Direct Posterior Approach to Repairing Posterior Cruciate Ligament Tibial Avulsion Injury.

Introduction: Posterior cruciate ligament (PCL) with tibial avulsion injuries commonly occur following high-energy trauma. While the posteromedial approach is traditionally favored for fixation, emerging evidence suggests that a direct posterior approach may be a safe and effective alternative for select fracture patterns. Case Report: We report the case of a 26-year-old polytrauma patient with no significant prior medical or surgical history who presented after a motorcycle accident with a PCL tibial avulsion injury resulting in posterolateral and tibial intercondylar eminence fracture with a central articular posterior rim involvement. We performed a direct posterior approach, as described by Abbott-Carpenter. Fixation was achieved with FiberWire sutures for the ligamentous avulsion and cannulated screws for the bony fragments. The post-operative recovery was notable for a transient tibial nerve neuropraxia that resolved before discharge, and the patient progressed well in rehabilitation with favorable clinical outcomes at follow-up. Conclusion: PCL tibial avulsion injuries associated with posterior rim fracture commonly result from hyperflexion mechanisms, classically described as dashboard-type injuries. The fracture morphology and ligamentous involvement determine the optimal surgical approach. This case highlights a less commonly reported fixation strategy using FiberWire sutures and cannulated screws through a direct posterior approach. Our findings contribute to the growing body of evidence that the direct posterior approach to repairing PCL tibial avulsion injury is safe and effective with minimal complications.