Posterior cruciate ligament (PCL) avulsion fractures usually involve the tibial insertion as a discrete fragment. Although combined PCL avulsion and tibial plateau fractures have been described, a continuous fracture fragment involving both the PCL insertion and the weight-bearing lateral tibial plateau is rarely reported and may require different treatment considerations. We report a woman, aged 38 years, with a neglected PCL avulsion fracture involving the weight-bearing region of the lateral tibial plateau as a single, continuous fragment. This morphology created a specific surgical dilemma because reduction of the PCL avulsion component directly influenced articular congruity. Arthroscopic reduction and fixation were performed to allow direct evaluation of the joint surface while securing the PCL insertion in a balanced position. The fracture achieved radiographic union by 3 months. Computed tomography at 6 months demonstrated a smooth, well-aligned articular surface with maintained congruity of the lateral tibial plateau. At 2-year follow-up, plain radiographs showed maintained reduction and articular alignment without loss of congruity after elective Kirschner-wire removal. The patient had good functional recovery (Knee injury and Osteoarthritis Outcome Score, 93), with no symptomatic posterior instability and only grade 1+ posterior drawer laxity on examination. This case describes a distinct PCL avulsion fracture pattern that differs from both conventional PCL avulsion fractures and typical tibial plateau fractures. Recognition of this morphology is important because it may alter reduction priorities and fixation strategy.

Patellar osteochondral fractures (OCFs) are common concomitant injuries in acute patellar dislocation, particularly in adolescents. Large free fragments (>15 mm in diameter) are relatively rare and require surgical reduction and fixation to restore articular surface congruity and prevent mechanical symptoms and secondary patellofemoral osteoarthritis. This article reports the case of a 16-year-old female athlete who sustained an acute patellar dislocation with a large patellar OCF. The osteochondral fragment was reduced and fixed using a suture anchor combined with transosseous tunnel technique, and concurrent medial patellofemoral ligament reconstruction was performed. The patient had an uneventful recovery, with satisfactory fragment healing at 3-month follow-up and return to pre-injury sports activity at 12-month follow-up. To the authors' knowledge, this is the first reported case of suture anchor fixation combined with transosseous tunnels for a large patellar osteochondral fragment following acute patellar dislocation. This technique provides reliable fixation, is simple to perform, and allows rapid recovery, representing an effective treatment option for this injury pattern.