Multiligament Knee Injuries

The collateral ligaments MCL and LCL control side to side movements, stabilize the knee and brace against abnormal movements. The cruciate ligaments ACL and PCL cross over each other to form an X and control front and backward motion in the knee, stabilize the knee and brace against abnormal movements.

Knee ligaments work together to stabilize the joint and deliver the necessary function to perform everyday activities and sports. When a ligament is torn the knee loses stability and consequently its normal function. When multiple ligaments are damaged the joint becomes highly unstable which increases the risk of additional knee damage including injury to the cartilage, menisci, and even the nerves and blood vessels. Multiple ligament injuries causing numbness, tingling or weakness require emergency evaluation.

Multiligament knee injuries are caused by a knee dislocation that occurs from high – velocity trauma like an auto accident, a crush injury, a low velocity sports injury, or a high or low – energy fall from a height. Multiligament knee injuries are rare and serious. They are often associated with injury to the meniscus and cartilage, and fractures of the tibia and femur. Up to 18% of multiligament knee injuries are associated with damage to the blood vessels. Studies report that cartilage and meniscus injuries have been reported in almost 75% of cases.

Early management of multiligament knee injuries is critical and complex beginning with identification of all injuries. Many variables must be considered including vascular and nerve injuries. Sometimes a specialist will be needed to perform vascular surgery. When the knee is grossly dislocated it must be immediately reduced (put back into alignment) and stabilized before moving on to the surgical reconstruction of the ligaments.

Dr. Petrigliano will make decisions about whether to perform all repairs and reconstructions at the same time or in a staged fashion which involves more than one surgery. Surgical management is superior to conservative management in most patients.

Arthroscopic evaluation of the joint under anesthesia is vital to the comprehensive diagnosis of all knee damage unless there are open injuries. X-rays will also be taken. Damage to the nerves, blood vessels, meniscus and bone may be treated first followed by ligament reconstruction with autografts (tendon tissue taken from another location in the patient’s body).

Early arthroscopic single-stage reconstruction is currently the mainstay of treatment for these injuries.  Early reconstruction is surgery performed within three weeks of the injuries. When surgery is delayed beyond 3 weeks it is considered chronic. However, studies report satisfactory outcomes from delayed reconstruction surgery.

The optimal surgical strategy depends on the characteristics of the injury. Each case is unique. Studies report that single stage multiligament reconstruction with proper rehabilitation is an effective and reliable procedure for multiligament knee injuries. Rehabilitation begins with early mobilization after multiligament knee injuries surgery and results in fewer range of motion deficiencies.