Anatomic Medial Collateral Ligament, Posterior Oblique Ligament, and Double-Bundle Posterior Cruciate Ligament Reconstructions With Concomitant Distal Femoral Osteotomy in the Setting of a Chronic Injury

The medial collateral ligament provides stability against valgus stress applied to the knee. Medial knee ligament injuries often occur concomitantly with posterior cruciate ligament injuries and may be aggravated by valgus malalignment. Intentional care and preparation must be taken to reconstruct all injured structures to their anatomic positions to best restore native knee biomechanics. This article describes an anatomic medial collateral ligament and posterior oblique ligament reconstruction using hamstring autograft, with a distal femoral osteotomy and a concomitant double-bundle posterior cruciate ligament reconstruction using Achilles tendon and tibialis anterior allografts for the anterolateral bundle and posteromedial bundle, respectively, in the setting of chronic ligament injuries.