November-December . 2024 | The HEALTH

Understanding multi-ligament knee injuries

BONE TO PICK

Dr Jonas Fernandez is an Orthopaedic Surgeon at Putrajaya Hospital . He is also a member of the Malaysian Arthroscopy Society ( MAS ).

MULTI-LIGAMENT knee injury occurs when two or more of the ligaments in the knee are damaged or torn , typically due to highimpact trauma or sudden force .

The knee is a complex joint , and understanding its structure and the role of the ligaments is critical to grasping the significance of multi-ligament injuries .

Firstly , let us have a look at the anatomy of the knee and the ligaments that contribute to stabilising them . The knee is stabilised by four primary ligaments : the anterior cruciate ligament ( ACL ), posterior cruciate ligament ( PCL ), medial collateral ligament ( MCL ), and lateral collateral ligament ( LCL ).

These ligaments work together to maintain joint stability , control motion , and protect against injury . The ACL and PCL are crucial for controlling forward and backward movement of the tibia ( shin bone ) in relation to the femur ( thigh bone ), while the MCL and LCL help stabilise the knee against side-toside stresses .

So , what causes these injuries , and who are at risk ?

Multi-ligament knee injuries are often the result of high-energy trauma , such as motor vehicle accidents , contact sports ( e . g ., football , soccer , or skiing ), or accidents involving falls from significant heights .

The combination of forces applied to the knee joint during such events can cause severe damage to the ligaments , bone , and cartilage , making these injuries particularly serious .

HIGH-RISK SPORTS

It is not uncommon for these injuries to be associated with fractures around the knee joint . In these instances , fracture union takes precedence over ligament reconstruction .

Specific individuals may be more prone to multi-ligament knee injuries , including athletes who participate in high-risk sports or individuals with pre-existing knee instability or previous knee injuries .

Additionally , people with insufficient muscle strength around the knee joint or poor proprioception ( the body ’ s ability to sense its position in space ) may be at greater risk for sustaining such injuries .

MRI IS BENEFICIAL

What are the symptoms , and how are they diagnosed ?

The symptoms of a multi-ligament knee injury can vary depending on the

“ The recovery process can be lengthy , often taking six to 12 months or longer , depending on the severity of the injury and the individual ’ s progress .” severity and the specific ligaments involved . Common symptoms include :

• Severe knee pain , especially during movement or weight-bearing activities .

• Swelling and bruising around the knee .

• Instability or the sensation that the knee may “ give way ”.

• Limited range of motion due to pain or swelling . To diagnose a multi-ligament injury , doctors typically perform a physical examination . They may use imaging techniques such as X-rays , MRI , or CT scans to assess the extent of the damage to the ligaments , bones , and cartilage .

An MRI is beneficial for visualising soft tissues like ligaments and tendons . So , how are such injuries treated ? Treatment for a multi-ligament knee injury often involves a combination of surgery , rehabilitation , and physical therapy . In most cases , surgery is required to repair the damaged ligaments and restore knee stability .

Surgical options may include ligament reconstruction , tendon repair , and cartilage restoration , depending on the extent of the damage .

After surgery , rehabilitation is critical to regain strength , flexibility , and function in the knee joint . Physical therapy focuses on improving the range of motion , strengthening the muscles around the knee , and restoring balance and coordination .

The recovery process can be lengthy , often taking six to 12 months or longer , depending on the severity of the injury and the individual ’ s progress .

In some cases , conservative treatments such as bracing , rest , ice , compression , and elevation ( RICE ) may be used in less severe injuries . However , surgery is typically the preferred method for restoring full function .

Multi-ligament knee injuries are severe and complex conditions that require prompt diagnosis and careful management .

These injuries often involve lengthy recovery times and may require a combination of surgical intervention and rehabilitation to restore knee function .

With the right approach to treatment and rehabilitation , many individuals can return to their normal activities and regain full mobility . However , the recovery process can be challenging and demands patience and commitment . – The HEALTH