Background:

Multiligament knee injuries (MLKI) occur as a result of high-energy angular and rotatory trauma to the knee. These injuries often occur in the setting of knee dislocation, with associated neurovascular injury in up to 40% of cases. Treatment generally consists of surgical reconstruction in either an acute or delayed fashion, depending on the type of injury and the patient’s overall readiness for surgery. An important aspect of the preoperative patient evaluation consists of screening for and identifying any coronal-plane malalignment, especially excessive varus, that places the reconstructed lateral and posterolateral structures at an elevated risk of re-rupture. In the setting of a MLKI with injury to the posterolateral corner (PLC), the presence of varus malalignment warrants strong consideration for performing a concomitant valgus-producing high tibial osteotomy (HTO) in addition to the PLC reconstruction. This is especially important in the setting of a previous failed PLC reconstruction.

Purpose:

This video overview and case presentation is intended to provide the viewer with a review of the pathogenesis and treatment of MLKI with associated coronal plane malalignment.

Methods:

An overview of the pathogenesis and treatment of MLKI with associated coronal plane malalignment is provided. This is the case of a 28-year-old male with right knee pain and the sensation of the knee giving way for the 2 weeks since a motorcycle accident. One year prior to presentation, he underwent a right knee PLC and posterior cruciate ligament (PCL) reconstruction that was unfortunately complicated by a Methicillin-sensitive Staphylococcus aureus infection, and required 2 subsequent arthroscopic debridements. His alignment was in asymmetric varus, and he had a grade III valgus and varus stress test and posterior drawer test, positive reverse Pivot shift test, and positive dial test at 30O and 90O. In this case, a technique for a staged reconstruction, with the first stage consisting of a 10O correction HTO and bone grafting of the previous tunnels, and the second stage consisting of a PLC, PCL, and medial collateral ligament (MCL) reconstruction is presented.

Results:

Excellent alignment and a stable knee were achieved after the 2 procedures. Adequate correction of the coronal plane malalignment, with the resultant weightbearing axis intersecting the medial tibial spine, and reconstruction of the PLC, PCL, and MCL were obtained.

Conclusion:

A staged reconstruction consisting of a medial opening wedge HTO and bone grafting in the first stage, followed by reconstruction of the PLC, PCL, and MCL in the second is an appropriate treatment for a failed prior PLC and PCL reconstruction with asymmetric varus malalignment.