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Published on: October 20, 2023
Minimally Invasive Approach to Multiligament Knee Reconstruction: Arthroscopic PCL and PLC With Percutaneous LCL
Corentin Philippe1, Ali Alayane2, Stefano Jacotti1
1Centre Hospitalier Universitaire de Toulouse, Clinique Universitaire du sport et Service de chirurgie orthopédique et traumatologie, Toulouse, France.
Background:
Multiligament knee injuries involving the posterior cruciate ligament (PCL), posterolateral corner (PLC), and lateral collateral ligament (LCL) are rare but complex pathologies. Historically managed with open surgery, these injuries are increasingly being addressed using minimally invasive techniques, which provide anatomical reconstruction and less surgical morbidity.
Indications:
We report the case of a 24-year-old male farmer who sustained a high-energy multiligament knee injury after a motorcycle accident. Six months after the accident, he presented with persistent daily instability affecting his work and recreational activities. Clinical and radiological evaluation confirmed chronic injuries to the PCL, PLC, and LCL.
Technique Description:
A 1-stage, all-arthroscopic and percutaneous reconstruction was performed. The PCL was reconstructed using a pedicled semitendinosus autograft with tibial tunnel placement via a trans-septal portal for direct visualization. The PLC was addressed arthroscopically by placing a knotless anchor for femoral fixation of the reconstructed popliteus tendon, using an extensor hallucis longus allograft. The LCL was reconstructed using a gracilis autograft via a percutaneous technique, minimizing soft-tissue dissection and avoiding tunnel convergence. This minimally invasive strategy enabled anatomical graft placement with reduced risk of neurovascular injury and greater potential for accelerated recovery.
Results:
Postoperatively, the patient wore a hinged PCL dynamic brace for 3 months with no weightbearing for the first 6 weeks. Physical therapy was initiated immediately after surgery with a focus on a controlled range of motion and progressive strengthening. The aim was to allow him to safely return to manual labor and sports activities 6 to 9 months after the surgery.
Discussion/Conclusion:
This case highlights the feasibility and effectiveness of a 1-stage, all-arthroscopic, percutaneous reconstruction of chronic PCL, PLC, and LCL injuries. This technique provides reliable anatomical restoration with minimal surgical morbidity and promising early clinical outcomes, particularly in physically demanding patients.
Patient Consent Disclosure Statement:
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.