Posterior Mini-Open Approach for Fixation of PCL Avulsion Fractures
DOI:
https://doi.org/10.63403/re.v33i2.483Keywords:
Avulsion fracture, posterior cruciate ligament, tibial avulsion, posterior knee instability, mini-open surgical approach, rehabilitationAbstract
Introduction: posterior cruciate ligament (PCL) avulsion fractures are uncommon injuries associated with posterior instability and early osteoarthritis if not treated promptly.
Objectives: describe the technical aspects of a mini-open posterior approach for the fixation of tibial PCL avulsion fractures and to report the functional and clinical outcomes, as well as complications, in 16 cases treated with this technique.
Material and methods: a total of 16 consecutive patients underwent fixation using two cannulated screws with washers through a mini-open posterior approach. Early rehabilitation was implemented, and functional and radiographic consolidation outcomes were evaluated.
Results: the mean age was 29.2 years (range 21–50), with a predominance of male patients (94%), and all injuries were secondary to traffic accidents. Anatomical reduction and bone union were achieved in 100% of cases, with no secondary displacement. The mean Lysholm score was 91.1 ± 8.8, IKDC score 71.9 ± 7.9, and Tegner score 3.1 ± 1.6. All patients achieved independent ambulation and returned to work and sports activities by the third and sixth postoperative month, respectively. No major complications were observed; mild-to-moderate stiffness and mild residual pain were the most frequent minor complications.
Conclusion: the mini-open posterior fixation technique allows stable anatomical reduction, facilitates early rehabilitation, and provides satisfactory outcomes with a low complication rate in PCL avulsion fractures.
Downloads
References
Katsman A, Strauss EJ, Campbell KA, Alaia MJ. Posterior cruciate ligament avulsion fractures. Curr Rev Musculoskelet Med. 2018;11(3):503-509. doi: https://www.doi.org/10.1007/s12178-018-9491-2.
Hooper PO 3rd, Silko C, Malcolm TL, Farrow LD. Management of posterior cruciate ligament tibial avulsion injuries: a systematic review. Am J Sports Med. 2018;46(3):734-742. doi: https://www.doi.org/10.1177/0363546517701911.
Qi H, Lu Y, Li M, Ren C, Xu Y, Ma T, et al. Open reduction and internal fixation of the tibial avulsion fracture of the posterior cruciate ligament: which is better, a hollow lag screw combined with a gasket or a homemade hook plate? BMC Musculoskelet Disord. 2022;23(1):143. doi: https://www.doi.org/10.1186/s12891-022-05096-0
Sundararajan SR, Joseph JB, Ramakanth R, Jha AK, Rajasekaran S. Arthroscopic reduction and internal fixation (ARIF) versus open reduction internal fixation (ORIF) to elucidate the difference for tibial side PCL avulsion fixation: a randomized controlled trial (RCT). Knee Surg Sports Traumatol Arthrosc. 2021;29(4):1251-1257. doi: https://www.doi.org/10.1007/s00167-020-06144-9.
Wen G, Chen C, Wang S, Jiang Z, Feng S, Zheng W. Comparison of three surgical methods for displaced posterior cruciate ligament tibial insertion avulsion fractures: a retrospective study. J Orthop Surg Res. 2025;20(1):333. doi: https://www.doi.org/10.1186/s13018-025-05703-5.
Gopinatth V, Mameri ES, Casanova FJ, Khan ZA, Jackson GR, McCormick JR, et al. Systematic review and meta-analysis of clinical outcomes after management of posterior cruciate ligament tibial avulsion fractures. Orthop J Sports Med. 2023;11(9):23259671231188383. doi: https://www.doi.org/10.1177/23259671231188383.
Guo H, Zhao Y, Gao L, Wang C, Shang X, Fan H, et al. Treatment of avulsion fracture of posterior cruciate ligament tibial insertion by minimally invasive approach in posterior medial knee. Front Surg. 2023;9:885669. doi: https://www.doi.org/10.3389/fsurg.2022.885669.
Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med. 1982;10(3):150-154. doi: https://www.doi.org/10.1177/036354658201000306.
Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;(198):43-49.
Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, et al. Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med. 2001;29(5):600-613. doi: https://www.doi.org/10.1177/03635465010290051301.
Abdallah AA, Arafa MS. Treatment of posterior cruciate ligament tibial avulsion by a minimally-invasive open posterior approach. Injury. 2017;48(7):1644-1649. doi: https://www.doi.org/10.1016/j.injury.2017.05.032.
Juneja J, Asiger M, Kumar D, Sharma A, Jain MP, Talesra A, et al. Clinical and functional outcome of isolated posterior cruciate ligament avulsion fractures treated by open reduction and internal fixation. Int J Res Orthop. 2022;8(3):325-330. doi: https://www.doi.org/10.18203/issn.2455-4510.IntJResOrthop20221120.
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Cristian C. Fajardo Cantillo, Helberth A. Gonzalez Rico, María P. Romero Correa, Daniel F. Peña Piñeros, Isabella Rodríguez Alonso
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This work is published under a Creative Commons Attribution–NonCommercial–ShareAlike 4.0 International License (CC BY-NC-SA 4.0). The authors retain the copyright.
