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Multiligament Knee Injuries

Multi ligament knee injuries while rare can be profoundly disabling. In addition to ligament injury, these injuries frequently involve damage to the meniscus, cartilage, nerves and blood vessels. Multi ligament knee injuries are complex and must be addressed with a comprehensive diagnosis workup and treatment plan.

Multi ligament knee injuries are defined as a tear of at least two of the four major ligaments in the knee: the anterior cruciate ligament, the posterior cruciate ligament, medical collateral ligament and the lateral collateral ligament.

Multi ligament knee injuries can occur through various mechanisms, including high-energy traumas such as motor vehicle accidents, significant falls, or sports-related injuries where there is a high force or impact applied to the knee, often involving a combination of twisting, bending, and/or a direct blow.

A comprehensive clinical assessment is vital to determine the extent of the ligament injuries, and to determine whether there are other injures to the cartilage, meniscus or nerves and blood vessels. Dr. Masi will review your medical history and the history of the injury. He will order stress X-rays and an MRI in order to evaluate the soft tissues for damage and determine the most optimal treatment strategy.

During the orthopedic examination he will test the function of the ligaments, review the x-rays and compare them to the uninjured knee. He will also examine the MRI results to identify ligament tears and meniscus damage.

The objective of treatment is to improve long-term knee stability and function. Surgical repair and ligament reconstruction are the treatments of choice. The goal is to reproduce the native anatomy to obtain superior stability.

Nonsurgical management

Treatment options depend on factors such as the patient’s advanced age, additional trauma, comorbid conditions and poor compliance. In these cases, nonsurgical management that includes bracing, physical therapy and activity modification may be the best option. The goal is to reduce pain and inflammation and to improve function and knee stability.

Acute single-stage ligament reconstruction

Acute surgery for severe injuries is considered to be within three weeks of the injury, but surgery may be delayed if there is life threatening trauma or excessive damage. Studies report that early ligament reconstruction surgery provides the best outcomes.  If surgery is delayed, a brace will be placed.

Early single-stage anatomic ligament reconstruction involves the use of autografts from the patient which has been shown to be the best option for restoring knee function. Reconstruction surgery is necessary to establish stability to allow functional rehabilitation which begins on day one after surgery with a focus on range of motion. The first six weeks after surgery the knee is nonweightbearing and is immobilized. After that the patient will wear a hinged brace for about six months

Because of the severity of these injuries, patients are also at risk for complications, including stiffness, persistent instability, pain, and post-traumatic arthritis.

Recovery from multiligament knee reconstruction typically requires 9-12 months with rehabilitation focused on rebuilding muscle strength and restoring balance, cardiovascular fitness, power and athletic capacity.

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