Multiligament Knee Injuries
Multiligament Knee Injuries
Knee Anatomy
The knee is a complex joint of the body which is vital for movement. The four major ligaments of the knee are anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) and lateral collateral ligament (LCL). They play an important role in maintaining the stability of the knee. A multiligament injury is a tear in one or more ligaments of the knee, thus affecting the knee stability.
Types of Ligament Injuries
ACL tear
An ACL injury is a sports-related injury that occurs when the knee is forcefully twisted or hyperextended. An ACL tear usually occurs with an abrupt directional change with the foot fixed on the ground or when the deceleration force crosses the knee. Changing direction rapidly, stopping suddenly, slowing down while running, landing from a jump incorrectly, and direct contact or collision, such as a football tackle can also cause injury to the ACL.
MCL tear
The medial collateral ligament (MCL) is the ligament that is located on the inner part of the knee joint. It runs from the femur (thighbone) to the top of the tibia (shinbone) and helps in stabilizing the knee. Medial collateral ligament (MCL) injury can result in a stretch, partial tear, or complete tear of the ligament. Injuries to the MCL commonly occur because of pressure or stress on the outside part of the knee.
PCL tear
PCL injuries are very rare and are more difficult to detect than other knee ligament injuries. Cartilage injuries, bone bruises, and ligament injuries often occur in combination with PCL injuries. Injuries to the PCL can be graded as I, II or III depending on the severity of injury. In grade I, the ligament is mildly damaged and slightly stretched, but the knee joint is stable. In grade II, there is a partial tear of the ligament. In grade III, there is a complete tear of the ligament and the ligament is divided into two halves making the knee joint unstable.
The PCL is usually injured by a direct impact, such as in an automobile accident when the bent knee forcefully strikes the dashboard. In sports, it can occur when an athlete falls to the ground with a bent knee. Twisting injury or overextending the knee can cause the PCL to tear.
Causes of Multiligament Injuries
Such injuries occur because of a direct blow to the knee, or a fall from a height, or motor vehicle trauma. Multiple ligament knee injuries are common in athletes involved in contact sports such as soccer, football and basketball.
Symptoms of Multiligament Injuries
Patients with multiligament knee injuries may experience pain, swelling, limited range of motion, injuries to nerves and arteries of the leg, and knee instability.
Evaluation of Multiligament Injuries
Sometimes, knee pain due to other injuries results in involuntary movements that give the sensation of instability. A thorough examination by an experienced doctor is very crucial for the correct diagnosis of multiligament instability.
Treatment of Multiligament Injuries
Usually grade I (mild tear) and grade II (partial tear) multiligament injuries are treated conservatively with rest, ice, compression and elevation. But, treatment of grade III (complete tear) multiligament injuries requires surgery. Moreover, unlike grade III single ligament injury, the surgery is usually performed soon after the injury and often involves more than one surgery.
The surgical reconstruction is usually performed arthroscopically. The surgery involves reconstruction of the torn ligament using a tissue graft taken from another part of the body, or from a donor. The damaged ligament is replaced by the graft and fixed to the femur and tibia using metallic screws. Gradually, over a period of a few months, the graft heals.
After the multi-ligament knee reconstruction surgery, crutches may be required for 6 to 8 weeks. Most patients can also return to their high-level sport after a period of rehabilitation.
It is important to seek your doctor’s advice if you hear a popping noise or feel as if your knee has given way at the time of injury and if you are unable to move your knee because of severe pain.
