Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-12-2012 | Trauma Surgery

Delayed detection of clinically significant posterior cruciate ligament injury after peri-articular fracture around the knee of 448 patients

Authors: Jae Gyoon Kim, Hong Chul Lim, Hak Joon Kim, Myung Hoi Hwang, Yong Cheol Yoon, Jong Keon Oh

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 12/2012

Abstract

Background

The purpose of this study was to report the frequency with which posterior cruciate ligament (PCL) injuries occurred in combination with peri-articular fractures around the knee, and to determine the frequency with which the detection of these PCL injuries was delayed (i.e., detected in an outpatient clinic after fracture treatment).

Methods

This retrospective study included 448 subjects with peri-articular fractures around the knee, including femoral shaft fractures, distal femoral fractures, patellar fractures, tibial plateau fractures, and tibial shaft fractures. The PCL injuries were detected through clinical examination, magnetic resonance imaging, and stress X-rays. We determined both the frequency of PCL injuries that occurred in combination with peri-articular fractures around the knee, and the frequency with which the detection of these PCL injuries was delayed. We also compared the frequency with which PCL injuries were associated with either isolated or combined fractures for different fracture types.

Results

We identified concomitant PCL injury and peri-articular fracture of the knee in 7.8 % of patients. In 22 of the 35 patients with concomitant PCL injury, the detection of the PCL injury was delayed. There were significant differences in the frequency with which PCL injuries were associated with isolated or combined fractures of the femoral shaft (P = 0.04), patella (P = 0.03), and distal femur (P = 0.03).

Conclusion

The delayed detection frequency was high for PCL injury after peri-articular fracture around the knee.

Fanelli GC, Beck JD, Edson CJ (2010) Current concepts review: the posterior cruciate ligament. J Knee Surg 23:61–72PubMedCrossRef

Shelbourne KD, Davis TJ, Patel DV (1999) The natural history of acute, isolated, nonoperatively treated posterior cruciate ligament injuries. A prospective study. Am J Sports Med 27:276–283PubMed

Parolie JM, Bergfeld JA (1986) Long-term results of nonoperative treatment of isolated posterior cruciate ligament injuries in the athlete. Am J Sports Med 14:35–38PubMedCrossRef

Ahn JH, Lee SH, Choi SH, Wang JH, Jang SW (2011) Evaluation of clinical and magnetic resonance imaging results after treatment with casting and bracing for the acutely injured posterior cruciate ligament. Arthroscopy J Arthrosc Relat Surg 27:1679–1687CrossRef

Boynton MD, Tietjens BR (1996) Long-term followup of the untreated isolated posterior cruciate ligament-deficient knee. Am J Sports Med 24:306–310PubMedCrossRef

Oakes DA, Markolf KL, McWilliams J, Young CR, McAllister DR (2002) Biomechanical comparison of tibial inlay and tibial tunnel techniques for reconstruction of the posterior cruciate ligament. Analysis of graft forces. J Bone Joint Surg Am 84-A:938–944PubMed

Torg JS, Barton TM, Pavlov H, Stine R (1989) Natural history of the posterior cruciate ligament-deficient knee. Clin Orthop Relat Res 246:208–216PubMed

Scapinelli R (1997) Vascular anatomy of the human cruciate ligaments and surrounding structures. Clin Anat 10:151–162PubMedCrossRef

Shelbourne KD, Jennings RW, Vahey TN (1999) Magnetic resonance imaging of posterior cruciate ligament injuries: assessment of healing. Am J Knee Surg 12:209–213PubMed

10.

Keller PM, Shelbourne KD, McCarroll JR, Rettig AC (1993) Nonoperatively treated isolated posterior cruciate ligament injuries. Am J Sports Med 21:132–136PubMedCrossRef

11.

Strobel MJ, Weiler A, Schulz MS, Russe K, Eichhorn HJ (2002) Fixed posterior subluxation in posterior cruciate ligament-deficient knees: diagnosis and treatment of a new clinical sign. Am J Sports Med 30:32–38PubMed

12.

Matic A, Kasic M, Hudolin I (1992) Knee-ligament injuries associated with leg fractures. Prospective study. Unfallchirurg 95:469–470PubMed

13.

Templeman DC, Marder RA (1989) Injuries of the knee associated with fractures of the tibial shaft. Detection by examination under anesthesia: a prospective study. J Bone Joint Surg Am 71:1392–1395PubMed

14.

Thiagarajan P, Ang KC, De Das S, Bose K (1997) Ipsilateral knee ligament injuries and open tibial diaphyseal fractures: incidence and nature of knee ligament injuries sustained. Injury 28:87–90PubMedCrossRef

15.

Pedersen HE, Serra JB (1968) Injury to the collateral ligaments of the knee associated with femoral shaft fractures. Clin Orthop Relat Res 60:119–121PubMedCrossRef

16.

