Multiligament injury treatment

What is involved?

Knee multiligament injury represents the more severe end of damage to a knee joint.  It is normally caused by a dislocation of the knee joint  as a result of a very significant mechanism of injury.  You will often therefore be treated as an inpatient having been admitted to hospital via accident and emergency.  Multiligament reconstruction is performed by knee surgeons with a special interest in this area as it represents complex and specialised surgery.  The evidence would now support early surgical reconstruction of multiligament injured knees rather than a non-operative course of treatment.  This is to allow the stability of the knee joint to be returned and therefore functional outcomes are maximised.  Surgery would involve reconstruction or repair of the damaged ligaments which may be two, three or in some cases four ligaments.  There are often associated injuries such as cartilage damage or tendon damage that may also require operative intervention at the same time.  Each surgery is bespoke depending on the level of injury but in general terms, a mixture of open and arthroscopic surgery to anchor ligaments back in to place or reconstruct them with donor graft tissue is required.

 

Why might I need a multiligament reconstruction? 

Multiligament reconstruction is carried out to improve the stability of the knee following major injuries such as knee dislocation. 

 

What happens after surgery?

The recovery from multiligament surgery is difficult and protracted and is variable dependent on the severity of the injury and operations you require.  Bracing regimes and the use of crutches to reduce weight bearing and intensive physiotherapy are normally required but will be adjusted and planned carefully to provide the optimum outcome from your specific circumstances.

 

Recovery milestones:

Weeks 0-2: Over this period you must keep the wounds clean and dry, use ice and anti-inflammatories to reduce swelling and help you regain your range of movement. 

Weeks 2-12: Over this period physiotherapy will become more intensive.  Initial stages look at improving the range of movement achieving full extension and flexion beyond 120º whilst preventing swelling and effusion. Gradually you will begin full weight bearing and may cycle and swim as appropriate.

Weeks 12-24: Over this period your physiotherapist will work with more proprioceptive and plyometric activities to improve muscle strength and coordination and allow you to gradually return to running.

Weeks 24 and beyond: Dependent on the severity of your injury and the level of activity that you want to return to, your physiotherapy team will work on sport-specific exercises and you will return to your activities.

 

Frequently asked questions 

Will I need a brace following surgery?

In the majority of cases the posterior cruciate ligament is involved in multiligament injuries and following reconstruction of this, we will normally recommend a brace to hold the tibia in the correct position and allow the posterior cruciate ligament repair or reconstruction to heal at the optimum tension.  You will normally be allowed to weight bear in the brace with the assistance of crutches.

When will I be able to return to work/sport?

This is normally dependent on the significance of your injury and the work you wish to return to.  As a ballpark figure, if you wish to return to a manual job, it may be that you require 3-4 months off work. 

What type of grafts are used for ligament reconstruction?

The graft choice for your ligament surgery will be dependent on the combination of injuries and the availability of undamaged tissue.  Sometimes ligaments can be directly repaired after multiligament injuries and supported with an internal brace (strong tape).  On other occasions donor grafts are required which can either be taken from your own tendons (quadriceps/hamstrings) or from a cadaveric donor.  Your treating surgeon will discuss the best combination of grafts dependent on the type of injury you have sustained.