axial view (Fig. 2-A) and sagittal section(Fig. 2-B) of the perforation made through the posterior septum behind the posterior cruciate ligament. Sung-Jae Kim et al. J Bone Joint Surg Am 2001;83:698-708 ©2001 by The Journal of Bone and Joint Surgery, Inc.

4 Axial view (Fig. 2-A) and sagittal section(Fig. 2-B) of the perforation made through the posterior septum behind the posterior cruciate ligament. Sung-Jae Kim et al. J Bone Joint Surg Am 2001;83:698-708 ©2001 by The Journal of Bone and Joint Surgery, Inc.

5 Viewed through the posteromedial portal, avulsion of the tibial attachment of the posterior cruciate ligament (PCL) can be seen (arrows). Sung-Jae Kim et al. J Bone Joint Surg Am 2001;83:698-708 ©2001 by The Journal of Bone and Joint Surgery, Inc.

6 A tibial posterior cruciate ligament guide (A) placed through the anteromedial portal is used to secure the fracture fragment (C) and to guide insertion of a threaded Kirschner wire (arrow). Sung-Jae Kim et al. J Bone Joint Surg Am 2001;83:698-708 ©2001 by The Journal of Bone and Joint Surgery, Inc.

7 A long 18 ‐ gauge spinal needle is inserted through the posterolateral sheath and passed through the posterior cruciate ligament just proximal to the fracture fragment, and a 23 ‐ gauge wire is passed through the lumen of the needle. Sung-Jae Kim et al. J Bone Joint Surg Am 2001;83:698-708 ©2001 by The Journal of Bone and Joint Surgery, Inc.

8 The 23 ‐ gauge wire or multiple sutures are pulled out through a sheath placed in the anteromedial portal, and the needle is removed. Sung-Jae Kim et al. J Bone Joint Surg Am 2001;83:698-708 ©2001 by The Journal of Bone and Joint Surgery, Inc.

9 Two bone tunnels are made from the anterior tibial cortex to the medial and lateral margins of the fracture bed. Sung-Jae Kim et al. J Bone Joint Surg Am 2001;83:698-708 ©2001 by The Journal of Bone and Joint Surgery, Inc.

10 Two looped wires are pulled distally, leading each end of the 23 ‐ gauge wire or the multiple sutures through the medial and lateral bone tunnels. Sung-Jae Kim et al. J Bone Joint Surg Am 2001;83:698-708 ©2001 by The Journal of Bone and Joint Surgery, Inc.

11 Each end of the previously passed 23 ‐ gauge wire or multiple sutures is pulled distally with even tension until the fracture fragment is accurately reduced. Sung-Jae Kim et al. J Bone Joint Surg Am 2001;83:698-708 ©2001 by The Journal of Bone and Joint Surgery, Inc.

12 Case 8. Sung-Jae Kim et al. J Bone Joint Surg Am 2001;83:698-708 ©2001 by The Journal of Bone and Joint Surgery, Inc.

13 Case 8. Sung-Jae Kim et al. J Bone Joint Surg Am 2001;83:698-708 ©2001 by The Journal of Bone and Joint Surgery, Inc.

14 Case 10. Sung-Jae Kim et al. J Bone Joint Surg Am 2001;83:698-708 ©2001 by The Journal of Bone and Joint Surgery, Inc.

15 Case 10. Sung-Jae Kim et al. J Bone Joint Surg Am 2001;83:698-708 ©2001 by The Journal of Bone and Joint Surgery, Inc.

16 Case 13. Sung-Jae Kim et al. J Bone Joint Surg Am 2001;83:698-708 ©2001 by The Journal of Bone and Joint Surgery, Inc.

17 Case 13. Sung-Jae Kim et al. J Bone Joint Surg Am 2001;83:698-708 ©2001 by The Journal of Bone and Joint Surgery, Inc.


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