Multiligament Knee Reconstruction

Multi-ligament knee reconstruction is a complex surgical procedure to restore a knee’s stability and function. Surgery involves reconstructing or recreating one or more of the damaged knee ligaments using a graft from another part of your body (autograft) or a donor tendon or ligament (allograft) to replace the damaged ligament. Both autograft and allograft ligament reconstruction can provide satisfactory restoration of knee function. Anatomical reconstruction is designed to restore knee function and prevent degenerative changes. Repair (sewing the injured ligament back together) is sometimes an option instead of reconstruction.

The primary goal of anatomic reconstruction is to reconstruct the ligaments using grafts placed in the original ligaments’ exact location. This involves precisely identifying the anatomical insertion points of the ligaments on the knee bones. By restoring the ligaments to their anatomical positions, the surgery seeks to replicate the natural biomechanics of the knee. This is crucial for maintaining the joint’s normal range of motion and stability through various activities.

This method is favored for its potential for improved outcomes and patient satisfaction, although it demands significant surgical expertise and a commitment to postoperative rehabilitation. The objective is to improve the patient’s long-term knee stability and function.

Depending on the specific injury and patient factors, options for surgery involve acute (immediate) or delayed surgery. Sometimes, surgery can be done in one setting; other times, staged surgeries (more than one surgery) may be recommended. Acute repair or reconstruction refers to surgery performed shortly after the injury, typically within a few weeks after injury. Early intervention aims to stabilize the knee and protect surrounding structures, repair injured tissue in a timely manner, and optimize outcomes. Immediate surgery may also be indicated if accompanying injuries require urgent care, such as damage to blood vessels or nerves, requiring prompt attention to minimize the risk of complications. Proper rehabilitation post-surgery is crucial for regaining strength and flexibility in the knee.

Staged reconstruction is a surgical approach in which the repair or reconstruction of the injured ligaments is performed in separate surgeries rather than all at once. One or more of the ligaments is reconstructed in an initial surgery to provide stability to the knee and allow for initial healing and improvement of swelling and motion. Subsequent surgeries can address the remaining ligaments after the knee has recovered from the initial surgery.

Studies show that outcomes can be optimized by carefully selecting the timing of surgery based on each individual’s specific circumstances and needs. The optimal surgical strategy depends on the characteristics of the injury. You and your UCSF Women’s Sports Medicine Center surgeon will have a thorough discussion. Hence, you understand the risks and benefits of early versus delayed surgery, considering both the technical aspects of the procedure and the expected recovery path.

Recovery time is generally long (1 year or longer) and varies depending on the extent of the injury, the patient’s overall health, and activity goals following surgery.

Rehabilitation from multi-ligament knee reconstruction surgery is essential for restoring knee function, strength, and stability. Rehabilitation programs are personalized based on the individual injury, surgery, and postoperative goals. A physical therapist will provide a comprehensive rehabilitation program for each injury. With realistic expectations, a return to sport is possible.