Multiligament Injury Treatment Options
Immediate Steps After a Knee Dislocation
If a knee dislocation is suspected, it is important to seek emergency medical attention immediately. Upon arrival at the emergency room, doctors will conduct a thorough assessment of the knee and surrounding structures, including the skin, muscles, and arteries. Special attention is given to the popliteal artery, which runs behind the knee and can be compromised during a dislocation, risking the blood supply to the lower leg.
In cases where an artery injury is suspected, a CT angiogram may be ordered. This test involves injecting dye into the artery to visualize blood flow and detect any blockages or injuries to the vessel.
Once the knee is reduced, meaning the bones are aligned back into place, the stability of the joint is reassessed. If the joint remains unstable, doctors may apply a cast or use an external fixator, a device that holds the bones in place using metal pins and bars. Imaging tests such as an MRI are often conducted to evaluate the status of the ligaments, cartilage, and menisci.
In most cases, surgery should be performed within the first two weeks after a knee dislocation, provided that satisfactory range of motion has been restored. Surgery on a stiff knee can lead to poor outcomes, so it is important to regain mobility before proceeding with reconstruction.
While surgery is the preferred treatment for healthy individuals with good range of motion, it may not be possible for all patients, particularly those with other health issues like diabetes or kidney disease. Additionally, elderly patients or those with open fractures may not be ideal candidates for immediate surgery. However, for patients in good health, repairing all damaged ligaments in a single procedure typically yields the best results.
Surgical reconstruction of the knee after a dislocation often involves repairing or reconstructing multiple ligaments and, if necessary, addressing torn menisci. Reconstruction is typically preferred over repair, as it provides a stronger and more durable outcome. The goal of surgery is to restore the knee’s anatomy, function, and stability while minimizing the risk of further damage.
Prognosis following surgery depends on the type of knee dislocation. Sports-related dislocations generally have a better outlook, with a low incidence of artery damage (less than 1%). These patients often experience favorable outcomes after multiligament reconstruction surgery.
On the other hand, high-velocity dislocations, which involve significant trauma to the knee’s soft tissues and blood vessels, can be more challenging. These patients require close monitoring to ensure proper recovery of knee motion and to avoid complications such as stiffness or ligament stretch. Furthermore, high-energy injuries increase the risk of developing post-traumatic arthritis within ten years, as cartilage damage often occurs during the initial trauma.
Post-surgery recovery for a multi-ligament knee injury is a lengthy process, typically taking 9 to 15 months for a complete return to normal activities. Early physical therapy is crucial to prevent stiffness and ensure proper healing of the reconstructed ligaments. Physical therapy should begin on day one after surgery, focusing initially on restoring range of motion. Patients are usually placed on crutches and instructed to avoid weight-bearing for the first six weeks.
Gradual progression to partial weight-bearing begins after six weeks, and patients may be cleared to drive by the 7 to 8-week mark. Full recovery, including return to sports or high-intensity activities, depends on individual progress and the severity of the injury. Patients with nerve or artery damage may face longer recovery times and more significant long-term challenges.
Accurately diagnosing a multi-ligament knee injury requires a combination of methods, including a detailed medical history, comprehensive physical examination, and imaging studies such as X-rays and MRIs. Stress X-rays are particularly useful for measuring the degree of ligament damage and determining which ligaments are involved.
For athletes, returning to sports after a multi-ligament knee injury is possible, but it requires patience and adherence to a structured rehabilitation program. For most, the timeline for returning to high-level activities ranges between 9 to 12 months post-surgery. High-energy injuries, however, may result in permanent limitations, particularly if other structures such as nerves or blood vessels were damaged during the injury.
Orthopedic surgeon Dr. Mark Cinque is a sports medicine surgeon in San Diego, California who specializes in the treatment of complex knee injuries. He has spent time training at The Steadman Clinic and Stanford Orthopaedic Surgery. He has published over 100 peer-reviewed manuscripts and has presented research internationally. He uses minimally invasive arthroscopic procedures to preserve the natural joint and reduce recovery time to accelerate his patients’ return to the activities they love.
At a Glance
Mark Cinque, MD
- Board-certified, fellowship-trained orthopedic surgeon
- Orthopedic Residency: Stanford University, Fellowship: The Steadman Clinic
- Authored over 100 peer-reviewed publications
- Learn more
