Multiligamentous Knee Injury 

Anatomy

The knee joint is the junction between the femur (thigh) bone and the tibia (shin bone). The end of the femur is referred to as the distal femur and the top of the tibia is referred to as the proximal tibia or tibial plateau.  The kneecap is referred to as the patella. The knee is said to have three compartments – medial (inside), lateral (outside), and patellofemoral (directly behind the patella).  Articular cartilage covers the end of the femur, top of the tibia, and behind the patella and allow the bone to glide easily with one another. A ligament is a tight band of tissue that connects bone to bone and helps to increase stability. The knee has a ligament on the inside (medial) and outside (lateral) of the knee called collateral ligaments (MCL and LCL). In the center part of the knee there are two ligaments that cross each other known as cruciate ligaments. One is the anterior cruciate ligament (ACL) and the other is the posterior cruciate ligament (PCL). The menisci are C-shaped structures that function as shock absorbers between the femur and the tibia. There is one on the inside (medial side) of the knee and one on the outside (lateral side).

What is a Multiligamentous Knee Injury?

A multiligament knee injury is an two 2 or more ligaments of the knee. When both the ACL and PCL are involved, then the injury is also referred to as a knee dislocation which can be potentially life- and limb-threatening as it can cause damage to blood vessels and nerves.  These injuries usually happen either during sporting events or from high energy mechanisms like a fall or motor vehicle collision.

Diagnosing a Multiligamentous Knee Injury

A thorough patient history and physical exam can help to identify patients with a suspected multiligamentous knee injury. X-ray images including stress x-rays and MRI are useful diagnostic tools to help rule out other injuries and to confirm the diagnosis. 

Treatment for Multiligamentous Knee Injury

• Ensure the knee is reduced.

• Go to the emergency department immediately for neurovascular assessment.

• Stabilize the knee.

• Surgery generally within the first couple of weeks. Although it may require multiple surgeries depending on the knee injury.