Multi-Ligament Knee Injury

What is a multi-ligament knee injury?

There are four major ligaments in the knee; consisting of the cruciate and collateral ligaments (there are two of each). Like strong ropes, these ligaments serve to stabilize the knee joint by maintaining bone alignment. The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) form an “X” within the knee joint and are important in limiting the forward and backward movement of the tibia (shin bone) in relation to the femur (thigh bone). The medial collateral ligament (MCL) and lateral collateral ligament (LCL) are found on the outside of the knee joint (extra-articular) and are important in protecting the knee against unusual twisting motions. A multi-ligament knee injury is a rare condition resulting from simultaneous damage to two or more of these ligaments. These complex knee injuries are often the consequences of high-impact traumatic events such as a fall from several feet, a rough tackle in football, or a motor vehicle collision. Because each of the four ligaments has a similar yet separate knee stability function, it is important to consult an orthopedic knee specialist for a proper diagnosis. Dr. Matthew T. Provencher, orthopedic knee specialist serving patients in Vail, Aspen, Colorado Springs, and the Denver, Colorado area, has the knowledge and understanding, as well as substantial experience in treating patients who have experienced a multi-ligament knee injury.

What are the symptoms of a multi-ligament knee injury?

A common complaint of a multi-ligament knee injury is severe pain of the knee joint immediate swelling and joint effusion after an injury. This pain may not be localized to one portion of the knee. Swelling of the affected knee joint and knee instability, particularly with weight-bearing, are other symptoms of a multi-ligament knee injury.

How is a multi-ligament knee injury diagnosed?

A comprehensive medical history, including the precipitating injury, will be obtained by Dr. Provencher. A thorough physical examination will then be performed involving various knee movements and ligament tests to evaluate joint laxity. Diagnostic imaging is often requested when ruling out multi-ligament knee injuries. X-rays can indicate any bone-related injuries, such as a dislocation or fracture, that resulted as part of this injury. Magnetic resonance imaging (MRI) can confirm the diagnosis of a multi-ligament knee injury by identifying the specific ligaments that sustained damage as well as any additional damage to the other soft tissue structures within the knee joint.

What is the treatment for a multi-ligament knee injury?

Dr. Provencher will review a number of important factors, such as the patient’s age, medical history, and desired outcome, to design an individualized treatment plan.

Non-surgical treatment:

If the injured ligaments sustained a minimal amount of damage, conservative therapies alone may be enough to alleviate symptoms. Pain and inflammation can be managed with a combination of RICE (rest, ice, compression, elevation) and non-steroidal anti-inflammatory medications (NSAIDs). When appropriate, a physical therapy program aimed at re-stabilizing the knee joint may be recommended by Dr. Provencher. It is important to note, however, that the knee ligaments lack their own blood supply, so conservative treatment options may only provide mild symptom relief.

Surgical treatment:

In the event of moderate to severe ligament damage, or when conservative therapy is unsuccessful, surgical intervention is necessary to fully restore the knee joint. The surgical procedure for reconstructing multiple knee ligaments is tailored to the patient, the ligaments involved, and the injury complexity. Dr. Provencher may combine arthroscopic and open surgical approaches to complete the necessary revisions for a multi-ligament knee injury. The knee ligaments are reconstructed using tissue grafts, either from the patient (autograft) or donor tissue (allograft), to repair the damaged portions of the original ligaments. Surgical reconstruction of multiple knee ligaments is often time-sensitive to limit scar tissue formation and improve functional outcomes after surgery.

For more information on multi-ligament knee injuries, or the excellent treatment options available, please contact the office of Dr. Matthew T. Provencher, MD, orthopedic knee specialist at The Steadman Clinic, serving Vail, Aspen, Colorado Springs, and the Denver, Colorado area.