Open Approach for Bony Avulsion Surgical Technique


PCL Avulsion 2PCL Avulsion 1


Open approach


A. Posterior approach to Knee


S shaped incision

- lateral proximally to medial distally


Superficial dissection

- small saphenous vein and medial sural nerve identified midline distally

- open deep fascia


Deep dissection

- popliteal fossa

- superiorly: semimebranosus & semitendinosus medial, biceps femoris lateral

- inferiorly: medial and lateral gastrocnemius

- popliteal artery deep and medial

- vein in middle, tibial nerve lateral

- common peroneal nerve laterally with biceps 


Find and protect medial sural nerve

- track to tibial nerve


Identify and ligate middle genicular artery

- allows mobilisation of vessel

- retract neurovascular structures laterally


Open capsule


B.  Burk modified posterior approach / Posteromedial approach



- avoids major neurovascular bundle


Interval between semimembranosus and medial gastrocnemius

- semimembranosus medially

- medial head gastrocnemius laterally / can be released

- release popliteus from medial tibia and reflect laterally

- place blunt homan across tibia

- open capsule


Posteromedial approach knee 1Posteromedial approach knee 2Posteromedial approach knee 3


AO foundation surgical approach


Vumedi video


Fixation options

- size dependent

- screw / staple


PCL bony fixationPCL bony fixation 2