Multi-Ligament Knee Injury
A complex knee injury occurs when more than one ligament within the knee has been damaged. The major knee ligaments are the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL) and the lateral collateral ligament (LCL). Two or more of these ligaments are injured, which is very common in a knee dislocation.
A multi-ligament injury is rare. In order to sustain this type of injury, the patient most often was involved in a major accident or very traumatic sporting fall or event. Complex knee surgery and multi-ligament knee surgery to repair this type of injury is complicated and oftentimes can only be optimally performed by a knee specialist who performs complex knee surgeries routinely.
Description of Complex Knee Surgery
Almost all two-ligament injuries of the knee, except for combined ACL and MCL injuries, require a combined surgical reconstruction. Dr. LaPrade recommends performing 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. Dr. LaPrade’s surgical team is set-up such that the overall surgical procedure does not take an extended period of time and we strongly recommend the patient’s multi-ligament knee surgery be performed in one setting to allow the patient to move forward with their rehabilitation and their life.
Are you a candidate for complex knee surgery?
There are two ways to initiate a consultation with Dr. LaPrade:
You can provide current X-rays and/or MRIs for a clinical case review with Dr. LaPrade.
You can schedule an office consultation with Dr. LaPrade.
(Please keep reading below for more information on this treatment.)
Post-Operative Protocol for Complex Knee Surgery
An absolutely essential part of a multi-ligament knee surgery is the postoperative rehabilitation. A very well done multi-ligament reconstruction can result in a less than ideal outcome if a concurrent supervised rehabilitation program is not followed. Thus, we believe it is essential for complex knee injury patients to start physical therapy the day after surgery, to work on range of motion and muscle reactivation immediately, and have the surgeon and physical therapist communicate directly to improve the patient’s outcome. We believe this will results in improved overall outcomes, less joint stiffness, and quicker return of muscle function.
- Outcomes and Surgical Technique of Acute Grade III and Combine PLC Injuries
- Double Bundle PCL Technique and Outcomes
- Biomechanical Comparison of Anatomical Single and Double Bundle ACL Reconstruction
- sMCL – Anatomic Augmented Repair vs Anatomic Reconstuction
- Effects of Grade III PLC Injuries on ACL Grafts
- Effects of PLC injuries on PCL Grafts
- PTO as Initial Treatment for Chronic PLC Deficiency
- Varus Stress Radiographs
- Correlation of Valgus Stress Radiographs
- Kneeling Stress Radiographs for Evaluation of Post Knee
Multiligament Reconstruction FAQ
1. What is a multiligament reconstruction?
A multiligament reconstruction involves the reconstruction of 2 or more of the 4 four ligaments around the knee. The main ligaments that are involved area the ACL, PCL, MCL, and the LCL. There are more ligaments on both the inside (medial) and outside (lateral) portions of the knee that are also commonly reconstructed, but the general feeling for a multiligament reconstruction description is that at least 2 of these 4 areas are involved with the reconstruction.
2. What is the rehabilitation program like for a multiligament reconstruction?
The rehabilitation program for multiligament reconstruction must be centered about the ability to ensure that the knee does not become stiff, the grafts do not stretch out, and that over time one has a good return of their overall strength of that lower extremity. In general, a program of range of motion on day one, weightbearing around the 6-week timeframe, and a progressive strengthening program going forward from there has been validated in the peer-reviewed literature as a new standard of care to return people back to high-level activities after a multiligament reconstruction
3. What is the recovery time for a multiligament knee reconstruction?
In general, most multiligament reconstructions take approximately 9 and 12 months to return back to full activities. For the first 6 weeks, the main focus is on the motion, with most patients being nonweightbearing during that time to allow the grafts to heal. After the 6-week timeframe, a progressive strengthening program is followed. Stress radiographs are usually obtained between 5 and 6 months postoperatively to determine if there has been sufficient healing of the grafts to be able to allow the patients to increase their activities. In particular, patients who have had a PCL reconstruction need to slow down their rehabilitation program to ensure that the graft does not stretch out. This requires the use of a dynamic knee brace designed specifically for PCL reconstructions as well as a slower postoperative rehabilitation program to maximize healing of the PCL reconstruction graft prior to initiating an impact or twisting or turning activities.