Anatomic Multiligament Knee Reconstruction With Biceps Femoris Tendon and Medial Meniscal Repair

Multiligament knee injuries are defined as tears of ≥2 of the following ligament structures: anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), posteromedial corner, or posterolateral corner (PLC). These injuries occur in various settings and may be associated with knee dislocations.

The literature has reported that anatomic technique and a single-;stage approach for treating multiligament knee injuries are optimal because they may lead to improved outcomes. An anatomic double-;bundle PCL reconstruction is suggested to improve knee kinematics compared with a single-;bundle PCL reconstruction.

The technique described was used to surgically reconstruct the ACL, PCL, and PLC, and to repair the medial meniscus and biceps femoris tendon. Neurolysis of the common peroneal nerve and dissection of the biceps femoris tendon were performed through the release of scar tissue. Tunnel drilling for the anatomic reconstruction of the PLC, PCL, and ACL was completed. The double bundle PCL reconstruction was performed with Achilles and tibialis anterior tendon allografts, the ACL reconstruction utilized a bone-;patellar tendon-bone autograft, and the PLC reconstruction was performed with a split Achilles tendon allograft. Final graft tensioning and fixation were performed in sequence as the PCL anterolateral bundle, the PCL posteromedial bundle, the ACL, the fibular collateral ligament (FCL), the popliteus tendon, and the popliteofibular ligament. A medial meniscal repair was performed with an all-;inside suture device, and the biceps femoris tendon repair was performed with 2 suture anchors on the fibular head.

Improved outcomes have been reported with single-;stage anatomic reconstructions of multiligament knee injuries, with early initiation of rehabilitation. Acute (<6 weeks) versus late-;stage surgical intervention has been discussed to have equivalent postoperative outcomes. A consensus statement described that the timing of surgery should be performed on a case-;by-;case basis, depending on patient factors.

The literature on multiligament knee reconstruction performed in a single stage continues to demonstrate improved outcomes. The technique described restores native knee biomechanics through anatomic-;based reconstructions of the ACL, PCL, FCL, popliteofibular ligament, and popliteus tendon.

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.