2021 ISAKOS Biennial Congress ePoster
Functional And Radiological Assessment Of “Bi-Cruciate Combination– Avulsion Fracture And Ligament Tear With Or Without Collateral Ligaments In Road Traffic Accidents”
Silvampatti Ramasamy Sundararajan, MS(Orth), COIMBATORE, TAMILNADU INDIA
S Rajasekaran, MS(Orth),DOrth,DNB,FRCS(Ed),FRCS(Lon),MCh(Liv),PhD, Coimbatore, Tamil Nadu INDIA
Rajagopalakrishnan Ramakanth, D.ortho, DNB(ortho), D.SICOT, Coimbatore, Tamil Nadu INDIA
Ganga medical centre and hospitals, COIMBATORE, Tamil Nadu, INDIA
FDA Status Not Applicable
Summary
Management ofBicruciate combination Avulsion fracture and ligament tear with or without collateral injury is challenging but yields good results with methodical management
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Abstract
Background
Bi-cruciate injuries with combination of avulsion fracture and ligament tears with or without collateral ligament injury as a part of multiligament knee injuries (MLKI) following road traffic accident (fall from motor bike) are rare and functional and radiological assessment were analysed.
Methods
The study is a retrospective case series of 48 patients operated between 2009 and 2019 for patients with bi-cruciate (avulsion fracture or tear) and/ collateral injury (MLKI). Peri-articular condylar fractures around the knee were excluded.. Patients were taken up for single stage or the staged repair and reconstruction depending on the severity and associated injuries. Patients were divided into 3 groups, Group 1- ACL tear+ PCL avulsion, Group 2- ACL avulsion +PCL tear, Group 3- ACL avulsion + PCL avulsion. Associated collateral ligament and meniscal tears were documented and treated accordingly. All the patients were followed up regularly and IKDC and Lyshom`s score were taken and Objective radiological stress x-rays were taken from 6 months postoperatively and during each follow up.
Results
The mean age was 35.95+/-11.96 SD. The average time to surgery was 28.5 days. follow-up was 34.45 months +/- 12.86SD. Mean postoperative Lysholm score and IKDC score of the were 90.87 (SD +/-3.83) and 82.43(SD +/-3.68). The difference in mean was statistically significant as p value of 0.01 no statistical differences between the groups. Mean postoperative ROM was 132.73 (SD 6.46) the difference in mean was statistically significant as p value <0.01. The stress x-rays showed more residual laxity when associated with collateral ligament injury. Knee stiffness seen in 6 patient and superficial infection in 2 patients.
Conclusion
Schenk`s Multi-ligament classification needs modification to include these combinations of avulsion fractures with ligament tears. Management of bi-cruciate avulsion and ligament tears is challenging and needs methodical approach and yields satisfactory results in spite of complexity