Clinical and Functional Outcomes of Posterior Cruciate Ligament Tibial Avulsion Fractures Treated with a Mini-Open...

The posterior cruciate ligament (PCL) is a key posterior stabilizer of the knee, and its injuries commonly present as bony avulsion fractures at the tibial insertion rather than midsubstance tears. Displaced fractures (Meyers-McKeever type II-IV) generally require surgical fixation to restore posterior stability and prevent chronic laxity, pain, and premature osteoarthritis. The mini-open posterior approach allows direct visualization and anatomical reduction of the avulsed fragment while minimizing neurovascular risk.

We present a prospective series of patients (age range 20-65 years) with displaced PCL tibial avulsion fractures treated with the mini-open posterior approach and internal fixation using cannulated cancellous screws. Injury mechanisms included road traffic accidents and sports injuries. All patients were followed for a minimum of 12 months and assessed clinically and radiologically, with functional outcomes recorded using the Lysholm and International Knee Documentation Committee (IKDC) scores. Fracture union was achieved in nearly all patients by approximately 12 weeks. Mean Lysholm score improved from 52.3 ± 10.5 preoperatively to 93.6 ± 4.2 postoperatively, and mean IKDC score improved from 48.7 ± 9.8 to 90.1 ± 5.3. Mean flexion improved from 95.2° ± 15.4 to 128.6° ± 8.7. Tegner Active score increased from 2.0 ± 0.8 to 5.5 ± 0.9. KT arthrometer improved from 8.1 ± 2.0 to 1.6 ± 0.7. Complications were infrequent and included mild residual laxity in a small subset of patients, with no neurovascular injuries.

The mini-open posterior approach with internal fixation is a safe, reproducible, and clinically effective technique for displaced PCL tibial avulsion fractures, providing excellent restoration of knee stability, range of motion, and functional outcomes and remains a practical alternative to arthroscopic fixation, particularly where arthroscopic resources are limited.