PCL UPDATE (K JONES AND M ALAIA, SECTION EDITORS)
Posterior Cruciate Ligament Avulsion Fractures
Eric J. Strauss
Kirk A. Campbell
Michael J. Alaia
Springer Science+Business Media, LLC, part of Springer Nature 2018
Purpose of Review The purposes of this review are to (1) discuss the epidemiology and workup of the rare posterior cruciate
ligament (PCL) avulsion fracture, (2) review the indications for nonoperative and operative management of patients with PCL
avulsion fractures, (3) examine surgical outcomes in this patient population, and (4) discuss the authors’ preferred management
algorithm and surgical approach.
Recent Findings In accordance with the rarity of these injuries, the literature is sparse regarding surgical outcomes. Many of these
injuries are in the setting of a multi-ligamentous injury. Most authors suggest that displaced PCL avulsion fractures should
undergo operative fixation and current data suggests excellent outcomes when treating these patients with either open or
arthroscopic fixation, with a low complication rate.
Summary PCL avulsion fractures, although rare, should undergo fixation when displacement is present. Current studies report
successful outcomes and a low complication rate.
Keywords Posterior cruciate ligament (PCL)
Posterior cruciate ligament (PCL) tears are uncommon inju-
ries, and posterior cruciate ligament avulsion fractures are an
extremely rare variant of this injury. A PCL injury most com-
monly results in an intrasubstance tear; however, femoral de-
tachment and tibial avulsion patterns have been described [1•].
The reported incidence of general PCL injuries varies between
3 and 38% of acute knee injuries ([2–4], with more recent
reports showing an increased incidence over the years .
The wide range noted in the reported incidence can be attrib-
uted to variable clinical presentations, including asymptomat-
ic PCL injury . Despite the low incidence of PCL injuries,
resulting instability and early degenerative changes can be
debilitating to patients, which are mostly young males .
Although there are many case series published on the man-
agement and outcomes of PCL avulsion fractures, no optimal
surgical management has been suggested. In this chapter, we
aim to present a concise review of PCL avulsion fractures and
the available treatment options. Our preferred treatment meth-
od is also offered.
Etiology and Epidemiology
In a recent review of PCL avulsion fractures, Hooper et al.
reported the mechanism of injury is similar to intrasubstance
PCL tears [1•]. Most commonly, as a result of a motor vehicle
accidents and especially motorcycle injuries, a dashboard in-
jury occurs when a posterior directed force is applied to the
proximal tibia when the knee is flexed. Therefore, PCL avul-
sion fractures are more frequently reported in China, India,
and other countries where motorcycle transportation is more
prevalent . The second most frequent mechanism is sports-
related trauma, in which the mechanism is knee hyperexten-
sion [1•]. Tibial-sided PCL avulsion fractures are the most
common form of isolated bony PCL disruption. However,
concomitant injuries can occur quite frequently. Hooper
et al. reported meniscal injuries in 16.8% and additional liga-
mentous injuries in 19% of patients [1•], and a series reported
by Pardiwala et al. revealed intra-articular pathology in 28%
of patients [8•].
In contrast to intrasubstance PCL tears seen in adults, skel-
etally immature patients are predisposed to osteochondral
avulsions as well, as ligaments are stronger than the
This article is part of the Topical Collection on PCL Update
* Michael J. Alaia
Department of Orthopaedic Surgery, NYU Langone Medical Center,
New York, NY, USA
Current Reviews in Musculoskeletal Medicine