Open Multiligament Reconstruction for Concomitant Patellofemoral and Type IV Tibiofemoral Dislocation and Bucket-Handle Medial Meniscus Injury.

Abstract

A knee dislocation combined with a patellofemoral dislocation is an extremely rare and complex injury that reflects severe multidirectional instability and extensive soft-tissue disruption. We show an open single-stage anatomic reconstruction method for a patient with type IV tibiofemoral dislocation, patellofemoral dislocation, and bucket-handle medial meniscus tear. A midline parapatellar approach provided direct access to both the medial and lateral compartments, allowing for the identification of all ligament attachments and the repair of the meniscal tear. Cruciate, collateral, posterolateral corner, and medial patellofemoral ligament tears were reconstructed using tibialis posterior allografts. To avoid tunnel convergence, common femoral tunnels were drilled for the posterior cruciate ligament-medial collateral ligament and anterior cruciate ligament-fibular collateral ligament complexes with an additional femoral tunnel for the popliteofibular ligament. The open approach allowed for an anatomical restoration of all major stabilizers, while minimizing multiple skin incisions and avoiding the complications related to arthroscopic fluid extravasation. Early reconstruction was indicated due to gross instability of both tibiofemoral and patellofemoral joints and the associated meniscal tear. This technique provides a practical and safe alternative for comprehensive anatomic reconstruction in selected cases of complex knee dislocation with severe capsular disruption.