Functional outcomes of posterior cruciate ligament tibial avulsion fractures treated with open reduction and internal fixation and screw fixation: a retrospective study

Sunny K. Patel; Dharmik P. Solanki; Bhumil C. Rathod

doi:10.18203/issn.2455-4510.IntJResOrthop20261004

Authors

Sunny K. Patel Department of Orthopaedics, GMERS Medical College, Gotri, Vadodara, Gujarat, India https://orcid.org/0009-0007-1444-7611
Dharmik P. Solanki Department of Orthopaedics, SSG Hospital, Vadodara, Gujarat, India
Bhumil C. Rathod Department of Orthopaedics, GMERS Medical College, Gotri, Vadodara, Gujarat, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20261004

Keywords:

Posterior cruciate ligament injuries, Knee joint, Open reduction and internal fixation, Recovery of function, Orthopedic procedures

Abstract

Background: Posterior cruciate ligament (PCL) avulsion injuries can result in significant knee instability and long-term functional impairment if inadequately treated. Open reduction and internal fixation (ORIF) is widely employed to achieve anatomical restoration and preserve the native ligament. This study aimed to evaluate the clinical and functional outcomes of ORIF in patients with acute PCL avulsion injuries.

Methods: A retrospective study was conducted at a tertiary healthcare center including 30 patients treated with ORIF for acute PCL avulsion injuries between 2022 and 2025. Inclusion criteria comprised MRI-confirmed tibial PCL avulsion fractures and a minimum 12-month follow-up. Patients with chronic injuries or prior knee pathology were excluded. Functional outcomes were assessed using the Cincinnati knee rating system (CKRS), international knee documentation committee (IKDC) score, and Lysholm score preoperatively and at 12 months postoperatively.

Results: The cohort consisted of 24 males (80%) and 6 females (20%), with a mean age of 34.6±11.8 years. Road traffic accidents were the most common mechanism of injury (50%). Preoperative mean scores were CKRS 46.1±7.9, IKDC 49.3±7.2, and Lysholm 14.2±4.5. At 12 months, significant improvement was observed: CKRS 84.3±5.9, IKDC 86.7±5.5, and Lysholm 93.8±6.4 (p<0.001).

Conclusions: ORIF provides significant functional improvement and reliable restoration of knee stability in acute PCL avulsion injuries. Early surgical intervention combined with structured rehabilitation results in favorable one-year outcomes.

Metrics

Metrics Loading ...

References

Janousek AT, Jones DG, Clatworthy M, Higgins LD, Fu FH. Posterior cruciate ligament injuries of the knee joint. Sports Med. 1999;28(6):429-41. DOI: https://doi.org/10.2165/00007256-199928060-00005

LaPrade CM, Civitarese DM, Rasmussen MT, LaPrade RF. Emerging updates on the posterior cruciate ligament: a review of the current literature. Am J Sports Med. 2015;43(12):3077-92. DOI: https://doi.org/10.1177/0363546515572770

Schulz MS, Russe K, Weiler A, Eichhorn HJ, Strobel MJ. Epidemiology of posterior cruciate ligament injuries. Arch Orthop Trauma Surg. 2003;123(4):186-91. DOI: https://doi.org/10.1007/s00402-002-0471-y

Caldas MT, Braga GF, Mendes SL, da Silveira JM, Kopke RM. Posterior cruciate ligament injury: characteristics and associations of most frequent injuries. Revista Brasileira Ortopedia. 2013;48(5):427-31. DOI: https://doi.org/10.1016/j.rboe.2012.09.010

Race A, Amis AA. The mechanical properties of the two bundles of the human posterior cruciate ligament. J Biomechanics. 1994;27(1):13-24. DOI: https://doi.org/10.1016/0021-9290(94)90028-0

Rosenthal MD, Rainey CE, Tognoni A, Worms R. Evaluation and management of posterior cruciate ligament injuries. Physical Therapy Sport. 2012;13(4):196-208. DOI: https://doi.org/10.1016/j.ptsp.2012.03.016

Shelbourne KD, Benner RW, Ringenberg JD, Gray T. Optimal management of posterior cruciate ligament injuries: current perspectives. Orthop Res Rev. 2017;5:13-22. DOI: https://doi.org/10.2147/ORR.S113617

Cosgarea AJ, Jay PR. Posterior cruciate ligament injuries: evaluation and management. J Am Acad Orthop Surgeons. 2001;9(5):297-307. DOI: https://doi.org/10.5435/00124635-200109000-00003

Margheritini F, Rihn J, Musahl V, Mariani PP, Harner C. Posterior cruciate ligament injuries in the athlete: an anatomical, biomechanical and clinical review. Sports Med. 2002;32:393-408. DOI: https://doi.org/10.2165/00007256-200232060-00004

Shelbourne KD, Gray T, Haro M. Incidence of subsequent injury to either knee within 5 years after anterior cruciate ligament reconstruction with patellar tendon autograft. Am J Sports Med. 2009;37(2):246-51. DOI: https://doi.org/10.1177/0363546508325665

Joshi S, Bhatia C, Gondane A, Rai A, Singh S, Gupta S. Open reduction and internal fixation of isolated posterior cruciate ligament avulsion fractures: clinical and functional outcome. Knee Surg Relat Res. 2017;29(3):210. DOI: https://doi.org/10.5792/ksrr.17.022

Rezazadeh S, Solooki S, Aboulhasani S, Vosoughi AR. Midterm results of open reduction and internal fixation of isolated posterior cruciate ligament avulsion fracture. Eur Orthop Traumatol. 2011;1:191-5. DOI: https://doi.org/10.1007/s12570-011-0045-y

Yang CK, Wu CD, Chih CJ, Wei KY, Su CC, Tsuang YH. Surgical treatment of avulsion fracture of the posterior cruciate ligament and postoperative management. J Trauma Acute Care Surg. 2003;54(3):516-9. DOI: https://doi.org/10.1097/01.TA.0000047048.37775.32

Sundararajan SR, Joseph JB, Ramakanth R, Jha AK, Rajasekaran S. Arthroscopic reduction and internal fixation (ARIF) versus open reduction internal fixation (ORIF) to elucidate the difference for tibial side PCL avulsion fixation: a randomized controlled trial (RCT). Knee Surg Sports Traumatol Arthrosc. 2021;29:1251-7. DOI: https://doi.org/10.1007/s00167-020-06144-9

Ivansyah MD, Kurniawan A, Parasmadhan R. Management of an isolated posterior cruciate ligament avulsion fracture in a pediatric patient using screw fixation: A case report. Int J Surg Case Rep. 2025;126:110785. DOI: https://doi.org/10.1016/j.ijscr.2024.110785