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Management of pediatric posterior cruciate ligament avulsion fractures: a systematic review
Christopher Jayne1, Giovanna Medina2, Brian Grottkau2
1St. Joseph's Medical Center, Stockton, CA, USA.
Insights
Surgical management, including open reduction and arthroscopic surgery, is effective for pediatric posterior cruciate ligament (PCL) avulsion fractures. Non-operative treatment also leads to good outcomes, with high rates of recovery and return to activity.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Sports Medicine
Background:
- Posterior cruciate ligament (PCL) avulsion fractures are injuries seen in pediatric patients.
- Both open and arthroscopic surgical techniques are utilized for managing these fractures.
- Evaluating the effectiveness and safety of different management strategies is crucial for optimal patient outcomes.
Approach:
- A systematic literature review was conducted using Medline, Scopus, and EMBASE databases.
- PRISMA guidelines were followed for data selection and extraction by independent reviewers.
- Included studies focused on pediatric patients with PCL avulsion injuries, excluding combined ACL/PCL injuries or those requiring reconstruction.
Key Points:
- Open reduction: 30/31 patients improved or returned to pre-injury activity; 2 complications; Lysholm scores 66-99.
- Arthroscopic surgery: 11/12 patients improved or returned to normal activity; 1 complication; Lysholm scores 90-100 (mean 95).
- Non-operative management: 3/3 recovered with fracture healing and full/near-full range of motion.
Conclusions:
- Both open reduction and arthroscopic surgery are safe and effective for pediatric PCL avulsion fractures, with high success rates (97% and 92% symptom improvement, respectively).
- Complication rates were comparable: 11% for open reduction and 9% for arthroscopic surgery.
- Non-operative treatment also demonstrated excellent recovery, with all patients achieving full or near-full pre-injury knee status.
Purpose:
Both open and arthroscopic surgical techniques have been used for PCL avulsion fractures. The goal of this study is to evaluate the effectiveness and safety of the different management strategies proposed for PCL avulsion fractures in children.
Methods:
A systematic literature review was performed utilizing Medline, Scopus, and EMBASE databases from 1977 to the present. PRISMA guidelines were followed. Data were selected and extracted by two independent reviewers. Inclusion criteria were clinical studies reporting injuries in pediatric patients with PCL avulsion injuries. Exclusion criteria were combined PCL and ACL injuries and ligamentous injuries requiring reconstruction. A subgroup analysis was performed between open reduction and arthroscopic surgeries.
Findings/Results:
Twenty-six studies were included in this systematic review. Patient sex was reported in 39 patients with a higher number of males (32/39). The age range was 7-18 years old. In the open group, 30/31 patients had clinical improvement or returned to pre-injury activity level with two complications. Lysholm scores ranged from 66 to 99. In the arthroscopic group, 11/12 patients experienced clinical improvement or returned to normal activity levels with only one complication. Lysholm scores ranged from 90 to 100 with a mean of 95. In the non-operative group, 3/3 recovered with evidence of fracture healing, full or near full knee range of motion. One Lysholm score was reported 14 months after injury and was 100/100.
Conclusions:
Open reduction and arthroscopic surgeries are effective and safe treatment options for pediatric PCL avulsion fractures-97% of open reduction and 92% of arthroscopic patients significantly improved symptoms. The complication rates for the open and arthroscopic groups were 11 and 9%, respectively. All three non-operative made full or near full recovery of pre-injury knee status.
Level Of Evidence Iv:
Systematic review of Level-II-IV studies. Prospero Registration No CRD42021290899.
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