Abdel-Hamid MZ, Chang C-H, Chan Y-S, Lo Y-P, Huang J-W, Hsu K-Y, Wang C-J (2006) Arthroscopic evaluation of soft tissue injuries in tibial plateau fractures: retrospective analysis of 98 cases. Arthroscopy J Arthrosc Relat Surg 22:669–675CrossRef

17.

Gardner MJ, Yacoubian S, Geller D, Pode M, Mintz D, Helfet DL, Lorich DG (2006) Prediction of soft-tissue injuries in Schatzker II tibial plateau fractures based on measurements of plain radiographs. J Trauma 60:319–323PubMedCrossRef

18.

Holt MD, Williams LA, Dent CM (1995) MRI in the management of tibial plateau fractures. Injury 26:595–599PubMedCrossRef

19.

Colletti P, Greenberg H, Terk MR (1996) MR findings in patients with acute tibial plateau fractures. Comput Med Imaging Graph 20:389–394PubMedCrossRef

20.

Blacksin MF, Zurlo JV, Levy AS (1998) Internal derangement of the knee after ipsilateral femoral shaft fracture: MR imaging findings. Skeletal Radiol 27:434–439PubMedCrossRef

21.

De Campos J, Vangsness CT Jr, Merritt PO, Sher J (1994) Ipsilateral knee injury with femoral fracture. Examination under anesthesia and arthroscopic evaluation. Clin Orthop Relat Res 300:178–182PubMed

22.

Schulz MS, Russe K, Weiler A, Eichhorn HJ, Strobel MJ (2003) Epidemiology of posterior cruciate ligament injuries. Arch Orthop Trauma Surg 123:186–191PubMed

23.

Fowler PJ, Messieh SS (1987) Isolated posterior cruciate ligament injuries in athletes. Am J Sports Med 15:553–557PubMedCrossRef

24.

Stanish WD, Rubinovich M, Armason T, Lapenskie G (1986) Posterior cruciate ligament tears in wrestlers. Can J Appl Sport Sci 11:173–177PubMed

25.

Kannus P, Bergfeld J, Jarvinen M, Johnson RJ, Pope M, Renstrom P, Yasuda K (1991) Injuries to the posterior cruciate ligament of the knee. Sports Med 12:110–131PubMedCrossRef

26.

Auffarth A, Bogner R, Koller H, Tauber M, Mayer M, Resch H, Lederer S (2009) How severe are initially undetected injuries to the knee accompanying a femoral shaft fracture? J Trauma 66:1398–1401PubMedCrossRef

27.

Walling AK, Seradge H, Spiegel PG (1982) Injuries to the knee ligaments with fractures of the femur. J Bone Joint Surg Am 64:1324–1327PubMed

28.

Tscherne H, Lobenhoffer P (1993) Tibial plateau fractures. Management and expected results. Clin Orthop Relat Res 292:87–100PubMed

29.

Melvin JS, Mehta S (2011) Patellar fractures in adults. J Am Acad Orthop Surg 19:198–207PubMed

30.

Carpenter JE, Kasman R, Matthews LS (1994) Fractures of the patella. Instr Course Lect 43:97–108PubMed

31.

Walker DM, Kennedy JC (1980) Occult knee ligament injuries associated with femoral shaft fractures. Am J Sports Med 8:172–174PubMedCrossRef

32.

Szalay MJ, Hosking OR, Annear P (1990) Injury of knee ligament associated with ipsilateral femoral shaft fractures and with ipsilateral femoral and tibial shaft fractures. Injury 21:398–400PubMedCrossRef

33.

Austin AF, Zoga AC (2012) Internal derangements: ligaments and tendons. In: Scott NW (ed) Insall & Scott surgery of the knee. Elsevier Churchill Livingston, Philadelphia, pp 87–123CrossRef

34.

Schulz MS, Steenlage ES, Russe K, Strobel MJ (2007) Distribution of posterior tibial displacement in knees with posterior cruciate ligament tears. J Bone Joint Surg Am 89:332–338PubMedCrossRef

Title: Delayed detection of clinically significant posterior cruciate ligament injury after peri-articular fracture around the knee of 448 patients
Authors: Jae Gyoon Kim
Hong Chul Lim
Hak Joon Kim
Myung Hoi Hwang
Yong Cheol Yoon
Jong Keon Oh
Publication date: 01-12-2012
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 12/2012
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-012-1605-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Delayed detection of clinically significant posterior cruciate ligament injury after peri-articular fracture around the knee of 448 patients

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2012

Biochemical lung, liver and kidney markers and early death among elderly following hip fracture

Is bipolar hemiarthroplasty a reliable option for Ficat stage III osteonecrosis of the femoral head? 15- to 24-year follow-up study

Above- or below-elbow casts for distal third forearm fractures in children? An updated meta-analysis of the literature

Cementless second-generation hydroxyapatite CaP-coated tibial component: an 8.7-year follow-up

Clinical and MRI results after microfracture of osteochondral lesions of the talus

Surgical management by one-stage posterior transforaminal lumbar debridement, interbody fusion, and posterior instrumentation for lumbo-sacral tuberculosis in the aged