Arthroscopic Fixation of a Posterior Cruciate Ligament Femoral Avulsion in an Adult: A Case Report.

Femoral avulsion of the posterior cruciate ligament (PCL) is an exceedingly rare injury pattern in adults, in contrast to the more commonly encountered mid-substance tears or tibial-sided avulsions. We present a rare case of a middle-aged male who sustained a complex multiligamentous knee injury following trauma. Initial imaging revealed avulsion fractures involving both the tibial plateau and medial femoral condyle. Further evaluation with MRI confirmed avulsions of the PCL from its femoral origin and anterior cruciate ligament (ACL) from its tibial attachment, along with posterior root tear of the medial meniscus and associated medial collateral ligament (MCL) injury. The patient was treated with arthroscopically assisted fixation of the PCL via femoral tunnel suturing and suspension device, along with open reduction and internal fixation of the medial epicondyle to restore MCL integrity. Postoperative management included brace immobilization and rehabilitation. At early follow-up, radiographs showed good fragment healing and the patient exhibited restoration of joint stability with clinical improvement. This case emphasizes the importance of early diagnosis through advanced imaging and supports the role of minimally invasive surgical approaches in managing rare, complex ligamentous injuries of the knee.