Two Case Reports of Tibial Avulsion Fractures of Both Cruciate Ligaments and the Medial Collateral Ligament: A Narrative Review of Current Literature

Abstract

Tibial avulsion fractures involving both the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) are rare and pose significant diagnostic challenges, particularly when accompanied by medial collateral ligament (MCL) injury. This report presents two such rare cases and provides a focused narrative review of the current literature. Both patients underwent individualized surgical strategies based on fracture morphology, soft-tissue status, and stability requirements, using a combination of open and arthroscopic techniques. Although postoperative complications occurred, including infection, arthrofibrosis, and complex regional pain syndrome, both patients ultimately achieved an acceptable functional recovery with structured multidisciplinary rehabilitation. These cases underscore the importance of precise injury characterization, careful selection of surgical approach, and comprehensive postoperative management when treating complex bicruciate avulsion injuries with concomitant MCL involvement.