Abstract
Tibial avulsion fractures of the Posterior cruciate ligament (PCL) are common; however, methods of surgical treatment are insufficiently described. PCL is the main posterior stabilizer of the knee and limits posterior tibial translation relative to the femur . In addition, the PCL serves as a central axis controlling and imparting rotational stability to the knee. Isolated tear or avulsion of the PCL can be caused by falling onto a flexed knee or by striking the flexed tibia on the dashboard during a motor vehicle accident . Isolated PCL disruption most commonly occurs as avulsion at the point of tibial insertion, as opposed to its femoral origin or as a mid-substance tear. The tibial insertion of the PCL is also more consistent than the femoral insertion. The two PCL fibre bundles insert, without anatomic separation, into the centrally-located fovea or facet on the posterior aspect of the tibia, 1-1.5 cm distal to the joint line, with the posterior horn of the medial meniscus being the anterior-most extension . Chronic disability and early degenerative changes can develop as a result of delayed diagnosis.
The posteromedial knee approach is a surgical technique for treating tibial avulsion fractures of the PCL. The technique involves reinsertion and fixation of the PCL bone fragment into its anatomical bed located on the posterior tibial surface. The posteromedial knee approach is reportedly sufficient for re-establishing ligament integrity and function; however, most surgeons are not familiar with this surgical approach because it is poorly-described within the published literature.