Complex Knee Ligament Injuries

1. Background
2. Symptoms
3. Diagnosis
4. Treatment of complex knee ligament injuries

Osteochondral injury implies an injury to the joint surface or articular cartilage with some of the underlying bone. Chondral injuries involve only the articular cartilage.

Background

A complex ligament injury of the knee implies that more than one of the major knee ligaments have been damaged. The major knee ligaments are the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL) and the lateral collateral ligament (LCL). The LCL has important associated structures grouped together and is referred to as the postero-lateral corner.

In order to sustain a complex ligament injury of the knee the patient will usually have experienced a major accident or high energy twisting injury. In such cases both the treatment and rehabilitation can be difficult and complicated.

An MRI scan showing the PCL

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Symptoms of complex knee ligament injury

The symptoms of a complex knee ligament injury can be similar to other ligament injuries. For example, the patient may describe a feeling of instability of the knee in the same way as with a simple ACL rupture. Pain may also be an issue.

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Diagnosis of complex knee ligament injury

After taking a full history of the problem, an examination is made of the knee looking at the tracking of the patella, the strength of the muscles above the knee, the tightness of the tissues around the knee cap and areas of tenderness. Specific tests may also be used to assess the patello-femoral joint.

It is often necessary to take x-rays of the knee sometimes using multiple views. Finally, more sophisticated imaging including MRI or CT scan may sometimes be required.

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Treatment of complex knee ligament injuries

Complex ligament injuries of the knee are quite rare and treatment is, by definition, more difficult.

It usually involves multiple ligament reconstruction and a long period of rehabilitation.

Sometimes if there is severe stretching of the outer ligaments of the knee you will also require an osteotomy to try and improve the alignment of the knee.

Results of surgery for complex knee ligament injury depend on the specific injury and are less predictable than for simple anterior cruciate ligament ACL reconstruction.

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