Double-Bundle Posterior Cruciate Ligament and Concomitant Medial Collateral Ligament and Posterior Oblique Ligament Reconstruction After a Motor Vehicle Accident

Motor vehicle accidents constitute the most prevalent high-energy mechanisms for knee dislocation, resulting in multiligament knee injuries (MLKIs). When concomitant posterior cruciate ligament (PCL) and posteromedial corner injury becomes chronic after failed conservative treatment, surgical intervention is indicated to restore the native knee biomechanics.

Double-bundle PCL reconstruction is indicated for chronic instability, increased posterior tibial translation, decreased tibial slope, and failure of conservative treatment measures. posteromedial corner reconstruction is indicated for increased valgus laxity, anteromedial rotary instability, and in the setting of a chronic MLKI.

The gracilis and semitendinosus autografts are identified, harvested, and fixated to suture anchors that are placed at the anatomic distal medial collateral ligament (MCL) attachment. At the femur, the adductor tubercle is identified to localize the anatomic femoral attachments of the MCL and the posterior oblique ligament (POL). Guide pins are placed in the anatomic attachment sites, and 7-mm tunnels are reamed. The tibial POL attachment is identified just distal to the anterior arm of the semimembranosus tendon and then overreamed with a 7-mm reamer. The hamstring grafts are passed under the sartorius fascia, with the excess used for the POL autograft. For the PCL, the anterolateral (ALB) and posteromedial (PMB) femoral tunnels are reamed to 11 mm and 7 mm, respectively. The tibial PCL tunnel guide pin location is confirmed with fluoroscopy and reamed with a 12-mm reamer using a protective curette. A tibialis anterior allograft is passed and fixed in the femoral PMB, and an Achilles allograft is passed and fixated in the femoral ALB PCL tunnels. The PCL ALB graft is fixed to the tibia at 90° and neutral rotation and the PMB at 0°. The MCL and POL grafts are pulled into their tunnels and fixated at 30° and 0°, respectively.

Concomitant PCL, MCL, and POL reconstruction with concurrent medial meniscus repair restores knee biomechanics, decreases pain and instability, and reduces the risk of progression of osteoarthritis.

Clinical and biomechanical studies report comparative outcomes for acute reconstructions of ACL- and PCL-based MLKIs in the short- and long-term follow-up.

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.