Anatomical medial and posteromedial ligamentoplasty for multiligament knee injury: an original technique using a pediculated autograft

BACKGROUND: The combined injury of multiple knee ligaments, commonly referred as "multiligament knee injury" (MKI), is a rare pathology that most often occurs in high-energy trauma. The associated lesions present a technical challenge for surgical reconstruction in terms of operative strategy. Various anatomical techniques have been described. Despite their proven advantages over non-anatomical techniques, these techniques have several disadvantages, such as the need for multiple grafts and allografts and the creation of multiple tunnels. Our technique aims to overcome these disadvantages. MATERIALS AND METHODS: We present an original surgical technique for the anatomical reconstruction of the medial collateral ligament and the posterior oblique ligament using a pediculated autograft from the semitendinosus or gracilis. Fourteen patients were analysed. RESULTS: The minimum follow-up period was 2 years (mean: 44 months, 33-61). Good clinical and objective paraclinical results were achieved, with a mean range of motion of 0-1-119° at the last follow-up. 93% of patients showed no valgus laxity and 100% of patients had an objective IKDC score of A or B. CONCLUSION: We propose a new approach to reconstructing the medial and posteromedial structures. This involves anatomical and isometric ligamentoplasty using an autograft. Our results confirm the effectiveness of this technique, demonstrating good clinical and paraclinical outcomes. LEVEL OF EVIDENCE: IV.