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Cruciate - multi-ligament instability

Submitted by admin on March 13, 2008 - 8:29pm.

 

'Multi-ligament' instability is the result of more than one injury being torn at one time.

This may include tears of both cruciates, or one or more cruciates and a collateral - plus or minus the popliteus tendon, arcuate ligament and part of the capsule.

A multi-ligament tear results in knee instability which is very much super-specialist territory. Remember than the KNEEguru website maintains a list of knee surgeons around the world.

Unhappy Triad of O'Donoghue

This particular multi-ligament knee injury has earned itself the infamous name of 'The unhappy triad of O'Donoghue'! -

  • torn anterior cruciate ligament (ACL)
  • torn medial collateral ligament (MCL)
  • torn medial meniscus

In fact much more common is -

  • torn anterior cruciate ligament (ACL)
  • torn medial collateral ligament (MCL)
  • torn lateral meniscus (if the medial meniscus is torn, the lateral one is usually torn also)

Popliteus tendon

Postero-lateral Rotatory Instability

This is a particular multi-ligament injury involving tears of these structures -

  • popliteus tendon
  • arcuate ligament
  • lateral collateral ligament (LCL)
  • lateral capsular ligaments

The ACL is frequently also torn, in which case a Segond fracture (bony attachment of the lateral capsular ligaments torn off) may be apparent. This is definitely a condition requiring super-specialist attention.

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