Arthroscopic Posterior Cruciate Ligament Tibial Spine Avulsion Fixation Using a Suture Pull-Through Single-Tunnel Technique.

Abstract

Introduction: Posterior cruciate ligament (PCL) tibial avulsion fractures are uncommon intra-articular injuries that may cause persistent posterior instability, loss of motion, and functional impairment if displaced fractures are not anatomically reduced. Arthroscopic suture pull-through fixation offers stable transosseous fixation while avoiding complications associated with screw fixation.

Aim: The aim of this study was to evaluate the functional and radiological outcomes of arthroscopic PCL tibial avulsion fixation using a suture pull-through single-tunnel technique.

Materials and methods: A prospective, single-center observational study without a control group was conducted in the Department of Orthopedics, N.D. Desai Medical College, from May 2026 to July 2026. Twenty-four patients with displaced isolated PCL tibial avulsion fractures underwent arthroscopic single-tunnel suture pull-through fixation. Lysholm scores and radiological union were assessed at 6 weeks, 3 months, and 6 months; no instrumented posterior laxity testing or additional validated patient-reported outcome measure was available.

Results: The cohort included 24 patients with a mean age of 28 years (range 18-60 years). The mean Lysholm score improved from 41.6 ± 3.2 preoperatively to 81.2 ± 5.6 at 6 weeks, 90.7 ± 3.5 at 3 months, and 94.9 ± 2.3 at 6 months (Friedman P < 0.001). All fractures were recorded as united by 3 months on follow-up radiographs, and 22 patients (approximately 92%) reported return to their pre-injury activity level within 4-6 months. One patient developed a mild extension lag that improved with physiotherapy. No non-union, fixation failure, or revision surgery was observed during the 6-month follow-up; however, objective posterior translation was not measured.

Conclusion: In this small single-center observational cohort, arthroscopic single-tunnel suture pull-through fixation was feasible and was associated with radiographic union and favorable short-term Lysholm score improvement. Because there was no comparator group, objective posterior stability testing, or long-term follow-up, these findings should not be interpreted as evidence of superiority or equivalence to other fixation techniques.