{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T06:51:05Z","timestamp":1775026265895,"version":"3.50.1"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The Meyers and McKeever (MM) classification is widely used for posterior cruciate ligament (PCL) tibial avulsion fractures; however, it fails to comprehensively reflect fracture characteristics and morphology due to its exclusive reliance on plain radiographs, which may result in suboptimal treatment decisions. Computed tomography (CT) scanning and three-dimensional computed tomography (3DCT) reconstruction can provide a more detailed visualization of articular fracture configurations, enabling the development of effective treatment strategies. Therefore, we developed a novel classification system for PCL tibial avulsion fractures based on fracture characteristics on 3DCT images, systematically evaluated and compared classification accuracy and reliability with the MM classification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients aged 18 years or older who underwent plain radiographs and CT examinations that confirmed PCL tibial avulsion fractures from June 2020 to Jan 2025 were included. A novel 3DCT-based classification system was established by considering three key fracture characteristics: fracture displacement degree, fracture line numbers, and fracture involvement regions. To verify the reliability and accuracy of the novel 3DCT-based and MM classification systems, intra- and inter-rater reliability assessments were performed. Additionally, the consistency and discrepancy in fracture patterns between the two classification systems were systematically described.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ultimately, 53 patients (40 males and 13 females) with PCL tibial avulsion fractures were enrolled in the final study (mean age 42.9, range 22\u201365). The novel 3DCT-based classification system consisted of four principles and seven categories. The intra-rater reliability of the MM classification demonstrated substantial agreement, whereas the 3DCT-based classification exhibited perfect agreement. The inter-rater reliability of both classifications displayed substantial agreement, and the novel classification had higher reliability values. In addition, approximately 22.6% of non-displaced fracture types, along with some type II and III fractures identified through radiographs, exhibited differing fracture characteristics when evaluated using 3DCT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The novel 3DCT-based classification is more reliable, simplified, and intuitive than the MM classification. This novel classification system allows for a more accurate description of these fractures and reduces the risk of misdiagnosis based on radiographs. Additionally, it provides valuable guidance for preoperative planning and the selection of appropriate treatment strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1790512","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T04:58:13Z","timestamp":1775019493000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A novel 3DCT-based classification for posterior cruciate ligament tibial avulsion fractures"],"prefix":"10.3389","volume":"13","author":[{"given":"Xiong","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Sports Medicine, Tongji Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]},{"name":"Department of Orthopedics, Shanghai Baoshan Luodian Hospital","place":["Baoshan District, Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yongqing","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Jinjiang Municipal Hospital, Shanghai Sixth People's Hospital Fujian","place":["Jinjiang, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenqiang","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shanghai Baoshan Luodian Hospital","place":["Baoshan District, Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuming","family":"Zi","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shanghai Baoshan Luodian Hospital","place":["Baoshan District, Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liehu","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Jinjiang Municipal Hospital, Shanghai Sixth People's Hospital Fujian","place":["Jinjiang, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"734","DOI":"10.1177\/0363546517701911","article-title":"Management of posterior cruciate ligament tibial avulsion injuries a systematic review","volume":"46","author":"Hooper","year":"2018","journal-title":"Am J Sports 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