Combined Knee Ligament Sprain

Combined knee ligament sprain is a tear of more than one of the major ligaments of the knee. The four knee ligaments are the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) and lateral collateral ligament (LCL). Ligaments connect bones. They often cross a joint to hold the bones together. The ligaments of the knee keep the thigh bone (femur) and shinbone (tibia) in alignment. These ligaments allow the joint to move within a certain range of motion. Movement outside this range causes a ligament strain. Injury to multiple ligaments at the same time results in difficulty playing sports and in daily living. The most common multiple knee ligament injury involves the ACL and MCL.

SYMPTOMS

  • A "popping" sound heard or felt at the time of injury.

  • Inability to continue activity after injury.

  • Inflammation of the knee within 6 hours after injury.

  • Possibly, deformity of the knee.

  • Inability to straighten the knee.

  • Feeling of the knee giving way or buckling.

  • Sometimes, locking of the knee, if the joint cartilage (meniscus) is injured.

  • Rarely, numbness, weakness, paralysis, discoloration, or coldness, due to nerve or blood vessel injury.

CAUSES

Spraining of multiple ligaments occurs when a force is placed on the ligaments that exceeds their strength. This is often caused by a direct hit (trauma). It may also be caused by a non-contact injury (hyperextending the knee while twisting it).

RISK INCREASES WITH:

  • Contact sports (football, rugby, lacrosse). Sports that involve pivoting, jumping, cutting, or changing direction (basketball, gymnastics, soccer, volleyball). Sports on uneven ground (cross-country running, soccer).

  • Poor strength and/or flexibility.

  • Improper fitted or padded equipment.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Thigh, leg, and knee flexibility.

  • Muscle strength and endurance.

  • Learn and use proper exercise technique.

  • Wear proper and well fitting equipment (correct length of cleats for surface).

PROGNOSIS

Without treatment, the knee will continue to give way and become vulnerable to recurring injury. Recurring injury can happen during athletics or daily living. If the injury includes damage to a nerve or artery, the chance of a poor outcome increases. Surgery is often needed to regain stability of the knee.

RELATED COMPLICATIONS

Frequently recurring symptoms, including:

  • Knee giving way.

  • Joint instability.

  • Inflammation.

  • Injury to the joint cartilage (meniscus). This may result in locking and/or swelling of the knee.

  • Injury to joint (articular) cartilage of the thigh bone or shinbone. This may result in arthritis of the knee.

  • Injury to other ligaments of the knee.

  • Knee stiffness (loss of knee motion).

  • Permanent injury to nerves (numbness, weakness, or paralysis) or arteries.

  • Removal (amputation) of the leg, due to nerve or artery injury.

TREATMENT

Treatment first involves medicine and ice, to reduce pain and inflammation. Crutches may be advised, to decrease pain while walking. The knee may be restrained. Rehabilitation focuses on reducing swelling, regaining range of motion, and regaining muscle control and strength. It may also include receiving proper use training, wearing a brace, and education. (Avoid sports that involve pivoting, cutting, changing direction, jumping and landing). Surgery often offers the best chance for full recovery. Surgery from combined ACL/MCL injury involves replacement (reconstruction) of the ACL. This also allows for MCL healing. Despite surgery, some athletes may never return to their prior level of competition. The ability to return to sports depends on the related injuries and demands of the sport.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Stronger pain relievers may be prescribed. Use only as directed and only as much as you need.

  • Contact your caregiver immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

COLD THERAPY

Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 6 weeks, despite treatment.

  • After injury or surgery, any of the following occur:

  • Pain, numbness, coldness, or a blue, gray, or dark color occurs in the foot or toenails.

  • Increased pain, swelling, redness, drainage of fluids, or bleeding in the affected area.

  • Signs of infection (headache, muscle aches, dizziness, or a general ill feeling with fever).

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)