Multiligamentous knee injuries commonly result from a high-energy incident that occurs during sports activity or a motor vehicle collision. These injuries often require acute surgical management and, if left unmanaged, may lead to pain, considerable functional impairment, instability, and osteoarthritis. Excellent postoperative outcomes have been reported in patients who undergo anatomic reconstruction of a multiligamentous knee injury; however, various graft materials, methods of graft fixation, and surgical techniques are available for reconstruction.

This video demonstrates the surgical management of a chronic multiligament knee injury via reconstruction of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and medial collateral ligament (MCL) with Achilles tendon and bone-patellar tendon-bone allografts. The video discusses the case presentation of a 33-year-old man who sustained a right knee dislocation while playing soccer 2 years prior to presentation. The patient’s knee was reduced at the time of the incident, and the patient did not seek additional treatment. The patient experienced persistent symptoms and had difficulty performing activities of daily living secondary to a sense of knee instability. A physical examination revealed evidence of ACL, PCL, and MCL deficiency. Advanced imaging studies revealed complete, chronic tears of the ACL, PCL, and MCL. Single-stage multiligament reconstruction was performed using Achilles tendon allografts for management of the PCL and MCL and a bone-patellar tendon-bone allograft for management of the ACL. Excellent restoration of anteroposterior knee stability and increased stability to valgus stress were attained intraoperatively. The patient was advanced through a standardized rehabilitation protocol and experienced decreased symptoms. The patient is able to perform all activities of daily living without limitations and is making progress toward return to sports activity. Multiligamentous knee reconstruction is the mainstay of treatment for symptomatic patients with chronic deficiency of the stabilizing structures of the knee. This complex procedure requires meticulous attention to anatomy and technique to restore function and avoid complications.