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Complex Multiple Ligament Knee Injuries

What is a ligament?

A ligament is a short band of tough, flexible, fibrous connective tissue that holds together a joint, in this case the knee. There are four main ligaments that provide stability to the knee.  They are called the collateral ligaments, they include the Anterior cruciate ligament (ACL), Posterior cruciate ligament (PCL), Medial collateral ligament (MCL), and the lateral collateral ligament (LCL).

What is a Complex Multiple Ligament Knee Injury?

Commonly, patients will tear their ACL in sporting activities such as skiing, soccer or football.  Multi-ligament knee injuries occur less frequently when at least two or more ligaments are torn.  For example, tearing the ACL and MCL, or the ACL, PCL and LCL.  These injuries can occur during sports activities or through high-energy trauma such as a fall from height or a car accident.

How is a Complex Multiple Ligament Knee Injury diagnosed?

All patients who suspect they might have a ligament knee injury should be evaluated by an orthopedic surgeon.  A comprehensive workup and evaluation is required, and should be completed as soon as possible after the injury.  This includes physical examination to determine which ligaments are torn, an assessment of the skin and amount of soft tissue swelling, and a neurovascular exam to detect any nerve or blood vessel damage.

Plain x-rays of the knee are performed to make sure there are no fractures or dislocations.  MRI is required to confirm which ligaments are torn and whether there is injury to the other structures in the knee, such as articular cartilage and the menisci.

What is the treatment for a Complex Multiple Ligament Knee Injury?

Nearly all cases of multi-ligament knee injury require surgery.  The goal of surgery is to restore knee stability, regain full range of motion, and to hopefully allow a return to athletic activities in the future.

After it’s determined ligaments are torn and require reconstruction, patients are prescribed physical therapy to work on regaining full motion before surgery and to decrease knee swelling.  All patients wear a brace to protect the knee before surgery.

Often the ligaments are reconstructed using the patient’s own tissue, such as the hamstring tendons or a bone-patellar tendon-bone graft.  Some ligaments such as the LCL and PCL are usually reconstructed using allograft tissue from a cadaver.  Surgery is performed arthroscopically, through small holes in the skin, to address the ACL, PCL and any meniscal damage.  Some injuries, such as those to the MCL and LCL are performed through larger incisions on the knee.

What can I expect after Complex Multiple Ligament Knee surgery?

After surgery, patients are advised to work closely with a physical therapist which is critical to regaining full knee motion and strength.  Aspirin is frequently used to minimize the risk of a blood clot.  The overall time for complete recovery depends on the number of torn ligaments and whether there is an associated injury to the menisci and cartilage.