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:

• The anterior cruciate ligament (ACL)
• The posterior cruciate ligament (PCL)
• The medial collateral ligament (MCL)
• The lateral collateral ligament (LCL)

What is a complex multiple ligament knee injury?

Multiple ligament knee injuries happen when more than one of the knee’s ligaments is torn. They are less common than single ligament injuries (like an ACL tear).

Multiple ligament knee 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:

• A physical examination to determine which ligaments are torn
• An assessment of the skin and amount of soft tissue swelling
• A neurovascular exam to detect any nerve or blood vessel damage

X-rays of the knee are performed to make sure there are no fractures or dislocations. An MRI scan is typically 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 multiple ligament knee injury require surgery. The goal of surgery is to:

• Restore knee stability
• Regain full range of motion
• Allow a return to athletic activities in the future

Before surgery, patients are prescribed physical therapy to work on regaining full motion 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 an outside source.

• For ACL or PCL injuries, surgery is performed arthroscopically, through small holes in the skin.
• For injuries to the MCL and LCL, surgery may be 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. Physical therapy 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.