Posterior cruciate ligament avulsion fracture

Case contributed by Dr Bruno Di Muzio

Presentation

MBA accident - hit by a car. Left midshaft femur fracture. Knee injuries on radiographs (not available).

Patient Data

Age: 19-year-old
Gender: Male
CT

CT Left Knee

There is an acute PCL avulsion fracture at the posteromedian articular surface of the upper tibia. The avulsed fracture fragment is displaced superiorly by approximately 2.3 cm and rotated anteriorly. A large trilevel lipohaemarthrosis is present.

There is acute undisplaced fracture passing through the fibular head.

The proximal tibiofibular articulation aligns normally.

No acute patellar or distal femoral fracture is seen.

CONCLUSION: 1. There is an acute PCL avulsion fracture at the posteromedian articular surface of the upper tibia. The avulsed fracture fragment is displaced superiorly by approximately 2.3 cm and rotated anteriorly. A large likely haemarthrosis is present.

2. There is acute undisplaced fracture passing through the fibular head.

MRI

MRI Left Knee

Intramedullary metallic haste with a transverse screw within the distal diaphysis the femur.

The posterior cruciate ligament avulsion fracture of the posterior and median articular surface of the upper tibia is again demonstrated, showing regional bone marrow oedema. The ligament is retracted/redundant and has high signal in its distal portion. The anterior cruciate ligament shows mild increased signal within its distal attachment, inferring high grade tear.

The medial and lateral collateral ligaments are intact. The menisci are normal. The semimembranosus and biceps femoris tendons are unremarkable. Apparently arcuate popliteal ligament tear.

Patella, quadriceps tendon, patellar ligament are normal.

Moderate joint effusion with fluid-fluid level in keeping with haematic component, specially observed within the suprapatellar recess.

Diffuse subcutaneous oedema.

The study was limited to evaluate the fibular head fracture.

Conclusion: Posterior cruciate ligament avulsion with fracture at the posteromedian articular surface of the upper tibia. Signs of PCL partial tear and high-grade ACL tear. Haemarthrosis.

Case Discussion

This case shows a posterior cruciate ligament avulsion fracture with fracture at the posteromedian articular surface of the upper tibia. The MRI/CT showed also signs of PCL partial tear and high-grade ACL tear, as well as haemarthrosis.

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Case information

rID: 43748
Case created: 24th Mar 2016
Last edited: 27th Mar 2016
Tag: rmh
Inclusion in quiz mode: Included

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