Anatomic Multiligament Knee Reconstruction With a Medial Meniscal Repair in the Setting of a Valgus Hyperextension Injury

Background: Simultaneous anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and medial collateral ligament (MCL) tears represent a severe form of multiligament knee injury (MLKI). This combination of injuries often results from high-energy trauma and leads to gross instability, impaired joint biomechanics, and long-term degenerative changes if not addressed appropriately. Untreated or improperly treated MLKIs may result in chronic pain, instability, and early onset osteoarthritis. Indications: Combined ACL, PCL, and MCL reconstruction is indicated in patients with complete tears of all 3 ligaments confirmed on physical examination, stress radiography, and magnetic resonance imaging, typically presenting with marked instability in both the anterior-posterior plane and to valgus stress. Early surgical intervention is often recommended in active individuals and in cases of knee dislocation, where spontaneous reduction may obscure the extent of concomitant ligament tears. Technique Description: The technique described was used to surgically reconstruct the ACL, PCL, and MCL, and repair the medial meniscus. A central-third bone-patellar tendon-bone autograft was used for the arthroscopic ACL reconstruction, and a double bundle PCL reconstruction used Achilles and tibialis anterior tendon allografts. The medial meniscal repair was also performed arthroscopically. The MCL was reconstructed open using autografts of the semitendinosus and gracilis tendons. Results: Clinical outcomes after simultaneous reconstruction of the ACL, PCL, and MCL have demonstrated significant improvements in subjective stability, return to sports, and pain reduction. Patients with multiligament injuries treated within 3 weeks have been reported to have improved outcomes compared with those who delay surgery. Discussion: Anatomic reconstruction of concomitant ACL, PCL, and MCL tears is an effective technique for restoring knee stability and function in the setting of multiligament knee trauma. Early diagnosis and treatment are critical for optimal outcomes. Single-stage reconstruction allows for efficient restoration of native biomechanics while minimizing the risk of instability, osteoarthritis, and chronic pain. Patient Consent Disclosure Statement: 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.