Single-Stage Anatomic Reconstruction of Anterior Cruciate Ligament, Posterior Cruciate Ligament, Medial Collateral Ligament, and Posterolateral Corner for Multiligament Knee Injury.

Abstract

Multiligament knee injuries represent rare and challenging injuries that require complex surgical management to restore stability and function. Current evidence supports anatomic single-stage reconstructions when feasible in order to re-establish knee kinematics and enable early rehabilitation. This technique paper describes single-stage anterior cruciate ligament reconstruction with a bone-patellar tendon-bone allograft, double-bundle posterior cruciate ligament reconstruction with Achilles tendon allograft for the anterolateral bundle and tibialis anterior allograft for the posteromedial bundle, medial collateral ligament reconstruction with hamstring autograft, and anatomic posterolateral corner reconstruction with Achilles tendon allograft. Key aspects emphasized include identification and protection of the common peroneal nerve, accurate anatomic tunnel placement to avoid convergence, and a graft tensioning sequence prioritizing the posterior cruciate ligament, followed by the anterior cruciate ligament, medial collateral ligament, and then the posterolateral corner. This technique provides a reproducible single-stage strategy to address multiligament knee injuries, restoring stability across all planes and supporting functional recovery.