Arthroscopic Treatment of Avulsion Fracture of the Posterior Cruciate Ligament from the Tibia: A Modified Surgical Technique and Case Series.

Abstract

Avulsion fractures of the posterior cruciate ligament (PCL) at its tibial insertion present technical challenges and are critical for restoring knee stability and function. Traditional open surgery may cause extensive soft-tissue disruption and increase the risk of neurovascular injury. Arthroscopic fixation has become the preferred approach. This study describes a modified arthroscopic technique using steel wire and high-strength sutures for PCL tibial avulsion fixation and evaluates its clinical outcomes in a case series. The technique utilizes anteromedial, anterolateral, and posterolateral portals. With a tibial PCL guide, steel wire and high-strength sutures are passed through three tibial tunnels to achieve anatomical reduction and secure fixation of the avulsed fragment. We retrospectively reviewed 27 patients who underwent this procedure between January 2021 and August 2024. Pre- and postoperative assessments included knee range of motion (ROM), posterior tibial displacement measured with a KT-1000 arthrometer, Lysholm score, Tegner activity score, International Knee Documentation Committee (IKDC) score, and postoperative complications. Satisfactory reduction and stable fixation were achieved in all cases. The follow-up duration ranged from 7 to 32 months (mean, 20 months). At the 3-month postoperative follow-up, all patients achieved knee flexion of at least 120°, with restoration of functional range of motion sufficient for activities of daily living. Radiographic evaluation demonstrated solid osseous union in all cases. At final follow-up, posterior drawer tests were negative. Mean ROM improved from 61.17 ± 9.32° preoperatively to 134.5 ± 4.5° postoperatively (P < 0.001). The Lysholm score increased from 48.48 ± 6.28 to 92.26 ± 3.13 (P < 0.001), IKDC score from 34.41 ± 5.16 to 90.44 ± 4.12 (P < 0.001), Tegner score from 1.5 ± 0.7 to 6.3 ± 0.9 (P < 0.001), and KT-1000 displacement decreased from 5.9 ± 0.63 mm to 1.1 ± 0.34 mm (P < 0.001). This modified arthroscopic fixation technique is safe, effective, and stable. It enables early rehabilitation, effectively restores knee stability, and supports rapid recovery of joint function. The method represents a practical and reliable option for treating PCL tibial insertion avulsion fractures and merits wider clinical adoption. III.