Orthopaedic Conditons & Treatments

Multi-ligament Reconstruction Treatment, Surgery

The treatment and surgery that is best for your multi-ligament reconstruction is determined by a few important factors, including your age, your present health, your health history, the specific ligaments injured, the extent of their 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.

Multi-Ligament Reconstruction Diagnosis
A multi-ligament injury requires immediate attention and can prevent you from being able to walk without proper treatment. If you are unsure if you have injured more than one ligament, it is important to seek medical attention. To help diagnose your condition, your doctor will ask you a number of questions about your past health and the activity when the injury occurred. He will 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 first-hand 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 only done in extreme cases and is sometimes used to help determine the best treatment method prior to surgery.

Nonsurgical Treatment for Multi-Ligament Reconstruction
In the vast majority of cases where a multi-ligament reconstruction is necessary, surgery will be required. However, 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 are also required to use crutches to avoid putting any weight on the joint.

Surgery for Multi-Ligament Reconstruction
In most cases, a multi-ligament reconstruction requires surgery. The goal of the multi-ligament reconstruction surgery is to reattach and repair the ligaments so that they are able to stabilize the joint again and function as normal. The majority of multi-ligament reconstructions are treated surgically using one of the following techniques:

  • Staged Approach – This technique requires multiple surgeries to repair the ligaments. First, the ligament is typically stitched together. Then, once this has had the chance to heal adequately, normally after a few weeks, the ligament is reattached using graft from either the patient or a donor.
  • Singular Approach – This approach is typically done weeks after the injury, once the ligaments have had a chance to heal some on their own. Graft is 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.

Multi-Ligament Reconstruction Research
Much of the research around multi-ligament reconstruction has to do with the diagnosis of the injury and determination of treatment. In the field of medicine, there are many people who fear that doctors diagnose and act too quickly without performing enough tests, which can lead to reduced mobility and other complications down the road.

One of the main areas in which researchers have focused their attention has been on the source of the graft tissues that aid in the reconstruction of ligaments. Tissues can come either from the patient’s own body or from a cadaver, also known as allograft tissues. 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. However, in the past allograft tissues have been a source of disease and bacteria. Through research, scientists are finding new ways to make the tissues more sterile and provide a better outcome for surgeries.

In one current study, research is being done on the effectiveness of immobilizing the joint for a period of time while it heals. Some researchers hypothesize that this can cause problems with mobility down the road, while others suggest that it can require less surgery and be ultimately better for the patient in the long run.

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.

Rehabilitation Services
The Rehabilitation Network of the North Shore-LIJ Health System is dedicated to providing you and your family with result-oriented, comprehensive rehabilitation services. Our goal is to help you and your loved ones find relief from pain and get moving again after an accident, illness, injury or surgery. We’re your partner in a safe, healthy, more rapid recovery.

The multidisciplinary team of orthopaedic experts at North Shore-LIJ Orthopaedic Institute's Trauma Services in New York performs Multi-ligament Reconstruction surgery as well as a broad range of nonsurgical and surgical treatments for conditions that affect the bones.