{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T15:52:01Z","timestamp":1773157921453,"version":"3.50.1"},"reference-count":31,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sportverletz Sportschaden"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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.<\/jats:p>","DOI":"10.1055\/a-2781-4703","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T23:35:12Z","timestamp":1773099312000},"page":"47-55","source":"Crossref","is-referenced-by-count":0,"title":["Two Case Reports of Tibial Avulsion Fractures of Both Cruciate Ligaments and the Medial Collateral Ligament: A Narrative Review of Current Literature"],"prefix":"10.1055","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8726-5092","authenticated-orcid":false,"given":"Emre","family":"Tun\u00e7can","sequence":"additional","affiliation":[{"name":"School of Medicine, Ac\u0131badem Mehmet Ali Ayd\u0131nlar University, Istanbul, T\u00dcRK\u0130YE"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u0130rem Hazal","family":"\u0130nan","sequence":"additional","affiliation":[{"name":"Orthopaedics and Traumatology, Acibadem University Atakent Hospital, Istanbul, T\u00dcRK\u0130YE"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mustafa","family":"Sungur","sequence":"additional","affiliation":[{"name":"Orthopaedics and Traumatology, Acibadem University Atakent Hospital, Istanbul, T\u00dcRK\u0130YE"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2595-9459","authenticated-orcid":false,"given":"Nezih","family":"Ziroglu","sequence":"additional","affiliation":[{"name":"Orthopaedics and Traumatology, Acibadem University Atakent Hospital, Istanbul, T\u00dcRK\u0130YE"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1445","DOI":"10.1136\/bjsports-2022-105495","article-title":"Rehabilitation after anterior cruciate ligament and meniscal injuries: a best-evidence synthesis of systematic reviews for the OPTIKNEE consensus","volume":"56","author":"AG Culvenor","year":"2022","journal-title":"Br J Sports Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1007\/s00167-019-05785-9","article-title":"Better functional outcomes for ORIF in tibial eminence fracture treatment: a national comparative multicentric study of ORIF vs ARIF","volume":"28","author":"R Pailh\u00e9","year":"2020","journal-title":"Knee Surgery, Sports Traumatology, Arthroscopy"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"40","DOI":"10.25259\/JASSM_19_2021","article-title":"Multiple ligament knee injuries: Clinical practice guidelines","volume":"3","author":"DN Pardiwala","year":"2021","journal-title":"Journal of Arthroscopic Surgery and Sports Medicine"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1177\/23259671251319532","article-title":"Clinical Outcome of Bicruciate Ligament Reconstruction in Multiple-Ligament Knee Injuries: Comparison With Bicruciate Reconstruction and Collateral Ligament Surgery","volume":"13","author":"Z Joutoku","year":"2025","journal-title":"Orthop J Sports Med"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1007\/978-3-030-05396-3_40","volume-title":"Complications Associated with the Treatment of the Multiple Ligament Injured Knee","author":"DC Johannesmeyer","year":"2019"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1007\/s12178-019-09549-3","article-title":"Combined Anterior Cruciate Ligament and Medial Collateral Ligament Knee Injuries: Anatomy, Diagnosis, Management Recommendations, and Return to Sport","volume":"12","author":"JL Elkin","year":"2019","journal-title":"Curr Rev Musculoskelet Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1016\/j.otsr.2009.10.003","article-title":"Bicruciate ligament lesions and dislocation of the knee: Mechanisms and classification","volume":"95","author":"S Boisgard","year":"2009","journal-title":"Orthopaedics & Traumatology: Surgery & Research"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1302\/2058-5241.5.190012","article-title":"Management of multiligament knee injuries","volume":"5","author":"JWG Ng","year":"2020","journal-title":"EFORT Open Rev"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1368","DOI":"10.1097\/CORR.0000000000001186","article-title":"Classifications in Brief: The Schenck Classification of Knee Dislocations","volume":"478","author":"CP Goebel","year":"2020","journal-title":"Clin Orthop Relat Res"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1007\/s00167-018-5039-7","article-title":"A new, MRI\u2010based classification system for tibial spine fractures changes clinical treatment recommendations when compared to Myers and Mckeever","volume":"27","author":"D Green","year":"2019","journal-title":"Knee Surgery, Sports Traumatology, Arthroscopy"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1007\/s001130050218","article-title":"Treatment of posterior tibial plateau fractures via posteromedial and posterolateral exposures","volume":"100","author":"P Lobenhoffer","year":"1997","journal-title":"Unfallchirurg"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1016\/j.jisako.2023.08.008","article-title":"Primary anterior cruciate ligament repair: Current concepts","volume":"8","author":"Jr Robinson","year":"2023","journal-title":"Journal of ISAKOS"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.cjtee.2023.01.002","article-title":"Arthroscopic fixation of chronic bicruciate tibial avulsion fractures: A case report","volume":"26","author":"G Purnomo","year":"2023","journal-title":"Chinese Journal of Traumatology"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1177\/03635465231153157","article-title":"Nonoperative Management, Repair, or Reconstruction of the Medial Collateral Ligament in Combined Anterior Cruciate and Medial Collateral Ligament Injuries\u2014Which Is Best? A Systematic Review and Meta-analysis","volume":"52","author":"CL Shultz","year":"2024","journal-title":"Am J Sports