Multi-Ligamentous Knee Injuries
Most knee injuries involve a single ligament tear, but sometimes, two or more ligaments in the knee can be injured simultaneously. This can be called a multi-ligamentous knee injury, or a complex knee injury. Most of these types of injuries occur from sports or traumatic events like a car accident or fall from a height. Surgery can be performed to mend the ligaments of the knee and help you return to all (or at least most) normal physical activities after rehabilitation.
Multi-ligamentous knee injuries usually present symptoms immediately or shortly after the injury occurs. Symptoms can include:
- Pain that builds steadily and quickly after the injury
- Swelling that builds steadily and quickly after the injury
- Sometimes, a “popping” feeling or sound from the knee at the moment of injury
- Difficulty walking, or walking with a limp
- Knee instability or buckling feeling that the knee will give way
- A catching sensation in the knee
- Knee stiffness
- Decreased range of knee motion
Treatment for a multi-ligamentous knee injury almost always requires complex surgery. The recommended surgical technique ultimately depends on the injury. Supplemental treatments may also be recommended in addition to surgery. Treatments include:
- RICE: Immediately after a complex knee injury, the RICE method (Rest, Ice, Compression, and Elevation) should be employed to help the tissues heal. To rest, avoid activities that place stress or weight on the knee. To ice, apply a cold compress to the knee in 15-minute intervals 4 times a day. To compress, wrap the knee in an elastic bandage to reduce swelling and inflammation. To elevate, prop your knee up on a pillow so that it is above the level of your heart.
- Anti-Inflammatory Medication: Non-steroidal anti-inflammatory medications can decrease inflammation and pain due to a multi-ligamentous knee injury. Patients undergoing physical therapy after knee surgery are frequently advised to take anti-inflammatory medications to reduce pain while they work to regain strength and mobility.
- Physical Therapy: After surgery, patients are advised to work with a physical therapist to restore knee motion, support, and strength.
- Surgery: Injuries to multiple ligaments in the knee will usually require surgical correction. The techniques used will depend on the injury itself. Early surgery may be recommended (within the first few weeks after the injury) to repair ligament tears that become more difficult to repair over time. Sometimes, multiple surgeries may be necessary to reconstruct the damaged ligaments and release scar tissue.
Frequently Asked Questions
There are four major ligaments in the knee: the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL). Most tears involve just one of these ligaments, but it’s possible for any combination of these ligaments to be injured simultaneously. Combined injuries usually involve the ACL and MCL, or the ACL and PCL and LCL.
A multi-ligamentous knee injury usually occurs from an injury, especially in sports or from a traumatic event like a car accident or fall from height. Often, symptoms (listed above) will occur immediately or shortly after the injury. If you have symptoms, or if you have endured a serious injury and suspect knee damage, you need a thorough examination. A diagnosis can be confirmed with a detailed history and exam, including x-rays and MRIs. These tests will determine which ligaments have been torn and whether multiple soft tissue structures in the knee have been damaged.
Multi-ligamentous injuries nearly always require surgery. These types of injuries should be taken seriously, as they can have major complications. A complex knee injury may affect the nerve supply and/or blood supply to the lower leg, and severe cases may even lead to amputation. If you suspect you have injured multiple ligaments in your knee, it is important to get a thorough examination by a qualified and experienced orthopedic surgeon. Most likely, if you are diagnosed with a multi-ligamentous knee injury, you will be advised to undergo surgery to prevent serious complications.
Because they are more complex, outcomes for multi-ligamentous knee injuries are not as predictable as outcomes for single ligament injuries. Advanced surgical techniques and expertise have made it possible for some athletes to return even to high level sporting activities after a complex knee injury. However, those with severe injuries that affected the nerves may be left with permanent weakness in the lower leg, which may affect future physical activity. Most patients will need 9 to 12 months of rehabilitation before they can resume full activities. Expert surgery, careful monitoring, and physical therapy after surgery can usually provide a good outcome for recovery after a multi-ligamentous knee injury.