A Novel Technique of Rerouting Semitendinosus Graft for Medial Collateral Ligament and Medial Patellofemoral Ligament Reconstruction – In a Polytrauma Patient with Multiligament Injury: Kakran et al. Technique

Introduction: Multiligament knee injuries (MLKIs) are complex injuries associated with significant instability and functional impairment. Surgical management is challenging due to controversies regarding timing, staging, and graft selection, particularly in polytrauma patients. Case Report: We report the case of a 60-year-old male who sustained a multiligament injury to the right knee following a road traffic accident, involving complete tears of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and medial patellofemoral ligament (MPFL), with associated meniscal injuries. After ruling out vascular compromise, the patient underwent single-stage arthroscopic reconstruction. The ACL and PCL were reconstructed using peroneus longus tendon grafts, whereas the MCL was repaired and augmented using a semitendinosus graft. The same semitendinosus graft was strategically utilized for concurrent MPFL reconstruction to address recurrent patellar instability. Results: Postoperatively, the patient demonstrated satisfactory clinical and radiological outcomes, with restoration of knee stability and progressive improvement in range of motion. Follow-up magnetic resonance imaging confirmed intact reconstructed ligaments, and the patient was able to mobilize with a stable knee at short-term follow-up. Conclusion: This case highlights that single-stage reconstruction with optimal graft utilization, including combined MCL and MPFL reconstruction using a single semitendinosus graft, is a feasible and effective option in complex MLKIs. This approach restores stability while preserving graft options for potential future revision surgery. Keywords: Multiligament knee injury, single-stage reconstruction, graft optimization, semitendinosus rerouting, medial collateral ligament, medial patellofemoral ligament, peroneus longus graft, case report.