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Multi-ligament Injuries

Multi-ligament injury in Adults

Ligaments are the fibrous tissue bands connecting the bones and stabilizing the joint. The knee joint has 2 sets of ligaments–collateral ligaments (medial and collateral ligaments) that connect the bones on the inner and outer side of the knee and cruciate ligaments (anterior and posterior cruciate ligament) which attach inside the joint. Multi-ligament injury is injury to multiple ligaments at the same time. Damage to three or more ligaments may cause joint dislocation.

Multi-ligament injuries occur as a result of major trauma such as a direct blow to the knee, a fall from height or Road Traffic Collision (RTC).

Patients with multi-ligament knee injuries may experience pain, deformity, swelling, limited range of motion, injuries to nerves and arteries of the leg, and will have an unstable knee.

Most multi-ligament knee injuries will require surgery to reconstruct 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 frequently donor tissue to create a new ligament. Surgical reconstruction is usually performed using an arthroscope, during which tunnels are created in the femur and tibia using a small drill to allow the grafts to be placed into the knee and to replace the torn ligaments. After the grafts are placed, screws, washers, and other fixation devices are used to secure the grafts in place and to help hold the ligament in place until healing takes place. After multiligament knee reconstruction, crutches and a knee brace may be required for 6 to 8 weeks.

Following multiligament 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 injury in Children

The skeletally immature knee differs slightly from the adult knee and may result in mild variations of injury patterns. In children the physeal plates (growth plates or physis) are weak compared with ligaments in the adults. The growth plate is the area of growing tissue made up of cartilage found at the ends of the long bones in children.Therefore any large traumatic force on the knee may cause physeal injury rather than ligament injury.

Growth plate injuries commonly occur in growing children and teenagers. Traditionally most multi-ligament knee injuries require surgery to reconstruct ligaments that involves drilling holes in the bone through the area of the growth plate. In a skeletally immature child the growth plates are open meaning that growth disturbance may result from growth plate damage. Therefore other treatment options, especially physeal-sparing surgery, a reconstruction procedure that avoids drilling holes through the growth plate may be required.

You will need to discuss the treatment options with your surgeon prior to making a decision that you and your child will be comfortable with.

RCS Logo British Orthopaedic AssociationRoyal College of Surgeons of EdinburghOTSISBritish Association for knee surgeryISOAMDU LogoOTSIS