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Arthroscopic Repair of Posterior Cruciate Ligament Avulsions in Children

March 01, 2019

Contributors: Alfonso Carlos Prada; Gonzalo Samitier Solis, MD; Gonzalo Samitier Solis, MD

This video demonstrates our technique for arthroscopic repair of a posterior cruciate ligament (PCL) avulsion in a 12-year-old child. No consensus exists with regard to the treatment of children with a PCL avulsion. Patients who undergo nonsurgical treatment for a PCL avulsion are at risk for persistent PCL insufficiency because of secondary displacement or nonunion of the fragment, which may lead to secondary meniscal injury and early articular degeneration. Surgical management of PCL avulsions is associated with the inherent risks of surgery and may result in iatrogenic physeal injury, especially in children younger than 10 years, in whom surgical management of PCL avulsions is relatively contraindicated. Growth arrest is a minor concern in children older than 12 years because no implants are necessary and a unique, small-diameter tibial tunnel is used for passage of the traction sutures for final fixation. We prefer a transseptal approach, posteromedial and posterolateral portals, and the use of an acromioclavicular joint guide rather than a classic PCL guide, which facilitate visualization of the anterior aspect of the knee. The main indications for PCL avulsion repair in children are an isolated grade II or grade III injury with more than 5 mm of posterior tibial translation and a displaced bony avulsion of the PCL, failure of nonsurgical management, combined ligamentous injuries, and an isolated chronic PCL injury and a functionally unstable knee.

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