Introduction

Posterior cruciate ligament injuries resulting from bony avulsion or intrasubstance rupture, if not managed, may lead to chronic pain and chondral degeneration as a result of posterior subluxation of the tibia. Posterior cruciate ligament tibial osseous avulsions commonly occur during a motor vehicle accident or a motorcycle accident and result from a dashboard injury, which occurs if a posteriorly directed force is applied to the proximal tibia with the knee in flexion. Open and arthroscopic surgical management of displaced tibial-sided posterior cruciate ligament avulsion fractures results in similar outcomes. Various open approaches can be used by less experienced surgeons. An arthroscopic approach is associated with a steep learning curve.

Purpose

This video shows the gross posterior anatomy of the knee and the proximal leg and reviews their relationship to the tibial insertion of the posterior cruciate ligament. In addition, the video presents a novel, open posterior approach for the management of posterior cruciate ligament tibial avulsions. The outcomes of the management of posterior cruciate ligament tibial avulsions via this novel open approach are investigated.

Methods

The indications for and a step-by-step demonstration of the surgical technique for fixation of avulsion fractures of the posterior cruciate ligament in the tibia via a new, minimally invasive direct posterior approach are described. Eight patients with a posterior cruciate ligament tibial avulsion and no associated intra-articular injuries who underwent this novel, posterior open approach were retrospectively reviewed. The rehabilitation protocol consisted of the use of crutches for 2 weeks postoperatively, allowing for progressive weight bearing and range of motion. Outcomes were assessed at a mean follow-up of 11 months (range, 3 to 24 months).

Results

A total of eight patients with injuries entirely secondary to motor vehicle accidents and no associated intra-articular injuries were treated. The mean patient age was 31.7 years (range, 18 to 55 years; standard deviation ±10.82 years), and the procedures were performed within 3 to 10 days after trauma. The mean visual analog scale score decreased from 7 points preoperatively to 1 point postoperatively, with mean recovery of the knee mobility arc from 0° to 138° of flexion. The posterior drawer test was negative in five patients (62.5%) and rated grade 1 (3 mm of posterior displacement) in two patients (25%).

Conclusion

The management of posterior cruciate ligament tibial avulsions via open or arthroscopic approaches is associated with successful outcomes. The novel open approach described in this video is an excellent treatment option for the management of posterior cruciate ligament tibial avulsions in patients without associated intra-articular injuries.