A multi-ligament knee injury involves tears of multiple major knee ligaments and may occur with a knee dislocation. The four major knee ligaments are the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL).
Knee dislocations usually involve injury to both cruciate ligaments and one collateral ligament. Injury to multiple ligaments can make sports and even day-to-day activities difficult.
What Is a Multi-Ligament Knee Injury?
The knee is stabilized by four major ligaments: the ACL, PCL, MCL, and LCL. These ligaments help maintain the normal relationship between the femur (thigh bone) and tibia (shin bone).
A knee dislocation involves injury to multiple ligaments, usually three of the four major knee ligaments. Knee dislocations usually require injury to both cruciate ligaments and one collateral ligament.
Causes and Risk Factors
A knee dislocation occurs when a force exceeds the strength of the ligaments. It usually results from a severe injury but may also occur from a non-contact injury, such as stepping in a hole, hyperextending the knee, or twisting.
Risk factors include:
- Sports that require pivoting, jumping, cutting, or changing direction, including basketball, gymnastics, soccer, and volleyball
- Contact sports such as football and rugby
- Sports on uneven terrain
- Motor vehicle accidents
- Poor physical conditioning, including strength and flexibility
- Improper equipment
Symptoms
Signs and symptoms may include:
- One or more pops heard or felt at the time of injury
- Inability to continue activity after the injury
- Knee swelling within six hours after injury
- Possible deformity of the knee
- Inability to straighten the knee
- Knee giving way or buckling
- Swelling with repeated episodes of giving way
- Occasional locking when there is an associated meniscus injury
- Rarely, numbness, weakness, or paralysis from nerve injury
- Discoloration or coldness of the foot and ankle from artery injury
Treatment
If the knee is dislocated, immediate reduction, or putting the knee joint back in place, and evaluation of artery and nerve function must be performed. An artery injury requires immediate surgical attention.
Initial treatment may include medications and ice to relieve pain and reduce knee swelling. Walking with crutches often is recommended, and bracing or casting may also be recommended initially.
Rehabilitation usually focuses on:
- Reducing knee swelling
- Regaining knee range of motion
- Regaining muscle control and strength
- Functional training
- Bracing
- Avoiding sports and activities that require pivoting, cutting, changing direction, jumping, and landing
Properly timed surgical repair or reconstruction of one or more injured ligaments may provide the best chance for an optimal result.
Nonsteroidal anti-inflammatory medications such as aspirin and ibuprofen, or other minor pain relievers such as acetaminophen, are often recommended as directed by a physician. Stronger pain relievers may be prescribed when necessary.
Cold can be used to relieve pain and reduce inflammation. It may be applied for 10 to 15 minutes every two to three hours and immediately after activities that aggravate symptoms. Heat may be used before stretching and strengthening activities prescribed by a physician, physical therapist, or athletic trainer.
Recovery and Outcomes
If untreated, a knee dislocation usually results in knee instability and recurrent injuries during sports and often during daily activities.
Injuries to the arteries or nerves can occur and carry a higher risk of poor outcomes. Surgery is often required to restore knee stability.
Some athletes do not return to sports after this injury. Prognosis is better when there is no injury to the arteries or nerves and early surgery is performed to repair or reconstruct the injured ligaments.
Potential complications may include recurrent instability and swelling, meniscus injury, injury to bone or articular cartilage, knee arthritis, knee stiffness, permanent nerve or artery injury, and in severe cases, amputation resulting from nerve or artery injury.
When to See Dr. Chudik
A knee dislocation requires immediate evaluation, including assessment of artery and nerve function. Artery injury requires immediate surgical attention.
Call 630-324-0402, request an appointment online, or email contactus@chudikmd.com.