• Full Name: PIYACHAT THONGHTANTHUM
• Affiliation/Institution: Srinagarind hospital, Khon Kaen University
• Country: Thailand

• Full Name: PUNYAWAT APIWATANAKUL
• Affiliation/Institution: Srinagarind hospital, Khon Kaen University
• Country: Thailand

Multiligament knee injuries are uncommon, and avulsion fractures involving multiple major ligaments are particularly rare. Simultaneous avulsion fractures of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and medial collateral ligament (MCL) in a single knee represent an extremely unusual injury pattern, with limited guidance in the literature regarding optimal management.

To report a rare case of triple ligament avulsion fractures of the knee and to highlight the mechanism of injury, single-stage surgical strategy, and clinical implications of anatomical fixation.

Case report.

A 41-year-old male sustained a high-energy motorcycle accident with direct impact to the left knee, presenting one week after motor cycle accident with pain, swelling, and instability. Imaging and intraoperative findings confirmed avulsion fractures of the ACL, PCL, and MCL. Surgical treatment was performed using a combined open and arthroscopic approach. The PCL avulsion fracture was fixed first through a posterior approach using posterior-to-anterior cannulated cancellous screws. Arthroscopic suture-bridge fixation through a tibial tunnel was used to anatomically reduce and stabilize the ACL avulsion. The femoral MCL avulsion was repaired via an open approach using suture anchors. Postoperative radiographs demonstrated satisfactory reduction and fixation of all avulsion fragments, and intraoperative examination confirmed restoration of knee stability.

This rare case of triple avulsion fracture of knee demonstrates that anatomical fixation of triple ligament avulsion fractures using a single-stage surgical approach can successfully restore knee stability and function. To our knowledge, this combination of injuries has not been previously reported in literature. Early recognition and appropriate surgical planning are essential for optimal outcomes in complex knee trauma.