The multiply injured knee
Multi-ligamentous knee injuries and knee dislocations are high energy devastating injuries to the knee. Than can be accompanied by artery and nerve injuries and should have a thorough workup in an emergency room at the time of the injury. Knee dislocations (not kneecap or patellar dislocations) are analogous to a multiple ligament injury. It is not possible to get a dislocated knee without significant injury to more than one structure. Multi-ligamentous injury refers to a knee injury where more than one of the major stabilizers of the knee (ACL, PCL, FCL, MCL, PLC) are injured at the same time and makes the knee significantly unstable.
Non-surgical treatment has a low success rate in the multi-lig or dislocated knee and therefore is not recommended
Because the knee is so unstable, surgery is often needed to fix this problem. Depending upon the injury, different treatments may be needed. If the knee is very unstable, temporary fixation may be needed with an external fixator. Nerve and blood vessels may need early treatment as well. definitive treatment of the knee injury is done once the initial swelling goes down and the knee is stabilized. The torn ligaments will first be identified based on exam and MRI and then reconstructed surgically, often using donor grafts, the patients tissue or a combination of both.
Recovery and Rehabilitation
Multi-lig knee injuries will require significant work in therapy. Range of motion will be restricted in the first 6 weeks. Patients will be on crutches with no weight on the leg and a brace for 6 weeks to 6 months depending upon the injured ligaments. The initial recovery period is focused on swelling, pain control, and range of motion. Full recovery is often not achieved for 12-18 months
- How long does surgery take? 2-4 hours depending upon how many ligaments need reconstruction.
- What kind of anesthesia will I need? General anesthesia is typically used, sometimes with a nerve block for pain control after surgery.
- How long will I be in the hospital? Many patients can leave that same day, occasionally Dr. Petre will have you stay one night in the hospital
- Is surgery safe? All surgery has risks; however, this surgery when compared to all other surgery is safe.
- Will I need physical therapy? Yes. Physical therapy is crucial to an excellent outcome.
- How long before I can return to work/school? For jobs and academics that require minimal physical exertion and can be done with crutches, many people can return in 2 weeks. For jobs that require heavy lifting or exertion, it is safe to plan 3 months off.
- How long before I can return to my sports? Return to sports depends upon what ligaments are being reconstructed and varies between one year and 18 months.
- How long before i can drive a car? All patients must be off pain medicine before driving. Many patients can return to driving in 2 weeks once they feel completely safe operating a vehicle. Right legged injuries will be slower than left legged injuries and may not be able to drive a car for 6 weeks.
- How long will I be on crutches? 6 weeks.
- How long will I need pain medicine? Most patients need 3-5 days of pain medicine and sometimes up to 2 weeks. If you are still having pain requiring narcotic pain medicine after a month, Dr. Petre may ask you to see a pain specialist.
- How long will I need a brace? 6 weeks.