Multiligament Injury

Multiligament Injury - Melbourne Knee Surgery

What is a multiligament knee injury?

A multiligament knee injury is when two or more of the ligaments of the knee have been injured. These types of injuries are uncommon and require a significant force to occur. Patients are often involved in a high-velocity sporting event or a motor vehicle accident.

As the knee can partially or fully dislocate during this injury, various ligaments can be damaged. These include:

In addition, the posterolateral corner, common peroneal nerve, and popliteal artery can also be injured at the time of the traumatic event.

Popliteal artery injury

With a knee dislocation, the blood vessels behind the knee joint can be damaged. This is a surgical emergency because the circulation of blood to the leg can be compromised.

Common peroneal nerve injury

The nerve (common peroneal nerve) on the outside of the knee joint can get stretched during the injury. This may cause weakness in the foot (foot drop) and altered sensation in the affected leg.

What are the symptoms of a multiligament knee injury?

Patients may present with swelling around the knee joint. The knee may feel wobbly to walk on. The knee may look abnormal, as the knee joint is still dislocated.

How do you treat a multiligament knee injury?

A multiligament knee injury is a complex problem that requires treatment by a knee specialist. The first priority is to ensure that the knee joint is back in position (enlocated) and that the blood supply is not compromised.

Sometimes, if the knee joint is highly unstable due to multiple ligament ruptures, an external frame may be used to hold the knee joint in its normal position.

If there are any concerns about the blood supply to the leg, a vascular surgeon will assess you and may either request a CT scan of the blood vessels or will perform an angiogram (an injection of dye into the blood vessels followed by an X-ray). If necessary, they will advise you about further procedures to restore the blood supply to the leg.

Once the knee is in position and the blood supply is not compromised, an MRI scan of the knee will be conducted to assess the extent of the damage. Depending on the scan, a repair and/or reconstruction of the affected ligaments will ideally take place within 3 weeks of the injury. If some ligaments are only partially torn, there may be a need to brace the knee to assist healing. 

Sometimes, the operation is performed in a single sitting, and other times the operation is staged (i.e., 2 sittings). Mr Pai will advise you which option is likely based on clinical examination of the knee and the investigations. 

What does surgery for a multiligament knee injury involve?

Most patients with a significant multiligament knee injury will require surgery. Sometimes the MRI scan may not reveal the true nature of the injury, and you may need a general anaesthetic so your knee can be examined for the degree and direction of instability.

Following the results of the examination and the MRI findings, an operative plan will be made that will involve repair and/or reconstruction of the damaged ligaments. Mr Pai will discuss the plan with you during the consultation, as specific advice is outside the scope of this information guide.

How long is recovery after a multiligament knee injury?

A multiligament knee injury is a serious injury with long-term consequences. Patients can experience arthritis, stiffness, pain, ongoing instability, and inability to return to a preinjury level.

A combination of good operative planning and execution with appropriate rehabilitation can still allow a significant proportion of patients to resume sporting activities. A detailed discussion of your prognosis will be part of your consultation with Mr Pai.

In general, the recovery time is 9-12 months before returning to full and unrestricted activities.