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Knee Ligament Injury Specialist
Combined knee ligament injuries refer to damage to two or more of the major ligaments in the knee joint.
- Are your knee pain symptoms affecting your quality of life? Consult our MOH-accredited knee ligament specialist for a comprehensive diagnosis of your condition & a personalised treatment plan.
Dr Poh Seng Yew (傅圣耀)
MBBS
MRCSEd
MMED (Ortho)
FRCSEd
What are Combined Knee Ligament Injuries?
Combined knee ligament injuries occur when more than one of the knee’s primary ligaments are damaged. The knee joint comprises four ligaments: the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), which control the shin bone’s rotation, and forward and backward movements; and the medial collateral ligament (MCL) and lateral collateral ligament (LCL), providing stability to the knee’s inner and outer parts. When two or more of these ligaments are injured, it results in a combined knee ligament injury. This can severely impede mobility, affecting daily activities and athletic pursuits.
Causes of Combined Knee Ligament Injuries
Combined knee ligament injuries can arise from situations including:
- High-Impact Trauma
Such as car accidents or falls from heights, leading to direct and severe impacts on the knee. - Sports-Related Injuries
Common in activities with sudden changes in direction, pivoting, jumping, or a blow to the knee, like football, basketball, or skiing. - Previous Knee Conditions
A history of knee injuries or chronic knee conditions can predispose individuals to further ligament damage. - Occupational Hazards
Jobs requiring heavy lifting, frequent kneeling, or sudden movements can increase the risk. - Age and Fitness Level
Older adults or those with lower fitness levels may have weakened ligaments, making them more susceptible to combined injuries under stress. - Improper Athletic Training
Inadequate training or lack of proper warm-up techniques in sports can lead to increased risk.
Symptoms and Signs
The symptoms of combined knee ligament injuries can vary depending on the severity of the injury and the specific ligaments affected.
- Severe Pain: Immediate and intense pain at the injury moment.
- Swelling and Bruising: Noticeable swelling and bruising around the knee, often developing rapidly after the injury.
- Instability: A sensation of the knee ‘giving way’ or being unable to support weight reliably.
- Limited Range of Motion: Difficulty or inability to fully bend or straighten the knee.
- Weight-bearing Challenges: Problems standing, walking, or supporting body weight on the affected leg.
- Joint Stiffness and Muscle Weakness: Leading to reduced mobility and discomfort in movement.
- Audible Sensations: A popping or tearing sound or sensation at the injury time, indicating ligament damage.
- Altered Gait: Changes in walking patterns to compensate for knee pain and instability.
Diagnosis
Diagnosing combined knee ligament injuries involves the following steps:
- Medical Evaluation
A thorough physical exam and review of medical history. - Imaging Tests
X-rays to rule out fractures and check for bone abnormalities; MRI scans for detailed images of knee ligaments, assessing injury extent and identifying involved ligaments. - Diagnostic Arthroscopy
In some cases, a minimally invasive procedure using a camera inserted into the knee joint to visualise and assess the ligaments’ condition directly.
Non-Surgical Treatment Options
Though combined knee ligament injuries usually require surgery, in cases where the injuries are milder or in patients whose lifestyles are less physically demanding, non-surgical treatments may be considered.
- Knee Braces - These are designed to provide additional support and stability to the injured knee. They help in limiting movement to prevent further injury and aid in the healing process.
- Physical Therapy - Specific exercises and techniques can strengthen the muscles around the knee, enhancing stability and improving range of motion. Therapy is often tailored to individual needs and injury specifics.
- Activity Modification - Involves altering daily routines and activities to minimise stress on the injured knee. This may include reducing activities that involve jumping, pivoting, or heavy lifting.
- Pain Management - Utilising anti-inflammatory medications and pain relievers to manage discomfort and swelling.
Surgical Treatment Options
Surgical intervention is often required for combined knee ligament injuries, especially in severe cases.
Ligament Repair and Reconstruction
This involves the surgical mending or replacement of the torn ligaments. Techniques vary from repairing the ligament to completely reconstructing it using tissue grafts from other parts of the patient’s body or donor tissue. Screws or other fixation devices may be used to anchor the grafts.
Multiple Procedures
In complex cases, multiple surgeries might be necessary to address each damaged ligament adequately.
Prevention Strategies
Preventing combined knee ligament injuries involves various strategies:
- Proper Athletic Training: Adequate training and warm-up routines in sports help prepare the ligaments for the stresses of physical activity.
- Use of Protective Gear: Wearing appropriate knee braces or supports during high-risk activities can help stabilise the knee and prevent injuries.
- Strengthening Exercises: Regular exercises that strengthen the muscles around the knee joint can provide better support and reduce the risk of ligament injuries.
- Avoiding High-Risk Activities: Being cautious about engaging in activities that put excessive stress on the knee, especially for individuals with a history of knee injuries.
Dr Poh Seng Yew (傅圣耀)
MBBS
MRCSEd
MMED (Ortho)
FRCSEd
With over 20 years of experience, Dr Poh Seng Yew (傅圣耀) is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.
- Former Director of Sports Service, Department of Orthopaedic Surgery, Singapore General Hospital
- Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany
- Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
- Master of Medicine (Orthopaedic Surgery), National University of Singapore
- Member, Royal College of Surgeons of Edinburgh (MRCSEd)
- Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #07-42
Singapore 329563
Weekdays: 9.00am – 5.00pm
Saturdays: 9.00am – 1.00pm
Sundays and Public Holidays: Closed
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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #07-42
Singapore 329563
Frequently Asked Questions (FAQ)
How long is recovery after a combined knee ligament injury?
Recovery time ranges from several weeks to over a year, depending on treatment type (surgical or non-surgical) and individual factors.
What are the possible complications of untreated combined knee ligament injuries?
Untreated injuries can lead to chronic instability, secondary injuries, meniscus tears, cartilage damage, and accelerated joint degeneration, potentially leading to osteoarthritis.
How is the severity of a combined knee ligament injury determined?
Severity is assessed based on the grade of ligament injury (mild sprain to complete tear), the number of ligaments injured, and associated structural damage (like meniscus tears or fractures).
Can combined knee ligament injuries recur after treatment?
There is a risk of re-injury, especially if post-treatment rehabilitation guidelines are not followed properly or if the individual returns to high-impact activities too soon.
Are there any long-term effects of combined knee ligament injuries?
Long-term effects can include reduced knee stability, persistent pain, and an increased likelihood of developing osteoarthritis in the knee joint.
Is it possible to fully regain knee function after a combined knee ligament injury?
While outcomes vary, with appropriate treatment and rehabilitation, many individuals can regain knee function. The extent of recovery depends on the severity of the injury and adherence to rehabilitation protocols.