Simultaneous ACL Reconstruction and MCL Reconstruction in Patients with High BMI using Modified Lind Technique.

Introduction: 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.