Combined Knee Ligament Sprain

From Zachazewski JE, Magee DJ, Quillen WS: Athletic Injuries and Rehabilitation.
Philadelphia, WB Saunders, 1997, p. 442.

Description
A combined knee ligament sprain is a sprain of multiple (two or more of the four) major ligaments of the knee. The four knee ligaments are the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL). Ligaments are structures that help maintain the normal position of the femur (thigh bone) and the tibia (leg bone) during movement. Injury to multiple ligaments results in difficulty in performing sports and often even with day-to-day living. Injury to the ACL and MCL is the most common combined knee ligament injury.

Common Signs and Symptoms – Notify a physician if you have any of the following:

One or more pops heard or felt at the time of injury
Inability to continue after the injury; knee swelling noticed within 6 hours after the injury
Possibly, deformity of the knee · Inability to straighten knee
Knee gives way or buckles; often, swelling with repeated giving way
Occasionally, locking when there is concurrent injury to the meniscus cartilage
Rarely, injury to nerves -numbness, weakness or coldness (due to artery injury) of the foot and ankle

Treatment
Initial treatment consists of ice and anti-inflammatory medication to relieve pain and reduce the swelling. Walking with crutches is often recommended. Bracing may also be prescribed initially. Rehabilitation of these injuries usually concentrates on reducing knee swelling, regaining knee range of motion, regaining muscle control and strength, receiving functional training, getting fitted for a brace (often), and education, such as avoiding sports that require pivoting, cutting, changing direction, and jumping and landing. Properly timed surgical repair or reconstruction (replacement) of all or some ligaments, in the hands of an experienced orthopaedic surgeon, offers the best chance for an optimal result. For combined ACL–MCL injuries, ACL reconstruction usually allows for adequate MCL healing. Nonetheless, some athletes may never return to sports with these injuries, although often this depends on the associated injuries and the demands of the sport.

RICE Principle With all acute injuries, follow the RICE principle to reduce swelling, pain and inflammation.

Rest - Walk with crutches if you cannot bear weight.
Ice - Use an ice pack for 20 minutes every two to three hours during the first 72 hours.
Compression - Use an ace wrap on the knee. Start at the top of the calf and wrap to mid-thigh.
Elevation - Keep the injured leg above the level of the heart when sitting or lying down.