Clinical and radiographic outcomes after fixation of posterior cruciate ligament tibial avulsion fractures using a modified anterior tension band construct.

BACKGROUND

Posterior cruciate ligament (PCL) tibial avulsion fractures may result in persistent instability and functional impairment if inadequately treated. This study aimed to evaluate the clinical and radiographic outcomes of patients with PCL tibial avulsion fractures treated using a modified anterior tension band construct.

METHODS

A retrospective review was performed on 23 consecutive patients treated with open reduction and internal fixation between 2017 and 2025. Fixation was achieved using two parallel screws combined with an anteriorly tensioned cerclage wire construct. The postoperative rehabilitation protocol included early controlled range-of-motion exercises without routine brace immobilization. Clinical outcomes, radiographic union, complications, and return-to-activity outcomes were evaluated at final follow up.

RESULTS

The mean follow up duration was 29.6 ± 7.4 months. All fractures achieved radiographic union without fixation failure or secondary displacement. The mean time to union was 10.8 ± 1.9 weeks. At final follow up, the mean knee flexion was 134.8 ± 5.7°. Mean Lysholm and International Knee Documentation Committee (IKDC) scores improved significantly from 43.2 ± 7.9 to 93.6 ± 4.8 and from 40.7 ± 8.4 to 91.2 ± 5.3, respectively (P < 0.001). No deep infection, neurovascular injury, or nonunion were observed.

CONCLUSIONS

This retrospective case series demonstrated satisfactory clinical and radiographic outcomes after fixation of PCL tibial avulsion fractures using a modified anterior tension band construct. However, because no biomechanical testing or control group was included, the present findings should not be interpreted as evidence of superior fixation stability or added benefit over conventional screw fixation alone.