Avascular osteonecrosis of the knee after multiligament reconstruction: a case report and a literature review

Multiligament knee reconstruction (MLKR) is a complex surgical procedure often required to treat severe injuries involving multiple knee ligaments. A rare complication of knee ligament reconstruction is avascular osteonecrosis (AVN). To our knowledge, only 8 cases of knee osteonecrosis (ON) after ligament reconstruction were described, 7 cases after anterior cruciate ligament (ACL) reconstruction and 1 case after posterior cruciate ligament (PCL) and medial collateral ligament (MCL) reconstruction. This case report presents a rare occurrence of knee ON following MLKR for Schenck type III lesion in a 61-year-old male patient with a history of alcohol, tobacco, cannabis, and cocaine abuse. Eleven months after the MLKR surgery, the patient had a new trauma. Magnetic Resonance Imaging (MRI) scans, in addition to re-rupture of two out of three reconstructed ligaments, revealed characteristic signs of avascular ON. Despite conservative treatment, follow-up MRI did not show normalization of the necrotic areas. This case emphasizes the need for awareness of potential osteonecrosis in patients with substance use history undergoing knee reconstruction and the challenges in managing such complications.