Femoral-Sided Bony Avulsion of the Posterior Cruciate Ligament in an Adolescent Athlete: A Case Report

Femoral-sided bony avulsion fractures of the posterior cruciate ligament (PCL) are uncommon injuries, particularly in skeletally immature patients.These injuries may occur following hyperextension trauma and can result in posterior knee instability.Displaced femoral-sided avulsion fractures are generally considered for operative treatment to restore the anatomical PCL attachment and knee stability.Arthroscopic primary repair may provide an opportunity to preserve the native ligament and avoid conventional ligament reconstruction, particularly when the avulsed fragment remains suitable for fixation.A 16-year-old male presented to the Sports Medicine Clinic approximately one month after sustaining a hyperextension injury to his left knee while playing recreational football.Clinical examination revealed posterior sag, a Grade II positive posterior drawer test, and a positive quadriceps active test, while the collateral ligaments and rotational stability were preserved.Radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) demonstrated a 1 × 1 cm posteriorly displaced femoral-sided bony avulsion of the PCL, with open distal femoral and proximal tibial physes.The native PCL remained attached to the avulsed fragment, while the medial and lateral menisci, articular cartilage, the anterior cruciate ligament, and collateral ligaments were intact.The patient underwent arthroscopic primary repair using two double-luggage-tag sutures and a 4.5-mm self-punching PEEK-Ti knotless anchor placed at the anatomical femoral footprint.Postoperatively, the knee was protected in a hinged brace with posterior tibial support for eight weeks, followed by a structured rehabilitation program.The patient was followed regularly after surgery with a structured rehabilitation program.At the three-month follow-up, he demonstrated full range of motion; the posterior drawer, posterior sagging, and active quadriceps test were all negative, and pain was about 2 out of 10.This case highlights that, in selected skeletally immature patients, arthroscopic primary repair of a displaced femoral-sided PCL bony avulsion may be a viable option when the native ligament and avulsed fragment remain suitable for anatomical fixation.Careful clinical assessment, appropriate CT and MRI evaluation, anatomical reduction, and protection of the repair during rehabilitation are important to achieve favorable outcomes.