Combined knee ligament injuries

The knee is the largest and probably the most complex joint in the body, important for movement. The knee joints connect the femur to the lower limb bones. The sprains of the knee joints are very common in sports activities. In particular, athletes who participate in team sports, such as football, are more likely to injure their lateral ligaments.



The knee joint consists of three bones: the femur, the tibia and the patella. The last one is located in front of the joint and provides, among other things, protection.

These bones are joined together by ligaments. There are four main knee ligaments, which act as strong straps (ropes) to hold the bones in place and stabilize the knee.



The cruciate ligaments are located within the knee joint and intersect with each other, forming an X, with the anterior cruciate ligament facing forward and the posterior facing posteriorly. This layout controls the anterior and posterior part of the knee rotation.



The collateral ligaments are, as the name implies, on the sides of the knee. The medial collateral ligament connects the femur to the tibia while the lateral collateral ligament connects the femur to the fibula. Both control the movement of the bones on the lateral axis and protect the knee from abnormal valgus and varus forces.



The knee rests on these ligaments and muscles for its stability, and is therefore easily injured. Any direct knee injury or strong muscle contraction or even a sudden change of direction while running can injure a knee ligament.

These injuries are called sprains and are treated according to their severity.

  • 1st Grade: At this stage the joint is slightly damaged, it can be extended, but can still keep the joint steady.
  • 2nd Grade: The joint extends to the extent that it becomes looser. This is often referred to as partial ligament rupture.
  • 3rd Grade: This damage is often referred to as total ligament rupture. The ligament is usually cut into pieces and the knee joint is unstable.

Injury to multiple ligaments is likely to occur. These injuries usually lead to serious complications. They may disrupt normal blood flow or nerve function in the lower extremities. In severe cases, multiple ligament injuries can even lead to amputation.

In particular, ruptures in the anterior cruciate ligament may, at the same time, be accompanied by injury to the medial collateral ligament.

Usually, the medial collateral ligament of the knee joint is most often injured from exterior forces and due to the complicated anatomy of the exterior of the knee, when the lateral collateral ligament of the knee is injured, there is usually concurrent damage to other parts of the knee.


In suspicion of multiple ligament injury, the patient needs a careful examination by an experienced Orthopedist. Depending on the severity of the injury, other specialties such as a vascular surgeon may be needed. In contrast to the therapeutic approach of individual ligament ruptures, the treatment of combined injuries should be performed relatively soon after injury. This is necessary, despite the fact that surgery immediately after injury increases the chance of scarring within the joint. When dealing with multiple ligament injuries, more than one surgical operation may be needed.



The effects of dealing with multiple ligament injuries are not as good and predictable as in individual ligament injuries. In the past, injury to more than one knee ligaments ended the patient’s subsequent athletic career. This is not the case today, as many athletes return to action even after multiple ligament injuries, although this is not the norm.