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S. Tanweer Ashraf

Consultant Knee Surgeon

MBBS, FRCS (Trauma and Orthopaedics), MRCS (Ed), MSOrth, MSc Orthopaedic Engineering (Cardiff), FRCS (Lond)

Multi-Ligament Injury

Ligaments are the fibrous tissue bands connecting the bones in the joint and stabilizing the joint. The knee has four major ligaments – the anterior cruciate ligament, posterior cruciate ligament, lateral collateral ligament, and medial collateral ligament. There is also a “fifth ligament” of the knee which is the posterior lateral corner, which is a complex of multiple small ligaments and muscles.

A multi-ligament knee injury involves injury to two or more ligaments of the knee. These injuries are usually high energy in nature – meaning motor vehicle accidents are most common, but we do see these types of injuries in skiing and football injuries at the higher levels. The injury could indicate a knee dislocation that can cause injuries to the nerves and blood vessels requiring specialized care.

A knee with multiple ligaments damaged requires special care. Some of these ligaments can be repaired if they are addressed early enough – within 3 weeks. This is especially crucial for the posterior lateral corner which is often misdiagnosed or neglected with bad results. A multi-ligament knee will often require serial surgeries for repair of certain structures and then reconstruction of other ligaments.


During the surgery, ligaments are reconstructed using a graft taken from the patient, or donor tissue (allograft). Surgical reconstruction is usually performed arthroscopically. Tunnels are created in the thigh and tibia bone using a small drill to allow the grafts to be placed into the knee and to replace the torn ligaments. After the grafts are placed, screws, washers, and other fixation devices are used to secure the grafts and hold the ligament in place until healing takes place. After multi-ligament knee reconstruction, crutches may be required for 6 to 8 weeks.

Significance of multi-ligament knee reconstruction

Early treatment of multi-ligament injuries allows satisfactory repair or reconstruction of the ligaments resulting in several advantages:

Normal Anatomy of the Knee Joint

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