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Case Reports
. 2025 Dec 7;17(12):e98659.
doi: 10.7759/cureus.98659. eCollection 2025 Dec.

Single-Stage Repair and Reconstruction of Multiligament Injury With Bicondylar Tibial Plateau Fracture Following Traumatic Posterolateral Knee Dislocation: A Case Report

Christian Roberti  1 , Savannah R Chapman  1 , John Paul Lemchak  1 , Margaret Mueller  2
Affiliations
Case Reports

Single-Stage Repair and Reconstruction of Multiligament Injury With Bicondylar Tibial Plateau Fracture Following Traumatic Posterolateral Knee Dislocation: A Case Report

Christian Roberti et al. Cureus. .

Abstract

Knee dislocations (KDs) accompanied by bicondylar tibial plateau fractures and multiligament injuries are uncommon and present significant technical challenges, particularly in patients at high thrombotic risk where tourniquet use is contraindicated. We present the case of a 30-year-old male who sustained a traumatic posterolateral KD with a bicondylar tibial plateau fracture, meniscal and capsular disruption, and patellar tendon and multiligament injury following a high-velocity motor vehicle accident. Due to bilateral lower-extremity deep venous thromboses, surgery was performed without a tourniquet using a single-stage combined arthroscopic and open approach. The medial meniscus, medial collateral ligament, joint capsule, and patellar tendon were repaired with suture anchors, while the lateral collateral ligament and popliteus tendon were reconstructed using an allograft. This approach achieved anatomic realignment, restored knee stability, and preserved peroneal nerve function. At three months, the patient demonstrated a full range of motion and returned to normal activity. This case highlights that complex KDs with bicondylar tibial plateau fractures can be safely and effectively managed in a single stage without a tourniquet. The described technique provides practical strategies for surgeons managing similar high-risk patients and contributes to the development of more standardized operative protocols for complex multiligament knee injuries.

Keywords: knee dislocation; lcl; mcl tear; multiligament injury; multiligament knee injuries; patellar tendon injury.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Right knee AP radiograph
Figure 2
Figure 2. Doppler US demonstrating occlusive thrombus formation in the bilateral posterior tibial and peroneal veins
(a) Occlusive thrombus in the right posterior tibial vein with Doppler signal confirming arterial flow. (b) Occlusive thrombus in the right peroneal veins with a Doppler signal confirming arterial flow. (c) Occlusive thrombus in one of the paired posterior tibial veins with preserved arterial flow and flow in the adjacent paired vein. (d) Occlusive thrombus in the left peroneal veins with a Doppler signal confirming arterial flow. A, artery; V, vein
Figure 3
Figure 3. MRI demonstrating extensive ligamentous, osseous, capsular, and meniscal injury with malalignment of the tibia relative to the femur
The green arrow indicates the MCL tear, the blue arrow indicates the LCL tear, and the red arrow indicates meniscal disruption. LCL, lateral collateral ligament; MCL, medial collateral ligament
Figure 4
Figure 4. MRI demonstrating mid-substance PCL tear
The green arrow indicates the PCL tear. PCL, posterior cruciate ligament
Figure 5
Figure 5. MRI demonstrating patellar tendon disruption near its tibial attachment
The red arrow indicates the patellar tendon tear.
Figure 6
Figure 6. MRI demonstrating anterior tibial plateau fracture
The red arrow indicates the tibial plateau fracture.
See this image and copyright information in PMC

References

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