Graft Options for Multiligament Knee Reconstruction Among Surgeons with Limited Allograft Access: A Cross-Sectional Survey.

Authors

Amit Joshi, Subhash Regmi, Rajiv Sharma, Rohit Bista

Published in

Journal of ISAKOS : joint disorders & orthopaedic sports medicine. Pages 101205. Aug 21, 2026. Epub Aug 21, 2026.

Abstract

Multiligament knee injuries (MLKIs) are typically treated with ligament reconstruction, yet controversies persist regarding graft selection, surgical techniques, and surgical staging. Although allografts are often used for MLKIs, their availability is limited for surgeons in South Asian Association for Regional Co-operation (SAARC) countries. Consequently, graft preferences are expected to vary distinctively among these surgeons. This study investigates the preferred graft options for reconstructing various ligaments in MLKIs among arthroscopic surgeons with limited allograft access.
An online survey was conducted among surgeons of India, Nepal, Bangladesh, Pakistan, Afghanistan, Sri Lanka and Maldives, performing at least 10 MLKI annually. The questionnaire included items with two or more response options, some allowing text input. Respondents were required to select one response per question; all items were mandatory. The survey was organized into two main sections: (1) graft options for each ligament in various types of MLKIs and (2) preferred reconstruction techniques. The survey was designed and reported in accordance with the Checklist for Reporting of Survey Studies (CROSS). Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software. Descriptive statistics were used to sum up the responses. Data were reported as numbers (percentages).
Autograft preferences for multiligament knee injuries (MLKIs) varied by injury type and ligament. For knee dislocation (KD) II, hamstring tendon (HT) (87.10%) and peroneus longus (PL) (79.73%) autografts were preferred for Anterior cruciate ligament (ACL) and Posterior cruiciate ligament (PCL) reconstruction, respectively. For KD IIIM, quadriceps tendon (QT) (30.42%), PL (76.96%), and HT (73.27%) autografts were used for ACL, PCL, and Medial collateral ligament (MCL) reconstruction, respectively. For KD IIIL, HT (42.86%), PL (76.50%), and HT (60.83%) autografts were chosen for ACL, PCL, and Lateral collateral ligament (LCL) reconstruction, respectively. For KD IV, QT (34.56%), PL (74.19%), HT (61.75%), and contralateral limb (65.44%) autografts were selected for ACL, PCL, MCL, and LCL reconstruction, respectively. Single-bundle PCL reconstruction was the most preferred technique (94.47%). The weave technique (41.47%) was preferred for MCL in KD IIIM, and Larson's technique (58.99%) for LCL in KD IIIL.
The graft choice for ACL reconstruction varied according to the type of MLKI, but PL autograft was consistently chosen for PCL reconstruction in all MLKI types. The majority preferred single-bundle PCL reconstruction used the weave technique for MCL, and Larson's technique for LCL reconstruction.
IV.

PMID:
42628878
Bibliographic data and abstract were imported from PubMed on 22 Aug 2026.

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