Surgical Information

Multi-ligament Knee Reconstruction

What is multi-ligament knee reconstruction?

Multi-ligament knee reconstruction is a surgical procedure to rebuild damaged ligaments in the knee joint.

The knee consists of four main ligaments: the anterior cruciate ligament, the posterior cruciate ligament, the medial collateral ligament and the fibular (lateral) collateral ligament. These ligaments work together to keep the knee stable as you walk, pivot, turn or play sports. Most knee ligament injuries – such as an ACL tear – involve a single ligament. Multi-ligament knee injuries affect two or more ligaments at the same time.

Because these injuries are so complex, a precise diagnosis and meticulous planning are necessary before surgery takes place. Assessment by a qualified surgeon is critical. There are a number of ways in which the ligaments may be reconstructed. Usually, a graft is used to replace a completely torn or deficient ligament. The graft is made from either the patient's own tissues (called an autograft) or from donor tissues (called an allograft).


There are numerous ligamentous stabilizers of the knee. The anterior cruciate ligament and the posterior cruciate ligament are located in the center of the knee joint and control the knee's "back and forth" motion, as well as rotational stability. The medial and fibular (lateral) collateral ligaments, on the sides of the knee, control sideways motion. The medial (inside) and posterolateral (outside) sides of the knee also have important secondary stabilizers. These include the knee capsule, posterior oblique ligament, popliteus tendon, popliteofibular ligament, and biceps tendon. There are important nerves and vessels intimately associated with the knee's stabilizers, including the peroneal nerve which can be injured as well. Please see the following article for more detail regarding these injuries: Nerve Injury Complicating Multiligament Knee Injury: Current Concepts and Treatment Algorithm

When is surgery recommended?

Although some multi-ligament knee injuries heal on their own, surgery is nearly always required to reconstruct the ligaments. The sooner surgery takes place, the better the results. Early treatment allows for improved function during the healing process, return to an active lifestyle and a decrease in the progression of arthritis in the future. Please see the following article for more information regarding timing of surgery: Multiple-Ligament Knee Injuries: A Systematic Review of the Timing of Operative Intervention and Postoperative Rehabilitation

What is the recovery time?

The restoration of normal knee motion and muscle strength are important to avoid complications and speed the recovery process. Following surgery, patients are instructed to wear a brace and restrict Weightbearing on the injured extremity for approximately six weeks. Special bracing may be recommended, depending of the type of surgery. A robust physical therapy program is necessary to regain, flexibility, stability and strength. As with all surgical procedures, specific recovery time varies by patient and demand.