Chronic tibial subluxation is a rare and complicated problem that requires careful evaluation and planning to achieve the desired outcome and patient satisfaction. Reconstruction of catastrophic knee injury requires obtaining a balance in 2 opposing goals: stability and range of motion. Complete understanding of the impact of each of the involved ligamentous structures on knee stability and motion is particularly important, given the absence of ligamentous restraints and landmarks in the multiligamentous knee injury. Three critical operative steps are necessary to produce a desired outcome: (1) complete release and excision of scar tissue, (2) recreation of the central knee axis through anterior cruciate ligament and posterior cruciate ligament allograft reconstruction, and (3) maintenance of postoperative stability and functional motion with an external hinge fixator or functional knee brace. Careful postoperative clinical and radiographic follow-up completes the process toward an excellent result in this difficult clinical scenario.
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