Publications

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
Material and Methods: 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.
Results: 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.
Conclusion: 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