Multi-Ligament Knee Reconstruction

What is a multi-ligament knee injury?

The knee has four ligaments that function similarly to strong ropes. The cruciate ligaments are found within the knee and limit forward and backward movement of the tibia (shin bone) in reference to the femur (thigh bone). The collateral ligaments are located outside of the knee joint (extra-articular) and are important in protecting against unusual twisting motions. A multi-ligament knee injury is characterized by simultaneous damage to two or more of the knee ligaments. This complex knee injury is uncommon and often the result of a major traumatic event, such as a motor vehicle collision, a fall from several feet, or a rough tackle in football.

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

Individuals with a confirmed multi-ligament knee injury should be aware that these ligaments lack their own blood supply; therefore, surgical intervention is often the recommended treatment. However, if minimal ligament damage was sustained, conservative therapies alone may be adequate in alleviating symptoms. A combination of RICE (rest, ice, compression, elevation) and non-steroidal anti-inflammatory medications (NSAIDs) can be used to control the pain and inflammation associated with this injury. When appropriate, a physical therapy program designed to re-stabilize and strengthen the knee joint may be recommended by Dr. Provencher.

In the event of moderate to severe knee ligament damage, or when conservative therapy failed to alleviate symptoms, surgical reconstruction is necessary. The goal of surgically repairing these ligaments is to re-stabilize the knee while also strengthening and restoring function to the knee joint. The reconstruction of multiple knee ligaments is a complicated surgical procedure involving tissue grafts, either from the patient (autograft) or donor tissue (allograft), to repair the damaged segments of the original ligaments. Dr. Matthew T. Provencher, orthopedic knee doctor, treats patients in Vail, Aspen, Colorado Springs, and the Denver, Colorado area who have experienced a multi-ligament knee injury and are in need of surgical reconstruction.

How is multi-ligament knee reconstruction performed?

Prior to operating on the knee, Dr. Provencher performs an examination under anesthesia to confirm the damaged ligaments and verify the integrity of the other knee ligaments. A tissue graft is then harvested from the patient, or donor tissue is used. When the tissue grafts are prepared, Dr. Provencher makes a few small incisions surrounding the knee and introduces a small camera (arthroscope) to methodically examine the muscles, ligaments, and tendons of the knee. The damaged fragments of the ligaments are identified and removed with specialized surgical instruments. The tissue grafts are then carefully situated in the same anatomical position as the native ligaments to ensure a successful recovery. Once the necessary revisions are complete, the repaired ligaments are assessed for good tension, and stability and range of motion of the knee is evaluated. The arthroscope and surgical instruments are withdrawn from the knee joint and the incisions are closed with steri-strips or sutures.

Because of the complexity of this surgical procedure, Dr. Provencher may combine the arthroscopic surgical approach with an open surgical technique. The larger incision of an open surgery enables Dr. Provencher to visualize the entire knee joint while completing the necessary revisions. Whether this surgery is completed using one surgical technique, or a combination of surgical methods, Dr. Provencher prefers to complete this surgery in one setting to provide the patient with the best possible recovery outcome.

What is the recovery period like after multi-ligament knee reconstruction?

The recovery period following a multi-ligament knee reconstruction is largely dependent upon the surgical technique employed by Dr. Provencher, the pre-operative fitness level of the patients, as well as the type and number of tissue grafts implemented. Most patients can expect a return to normal daily activities in approximately 9 to 12 months. Patients in Vail, Aspen, Colorado Springs, and the Denver, Colorado area can anticipate the following:

• The knee is immobilized with a brace or other immobilization device immediately following surgery. Weight bearing is also limited with the help of crutches.
• Pain and inflammation are managed with a combination of rest, ice, and non-steroidal anti-inflammatory medications (NSAIDs). If necessary, Dr. Provencher can prescribe stronger pain medication to be taken as directed.
• A physical rehabilitation program, with an early emphasis on strengthening the quadriceps muscle and improving knee range of motion, will be tailored after a post-operative evaluation.
• The key to a successful recovery following a multi-ligament knee reconstruction is the patient’s willingness to comply with the post-operative care instructions set forth by Dr. Provencher. This includes remaining consistent and completing the prescribed physical therapy program.

For more information on multi-ligament knee reconstruction, or to discuss your multi-ligament knee injury treatment options, please contact the office of Matthew T. Provencher, MD, orthopedic knee doctor at The Steadman Clinic, serving Vail, Aspen, Colorado Springs, and the Denver, Colorado area.