A multi-ligament knee injury or dislocation is diagnosed when at least two or more, of the knee’s four major ligaments are disrupted¹. These ligaments are made up of four types:

  • Anterior Cruciate Ligament (ACL)
  • Posterior Cruciate Ligament (PCL)
  • Medical collateral Ligament (MCL) and
  • Lateral Collateral Ligament (LCL).

This kind of injury is associated with potentially serious complications, such as damage to the popliteal artery and common peroneal nerve, which are situated at the back of the knee. There is also usually damage that occurs to the soft tissue and musculature that surround the knee and to the meniscus².

Depending on the severity of the injury, a multi-ligament knee injury may be classified as a subluxation or dislocation of the knee joint². In such an instance, a dislocation will include any damage that is made to the surface of the actual knee joint. Generally, these kinds of injuries are rare and make up a very small portion of orthopaedic cases¹.

chart showing what happens when a knee is dislocated

Causes of Knee Injuries

Multi-ligament knee injuries may occur from both high and low impact causes or mechanisms¹. The most common high impact mechanism of injury is a motor vehicle accident, where the top of the shin bone comes into contact with the dashboard and thereby force the lower part of the knee back¹. A low impact mechanism is more common and mostly is a result of sporting activity. For example, this may happen when the knee is hyper-extended with the foot on the ground and when there is a force which causes the knee to buckle left or right during contact. This can occur in several sports, such as soccer, running and rugby.

In rare cases, you can also have a multi-ligament knee injury which happens spontaneously. This could happen with patients who are morbidly obese or with an unnatural movement on a trampoline ².

Management of a serious knee dislocation

According to the medical information, there is still a debate as to how such injuries should be managed. However, evidence seems seems to show that people who are returning to sport benefit more with a surgical intervention, whereas for people returning to everyday life, surgery is not indicated, depending on the severity of the injury¹. There is also consensus that patients who are obese, are old or who have serious co-morbidities, do not necessarily require surgery. When surgery is recommended, it will consist of repairing the torn or injured ligaments, as well as attending to any vascular or nerve damage.

X-Ray of a dislocated knee repaira serious multi-ligament knee dislocation may require a full leg brace

How can Physiotherapy help a multi-ligament injury?

The role of Physiotherapy in multi-ligament knee injuries is to restore stability and function² to restore the knee to pre-injury status, whether the treatment is being managed surgically or conservatively. In both cases, the patient will be placed in a range-limiting brace. It is part of the Physiotherapist’s role to help and guide the patient when the knee functionality or range needs to be adjusted and when the brace itself needs to be removed.

Physiotherapy will also assist with teaching patients to walk with crutches until such time as they are able to walking without help in weeks following the injury. Along with this, Physiotherapists can also provide a suitable exercise programme, specific to the patient, in order to improve and regain strength, stability and joint awareness. These exercises range from acute injury management to end stage rehabilitation.

physiotherapy can help post operative treatment of a knee dislocationphysiotherapy and kinesio taping is used in therapy for knee dislocation

This article was submitted by Natalie Ruivo who is the Practice Manager at Lamberti Physiotherapy, Dainfern. Book a consultation with her if you have some knee ligament injury concerns using this quick-link to our handy appointment form.

References

  1. Skendzel J et al. Diagnosis and Management of the Mulitiligament Injured Knee. 2012; 42(3):234-242
  2. Mulitligament Injured Knee Dislocation. 2020. http://physio-pedia.com/Mulitligament_Injured_Knee_Dislocation.