Multi-ligament knee reconstruction is a technical procedure that involves the reconstruction of several torn ligaments in the knee joint. Such an injury usually results from high energy trauma like road accidents, sporting injuries or falls. The knee has four main ligaments that provide stability: These include the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL). If more than one of these ligaments is injured, the knee becomes very unstable, and reconstruction of multiple ligaments is necessary.

Knee Ligament Injuries: A Brief Overview

1.     ACL Injury: Commonly occurs as a result of abrupt halts, jumps, or changes in the direction.

2.     PCL Injury: It is often caused by a direct hit on the front side of the knee or a fall with the knee bent.

3.     MCL Injury: Most often due to a blow on the external aspect of the knee joint.

4.     LCL Injury: It can be caused by a direct contact to the inner part of the knee.

Indications for Multi-Ligament Reconstruction

·        Rupture of multiple knee ligaments with high-grade tears.

·        Extreme instability of the knee joint.

·        Other injuries that may be present include meniscal tears, cartilage damages or fractures.

Preoperative Evaluation

·        Imaging: MRI is crucial in determining the degree of ligament damage and other accompanying injuries. X-rays are also used to exclude fractures.

·        Physical Examination: These are tests that are used to examine the status of each ligament individually.

·        Patient History: It is crucial to know how the injury occurred, and the patient’s activity levels prior to the injury.

Surgical Procedure

1.     Timing: It may be acute (occurring in the first few weeks following the injury) or chronic (occurring weeks or even months after the injury) depending on the patient’s condition, the degree of swelling, and other injuries.

2.     Graft Selection: Autograft (patient’s own tissue), allograft (tissue from a donor) or synthetic grafts can be used.

3.     Technique: Arthroscopic (less invasive) or open surgery. The choice depends on the particular ligaments which are involved and the preference of the surgeon.

4.     Repair Sequence: Usually, the PCL is targeted first because it is in the middle of the knee and affects other ligaments, then the ACL, MCL, and LCL.

5.     Fixation: Different methods and tools (screws, buttons) are employed to fix the grafts.


·        Phase 1 (0-6 weeks): Emphasis should be placed on preventing further damage to the reconstruction, minimizing inflammation, and improving joint mobility. Weight-bearing is limited.

·        Phase 2 (6-12 weeks): Slow progressive loading and resistance training.

·        Phase 3 (3-6 months): Gradual increase in strengthening, proprioceptive exercises and introduction to sport specific drills.

·        Phase 4 (6-12 months): Gradual return to regular activity and sports depending on functional and strength capacity.

Outcomes and Complications

·        Success Rates: Good outcomes with proper surgical procedures and postoperative care.

·        Complications: May be infection, stiffness, graft failure, and residual instability. It is also important to follow up on a regular basis in order to check the effectiveness of the intervention and respond to any concerns.


Multi-ligament knee reconstruction is a delicate procedure that helps to restore stability and function of a knee that has been severely damaged. This is because it demands rigorous preoperative planning, accurate surgical methods, and systematic rehabilitation to produce the best results.