Modified Gavaskar Minimally Invasive Posterior Approach For The Fixation Of Posterior Cruciate Ligament Avulsion Fractures

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Abstract

Background: The common open surgical techniques for posterior cruciate reinsertion require extensive exposure of critical anatomical structures. With the aim of minimizing dissection and improving the patient’s recovery, Gavaskar et al performed a minimally invasive technique for approaching and fixing the posterior cruciate ligament attachment through the space between the two heads of the gastrocnemius. In his description, the author emphasizes the key point to the success of his surgical technique is the skin incision location using fluoroscopy. We, per contra, found that bringing the skin incision to the popliteal crease systematically, did not have any negative affects on the approach of posterior capsule as well as the screw orientation to achieve good fragment compression. In addition, this modification could theoretically shorten the duration of preparation and surgery and provide a better postoperative scar satisfaction. We, thereby, describe our surgical technique in detail, and report the functional, aesthetic results as well as the safety of the modified incision.
Methods: Based on the descriptions of Ashok S. Gavaskar, we performed this along the popliteal creasemodified skin incision, approached the posterior capsule through the space between the two heads of the gastrocnemius to reinsert isolated posterior cruciate ligament avulsion on 9 patients. The length of incision, surgical time, visual analogue scale (VAS), duration of hospital stay, screw/bone tunnel direction, were recorded in order to evaluate the effectiveness of the technique. Lysholm scale knee functionality at 3 months and 6 months after surgery, bone union, neurovascular complications, postoperative scar satisfaction were also evaluated.
Results: The average surgical time was 38 minutes (30 - 50 minutes), the average incision length was 4.5 ± 0.7cm (3.5 - 5.5). The fracture was fixed with 2 cancellous screws in 6 patients, 3 cancellous screws in 1 patient and fiberwire through bone tunnels in 2 patients. The patients’ mean age was 19 years (15 - 29). Median hospital stay was 6 days (4 - 11). The pain level on the VAS scale at day one after surgery and at hospital discharge was 4.2 and 1.8, respectively. The mean follow - up time was 21 months (15 - 25 months). Mean Lysholm scores were 90 points at 3 months and 98 points at 6 months after surgery. X - ray showed healing in all cases. No postoperative neurovascular complications were recorded. Satisfaction with surgical scars 9.4/10 (8 - 10).
Conclusions: A small posterior incision directly through the popliteal crease provides a minimally invasive approach for the fixation of posterior cruciate ligament avulsion. Modification of the skin incision position still allows for functionally and radiologically good outcomes, ensures the safety of important anatomical structures in the popliteal fossa, and provides a high degree of esthetic satisfaction

https://doi.org/10.38103/jcmhch.2021.73.11

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Published 09-01-2025
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Language
Issue No. 73 (2021)
Section Original article
DOI 10.38103/jcmhch.2021.73.11
Keywords Từ khóa: Bong điểm bám dây chằng chéo sau, đường mổ xâm lấn tối thiểu Keywords: Posterior cruciate ligament avulsion fracture, minimally invasive posterior approach.

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Copyright (c) 2021 Journal of Clinical Medicine Hue Central Hospital

Quyen, N. Q. T., Loc, H. D., Dat, N. M., Long, T. D. D., & Thang, N. D. (2025). Modified Gavaskar Minimally Invasive Posterior Approach For The Fixation Of Posterior Cruciate Ligament Avulsion Fractures. Journal of Clinical Medicine Hue Central Hospital, (73), 68–77. https://doi.org/10.38103/jcmhch.2021.73.11