What Is a Multiple Knee Ligament Injury?
There are a number of combined knee ligament injury patterns such as 1) anterior cruciate ligament and posterior cruciate ligament tear with tears of the posterolateral corner, and 2) anterior cruciate ligament and posterior cruciate ligament tear with a tear of the medial collateral ligament.
Causes
Most knee ligament injuries involve a single ligament injury, such as an isolated anterior cruciate ligament, medial collateral ligament, or posterior cruciate ligament tear. However, when there is major trauma, such as a direct blow to the knee, a fall from a height, or a motor vehicle trauma, several knee ligaments can be torn at the same time. This requires immediate attention, and patients will have various immediate treatments, such as an arterial graft and external fixator, applied to hold the knee in place while these other injuries heal.
Symptoms
Typical symptoms include:
- Severe instability and disability that adversely affect everyday life, work, and sports participation.
- A dislocated knee.
- Nerve injury at the level of the knee.
- Severe artery injury.
Treatment
The treatment of these very severe knee ligament injuries almost universally requires surgery. Rarely, in the most sedentary and low-demand patients, bracing and rehabilitation will diminish the instability complaints. For most other patients, a very involved surgical reconstruction is required. Because surgical correction involves the rebuilding of several ligaments, the surgeon often will utilize grafts or tendon tissue from cadavers or human donors.
The surgical reconstruction takes a dedicated team and is technically demanding. This type of surgery is best performed by surgeons with experience with these procedures and one that performs a number of these procedures annually. The surgeon will use the arthroscope, a small instrument that is inserted into the knee and connected to a camera and monitor. Often, several of the ligaments will require reconstruction, including the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and collateral ligaments
The surgeon will use the arthroscope to create tunnels in the thigh and tibia bone with a small drill, allowing the grafts to be placed into the knee and re-creating the torn ligaments. It takes nearly three months for the re-created ligaments to get really strong. That is why most patients will have to use crutches for 6 to 8 weeks and why the rehabilitation is typically much slower than for a single ligament injury.
Because the surgery is very extensive, the risk of complications is higher. The most common complication is recurrent instability. On the opposite spectrum, patients may develop stiffness or loss of motion. Rarely will the patient require a manipulation or a repeat arthroscopic procedure to remove scar tissue. Because the surgery is performed around major nerves and blood vessels, injury to these structures can occur, which may demand additional surgical treatment, although rare.