The treatment and surgery that is best for your multi-ligament reconstruction is determined by a few important factors, including your age, present health, health history, specific ligaments injured, extent of the injuries and your history with other medications and treatments. Multi-ligament reconstruction is necessary when more than one ligament has been torn or injured, which typically occurs during high-impact trauma or falls.
A multi-ligament injury requires immediate attention and without proper treatment can prevent you from being able to walk. If you are unsure of whether you have injured more than one ligament, it is important to seek medical attention. To help diagnose your condition, your doctor will ask about your past health and the activity when the injury occurred, then perform a physical exam. To determine how many ligaments have been injured, one or more of the following techniques will be used:
- X-ray (radiograph) – This is likely the first test that will be performed. It is done using electromagnetic radiation that is sent through the site of the injury at various angles. At each angle, the radiation is absorbed by the bone and projects an image of the area in black and white. This test is used to rule out any fractures of the bone.
- Computed tomography scan (CT or CAT scan) – A CAT scan combines the use of X-ray technology with computer technology to help the doctor rule out vascular injuries, which is important when deciding on the appropriate treatment.
- Magnetic resonance imaging (MRI) – An MRI is one of the best imaging tests to see the ligaments more clearly. During this test you will be placed in a vessel that will generate magnetic radio waves. These waves will cause vibrations, and their resonance is then turned into a high-definition image that can show the doctor the ligaments and blood vessels.
- Arthroscopy – This is a surgical test that can be used to look inside the knee to see if there is any damage. This is minimally invasive and requires only small incisions to put an endoscope into the joint to view the injury. This is done only in extreme cases and is sometimes used to help determine the best treatment method prior to surgery.
In some instances, the injury is minor enough that the ligaments can heal on their own. This is done by putting the joint where the ligaments are located, usually the knee, in a brace that keeps the joint fully extended and completely immobile. Patients also are required to use crutches, to avoid putting any weight on the joint.
In most cases, a multi-ligament reconstruction requires surgery. The goal is to reattach and repair the ligaments so that they are able to stabilize the joint again and function as normal. The surgery uses one of the following techniques:
- Staged approach – This technique requires multiple surgeries to repair the ligaments. First, the ligaments are stitched together. Then, once they have had the chance to heal adequately (normally after a few weeks), the ligament is reattached using a graft from either the patient or a donor.
- Singular approach – This approach typically is done weeks after the injury, once the ligaments have had a chance to heal somewhat on their own. Grafts are still used, either from the patient or a donor, to help reconstruct the ligaments in the joint. A brace and screws are used to hold them in place as they heal.
Much of the research on multi-ligament reconstruction has to do with the diagnosis of the injury and determination of treatment. Many people fear that doctors diagnose and act too quickly without performing enough tests, and that this can lead to a patient’s reduced mobility and other complications down the road.
One of the main areas of research has been the source of the graft tissue that aids in the reconstruction of ligaments. Tissue can come either from the patient’s own body or from a cadaver (allograft tissue). These have been shown to produce positive results over the long term. However, the two methods come with distinct advantages and disadvantages. When a patient’s own tissue is used to repair the damaged ligament, there is less stress put on the body. In the past, some allograft tissue has been a source of disease and bacteria. Through research, scientists are finding new ways to make the tissue more sterile and provide a better outcome for surgeries.
In one study, research was done on the effectiveness of immobilizing the joint while it heals. Some researchers hypothesize that this technique can cause later problems with mobility, while others suggest that it can require less surgery and ultimately be better for the patient.
As research on diagnosis and treatment is ongoing, it is a good idea for your conversation about it with your doctor to be ongoing as well.
The multidisciplinary team of trauma and fracture experts at Northwell Health Orthopaedic Institute performs multi-ligament reconstruction surgery as well as a broad range of nonsurgical and surgical treatments for conditions that affect the bones.