Comprehensive Medial Knee Four-Arm Reconstruction to Address Complex Instability With Hamstring Autograft

Medial knee ligament injuries are increasingly recognized as complex, multiplanar lesions, resulting not only in simple medial instability but also anteromedial rotatory instability, anteromedial instability, posteromedial instability, posteromedial rotatory instability, and post-traumatic medial asymmetric hyperextension. The described technique extensively addresses all 6 above-described types of instability. It is based on 4 reconstruction arms with independent fixation. Two arms are created from a pedunculated semitendinosus autograft and 2 arms from a free gracilis autograft. The technique can reconstruct the medial ligamentous complex from the anteromedial aspect (anteromedial capsule/anterior oblique ligament/deep medial collateral ligament), through the superficial medial collateral ligament and posterior oblique ligament, up to the posteromedial capsule, in response to the pathology identified.