The Torn Knee: Understanding Multiligament Knee Injuries

A multiligament knee injury occurs when two or more of the ligaments in the knee are damaged or torn, typically due to high-impact trauma or sudden force. The knee is a complex joint, and understanding its structure and the role of the ligaments is key to grasping the significance of multiligament injuries.

Firstly, let us have a look at the anatomy of the knee and the ligaments that contribute in stabilising them. The knee is stabilized by four primary ligaments: the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL). These ligaments work together to maintain joint stability, control motion, and protect against injury. The ACL and PCL are crucial for controlling forward and backward movement of the tibia (shin bone) in relation to the femur (thigh bone), while the MCL and LCL help stabilize the knee against side-to-side stresses.

So what causes these injuries and who are at risks?

Multiligament knee injuries are often the result of high-energy trauma, such as motor vehicle accidents, contact sports (e.g., football, soccer, or skiing), or accidents involving falls from significant heights. The combination of forces applied to the knee joint during such events can cause severe damage to the ligaments, bone, and cartilage, making these injuries particularly serious. It is not uncommon for these injuries to be associated with fractures around the knee joint. In these instances, fracture union takes precedence over ligament reconstruction.

Certain individuals may be more prone to multiligament knee injuries, including athletes who participate in high-risk sports or individuals with pre-existing knee instability or previous knee injuries. Additionally, people with insufficient muscle strength around the knee joint or poor proprioception (the body’s ability to sense its position in space) may be at greater risk for sustaining such injuries.

What are the symptoms and how are they diagnosed?

The symptoms of a multiligament knee injury can vary depending on the severity and the specific ligaments involved. Common symptoms include:

- Severe knee pain, especially during movement or weight-bearing activities

- Swelling and bruising around the knee

- Instability or the sensation that the knee may "give way"

- Limited range of motion due to pain or swelling

To diagnose a multiligament injury, doctors typically perform a physical examination and may use imaging techniques such as X-rays, MRI, or CT scans to assess the extent of the damage to the ligaments, bones, and cartilage. An MRI is particularly useful for visualizing soft tissues like ligaments and tendons.

 How are such injuries treated?

Treatment for a multiligament knee injury often involves a combination of surgery, rehabilitation, and physical therapy. In most cases, surgery is required to repair the damaged ligaments and restore knee stability. Surgical options may include ligament reconstruction, tendon repair, and cartilage restoration, depending on the extent of the damage.

After surgery, rehabilitation is critical to regain strength, flexibility, and function in the knee joint. Physical therapy focuses on improving range of motion, strengthening the muscles around the knee, and restoring balance and coordination. The recovery process can be lengthy, often taking 6 to 12 months or longer, depending on the severity of the injury and the individual’s progress.

In some cases, conservative treatments such as bracing, rest, ice, compression, and elevation (R.I.C.E.) may be used in less severe injuries, although surgery is typically the preferred method for restoring full function.

Multiligament knee injuries are serious and complex conditions that require prompt diagnosis and careful management. These injuries often involve long recovery times and may require a combination of surgical intervention and rehabilitation to restore knee function. With the right approach to treatment and rehabilitation, many individuals can return to their normal activities and regain full mobility, although the recovery process can be challenging and demands patience and commitment.