Objective: Tibial avulsion fractures of the posterior cruciate ligament (PCL) are uncommon injuries that may lead to persistent posterior instability and functional limitations if not anatomically reduced and rigidly fixed. This study aimed to evaluate the clinical and radiological outcomes of open reduction and screw fixation of tibial PCL avulsion fractures performed through a posterior knee approach.
Materials and Methods: We retrospectively reviewed 33 patients who underwent open reduction and screw fixation for tibial PCL avulsion fractures via a posterior knee approach. The cohort included 29 males (87.9%) and 4 females (12.1%), with a mean age of 34.9±12.9 years (range, 14–65). The right knee was involved in 19 cases (57.6%) and the left knee in 14 (42.4%). The most common injury mechanisms were motorcycle accidents (45.5%) and falls (36.4%), followed by bicycle accidents (9.1%) and sports injuries (9.1%). In 25 patients (75.8%), the fracture was isolated, whereas 8 (24.2%) had associated periarticular fractures involving the patella, femur, tibia, or combinations of these structures. Radiological follow-up averaged 31.9±29.4 months (range, 12–120), and functional follow-up averaged 54.1±39.5 months (range, 12–120). Outcome measures included the Lysholm knee score, the IKDC score, range of motion, and the visual analog scale (VAS) for pain.
Results: At the final follow-up, the mean Lysholm score was 73.0±15.5 (range, 37–100), and the mean IKDC score was 70.6±16.1 (range, 32–98). The mean knee flexion deficit was 21.2°±15.0° (range, 0–45), and the mean extension lag was 10.0°±10.0° (range, 0–30). The mean VAS pain score was 2.2±1.5 (range, 0–6), indicating generally low pain levels during daily activities. All fractures united.
Conclusion: Open reduction and screw fixation through a posterior approach consistently achieved fracture union with low residual pain. However, functional outcomes were moderate, and residual range-of-motion deficits were observed, indicating that successful osseous healing does not necessarily translate into optimal clinical recovery in this heterogeneous trauma cohort.