Repair of Posterior Cruciate Ligament Femoral Avulsion in Multiligament Knee Injuries

Background: In patients with multiligament knee injuries (MLKIs), arthroscopic primary repair of the posterior cruciate ligament (PCL) can be considered for proximal soft tissue avulsion or femoral “peel-off” injuries. The advantages of PCL repair include preservation of native anatomy, providing be...

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Main Authors: Jhulia Kawachi Cruz MD, DPBO, MBA, Salim Al Habsi MD, Mok Ying Ren MBBS, MRCS (Edinburgh), MMed (Ortho), MSpMed (Queensland), FRCS (Ed) (Ortho), Yee Han Dave Lee MBBS, FRCS (Ortho)
Format: Article
Language:English
Published: SAGE Publishing 2025-08-01
Series:Video Journal of Sports Medicine
Online Access:https://doi.org/10.1177/26350254251315498
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author Jhulia Kawachi Cruz MD, DPBO, MBA
Salim Al Habsi MD
Mok Ying Ren MBBS, MRCS (Edinburgh), MMed (Ortho), MSpMed (Queensland), FRCS (Ed) (Ortho)
Yee Han Dave Lee MBBS, FRCS (Ortho)
author_facet Jhulia Kawachi Cruz MD, DPBO, MBA
Salim Al Habsi MD
Mok Ying Ren MBBS, MRCS (Edinburgh), MMed (Ortho), MSpMed (Queensland), FRCS (Ed) (Ortho)
Yee Han Dave Lee MBBS, FRCS (Ortho)
author_sort Jhulia Kawachi Cruz MD, DPBO, MBA
collection DOAJ
description Background: In patients with multiligament knee injuries (MLKIs), arthroscopic primary repair of the posterior cruciate ligament (PCL) can be considered for proximal soft tissue avulsion or femoral “peel-off” injuries. The advantages of PCL repair include preservation of native anatomy, providing better proprioception and earlier rehabilitation, as well as a lower risk of tunnel convergence. Indications: We discuss 2 cases of MLKIs with acute femoral soft tissue avulsion of the PCL. Technique Description: The first case involves a complete PCL femoral avulsion with concomitant anterior cruciate ligament (ACL) and medial collateral ligament (MCL) tears. Outside-in femoral tunnel drilling for the PCL femoral tunnels was used to prevent convergence with the MCL footprint on the medial femoral condyle. The second case involves a proximal tear of the PCL with concomitant ACL tear and posterolateral corner injury. In this case, the femoral tunnels were drilled from inside-out. Results: The postoperative clinical examination shows restoration of knee stability, while magnetic resonance imaging 6 months after surgery demonstrates intact ligament repair and reconstruction. Discussion/Conclusion: The literature has shown no significant difference in clinical outcomes when comparing primary repair of PCL femoral avulsion with PCL reconstruction in MLKIs. With careful patient selection and surgical planning, primary repair of PCL femoral avulsion in MLKIs shows good knee stability, good patient satisfaction, and promising clinical outcomes. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
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spelling doaj-art-d5f4bdf56be1487daf3fe819d2a7a8d32025-08-20T03:43:58ZengSAGE PublishingVideo Journal of Sports Medicine2635-02542025-08-01510.1177/26350254251315498Repair of Posterior Cruciate Ligament Femoral Avulsion in Multiligament Knee InjuriesJhulia Kawachi Cruz MD, DPBO, MBA0Salim Al Habsi MD1Mok Ying Ren MBBS, MRCS (Edinburgh), MMed (Ortho), MSpMed (Queensland), FRCS (Ed) (Ortho)2Yee Han Dave Lee MBBS, FRCS (Ortho)3Department of Orthopedic Surgery, Division of Sports Shoulder & Elbow Surgery, National University Hospital, SingaporeDepartment of Orthopedic Surgery, Division of Sports Shoulder & Elbow Surgery, National University Hospital, SingaporeDepartment of Orthopedic Surgery, Division of Sports Shoulder & Elbow Surgery, National University Hospital, SingaporeDepartment of Orthopedic Surgery, Division of Sports Shoulder & Elbow Surgery, National University Hospital, SingaporeBackground: In patients with multiligament knee injuries (MLKIs), arthroscopic primary repair of the posterior cruciate ligament (PCL) can be considered for proximal soft tissue avulsion or femoral “peel-off” injuries. The advantages of PCL repair include preservation of native anatomy, providing better proprioception and earlier rehabilitation, as well as a lower risk of tunnel convergence. Indications: We discuss 2 cases of MLKIs with acute femoral soft tissue avulsion of the PCL. Technique Description: The first case involves a complete PCL femoral avulsion with concomitant anterior cruciate ligament (ACL) and medial collateral ligament (MCL) tears. Outside-in femoral tunnel drilling for the PCL femoral tunnels was used to prevent convergence with the MCL footprint on the medial femoral condyle. The second case involves a proximal tear of the PCL with concomitant ACL tear and posterolateral corner injury. In this case, the femoral tunnels were drilled from inside-out. Results: The postoperative clinical examination shows restoration of knee stability, while magnetic resonance imaging 6 months after surgery demonstrates intact ligament repair and reconstruction. Discussion/Conclusion: The literature has shown no significant difference in clinical outcomes when comparing primary repair of PCL femoral avulsion with PCL reconstruction in MLKIs. With careful patient selection and surgical planning, primary repair of PCL femoral avulsion in MLKIs shows good knee stability, good patient satisfaction, and promising clinical outcomes. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.https://doi.org/10.1177/26350254251315498
spellingShingle Jhulia Kawachi Cruz MD, DPBO, MBA
Salim Al Habsi MD
Mok Ying Ren MBBS, MRCS (Edinburgh), MMed (Ortho), MSpMed (Queensland), FRCS (Ed) (Ortho)
Yee Han Dave Lee MBBS, FRCS (Ortho)
Repair of Posterior Cruciate Ligament Femoral Avulsion in Multiligament Knee Injuries
Video Journal of Sports Medicine
title Repair of Posterior Cruciate Ligament Femoral Avulsion in Multiligament Knee Injuries
title_full Repair of Posterior Cruciate Ligament Femoral Avulsion in Multiligament Knee Injuries
title_fullStr Repair of Posterior Cruciate Ligament Femoral Avulsion in Multiligament Knee Injuries
title_full_unstemmed Repair of Posterior Cruciate Ligament Femoral Avulsion in Multiligament Knee Injuries
title_short Repair of Posterior Cruciate Ligament Femoral Avulsion in Multiligament Knee Injuries
title_sort repair of posterior cruciate ligament femoral avulsion in multiligament knee injuries
url https://doi.org/10.1177/26350254251315498
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