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21 Mar 2024
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Hoffa Type II Fracture with PCL Avulsion

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Clinical Details

Clinical and radiological findings:  A 59-year-old male sustained multiple injuries in an industrial accident, including a closed injury of the right knee. Plain film, CT, and MRI revealed a Hoffa Type II ab (multifragmentary) fracture of the medial condyle and a bony avulsion of the posterior cruciate ligament (PCL) origin on the lateral wall of the medial condyle in the femoral notch.

Preoperative Plan

Planning remarks:  The preoperative plan included addressing the Hoffa Type II fracture through a medial parapatellar approach. The PCL avulsion was to be managed by anchoring the avulsed fragment using a cortical button technique.

Surgical Discussion

Patient positioning:  The patient was positioned supine on a radiolucent operating table, with the right leg over a carbon fiber roll beneath the distal femur allowing intraoperative knee flexion of approximately 70 degrees, adjustable to 90 degrees.

Anatomical surgical approach:  A longitudinal incision over the anterior aspect of the knee was made, followed by a medial parapatellar arthrotomy.

Operative remarks: 

Intraoperatively, the Hoffa Type II fracture was found to be grossly displaced with an absent PCL causing posteromedial luxation. Debridement and irrigation were followed by reduction and provisional fixation with Kirschner wires. Definitive fixation was achieved using subchondral poly-L-lactic acid (PLLA) Trim-It Drill-Pins and anterior-to-posterior partially threaded ASNIS cancellous screws with washers. The PCL avulsion was addressed by reattaching the avulsed fragment using a cortical button technique after antegrade drilling and suture passage.

Postoperative protocol:   Postoperative rehabilitation included immobilization of the knee in an PCL orthosis.

Follow up:   Not specified

Orthopaedic implants used:   Orthopaedic implants used: Subchondral poly-L-lactic acid (PLLA) Trim-It Drill-Pins from Arthrex, 8.0-millimeter partially threaded ASNIS cancellous screws with washers, cortical button for PCL avulsion.

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Dr Ed Oates
  • Germany , Schleswig Holstein
  • Area of Specialty - General Trauma
  • Position - Specialist Consultant
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