Introduction
Ligaments are fibrous tissue bands that connect bones and stabilize joints. The knee joint has four major ligaments:
- Anterior cruciate ligament
- Posterior cruciate ligament
- Lateral collateral ligament
- Medial collateral ligament
A multi-ligament knee injury involves injury to two or more ligaments of the knee. These injuries are usually high energy in nature such as motor vehicle accidents, severe fall from height, or during sports such as skiing and football.
Multi ligament knee injury requires reconstruction surgery to rebuild the damaged tissues and prevent problems associated with an unstable knee such as premature osteoarthritis.
Symptoms
Patients with multi-ligament knee injuries may experience pain, swelling, limited range of motion, injuries to nerves and arteries of the leg, as well as knee instability.
Diagnosis
The main problem in diagnosing patients with multiple ligament tears is to accurately detect which ligaments are torn, and the extent of the tears.
The diagnosis starts with a comprehensive clinical evaluation by an orthopedic surgeon.
The main imaging techniques which are employed for the diagnosis are knee X-rays and MRI scan of the joint. In addition, functional testing can be performed during an arthroscopic examination, before the surgical reconstruction, to help confirm the results of the diagnosis. This testing includes tests such as “gap test” which measures the space between the femur and tibia.
Contraindications for reconstructive knee surgery include previous knee joint infection, reflex sympathetic dystrophy, complex regional pain syndrome, and morbid obesity.
Procedure
The surgery is performed with the patient under general anesthesia. Multiligament knee reconstruction is usually performed arthroscopically through tiny incisions with the use of an arthroscope and small surgical instruments. This minimally invasive approach results in faster recovery and smaller incisions.
During multiligament knee reconstruction surgery, ligaments that are avulsed (pulled from the bone) are reattached to the bone using special sutures. When a ligament is ruptured it may be reconstructed using a graft taken from the patient (autograft) or donor tissue (allograft).
Your surgeon will create a tunnel in the thigh and tibia bone using a small drill. Your surgeon then inserts the grafts into the tunnel to replace the torn ligaments.
After the grafts are placed, fixation devices are used to secure the grafts and hold the ligament in place until healing occurs.
Postoperative Care
Following the surgery, you will be given pain medication to keep you comfortable. Physical therapy will be recommended for restoration of normal knee motion and muscle strength after surgery. You will be required to use crutches and a knee brace for 6 to 8 weeks with minimal or no weight-bearing during this time.
Risks and complications
As with any surgery, there are risks and complications that may occur following multiligament knee reconstruction surgery. These can include:
- Complications of the anesthesia
- Bleeding
- Infection
- Vascular or nerve injury
- DVT Deep Vein Thrombosis (blood clot)
- Compartment syndrome
- Failure of the repair
Summary
Multiligament knee reconstruction is a surgical procedure for treating multiple ligament injuries of the knee joint which occur as a result of major trauma such as a direct blow to the knee or falls from a height or motor vehicle trauma. It can be performed through minimally invasive surgery rather than through a traditional open incision.
