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Objectives and questions: The purpose of this study was to analyze the influence of fixed posterior drawer (FPD) on knee function, anterior knee pain, and quality of life in patients with posterior cruciate ligament (PCL) ruptures. The hypothesis was that the presence of FPD is associated with significantly inferior patient-reported outcomes.

Material and methods: Between 2021 and 2025, 95 patients presented with PCL ruptures. From this cohort, preliminary datasets of 54 patients were fully evaluated for this study. Clinical and radiological outcomes were assessed at the time of study inclusion. FPD was defined according to Strobel as a posterior tibial translation of ≥3 mm in stress radiographs where the tibia remained fixed despite anterior stress. Patients were stratified into fixed (n=11; 20.4%) and non-fixed (n=43; 79.6%) groups to compare functional outcomes (KOOS, Tegner), anterior knee pain, and demographic factors.

Results: FPD was identified exclusively in chronic PCL ruptures (n=11; 32.4%) and was absent in all acute cases (p=0.004). Patients with FPD were significantly older (54 ± 12 years) compared to those without fixed instability (43 ± 16 years; p=0.019). Clinically, the FPD group demonstrated significantly worse KOOS Quality of Life scores (19 ± 18) compared to the non-fixed group (38.5 ± 24; p=0.036). Activity levels were also reduced, with lower Tegner scores in the FPD group (2.3 ± 1.9 vs. 3.8 ± 2.4; p=0.05). Additionally, a trend toward a higher rate of anterior knee pain was observed in patients with FPD (36.4%) compared to those without (14%), though this did not reach statistical significance.

Discussion and conclusions: Advanced age and chronicity were identified as significant risk factors for the development of FPD. The presence of this deformity leads to significantly poorer clinical scores, severely affecting daily living and physical activity. These findings suggest that PCL injuries, particularly in older patients, may require earlier surgical intervention to prevent fixed subluxation. Avoiding FPD is crucial to ensuring a successful return to daily life and preserving quality of life.