There are four main areas of the knee, which must be assessed for possible injury when there is suspicion for a multi-ligament knee injury. Within these areas, there can be several bundles or several structures, which need to be reconstructed. These areas include the ACL, PCL, posterolateral knee and medial knee (MCL). Although most complex knee injuries are thought to occur due to a knee dislocation, in actuality, a complete knee dislocation is very rare. Thus, an evaluation of a knee, which involves at least two ligaments being torn, is considered a complex knee injury. Almost all complex knee injuries involve either the anterior cruciate ligament (ACL) and/or posterior cruciate ligament (PCL). Combined with this may be a knee ligament injury involving the medial knee structures (commonly called the MCL). In addition, the posterolateral corner structures of the knee must be completely evaluated.
A large number of combined ACL and MCL injuries can be treated with rehabilitation to allow the MCL to heal first, prior to staging an ACL reconstruction. Almost all other complete grade III two ligament injuries of the knee require a combined surgical reconstruction. The literature is somewhat confusing as to whether to perform a staged reconstruction or to perform a surgical reconstruction all at one setting. Dr. LaPrade usually recommends to perform a multiple ligament reconstruction all at one setting. This is because it is well recognized that each ligament depends upon other ligaments for overall stability and performing a reconstruction first for just a portion of the injury increases the risk of that ligament reconstruction stretching out. In our hands, our surgical team is set-up such that the overall surgical procedure does not take an extended period of time and we strongly recommend all multi-ligament knee reconstructions be performed in one setting to allow the patient to move forward with their rehabilitation and their life.
Dr. LaPrade is skilled in diagnosing and treating the following injuries:
