In cases of complex ligament injuries in the knee, a more extensive surgical procedure than a standard cruciate ligament reconstruction may be necessary. This is true, for example, if multiple ligaments are damaged at the same time, or if a previous reconstruction no longer provides sufficient stability.
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The stability of the knee depends on several ligaments, including the anterior and posterior cruciate ligaments, as well as the collateral ligaments on the inner and outer sides of the knee. These ligaments stabilize the knee in various directions and during activities such as rotation and weight-bearing.
An injury may affect a single ligament, but in cases of more severe trauma, multiple ligaments and other structures in the knee may be damaged at the same time. This can result in a more complex form of instability, where, for example, the knee feels loose or gives way during activity.
Advanced knee surgery may be appropriate if you have significant instability resulting from a combined ligament injury, or if previous treatment has not resulted in a sufficiently stable and functional knee.
Revision surgery involves evaluating a ligament that has previously undergone surgery and, if necessary, reconstructing it again. This may be necessary, for example, if a reconstructed cruciate ligament is damaged again, or if there is still bothersome instability following a previous surgery.
A revision surgery is not necessarily a repeat of the original procedure. The specialist evaluates both the previous reconstruction and the rest of the knee to determine the cause of the instability and plan the treatment that is appropriate for the current situation.
Depending on the findings, treatment may involve a new reconstruction of the previously operated-on ligament and, if necessary, treatment of other damaged stabilizing structures.
When two or more of the knee’s major ligaments are damaged, it is called a combined or multiligament injury. For example, this may involve a cruciate ligament injury along with an injury to a collateral ligament, or a combination of injuries to both the anterior and posterior cruciate ligaments and other stabilizing structures.
Some ligament injuries can be treated without surgery. In cases of major combined injuries or persistent significant instability, surgical reconstruction may be appropriate.
The purpose of the surgery is to improve the stability and function of the knee. Which ligaments need to be reconstructed and how the surgery is planned depend on the specific injury pattern and your symptoms.
In cases of complex ligament injuries, it is important to evaluate the entire knee and not just a single cruciate ligament or collateral ligament.
Among other things, the specialist will assess the knee’s range of motion and stability and review how the injury occurred, what symptoms you are experiencing, and what treatment you have received in the past. If you have had surgery before, that previous surgery will also be taken into account in the treatment plan.
Imaging studies, such as MRI scans, may be part of the evaluation, depending on the specific issue. These studies are used in conjunction with the clinical assessment to determine which structures are damaged and what treatment may be appropriate.
Before surgery
Before the surgery, you will undergo an individual evaluation by a specialist in knee surgery. During this evaluation, the specialist will assess the degree and type of instability and determine whether a revision of a previous reconstruction, reconstruction of multiple ligaments, or another treatment is necessary.
It is important that the surgical plan takes into account the overall function of the knee and any accompanying injuries. If applicable to your case, preoperative exercise can be used to improve range of motion and muscle control.
You will receive specific information about the planned surgery and the expected postoperative course based on your particular procedure.
During the operation
The surgery is planned based on which ligaments and other structures are damaged. During reconstruction, the function of the damaged ligament is replaced or restored using tissue that is secured in place to help maintain knee stability.
During revision surgery, the condition of the knee following the previous surgery is also assessed. If multiple ligaments are damaged, the treatment plan is based on their combined impact on knee stability.
Therefore, there is no single standard procedure that works for everyone with complex ligament injuries.
After surgery
Rehabilitation is an important part of treatment following knee ligament reconstruction or revision surgery. The course of rehabilitation depends, among other things, on which ligaments were operated on, whether multiple structures were treated, and how the knee responds after surgery.
You will receive a personalized plan for weight-bearing, mobility, and gradual rehabilitation. In some cases, there may be specific restrictions or a need for knee support during the initial period.
Rehabilitation is built up gradually, focusing on mobility, muscle strength, balance, and knee control, among other things. When you can return to work, sports, and other activities depends on the extent of the surgery and your individual progress.
The goal of treatment is to achieve the best possible stability and function in the knee, based on your individual circumstances. The outcome depends, among other things, on the extent of the injury, any previous surgeries, other knee injuries, and the subsequent rehabilitation program.
If your knee remains unstable after a previous ligament surgery, or if you have been diagnosed with injuries to several of the knee’s ligaments, a specialized evaluation of your knee can clarify your options for further treatment.
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