Multi-ligament Injuries

Ligaments are fibrous bands of tissue that connect the bones in a joint and stabilize the joint. The knee joint has 2 sets of ligaments: 

  • Collateral ligaments: The medial and lateral collateral ligaments connect the bones on the inner and outer side of the knee.
  • Cruciate ligaments: The anterior cruciate ligament and posterior cruciate ligament are present inside the joint.

A multi-ligament injury is an injury where two or more ligaments are damaged. Such damage can lead to joint dislocation.

Multi-ligament injuries in adults

Multi-ligament injuries can occur as a result of major trauma such as a direct blow to the knee, a fall from a height or motor vehicle accident. Patients with multi-ligament knee injuries may experience pain, swelling, limited range of motion, injuries to the nerves and arteries of the leg, and knee instability.

Most multi-ligament knee injuries require surgery to reconstruct the ligaments. This serious and complex injury may require more than one surgical procedure to stabilize the knee. Ligaments are reconstructed using a graft taken from the patient or donor tissue to create a new ligament. Surgical reconstruction is usually performed using an arthroscope. Tunnels are created in the thighbone and tibia using a small drill to allow the grafts to be placed into the knee and replace the torn ligaments. After the grafts are placed, screws, washers and other fixation devices are used to secure the grafts in place and help hold the ligament in place until healing takes place. After a multi-ligament knee reconstruction, crutches may be required for 6 to 8 weeks.

Following multi-ligament knee reconstruction, the most common complications include recurrent instability, stiffness, loss of motion, scar tissue formation, and injury to nerves and blood vessels.

Multi-ligament injuries in children

The skeletal system in children is immature when compared to adults. Children have epiphyseal plates (physis) or growth plates at the ends of long bones, which are areas of growing tissue. Made up of cartilage, these regions are weak when compared to the fully formed bones found in adults. Growth plate injuries commonly occur in growing children and teenagers.

Traditionally, most multi-ligament knee injuries require surgery to reconstruct ligaments, which involves drilling holes in the bone through the area of the growth plate. In a skeletally immature child, the growth plates are open. Therefore, other treatment options such as physeal-sparing surgery, a reconstruction procedure that avoids drilling holes through the growth plate, may be done.

You can discuss with your doctor the treatment options that would best suit you and your child.