OBJECTIVE: To introduce a small incision to reveal the posterior cruciate ligament tibial attachment point and reposition, screw or Aiphon 5 wire fixation under direct vision. METHODS: Fourteen cases of posterior cruciate ligament tibial attachment point avulsion fractures were treated, including one old fracture, 13 cases with blood joints, 14 cases with positive posterior drawer test, positive step sign, and positive gravity test. radiographs all showed an avulsion fracture block posterior to the tibial plateau. The posterior joint capsule was exposed from between the medial head of the gastrocnemius muscle and the N cord tendon using a straight posterior medial knee incision, about 6 cm long, and the medial head of the gastrocnemius muscle was drawn outward, and the posterior joint capsule was incised longitudinally, directly exposing the fracture site, and the fracture was repositioned under direct vision, fixed with absorbable screws in 5 cases, hollow compression screws in 6 cases, and AHPB 5 wire in 3 cases, with postoperative brace braking for 6 weeks. RESULTS: After 8-12 months follow-up, all cases showed no joint instability, good joint mobility, bony healing of fracture, negative posterior drawer test in 13 cases, 1 case with 1+ posterior drawer test, but negative step sign. Conclusion: A small incision on the posterior medial side of the knee to expose the posterior cruciate ligament tibial attachment point and reposition and fix under direct vision is less traumatic and safer without exposing the N fossa neurovascular; posterior cruciate ligament tibial attachment point avulsion fracture should be treated with early surgery. Treatment of posterior cruciate ligament tibial attachment point avulsion fractures As the incidence of traffic accidents increases, the chance of posterior cruciate ligament injury increases significantly. The indications for choosing surgical treatment after posterior cruciate ligament injury are strict, with conservative treatment recommended for posterior drawer tests within the second degree and surgical reconstruction and repair recommended only for third degree injuries, but posterior instability of the knee joint caused by posterior cruciate ligament tibial attachment point avulsion fracture is generally considered to require early surgical treatment to reposition the fracture for internal fixation, which can lead to better clinical outcomes [1]. We used a small longitudinal incision in the back of the knee to reveal the fracture block of the tibial attachment point of the posterior cruciate ligament [2], and fixed the fracture block with screws or Aishikang 5 wire, which was less traumatic and obtained better clinical results, as reported below. 1, Data and methods 1.1, General data From August 2002 to March 2007, 14 cases of posterior cruciate ligament tibial attachment point avulsion fractures were treated in our hospital, including one case of old fracture. There were 12 male cases and 2 female cases, age 18–46 years old, average 32.2 years old; 11 cases of car accident injury, 3 cases of anterior tibial impingement injury, 13 cases with blood joint, 14 cases with positive posterior drawer test, positive step sign, and positive gravity test. x-ray films all showed posterior tibial plateau avulsion fracture block with obvious displacement. Except for one case of old fracture, all were treated surgically within 14 days after injury. The posterior joint capsule was exposed from between the medial head of the gastrocnemius muscle and the N-cord tendon by using a straight posterior medial knee incision, about 6 cm long, and the posterior joint capsule was exposed by flexing the knee 90 degrees and holding the medial head of the gastrocnemius muscle outward, and a 4 cm longitudinal incision was made in the middle of the posterior joint capsule to directly expose the fracture site and reset the fracture under direct vision. If the fracture block is large, the screw fixation method is simple and effective. 5 cases in this group were fixed with absorbable screws and 6 cases were fixed with AO hollow pressurized titanium screws, and the anterior drawer position was fixed at 70 degrees of knee flexion; if the fracture block is small and cannot be fixed with screws, the posterior cruciate ligament tibial attachment point can be braided and sutured with AIC 5, followed by drilling two 2 mm bone holes from the tibial attachment point to the anteromedial tibia, leading the thread to the tibia The anteromedial side of the tibia was stretched tightly and fixed in an anterior drawer position with the knee flexed at 70 degrees. After 6 weeks of postoperative brace braking, the patella and quadriceps function were practiced daily, and knee flexion was started after 4 weeks, reaching 90 degrees in 6 weeks, and joint function was basically restored to normal in 8-10 weeks. 1.3, Results After 8-12 months follow-up, all cases had no feeling of joint instability, no limpness; good joint mobility, no limitation of extension and flexion activities, no recurrent swelling of the joint, 13 cases had negative posterior drawer test, 1 patient with old fracture had positive posterior drawer test, but negative step sign. Postoperative radiographs 3-4 months later showed bony healing of all fractures. 2, Discussion In 1990, Burks et al [2] revealed the posterior cruciate ligament tibial attachment point from the posterior medial approach, revealed the posterior joint capsule from between the medial head of the gastrocnemius muscle and the N cord tendon, and pulled the medial head of the gastrocnemius muscle outward without revealing the N fossa neurovascular, which is safer and less traumatic. In recent years, some scholars at home and abroad have tried to perform arthroscopically assisted fixation of posterior cruciate ligament tibial attachment point avulsion fractures [3-4], but this procedure requires a more skilled arthroscopic technique, a long learning curve, and a longer operative time than incisional surgery, and the fracture is not as well repositioned as incisional repositioning and more difficult to fix. Therefore, we prefer to use a small posterior medial incision to expose the posterior cruciate ligament attachment point and reposition and fix the fracture under direct visualization.Compbell et al [5] concluded from in vitro experiments on specimens that the posterior cruciate ligament tibial attachment point striated with screws or fixed with two No. 5 Aikibon wires can provide adequate initial fixation strength, so different fixation methods can be used intraoperatively depending on the size of the striated fracture fragment. A complete Strobel fracture block, larger than 0.5Xo.5 cm2, can be fixed with screws; a smaller fracture block, which cannot be fixed with screws, can be fixed with braided sutures of AIC 5 wire at the tibial attachment point of the posterior cruciate ligament. Early surgery for fresh fractures is conducive to complete fracture repositioning, and 13 cases in our group underwent incision and internal fixation within 2 weeks after fracture, with complete restoration of joint stability. Therefore, we believe that posterior cruciate ligament tibial attachment point avulsion fractures should be treated with early surgery, preferably with internal fixation of the fracture within 2 weeks after the injury.