Krishna J B Vadhiraj, Shakeel Mohammed Aquib, Rakshith A G, Amaravathi Rajkumar S, Sandesh G M, Pilar Anoop
Department of Orthopaedics, St Johns Medical College and Hospital, Bengaluru, Karnataka, India.
J Orthop Case Rep. 2025 Sep;15(9):334-341. doi: 10.13107/jocr.2025.v15.i09.6118.
Multiligamentous knee injury (MLKI) is a difficult and devastating injury of the knee defined as tear/disruption (involving grade III) of at least 2 of the 4 major ligaments of the knee. Combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries are the most common type of MLKI. MCL injuries are concurrent in 20-38% of ACL injuries and are common in sports activities that involve pivoting of the knee joint, forced hyperextension, and rapid deceleration. Many techniques have been described for superficial MCL (sMCL) reconstruction, with single-bundle and double-bundle techniques used for the associated posterior oblique ligament (POL) using both allografts and autografts. Among these, one of the most common techniques with a good outcome (keeping the semitendinosus tibial attachment intact) was described by Lind et al. Our technique for sMCL and POL reconstruction is a modification of the Lind technique. In this technique, the semitendinosus with its intact tibial attachment is rerouted anatomically in the tibial tunnel with an adjustable loop, and on the femoral side, an adjustable loop UltraButton is used with a 2-incision technique. The remaining graft is reattached to the posteromedial tibia as POL using an interference screw.
We treated patients with chronic ACL injuries combined with grade III valgus laxity. A total of 5 patients met the inclusion criteria of the study, and there were no patients lost to follow-up. The mean age was 26.5 years with a standard deviation of 4.05 years. All surgeries were performed by a single experienced author, Dr RK, at our institution between September 2023 and May 2024. The mean time from injury to surgery was 2.5 months, and the duration of follow-up was 6 months. 3 patients were female and 2 were male patients.
Out of 5 patients who were treated, 2 were in the age group of 15-20 years and 3 were 20-30 years. 2 were male patients and 3 were females. Road traffic accidents accounted for 66% (3 cases) of the total cases as the most common mechanism of injury followed by sports injuries (34%, 2 cases). All 5 patients operated on with simultaneous ACL and MCL reconstruction (modified Lind technique) had excellent results based on the Lysholm scoring system. Comparative analysis was done between pre-surgery and post-surgery Lysholm scores and we found that there was a statistically significant difference between them with P < 0.001. A significant improvement in the International Knee Documentation Committee subjective score was detected at follow-up.
In patients with high body mass index >25 kg/m2, chronic ACL-MCL (grade III) injuries, simultaneous ACL-MCL reconstruction with the modified Lind technique improves anterior, valgus, and rotatory stability of the knee and produces a good functional result.
多韧带膝关节损伤（MLKI）是一种严重且棘手的膝关节损伤，定义为膝关节4条主要韧带中至少2条发生撕裂/断裂（累及III级）。前交叉韧带（ACL）和内侧副韧带（MCL）联合损伤是MLKI最常见的类型。在20% - 38%的ACL损伤中会同时发生MCL损伤，且在涉及膝关节旋转、强迫性过度伸展和快速减速的体育活动中较为常见。已有多种技术用于浅层MCL（sMCL）重建，单束和双束技术用于相关的后斜韧带（POL）重建，均采用同种异体移植物和自体移植物。其中，Lind等人描述了一种效果良好（保留半腱肌胫骨附着点完整）的最常见技术之一。我们的sMCL和POL重建技术是对Lind技术的改良。在该技术中，带有完整胫骨附着点的半腱肌通过可调环在胫骨隧道内进行解剖学重新布线，在股骨侧，采用双切口技术使用可调环UltraButton。剩余的移植物使用干涉螺钉重新附着于胫骨后内侧作为POL。
我们治疗了慢性ACL损伤合并III级外翻松弛的患者。共有5例患者符合本研究的纳入标准，且无失访患者。平均年龄为26.5岁，标准差为4.05岁。所有手术均由经验丰富的RK医生于2023年9月至2024年5月在我们机构进行。受伤至手术的平均时间为2.5个月，随访时间为6个月。3例为女性患者，2例为男性患者。
在接受治疗的5例患者中，2例年龄在15 - 20岁之间，3例在20 - 30岁之间。2例为男性患者，3例为女性患者。道路交通事故占总病例的66%（3例），是最常见的损伤机制，其次是运动损伤（34%，2例）。所有5例接受ACL和MCL同时重建（改良Lind技术）手术的患者，根据Lysholm评分系统均取得了优异的结果。对术前和术后的Lysholm评分进行了对比分析，发现两者之间存在统计学显著差异，P < 0.001。随访时检测到国际膝关节文献委员会主观评分有显著改善。
对于体重指数>25 kg/m²、慢性ACL - MCL（III级）损伤的患者，采用改良Lind技术同时进行ACL - MCL重建可改善膝关节的前向、外翻和旋转稳定性，并产生良好的功能结果。
