MULTILIGAMENT INJURY

The Knee Joint has four major ligaments Anterior & Posterior Cruciate Ligaments (ACL & PCL) and Medial & Lateral Collateral Ligaments (MCL & LCL) that are necessary for the knee stability. Sports-related injuries and traumas often cause the wear and tear of more than one of these four ligaments and is called a Multiligament Injury.

This condition needs an immediate management and often multiple surgeries are required so a doctor must be consulted without any delay for a proper examination.

Forceful accidents during sports, severe fall from a height or traffic injuries can cause Multiligament Damages.

The patient may experience:

Pain

Swelling

Limited range of motion

Arterial and Nerve Damage

Knee instability

The diagnosis mainly deals with the accurate detection of injured ligaments and the degree of tear. This requires an orthopedic surgeon to thoroughly examine and do a Comprehensive Clinical Evaluation.

The doctor may go for investigations before the Reconstruction Surgery, such as

• X-ray
• MRI scan
• Functional Testing (Gap Test)
• Arthroscopic Examination

The symptoms are common to many sports-related injuries and so a thorough examination by the doctor is necessary after which grading is done as per the severity of the sprain.

Grade 1 Sprain with mild damage due to “slight stretch” but a stable knee joint

Grade 2 Sprain (rare) with a “partial tear” of the ligament

Grade 3 Sprain (most common) with a “complete tear” of the ligament breaking it into two pieces

Grade I & II: Based on the grading of injury grade I and II are dealt conservatively with the RICE Method (Rest, Ice, Compression, Elevation)

Grade III: Reconstruction Surgeries of damaged knee ligaments to be done as soon as possible and may require more than one surgeries

Preparations: The doctor after all the necessary investigations counsels the patient for surgery and might ask to stop some medicines like aspirin around a week before surgery to avoid the risk of bleeding.

Anesthesia: Usually general anesthesia is given and the doctor advises to stop eating and drinking water from a night before surgery.

Arthroscopy: Arthroscopic Reconstruction is a minimally invasive procedure in which small incisions are made; one to hold a thin, tube-like video camera (arthroscope) and others to allow surgical instruments to reach the joint space.

• Avulsed (pulled from the bone) ligaments are reattached to the bones using special sutures
• Ruptured Ligaments are reconstructed using a

Grafting: The surgeon removes the damaged ligament and replaces it with a portion of tendon which is a tissue similar to a ligament that connects muscle to bone. This replacement tissue is called a graft that comes from another part of your knee (autograft) or donor tissue (allograft).

The graft is secured to the bones with screws and other instruments which helps a new ligament to grow soon.

Rehabilitation and Recovery: Following the surgery

• The doctor advises some pain-killers and physical therapy after which the patient fully recovers in a period of months.
• Crutches may be required for up to 6-8 weeks

Most patients after a timely treatment show complete recovery and can return to their normal high-level sports activities.

• Anesthesia complication
• Bleeding
• Blood clotting (Deep Vein Thrombosis)
• Infection
• Vascular or Nerve Injury
• Compartment Syndrome
• Failure of the repair

Plasma Rich Protein (PRP) is a naturally derived substance that utilizes a blood component (plasma) of the patient and is reinjected on the site of treatment.

This is a modern technique to treat some common orthopedic conditions yielding fast recovery and perfect results

The complete details of the advantages of PRP therapy are given here