Simultaneous Anterior Cruciate Ligament, Posterior Cruciate Ligament, Posteromedial Corner, and Posterolateral Corner Reconstruction of the Knee

Abstract

The concomitant injuries of the four groups of ligaments of the knee is relatively rare but poses challenges to orthopedic surgeons in the case that all four groups of ligaments require reconstruction. Under this condition, staged reconstruction is a reasonable choice. However, simultaneous reconstruction may be better for the ligament balancing, as well as for earlier rehabilitation and recovery [1]. We would like to introduce a simultaneous anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), posteromedial corner (PMC), and posterolateral corner (PLC) reconstruction technique to present the basic principle and sequences of bone tunnel creation, graft emplacement, and final distal fixation (Table 47.1). Theoretically, simultaneous four-ligament reconstruction of the knee can be performed in the most complicated combination involving double-bundle ACL and PCL reconstruction [2, 3]. However, in our current clinical practice, the most performed simultaneous four-ligament reconstruction procedures involve always single-bundle ACL and PCL reconstruction instead of double-bundle ACL and PCL reconstruction, as well as single-bundle PMC and single-femoral tunnel PLC reconstruction [4]. The indication of this technique is the combination of the indications of each isolated ligament reconstruction in case of multi-ligament injuries.