Repair of Posterior Cruciate Ligament Femoral Avulsion in Multiligament Knee Injuries

In patients with multiligament knee injuries (MLKIs), arthroscopic primary repair of the posterior cruciate ligament (PCL) can be considered for proximal soft tissue avulsion or femoral "peel-off" injuries. The advantages of PCL repair include preservation of native anatomy, providing better proprioception and earlier rehabilitation, as well as a lower risk of tunnel convergence.

We discuss 2 cases of MLKIs with acute femoral soft tissue avulsion of the PCL.

The first case involves a complete PCL femoral avulsion with concomitant anterior cruciate ligament (ACL) and medial collateral ligament (MCL) tears. Outside-in femoral tunnel drilling for the PCL femoral tunnels was used to prevent convergence with the MCL footprint on the medial femoral condyle. The second case involves a proximal tear of the PCL with concomitant ACL tear and posterolateral corner injury. In this case, the femoral tunnels were drilled from inside-out.

The postoperative clinical examination shows restoration of knee stability, while magnetic resonance imaging 6 months after surgery demonstrates intact ligament repair and reconstruction.

The literature has shown no significant difference in clinical outcomes when comparing primary repair of PCL femoral avulsion with PCL reconstruction in MLKIs. With careful patient selection and surgical planning, primary repair of PCL femoral avulsion in MLKIs shows good knee stability, good patient satisfaction, and promising clinical outcomes.

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