# Surgical approach on combined chronic patellar tendon and bicruciate knee ligament injury

## TL;DR

This paper discusses the surgical treatment of a rare and complex knee injury involving the patellar tendon and cruciate ligaments.

## Contribution

The paper provides a surgical approach based on biomechanical understanding for two-stage reconstruction of combined knee injuries.

## Key findings

- Combined injury affects knee kinematics and biomechanics, requiring careful surgical decision-making.
- The manuscript emphasizes the importance of reconstructing structures in a specific order during two-stage procedures.
- Surgical success depends on graft selection, fixation, and rehabilitation protocols.

## Abstract

A combined injury of the patellar tendon and both the anterior and posterior cruciate ligaments is disabling. It directly affects knee kinematics and biomechanics, presenting a considerable surgical challenge. In this complex and uncommon injury, decision-making should take into account the surgeon’s experience and consider one- or two-stage surgery, tendon graft, graft fixation, and rehabilitation protocol. This manuscript discusses the surgical approach based on a comprehensive understanding of the patellar tendon and bicruciate biomechanics to guide which structures should be reconstructed first, especially when a two-stage procedure is chosen.