Multiligament Knee Injuries

The symptoms of multi-ligament knee injuries can vary depending on the specific ligaments involved and the severity of the injury. Common symptoms include:

• Severe Pain: Intense pain at the time of injury may continue as a deep, aching pain.
• Swelling: Rapid onset of swelling in the knee, often within hours of the injury.
• Instability: A feeling of the knee giving way or instability, especially during weight-bearing activities.
• Limited Range of Motion: Difficulty in bending or straightening the knee.
• Bruising: Visible bruising around the knee and sometimes down into the calf and shin.
• Difficulty Walking: Inability to bear weight on the affected leg or difficulty walking.

Multi-ligament knee injuries are usually caused by high-energy trauma from a sports injury, a serious fall, and auto accidents. However, low-energy injuries may also occur in individuals with higher body mass.

Common causes include:

• Sports Injuries: Contact sports like football, rugby, and soccer often result in high-energy impacts or awkward landings. Athletes in high-impact sports like football, basketball, and skiing are at high risk of multi-ligament knee injuries.
• Motor Vehicle Accidents: High-speed collisions can generate enough force to cause severe knee injuries.
• Falls from significant heights or severe twisting injuries can lead to multiligament damage.

Accurate diagnosis can be challenging. Dr. Waterman will review your medical history, inquire about the injury, and perform an orthopedic examination to assess the knee’s stability and identify the damaged ligaments. Diagnosis is confirmed with MRI and stress X-rays. X-rays rule out fractures, and an MRI examines the detailed images of the ligaments and meniscus to determine the extent of the injuries.

Recent studies support early (within 3 weeks of injury) single-stage surgery. A delay increases the risk of scarring and tissue compromise. Dr. Waterman is the lead investigator in an ongoing clinical trial to evaluate the role of timing of surgery and rehabilitation with multi-ligamentous knee surgery.   Anatomic ligament repair and reconstruction of the torn ligaments with grafts and repair of other damaged structures are generally performed in a single surgery. However, two procedures may sometimes be necessary. Anatomic ligament reconstruction emphasizes the reproduction of native knee biomechanics and effectively restores knee range of motion and stability. The objective is to improve the patient’s long-term knee stability and function.

Treatment of multi-ligament knee injuries depends on the severity of the injury, the specific ligaments involved, and the patient’s overall health and activity level. Treatment options include:

• Non-Surgical Treatment: This approach involves bracing, physical therapy, and activity modification. It may be suitable for less active individuals or those with lower-grade injuries.
• Surgical Treatment: Often required for active individuals or those with severe injuries. Surgical options include:
  • Ligament Repair: Directly repairing the torn ligaments.
  • Ligament Reconstruction: Using grafts from the patient’s tissues or from a donor to replace the damaged ligaments.
  • Ligament Augmentation:  Repair with Reconstruction or synthetic augmentation

Rehabilitation is an essential part of recovery involving physical therapy to restore strength, stability, and range of motion. Rehabilitation can be a lengthy process, often taking six months to a year or more. Recovery from multi-ligament knee reconstruction requires at least nine to twelve months.