Multi-ligament treatment
What is involved?
A multi-ligament 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 injury. Patients with this degree of injury will often need to be admitted to hospital via accident and emergency.
Multi-ligament reconstruction is performed by knee surgeons with a special interest in this area, as it represents complex and specialised surgery. Evidence supports the benefits of early surgical knee reconstruction over non-surgical treatments for the best long term outcome.
Surgery would involve reconstruction or repair of the damaged ligaments. There are often associated injuries, such as cartilage or tendon damage, that may also require repair. Each surgery is bespoke, but will generally comprise a combination of open and arthroscopic surgery, to anchor ligaments back into place or reconstruct them with donor graft tissue.
Why might I need a multi-ligament reconstruction?
Multi-ligament reconstruction is carried out to improve the stability of the knee following major injuries, such as a knee dislocation.
What happens after surgery?
The recovery from multi-ligament surgery is difficult, protracted and variable, depending on the the severity of the injury and type of operation you require. The use of a brace and crutches to reduce weight-bearing, and intensive physiotherapy, are normally required and will be planned according to your specific circumstances.
Recovery milestones
Weeks 1 to 2: Wounds must be kept clean and dry. You will use ice and anti-inflammatories to reduce swelling and help you to regain your range of movement.
Weeks 2 to 12: Over this period physiotherapy will become more intensive. Initially we look to improve the range of movement, while preventing swelling and or damage to the wounds. Gradually, you will begin bearing your full weight on the leg, may cycle and swim.
Months 3 to 6: Your physiotherapist will work with more proprioceptive and plyometric activities which involve providing intensive input to the muscles and joints, to improve their muscle strength and coordination.
Month 6 and beyond: Depending on the severity of your injury, and the level of activity that you want to return to, your physiotherapy team will work on activity or sport-specific exercises.
Frequently asked questions
Will I need a brace following surgery?
In the majority of cases, the posterior cruciate ligament is involved in multi-ligament injuries. Following the reconstruction of this, we would normally recommend a brace, both to hold the tibia in the correct position and to allow the posterior cruciate ligament repair and the reconstruction to heal. 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 normally depends 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, you may require 3 to 4 months off work.
What type of grafts are used for ligament reconstruction?
The graft choice for your ligament surgery will depend on the combination of injuries, and the availability of your own undamaged tissue. Sometimes ligaments can be directly repaired after multi-ligament injuries, and supported with an internal brace. On other occasions, donor grafts are required, which can either be taken from your own tendons (quadriceps/hamstrings) or from a cadaveric (deceased) donor. Your surgeon will discuss the best combination of grafts for your particular case.
