Editorial Commentary: Arthroscopic Fixation of Posterior Cruciate Ligament Tibial Avulsion Fractures Is the Way to Go…. But It's Not Easy!

Isolated posterior cruciate ligament injuries are often successfully managed nonoperatively, but displaced tibial-sided bony avulsion fractures are generally considered optimal for surgical fixation. Open reduction and internal fixation and arthroscopic techniques are viable options, each with its own advantages and disadvantages. Recent literature describes an arthroscopic 3-tunnel suture-bridge fixation technique for displaced posterior cruciate ligament tibial avulsion fractures, which achieved excellent clinical and radiological outcomes including 100% anatomic reduction and bony union with no complications in 22 patients at a minimum 2-year follow-up. Despite the appeal of arthroscopic minimally invasive fixation strategies, surgeons should rehearse these techniques extensively in a cadaveric lab before performing live surgery, given the significant technical challenges and expertise required.