About
The ligaments in and around the knee are one of the main reasons for the stability. There are 4 ligaments around the that provide stability to the knee joint. They are ACL, PCL, MCL and LCL - (ACl- Anterior Cruciate ligament, PCL- Posterior Cruciate Ligament, MCL- Medial collateral ligament, LCL- Lateral collateral Ligament).
Normal tension within the ligament prevents abnormal movements within the knee joint
When one or more major ligaments of the knee is injured, it is termed as multiligamentous injury.
Such type of injury occur because of high velocity trauma like Road Traffic Accidents, however can also occur with low velocity trauma in susceptible individuals like obese or hyperlax patients.
These injuries are very important to diagnose because very often they are associated with blood vessel and nerve injury especially if associated with dislocation of the knee.
Figure 1 : Showing multi-ligaments (ACL,PCL,MCL,LCL) around the knee.
Figure 2: Pictorial illustration of multi-ligament knee injury.
Investigations
X-rays of the knee to rule out fractures and to check the knee alignment/ knee dislocation.
Figure 3: showing dislocation of knee at the time of presentation.
MRI of the knee will reveal the number of the ligaments that have been damaged & also other associated injuries like meniscus/cartilage injuries.
Treatment
Treatment for multi-ligaments is always surgical reconstruction. . Usually such grievous injuries can be treated with Arthroscopy and open ligament reconstructive procedure in combination.
The reconstruction may require autografts (patient’s own) harvested from the same or opposite knee or allografts (tissue bank).
Generally a waiting period of 10-14 days is required for the soft tissue swelling to subside before surgery. In cases associated with dislocation/very unstable knees, an initial external pin fixator is advisable initially followed by a staged reconstruction(surgery done twice) for the ligament reconstruction.
Figure 4: Pictorial illustration of ACL, PCL, LCL and MCL reconstruction.