All-arthroscopic treatment of combined anterior and posterior cruciate ligament tibial avulsion fractures: A case report and literature review

Introduction Anterior cruciate ligament (ACL) tibial avulsion fractures are more commonly observed in the pediatric population, whereas posterior cruciate ligament (PCL) tibial avulsion fractures typically occur in adults following high-energy trauma. Simultaneous avulsion fractures of both cruciate ligaments are rare and may result in significant knee instability, with no consensus on the optimal management strategy. Case Presentation We report the case of a 33-year-old previously healthy woman who presented 8 days after a motor vehicle accident with knee pain, swelling, and subjective instability. Clinical examination suggested both anterior and posterior instability. Plain radiographs and computed tomography (CT) confirmed displaced simultaneous tibial avulsion fractures of the ACL and PCL. Management and Outcomes All-arthroscopic suture fixation was performed using a trans-septal (TS) approach for anatomic PCL reduction, followed by ACL fixation through standard anterior portals. At 3 months, CT demonstrated complete union. At 6 months, range of motion (ROM) was 0°–150° with negative stability tests and excellent functional scores (IKDC grade A; Lysholm 100). Conclusion This case suggests that an all-arthroscopic approach with simultaneous suture fixation of both cruciate ligament avulsion fractures is a feasible and effective strategy, providing stable fixation and excellent short-term functional recovery.