Mechanism
of injury
Forced flexion or hyperextension of the knee. The cruciate ligaments
remain intact, and a pull off of their insertion into the proximal tibia occurs
usually in adolescents
This injury is usually equivalent to injuries of the anterior cruciate
ligament.
Clinical
presentation
Pain, swelling, and restriction on extension; weight bearing is not
possible with the leg extended. The knee is held in flexion.
Diagnostics
Physical examination: Hemarthrosis, restriction and pain on extension,
laxity in AP direction with good collateral stability.
X-ray examination: X-rays of the knee in two planes, combined
with a tunnel view; CT scan or tomography may be used to determine the extent
of the fracture.
Classification
- Nondisplaced fracture
- Fracture with marginal displacement that can be reduced by extending the leg
- Displaced (irreducible) fracture
Treatment
Conservative treatment: If good reduction can be obtained with the knee
extended in a cast.
Surgical treatment: For persistent displacement use fixation by means
of osteosynthesis, screw, or tension suture which may be performed by arthros-
copy.
Follow-up treatment: 4−5 weeks in a cast followed by mobilizing
exercises and temporary protection in a brace. Muscle-strengthening exercises.
Duration
Injury takes 6 weeks to heal. Duration of disability is 8 weeks.
Prognosis
Prognosis is good.
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