Multiligament Knee Reconstruction

Overview
The knee is stabilized by several important ligaments: the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL). High-energy injuries, such as sports accidents, falls, or motor vehicle crashes, can damage more than one of these ligaments at the same time. This is called a multiligament knee injury. When multiple ligaments are torn, the knee becomes highly unstable, making activities like walking or climbing stairs difficult. Multiligament knee reconstruction restores stability by repairing or reconstructing the injured ligaments to help patients regain function and return to an active lifestyle.

Factors Influencing Outcomes
Several factors can affect recovery after multiligament knee reconstruction:

• Severity of injury: Damage to other structures in the knee, such as cartilage, meniscus, or nerves, can impact overall recovery.

• Timing of surgery: Surgery is often delayed until swelling improves and knee motion is restored, to reduce complications and improve outcomes.

• Patient factors: Younger, active patients and those who commit to physical therapy tend to have better results.

The Shift Toward Early Comprehensive Reconstruction
Historically, multiligament injuries were treated in stages or with non-operative approaches. Today, research supports early comprehensive reconstruction of all injured ligaments in a single surgery or staged approach depending on the specifics of the injury. This approach restores stability more effectively, protects the cartilage and meniscus from further damage, and gives patients the best chance at returning to their desired activities.

The Procedure
Multiligament knee reconstruction is typically performed using a combination of tendon grafts — either from the patient (autograft) or from a donor (allograft). Multiple ligaments are reconstructed during the same surgery, and careful attention is paid to restore the correct tension and alignment of each ligament. Surgical techniques involve creating small tunnels in the bone to anchor the grafts securely and rebuild the knee's natural stability.

Graft Choice: Autograft vs. Allograft
For multiligament injuries, we often recommend the use of allograft tissue (donor grafts). Studies have shown that allografts provide reliable outcomes while avoiding the need for multiple tissue harvests from the patient’s own body, which helps reduce surgical time and avoids added pain or weakness from graft site harvesting.

Addressing Associated Injuries
Multiligament knee injuries often involve more than just torn ligaments. It is common to see associated injuries, such as:

• Meniscus tears or cartilage damage: These injuries may require repair at the time of reconstruction to protect the long-term health of the knee.

• Nerve or blood vessel injuries: In severe trauma cases, damage to nearby nerves or vessels requires immediate attention before ligament reconstruction can be performed.

• Alignment issues: In rare cases, if there is abnormal alignment of the leg bones, additional procedures such as an osteotomy (bone realignment surgery) may be recommended to optimize knee function and protect the reconstructed ligaments.

Your surgeon will develop a personalized plan based on the specific patterns of injury identified on physical examination and imaging.

Recovery Process

• Initial Phase (0–6 Weeks): The knee is protected in a brace, and weight-bearing is gradually introduced. Physical therapy focuses on regaining motion while protecting the healing ligaments.

• Intermediate Phase (6–12 Weeks): Therapy progresses to muscle strengthening and balance exercises. Bracing and activity restrictions continue to protect the repair.

• Advanced Phase (3–6 Months): Therapy becomes more aggressive, focusing on advanced strength, stability, and preparing for a return to sport or demanding activities.

• Full Recovery: Return to full sports or high-demand activities is often expected around 9–12 months, depending on progress and associated injuries.

Risks and Considerations

• Risk of knee stiffness or loss of motion.

• Possibility of graft failure or loosening over time.

• Risk of persistent instability, especially if rehabilitation is not followed closely.

• Rare risk of infection, nerve, or blood vessel injury during surgery.

• Possibility of needing additional procedures to address cartilage damage, alignment concerns, or hardware removal.

Conclusion
Multiligament knee reconstruction is a complex but highly effective surgery designed to restore knee stability and help patients return to their normal activities. If you have suffered a multiligament knee injury, contact our office for a comprehensive evaluation and personalized treatment plan.