The knee has four ligaments that work together in concert. They act like strong ropes to hold the bones together and keep the knee stable for walking, pivoting, turning, and almost any athletic activity. It’s bad when just one ligament like the ACL gets injured, but when two or three or even four get injured, the injury becomes exponentially more difficult to treat. These combined injuries can have serious complications: they can disrupt blood supply to the leg and affect the nerves that supply the muscles of the limb. In severe cases, combined ligament injuries may lead to amputation. That’s why it is vital to seek out the help of an orthopedic specialist with extensive experience in treating it. The place to start is Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado, where you can trust you’ll get the best of care.
OVERVIEW
What most people refer to as a “blown knee”, is usually an injury to one of the knee’s four major ligaments: the lateral collateral ligament (LCL), the medial collateral ligament (MCL), the anterior cruciate ligament (ACL) or the posterior cruciate ligament (PCL). While serious and complex, combined ligament injuries are not as common as single ligament injuries like ACL tears. It is estimated that combined ligament injuries make up about 5-10% of all knee ligament injuries. Among athletes, particularly those in contact sports, the incidence can be slightly higher due to the nature of the activities and the increased risk of high-impact injuries.
ABOUT THE KNEE
The knee is the largest joint in the body and one of the most complex. It is the joint in the middle of the leg where the thigh bone and shin bone meet. The knee is a synovial joint. A fluid-filled sac that lubricates and protects the joint, lines the space between the bones. This extra cushioning helps them move with as little friction as possible. The knee is made not just of bones, but cartilage, muscles, nerves, and ligaments. The MCL on the inside of the knee, controls sideways motion. The LCL on the outside of the knee controls sideways motion. The ACL in the front of the knee controls forward motion. The PCL in the back of the knee controls backward motion.
WHAT IS A COMBINED LIGAMENT (BLOWN KNEE) INJURY?
Most knee ligament injuries involve a single ligament injury. A blown knee involves two, three, or four injured ligaments. Combined ligament injuries are graded on a severity scale:
Grade 1—Mild damage to one or more ligaments with the structures being slightly stretched. Often known as a minor sprain. The knee joint is stable.
Grade 2—Noticeable looseness in the knee. This means there have been larger tears in the ligaments, but they are not completely torn. Often known as a severe sprain. The knee is not stable.
Grade 3—Severe knee instability, and ligaments are completely torn. This is otherwise known as a rupture.
Together these injuries can cause serious complications.
CAUSES
Injuries to each of the four ligaments can have different causes. When combined, the results can be devastating. When there is a major trauma, such as a direct blow to the knee, a fall from a height, or a motor vehicle collision or industrial accident, several knee ligaments can be injured at the same time. Combined ligament injuries are most commonly seen in rugby, martial arts, skiing, and ball sports such as football. It might happen when a football player has their cleats planted in the ground while being hit with great force on their outer knee. Or imagine a skier whose ski doesn’t release from the bindings during a fall. The ankle can’t turn in a ski boot, so the knee ends up twisting, which can damage multiple ligaments.
SYMPTOMS
- Knee pops and buckles when trying to stand on it
- Extreme pain
- Rapid swelling
- Stiffness
- Limited range of motion
- Feeling of instability
- Bruising and discoloration around the knee
NON-SURGICAL TREATMENTS
As this injury often occurs to athletes, acute non-surgical treatment immediately after injury typically includes the PRICE protocol; Protection, rest, Ice, compression, and elevation. Pain management will be necessary, and crutches will be prescribed so that the patient is non-weight-bearing. A splint or hinged brace may provide added support. Physical therapy will help increase strength and mobility.
WHEN IS SURGERY INDICATED?
Surgery is almost always necessary for combined ligament injuries. Addressing which type of surgery will depend on the severity and if the patient’s ligaments can be salvaged. Surgery is usually done arthroscopically where a small instrument is inserted into the knee that is connected to a camera and monitor. This allows the surgeon a clear view of what the damage is and allows them to perform reconstruction and salvage the ligament in a less invasive manner. For many other patients, a very involved surgical reconstruction is required. Because surgical correction involves the reconstruction of several ligaments, the surgeon will often utilize grafts or tendon tissue from cadavers or human donors to recreate the torn ligaments. 51 percent of those treated without surgery, end up having surgery within 5 years due to knee instability. Another potential problem is that by delaying surgery, the potential for developing arthritis exists because of the instability that could affect the knee as the patient gets older.
GETTING THE RIGHT DIAGNOSIS. GETTING THE RIGHT DOCTOR.
Diagnosing combined ligament injuries takes a very dedicated orthopedic surgeon because diagnosing and treating are very demanding procedures. That’s why we’ll get right to the experts who are notable for their results; Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado. A detailed medical history and clinical exam are the first steps in diagnosing a blown knee. The surgeon needs to get a lot of information just by knowing how an injury happened. X-rays will assess bone structure and MRIs can assess ligament tears and injuries. It’s how it is all put together that allows a perfect plan to be made that will eventually get patients back on their feet. The entire process—both diagnosis and surgical are very technically demanding procedures. Which is why you want nothing but the best. Both accomplished and supportive, the orthopedic surgeons at CCOE have impeccable credentials and meticulous skills. Not to mention the most success.
