A multi-ligament knee injury involves injury to two or more ligaments of the knee. These injuries are usually high energy in nature such as motor vehicle accidents, severe fall from height, or during sports such as skiing and football. Multi ligament knee injury requires reconstruction surgery to rebuild the damaged tissues and prevent problems associated with an unstable knee such as premature osteoarthritis.
Ligaments are fibrous tissue bands that connect bones and stabilize joints. The knee joint has four major ligaments – the anterior cruciate ligament, posterior cruciate ligament, lateral collateral ligament and medial collateral ligament.
Patients with multi-ligament knee injuries may experience pain, swelling, limited range of motion, injuries to nerves and arteries of the leg, and knee instability.
The main problem in diagnosing patients with multiple ligament tears is to accurately detect which ligaments are torn, and the extent of the tears. The diagnosis starts with a comprehensive clinical evaluation by an orthopedic surgeon. The main imaging techniques that are employed for the diagnosis are X-rays and MRI scan. In addition, functional testing can be performed during an arthroscopic examination, before the surgical reconstruction, to help confirm the results of the diagnosis. This testing includes tests such as “gap test” which measures the space between the femur and tibia.
Contraindications for reconstructive knee surgery include previous knee joint infection, reflex sympathetic dystrophy, complex regional pain syndrome, and morbid obesity.
During multiligament knee reconstruction surgery, ligaments are reconstructed using a graft taken from the patient (autograft) or donor tissue (allograft). Surgical reconstruction is usually performed arthroscopically through tiny incisions with the use of an arthroscope and small surgical instruments. Your surgeon will create a tunnel in the thigh and tibia bone using a small drill. Your surgeon then inserts the grafts into the tunnel to replace the torn ligaments. After the grafts are placed, fixation devices are used to secure the grafts and hold the ligament in place until healing occurs.
Physical therapy is recommended for restoration of the normal knee motion and muscle strength to avoid complications and also prolonged course of rehabilitation is recommended after surgery. After multi-ligament knee reconstruction, crutches may be required for 6 to 8 weeks.
Risks and complications
Unfortunately, there can be failure of ligament reconstruction surgery, to restore normal stability of the knee joint. Reasons for such failure may be due to errors in surgical techniques, failure of graft integration, inadequate rehabilitation, postoperative infection, and traumatic re-injury.