Multiligament Knee injury with MCL intra-articular incarceration: A case report

Knee dislocations are rare but severe injuries, often associated with multiligament damage and potential neurovascular compromise. Intra-articular incarceration of the medial collateral ligament (MCL) is a rare but serious condition that may require urgent intervention. This case report presents a rare instance of multiligament knee injury with MCL incarceration, discusses the mechanism of injury, and details the surgical management. A 45-year-old man was admitted to the emergency department with severe knee pain and deformity following a skiing accident. Radiographs showed lateral tibial translation with a widened medial joint space, and MRI confirmed a multiligament injury, including a complete anterior cruciate ligament (ACL) rupture, a subtotal posterior cruciate ligament (PCL) rupture, and a complete proximal MCL rupture with intra-articular incarceration. The patient underwent a two-stage surgical approach. The first procedure involved an arthroscopic reduction of the incarcerated MCL bundle, followed by extra-articular extrusion and reattachment using two suture anchors. Due to persistent knee instability, a second surgery was performed, consisting of ACL and PCL reconstruction using synthetic LARS ligaments and an extra-articular Lemaire plasty. Postoperative imaging confirmed well-positioned graft tunnels and joint realignment. The patient was immobilized in a Jack brace and followed a structured rehabilitation protocol. This case highlights the importance of early recognition and management of multiligament knee injuries. MCL incarceration can lead to complications such as skin necrosis, necessitating timely reduction. Proximal MCL tears are known to have a poorer prognosis with residual valgus laxity, making surgical intervention crucial. When addressing multiligament injuries, ACL and PCL reconstruction should be prioritized, especially in cases of significant instability. Due to the complexity of such injuries, treatment should be performed by an experienced knee surgeon to ensure optimal outcomes.