Arthroscopic treatment of a PCL avulsion fracture in a skeletally immature patient.

Posterior cruciate ligament (PCL) avulsions from the tibial attachment site in children are rare. Six cases have been reported in the English literature since 1975. Osteochondral avulsions of the PCL can be easily missed on plain radiographs in skeletally immature patients because of the rarity of these injuries and open proximal tibial physis. To properly recognize and treat the condition, careful physical examination and adequate imaging studies are crucial. Few case reports demonstrate successful surgical treatment of the injury using screw fixation. This article presents a case of a 13-year-old girl with tibial avulsion of the PCL treated by arthroscopic reduction and pull-out suture, sparing the epiphyseal plate using a posterior transseptal portal. The proximal substance of the avulsed PCL was grasped with a suture hook introduced from posterolateral to posteromedial rather than through the small, fragmented bony portion. The suture material was passed and retrieved through the bony tunnel from posterior to anterior above the epiphyseal plate. Although it has not been proven yet in terms of biomechanical benefit, we believe this alternative treatment to PCL avulsion injuries in skeletally immature patients will provide sufficient strength to maintain ligament tension during the healing process and avoid physeal injury.