The knee is one of the largest and strongest joints in the human body. Vital for multi-directional movement, the knee connects the thigh-bone (the femur) to the leg bone (the tibia). Most of this connecting mechanism is accomplished through ligaments.
Ligaments are made up of strong, dense connective tissue and are crucial to maintaining knee stability. They are what allow the knee to perform movements such as walking, bending, running, turning, pivoting, etc. There are four main ligaments that stabilize the knee:
The anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL): These ligaments are located on the inside of the knee and form an “X” in order to prevent the knee joint from sliding back and forth (up and down).
The medial collateral ligament (MCL) and the lateral (fibular) collateral ligament (FCL or LCL): These ligaments are located on the sides of the knee and prevent the joint from moving side-to-side.
Knee ligament injuries that involve a ligament tear are very common, especially among athletes. Soccer, football, basketball, skiing and gymnastics produce the most knee ligament injuries. While most ligament injuries involve a single ligament, such as an ACL tear or MCL tear, when a major force or trauma is placed on the knee, multiple ligaments can be affected. For example, motor vehicle accidents, a hard crash on snow skis or a severe tackle on the football field can all result in complex knee injuries.
When multiple ligaments of the knee are injured, oftentimes, other problems are occurring such as a dislocated knee or a fracture. Special attention will be needed by an orthopedic surgeon to surgically reconstruct the tears of the various ligaments.
A careful clinical exam and the use of stress x-rays are very useful, especially when there is a chronic injury or in the case of traumatic knee injuries. In these injuries, a patient’s alignment must be assessed, especially for chronic injuries, and a high quality MRI scan should be obtained to look for any concurrent cartilage or meniscus injuries.
Non-operative treatment may be suggested initially when there is a concurrent ACL and low grade medial sided knee injury to allow the MCL to attempt to heal first. When there is more than this amount of instability present in the knee, Dr. Savadekar will usually recommend a concurrent or two staged multiple ligament reconstruction. The basic principles followed for multi-ligament knee injuries are to attempt a secure and well-positioned anatomic reconstructive procedure, whereby one can start early range of motion to minimize the chance of the patient developing stiffness and scaring around the knee. It is proven that this ultimately leads to decreased function and osteoarthritis and our goal is to help patients return to their highest level of functioning.
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