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When there is suspicion for a multi-ligament knee injury, four main ligament areas of the knee must be assessed for possible injury. Within these areas, there can be several bundles or structures that need to be reconstructed.
The four main ligament areas of the knee that need assessment include: anterior cruciate ligament (ACL),posterior cruciate ligament (PCL), posterolateral knee and medial knee (MCL). Although most complex knee injuries are thought to occur due to a knee dislocation, in actuality, a complete knee dislocation is very rare. Thus, an evaluation of a knee injury that , which involves at least two ligaments being torn, is considered a complex knee injury. Almost all complex knee injuries involve either the anterior cruciate ligament (ACL) and/or posterior cruciate ligament (PCL). Combined with this may be a knee ligament injury involving the medial knee structures (commonly called the MCL). In addition, the posterolateral corner structures of the knee must be completely evaluated.
A large number of combined ACL and grade III (complete) MCL injuries can be treated with rehabilitation to allow the MCL to heal prior to ACL reconstruction. Almost all other complete grade III tears that occur in combination with other knee ligament tears require a combined surgical reconstruction. The literature is somewhat unclear on whether to perform a staged reconstruction or to perform a surgical reconstruction all in one setting. Ligaments of the knee are co-dependent for overall stability in the knee – performing a reconstruction for just a portion of the injured knee increases the risk for the reconstructed ligament to be stretch out in the future – in most cases, Dr. LaPrade recommends performing a multiple ligament reconstruction in one setting.
In our hands, our designed multi-ligament reconstruction procedure does not take an extended period of time. This is because we have assembled a surgical team which specializes in the treatment of complex knee injuries. Thus, these surgeries are usually performed efficiently and in a timely fashion which spares the patient two large surgeries over several months. We strongly recommend all multi-ligament knee reconstructions be performed in one setting to allow the patient to move forward with their rehabilitation and return to their normal activities of daily life.
Dr. LaPrade is skilled in diagnosing and treating the following injuries: