PCL Avulsion Injuries Surgical Treatment

What are the surgical treatment options for a PCL avulsion injury?

For patients with cases of a displaced PCL avulsion injury or for those that remain symptomatic despite the conservative treatment, surgery is recommended.  In a recent systematic review and meta-analysis study published by Dr. Chahla and his research team in 2023, it was found that surgical treatment of PCL avulsion fractures achieves a high rate of fracture union with excellent restoration of posterior tibial translation. Surgical PCL repair can be completed either as an open or arthroscopic procedure. The study published by Dr. Chahla suggested that displaced PCL avulsion fractures treated with either open or arthroscopic surgery will lead to the best outcomes and patient satisfaction.

During PCL repair, Dr. Chahla will reduce the avulsion fracture back to the footprint of the PCL attachment. Since it is most common for the PCL avulsion injury to occur at the tibial attachment, the repair usually involves reducing the fracture at the PCL tibial attachment site.

During open PCL avulsion repair surgery, it is most common for the avulsed bone to be secured using a screw and washer fixation. For patients treated arthroscopically, typically a technique known as a transtibial suture pull-out fixation is used. In this case, sutures secured on the fractured bone piece are passed through a small tunnel in the tibia, pulling the piece of bone fragment back down to the tibia. Once the correct tension is set to keep the bone fragment in its correct anatomical place, a non-metal anchor or cortical button is used for fixation.