Changing trends in posterior cruciate ligament avulsion fracture fixation: A current concepts review
Prahalad Kumar Singhi, P. G. Shylendra Babu, R. Sivakumar, V. Gunasekar, Ebin Jose, Vinoth ThangamaniBackground and Aims:
Posterior cruciate ligament (PCL) tibial avulsion fractures represent a distinct injury where restoration of ligament–bone continuity is essential for normal knee stability. Surgical management has evolved from traditional open posterior approaches with screw fixation to minimally invasive arthroscopic and percutaneous techniques using sutures, buttons, and hybrid constructs. This review aims to summarize the historical evolution, current trends, and future directions in the management of PCL tibial avulsion fractures, with emphasis on the transition to arthroscopic fixation methods.
Materials and Methods:
A narrative review was conducted including landmark historical publications, contemporary clinical studies, biomechanical investigations, and recent systematic reviews. The literature was analyzed to compare surgical techniques, clinical outcomes, complications, and biomechanical considerations associated with different fixation strategies.
Results:
The literature demonstrates a clear shift toward arthroscopic and minimally invasive fixation techniques. These methods provide comparable or improved clinical outcomes relative to open approaches, with advantages such as reduced surgical morbidity, improved visualization, and the ability to address associated intra-articular injuries. Biomechanical studies support the strength and reliability of modern suture and button-based constructs.
Conclusion:
Management of PCL tibial avulsion fractures has progressively moved toward arthroscopic techniques with favorable outcomes and lower morbidity. Treatment should be individualized based on fracture characteristics, patient factors, and surgeon expertise. Further high-quality comparative studies are needed to refine optimal surgical decision-making.