BMC Surg. 2026 Jun 4. doi: 10.1186/s12893-026-03853-9. Online ahead of print.
ABSTRACT
BACKGROUND: Posterior cruciate ligament (PCL) avulsion fractures at the tibial insertion can cause posterior knee instability and accelerate osteoarthritis. Meyers-McKeever type II/III fractures require surgery. Traditional open approaches are traumatic, while arthroscopic techniques are limited by equipment, learning curves, and fixation efficacy.
OBJECTIVE: To evaluate the short-term clinical outcomes and feasibility of a combined vertical medial posterior incision approach using a small T-plate and high-strength suture fixation for isolated PCL avulsion fractures.
METHODS: We retrospectively reviewed 21 patients with isolated Meyers-McKeever type II/III PCL tibial avulsion fractures treated with posteromedial longitudinal mini-incision fixation using a mini T-plate combined with high-strength suture. Operative parameters, fracture healing, knee ROM, Tegner-Lysholm score, IKDC score, posterior drawer test, and complications were assessed.
RESULTS: The mean surgery duration was 81.5 ± 20.9 min, with an average intraoperative blood loss of 33 ± 11 ml. All fractures achieved anatomical reduction, with an average healing time of 10.9 ± 1.6 weeks. At the final follow-up (mean 10.6 ± 5.2 months), knee ROM improved significantly from 76.5°±12.1° preoperatively to 132.2°±4.2° (P < 0.05). Both Tegner-Lysholm scores (from 45.5 ± 9.3 to 95.5 ± 2.8) and IKDC scores (from 35.9 ± 8.9 to 96.8 ± 1.5) showed statistically significant improvements (P < 0.05). The posterior drawer test was negative in all patients, and no infection, implant failure, or gastrocnemius weakness was observed.
CONCLUSION: Posteromedial longitudinal mini-incision fixation with a mini T-plate combined with high-strength suture achieved satisfactory clinical outcomes for PCL tibial avulsion fractures. The proposed 5T concept summarizes the main practical advantages of this technique. In this descriptive case series (Level IV evidence), the technique achieved satisfactory short-term clinical outcomes for PCL tibial avulsion fractures, particularly in patients with small or comminuted fragments. Further prospective comparative studies are needed to validate its long-term clinical value.
PMID:42243827 | DOI:10.1186/s12893-026-03853-9
