Single-stage autograft-only reconstruction of ACL, MCL, and LCL injuries with concomitant lateral meniscal repair in a resource-limited setting: a case report

Introduction and importance: Multiligament knee injuries (MLKIs) are rare, complex injuries that cause severe instability and functional impairment. Single-stage anatomical reconstruction using multiple distinct autografts is infrequently reported due to graft supply limitations. Case presentation: A 40-year-old male farmer sustained a high-energy left knee twisting injury from a cow-driven rope-traction mechanism. Clinical examination and magnetic resonance imaging confirmed complete anterior cruciate ligament (ACL), medial collateral ligament (MCL), and lateral collateral ligament (LCL) tears, with a posterior horn tear of the lateral meniscus; the posterior cruciate ligament was intact. The patient underwent single-stage, combined arthroscopic and open reconstruction using a quadriceps tendon autograft for the ACL, an iliotibial band graft for the LCL, and a peroneus longus tendon graft for the MCL, along with lateral meniscal repair, followed by supervised rehabilitation. Clinical discussion: Single-stage multi-autograft reconstruction represents a pragmatic, viable solution when tissue-bank allografts are inaccessible. Careful divergent tunnel planning prevented intraosseous tunnel collision. At the 1-year follow-up examination, manual multi-planar stability was restored without clinically apparent donor-site morbidity, yielding a symmetric range of motion (0°–135°), an International Knee Documentation Committee (IKDC) score of 88, and successful occupational reintegration. Conclusion: Single-stage combined open and arthroscopic reconstruction using multiple autografts demonstrated satisfactory clinical stability and functional recovery at 12 months following a MLKI in a resource-limited setting.