ACL, PCL Injuries with PLRI or MCL Combined Injury

In the acute stage of multi-ligament injuries, there should be a careful analysis of the neurovascular injury, and also as early as possible, as surgery will be better. Early mobilization after the MLKI procedure results in less range of motion deficit. The order of fixation of the grafts id as follows: simultaneous tensioning of the ACL, PCL, and PLCS graft; cyclic loading about 10–15lbs tensioning; PCL first fixation at 90 flexion and then ACL graft fixation at 0–10 flexion of the knee; and, finally, PLCS fixation to the femoral tunnel at 70–90 flexion of the knee position. Usually I’d recommend 10lbs tension for the PLCS and check the lateral joint space in flexion and extension of the knee arthroscopically. Postoperative rehabilitation is almost same as PCL reconstruction with PLCS.