Transverse patellar fracture with avulsion fracture of the tibial posterior cruciate ligament attachment: a case report

We present a case of patellar fracture with avulsion fracture of the tibial posterior cruciate ligament (PCL) attachment; to our knowledge, this is the first report of its kind. Patellar fracture is often accompanied by anterior knee pain, which can make it difficult to perform the draw test and thereby mask the PCL injury. Moreover, cases of avulsion fracture of the tibial PCL attachment are rarely encountered, which probably indicates that it is frequently undiagnosed. Undiagnosed avulsion fractures can have serious sequelae. We present the case of a 23-year-old man with patellar fracture and avulsion fracture of the tibial PCL attachment after sustaining a direct contact injury of the left knee due to a fall on the ground with the knee flexed. The patellar fracture was treated with implantation of three percutaneous cannulated screws. The avulsion fracture of the tibial PCL attachment was accessed via a posteromedial approach between the semitendinosus and the medial head of the gastrocnemius and fixed with cannulated screws (4.0 mm). After recovery, the patient was completely pain free and satisfied with the outcome. This case highlights the importance of ruling out avulsion fracture of the tibial PCL attachmentin patients with a patellar fracture.