Arthroscopic suture fixation for bony avulsion of the posterior cruciate ligament

We describe a new arthroscopic technique for suture fixation of a posterior cruciate ligament (PCL) avulsion fracture from the tibia. This technique is indicated when the size of the avulsed fragment is small and fixation with a screw or pins is inadequate. Three portals are used: a parapatellar anteromedial portal, a high posteromedial portal, and a posterolateral portal. Using a PCL tibial guide, 2 bone tunnels are made from the anterior cortex of the tibia to the medial and lateral border of the avulsed site. One or 2 strands of 23-gauge wire or multiple nonabsorbable sutures are used for fixation through the tunnels. If the bony fragment is small or comminuted, fixation with wires or sutures leads to rigid fixation and early rehabilitation.