Med"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1186\/s40634-017-0087-3","article-title":"Varus\u2010valgus instability in the anterior cruciate ligament\u2010deficient knee: effect of posterior tibial load","volume":"4","author":"T Ohori","year":"2017","journal-title":"J Exp Orthop"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"24","DOI":"10.4103\/jmsr.jmsr_68_20","article-title":"Rotational instability of the knee: Injury of anterior cruciate and anterolateral knee ligaments, MRI findings","volume":"5","author":"R Gonzalez-Pola","year":"2021","journal-title":"Journal of Musculoskeletal Surgery and Research"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.RVW.24.00036","article-title":"Lack of Consensus on the Management of Medial Collateral Ligament Tears in the Setting of Concomitant Anterior Cruciate Ligament Injury","volume":"12","author":"OK Blaber","year":"2024","journal-title":"JBJS Rev"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1177\/230949900701500117","article-title":"Medial Collateral Ligament Avulsion from Both Tibial and Femoral Attachments: A Case Report","volume":"15","author":"A Naik","year":"2007","journal-title":"Journal of Orthopaedic Surgery"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"3879","DOI":"10.12998\/wjcc.v10.i12.3879","article-title":"Surgical treatment for a combined anterior cruciate ligament and posterior cruciate ligament avulsion fracture: A case report","volume":"10","author":"K Yoshida","year":"2022","journal-title":"World J Clin Cases"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000018376","article-title":"Avulsion of the femoral attachment of the medial collateral ligament in the setting of knee multiligament injury","volume":"98","author":"D Guo","year":"2019","journal-title":"Medicine"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1272\/jnms.84.301","article-title":"Midterm Result of Arthroscopic Bicruciate Ligament Sutures for Multiligament Knee Injury in an Adolescent Patient","volume":"84","author":"Y Oshima","year":"2017","journal-title":"Journal of Nippon Medical School"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"423","DOI":"10.52628\/89.3.11663","article-title":"Bicruciate retaining total knee arthroplasty: current state and future promise","volume":"89","author":"A-S COOLS","year":"2023","journal-title":"Acta Orthop Belg"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1872","DOI":"10.1007\/s00167-020-06207-x","article-title":"Treatment of medial-sided injuries in patients with early bicruciate ligament reconstruction for knee dislocation","volume":"29","author":"MA Jokela","year":"2021","journal-title":"Knee Surgery, Sports Traumatology, Arthroscopy"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1177\/23259671211050929","article-title":"Treatment of Combined Injuries to the ACL and the MCL Complex: A Consensus Statement of the Ligament Injury Committee of the German Knee Society (DKG)","volume":"9","author":"D Guenther","year":"2021","journal-title":"Orthop J Sports Med"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.jor.2022.07.024","article-title":"The management of combined ACL and MCL injuries: A systematic review","volume":"34","author":"R Rao","year":"2022","journal-title":"J Orthop"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.52965\/001c.35825","article-title":"An Evidence-Based Approach to Multi-Ligamentous Knee Injuries","volume":"14","author":"LM Fortier","year":"2022","journal-title":"Orthop Rev (Pavia)"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1107","DOI":"10.1016\/j.otsr.2019.04.015","article-title":"The effect of knee bracing on the knee function and stability following anterior cruciate ligament reconstruction: A systematic review and meta-analysis of randomized controlled trials","volume":"105","author":"X Yang","year":"2019","journal-title":"Orthopaedics & Traumatology: Surgery & Research"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1069","DOI":"10.1002\/pmrj.12542","article-title":"The Combination of Exercise and Manual Therapy Versus Exercise Alone in Total Knee Arthroplasty Rehabilitation: A Randomized Controlled Clinical Trial","volume":"13","author":"S Karaborklu Argut","year":"2021","journal-title":"PM&R"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1466","DOI":"10.1016\/j.arthro.2018.10.138","article-title":"Outcomes of Grade III Medial Collateral Ligament Injuries Treated Concurrently With Anterior Cruciate Ligament Reconstruction: A Multicenter Study","volume":"35","author":"RW Westermann","year":"2019","journal-title":"Arthroscopy: The Journal of Arthroscopic & Related Surgery"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1177\/2325967121994203","article-title":"Risk Factors Associated With Complications After Operative Treatment of Multiligament Knee Injury","volume":"9","author":"NK Patel","year":"2021","journal-title":"Orthop J Sports Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1302\/2058-5241.6.210057","article-title":"Complications of surgical reconstruction of multiligament injuries of the knee joint: diagnosis, prevention and treatment","volume":"6","author":"EC Rodr\u00edguez-Merch\u00e1n","year":"2021","journal-title":"EFORT Open Rev"}],"container-title":["Sportverletzung \u00b7 Sportschaden"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2781-4703.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T23:35:27Z","timestamp":1773099327000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2781-4703"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":31,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2026,3,9]]},"published-print":{"date-parts":[[2026,3]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2781-4703","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0932-0555","1439-1236"],"issn-type":[{"value":"0932-0555","type":"print"},{"value":"1439-1236","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]}}}