Multi-Ligament Knee Injuries
A multi-ligament knee injury happens when two or more ligaments in the knee are damaged.
The Knee Ligaments:
- Cruciate Ligaments: These are in the center of the knee and control front-to-back movement as well as some rotational movement. The anterior cruciate ligament (ACL) is in the front, and the posterior cruciate ligament (PCL) is in the back.
- Collateral Ligaments: These stabilize the knee during side-to-side movement. The medial collateral ligament (MCL) is on the inner side, and the lateral collateral ligament (LCL) is on the outer side.
- Other Ligaments and Tendons: These help with the rotation of the shin bone. They include the posterior oblique ligament (POL) on the inside, and the popliteus tendon and popliteofibular ligament on the outside.
- Oblique Posterior Ligament: This important ligament at the back of the knee helps prevent the shin bone from bending the wrong way.
Knee Dislocation: This term refers to a serious injury where both cruciate ligaments (ACL and PCL) are damaged and usually a collateral ligament as well. The knee becomes very unstable and can cause severe damage to blood vessels and nerves, making it a medical emergency.
- Sports-Related: This type of dislocation can occur during sports activities and needs immediate attention to put the knee back in its normal position.
- High-Energy Dislocations: These occur from severe impacts, like car or motorcycle accidents or high energy falls or trauma, and can cause significant damage to the skin, muscles, tendons, nerves, and blood vessels.
- Pain: The knee may hurt, ranging from mild to severe.
- Swelling: The knee may swell up.
- Stiffness: It may be hard to fully bend or straighten the leg.
- Instability: The knee might feel unstable, as if it can’t support your weight.
- Bruising: You may see bruises around the knee, often on the inside.
- Difficulty Walking: Walking may be painful or difficult.
- Popping or Clicking: Some people hear a popping or clicking sound when the injury happens.
Emergency Care: If you suspect a knee dislocation, go to the emergency room right away. We need to check the skin, muscles, blood flow, nerves and overall condition of the knee.
Checking for Artery Injury: The popliteal artery, which supplies blood to the lower leg, runs in the back of the knee. A dislocation can damage this artery, affecting blood flow to the entire leg below the knee. If there’s concern about artery damage, a CT angiogram might be done to see if the artery is injured. During this CT, dye is injected into your vessels to have good visualization of the artery to determine if there is any damage.
After Initial Care: Once the knee is put back into its proper place and it has been confirmed that there is no damage to the artery and nerves, we examine the knees stability. If it continues to pop out of place you might need a cast, brace or temporary fixation with an external fixation device. This device puts pins into your bone and holds the knee in the proper position with long rods outside of your body until your tissue heals. If it’s stable, we will perform a physical exam and order an MRI to check the condition of the cartilage, ligaments, and menisci. Stress X-rays might also be taken to precisely measure and diagnose the extent of the injury and determine which ligaments may need a future reconstruction or repair.
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