Management of the Failed Multiligament Reconstruction

Failure of multiligament knee reconstruction is a complex problem that requires a thorough evaluation and diligent planning. A detailed history and physical examination is supported by a comprehensive imaging evaluation which includes radiographs (plain, stress, and mechanical axis), computed tomography (CT), and magnetic resonance imaging (MRI). Surgical intervention may require staged procedures depending on limb alignment and existing tunnel size and location. An osteotomy may be required to address malalignment, and tunnel bone grafting is often necessary due to tunnel osteolysis or nonanatomic placement. Revision multiligament reconstruction must adhere to anatomic and mechanical principles to avoid tunnel collision and achieve secure fixation and tension grafts in the appropriate order and knee position. Adherence to these principles will support a mechanically stable knee and permit early range of motion.