Posterior Cruciate Ligament Injury After Retrograde Nailing of Periprosthetic Distal Femur Fractures: A Report of 2 Cases
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Updated: Jun 29, 2025
Author Spotlight: Double Posteromedial Approach for Treating Posterior Cruciate Ligament Cysts
Published on: October 20, 2023
Frank A Martinez1, Brandon J Yuan2
1Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota.
Case:
A 51-year-old man and 64-year-old woman with bilateral cruciate-retaining total knee arthroplasties (CR-TKAs) who sustained unilateral periprosthetic distal femur fractures above their CR-TKA and experienced knee instability secondary to an iatrogenic posterior-cruciate-ligament (posterior cruciate ligament [PCL]) injury from retrograde intramedullary nailing. Both patients recovered knee stability after undergoing revision surgery.
Conclusion:
Many CR-TKA designs have sufficient medial-lateral intercondylar distance to place a retrograde nail, femoral components with a relatively posterior transition from the trochlear groove to the intercondylar box will necessitate a nail starting point closer to the PCL origin. This may contribute to iatrogenic postoperative knee instability for patients with CR-TKA designs.
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