Multiligament Injury

A multiligament knee injury occurs when two or more of the four major ligaments in the knee are torn or damaged. These injuries are typically caused by high-energy trauma, such as motor vehicle accidents, falls, or sports injuries. The knee ligaments work together to provide stability, so damage to multiple ligaments can lead to severe instability and functional impairment.

The four major knee ligaments are

• Anterior Cruciate Ligament (ACL) – Prevents the tibia (shinbone) from moving too far forward.
• Posterior Cruciate Ligament (PCL) – Prevents the tibia from moving too far backward.
• Medial Collateral Ligament (MCL) – Provides stability on the inner side of the knee.
• Lateral Collateral Ligament (LCL) – Provides stability on the outer side of the knee.

When two or more of these ligaments are injured, it is classified as a multiligament knee injury.

Causes of Multiligament Knee Injuries

• High-energy trauma: Car accidents, falls from heights, or other high-velocity incidents.
• Sports injuries: Contact sports like football, rugby, and skiing can lead to multiligament injuries, especially if the knee is hit from the side or twisted forcefully.
• Work-related accidents: Falls or heavy impact can cause such injuries.

Symptoms of Multiligament Knee Injury

• Severe pain immediately following the injury.
• Significant swelling within hours of the injury.
• Instability: The knee may feel like it will give out, or the person may be unable to bear weight.

• Bruising and tenderness around the knee.
• Difficulty moving the knee or loss of range of motion.
• Numbness or weakness if nerves or blood vessels are damaged, which can sometimes happen in severe multiligament injuries.

Diagnosis

A physical examination and imaging tests are essential for diagnosing multiligament knee injuries. Specific tests to assess each ligament's integrity are performed. Common diagnostic tools include:

• X-rays: To check for fractures.
• MRI: Provides detailed images of the soft tissues in the knee, including the ligaments.
• CT angiogram: If there is concern about blood vessel damage, this test evaluates the blood flow in and around the knee.

Treatment for Multiligament Knee Injuries

Treatment of multiligament injuries typically requires surgical intervention and an extended rehabilitation period. The goal is to restore knee stability, prevent long-term damage, and return the patient to normal activities.

Non-surgical Treatment

• Bracing to stabilize the knee.
• Physical therapy to regain strength and mobility.
• However, non-surgical treatment is typically not the best option for most patients, as it may lead to chronic instability and functional limitations.

Surgical Treatment

Most multiligament knee injuries require surgery to repair or reconstruct the damaged ligaments. Surgery may be performed in one or two stages, depending on the injury severity, and may involve one or more of the following:

• Ligament repair: For some injuries, the surgeon may repair the torn ligaments directly.
• Ligament reconstruction: For more severe injuries, ligaments are reconstructed using grafts (tissue taken from another part of the body, such as the hamstring tendon or a donor).
• Addressing associated injuries: Cartilage damage, meniscal tears, and fractures may also need to be treated during surgery.
• Vascular or nerve repair: If blood vessels or nerves are damaged, they may also need to be surgically repaired.

Recovery and Rehabilitation

Recovery after a multiligament knee injury is a long-term process and requires extensive rehabilitation.

• Immobilization: The knee is typically immobilized in a brace following surgery, and the patient will need to use crutches to avoid putting weight on the leg for several weeks.
• Physical Therapy: Rehabilitation focuses on regaining range of motion, building strength in the surrounding muscles, and improving knee stability. Early stages of physical therapy focus on gentle movements and stretches, while later stages include more advanced exercises to restore function.
• Full Recovery: The recovery period can take anywhere from 6 months to a year, depending on the severity of the injury and the patient's commitment to rehabilitation.
• Return to Sports: Athletes may require additional time to regain full strength and stability before returning to competitive sports, often taking closer to a year.

Risks and Complications

Surgical repair of multiligament knee injuries carries some risks, including:

• Infection.
• Stiffness or reduced range of motion.
• Full Graft failure or re-injury.
• Chronic knee instability if the ligaments do not heal properly.
• Post-traumatic arthritis, which can develop over time due to the severity of the injury.