Multi-ligament knee reconstruction following complex distal femur intraarticular fracture - Case report

Multiple-ligament injuries of the knee (MLKI), although rare (0.02-0.2% of all orthopaedic injuries), are often devastating. The management of MLKI is intricate and technically demanding, often necessitating a staged approach. In polytrauma situations, MLKI poses considerable challenges to the operating surgeon, especially when combined with complex intra-articular fractures. Accurate initial diagnosis under these circumstances can be difficult, underscoring the in-depth understanding of knee anatomy and injury mechanism for early detection. Furthermore, the presence of multiple fixation devices adds complexity. Our patient underwent Multi-ligament reconstruction of ACL (anterior cruciate ligament), PCL (posterior cruciate ligament), and PLC (posterolateral complex) in the setting of complex distal femur fracture (AO 33 C3) and exhibited a good clinical outcome at 2 years follow-up. We describe a successful surgical management and discuss the technical considerations, operative strategies, and encountered challenges.