Single-Stage Repair and Reconstruction of Multiligament Injury With Bicondylar Tibial Plateau Fracture Following...

Knee dislocations (KDs) accompanied by bicondylar tibial plateau fractures and multiligament injuries are uncommon and present significant technical challenges, particularly in patients at high thrombotic risk where tourniquet use is contraindicated. We present the case of a 30-year-old male who sustained a traumatic posterolateral KD with a bicondylar tibial plateau fracture, meniscal and capsular disruption, and patellar tendon and multiligament injury following a high-velocity motor vehicle accident. Due to bilateral lower-extremity deep venous thromboses, surgery was performed without a tourniquet using a single-stage combined arthroscopic and open approach. The medial meniscus, medial collateral ligament, joint capsule, and patellar tendon were repaired with suture anchors, while the lateral collateral ligament and popliteus tendon were reconstructed using an allograft. This approach achieved anatomic realignment, restored knee stability, and preserved peroneal nerve function. At three months, the patient demonstrated a full range of motion and returned to normal activity. This case highlights that complex KDs with bicondylar tibial plateau fractures can be safely and effectively managed in a single stage without a tourniquet. The described technique provides practical strategies for surgeons managing similar high-risk patients and contributes to the development of more standardized operative protocols for complex multiligament knee injuries.