Knee Ligament Reconstruction Adelaide
Knee Ligament Reconstruction
MCL, PCL, LCL, posterolateral corner and multiligament injuries.
Not every unstable knee is an ACL. Injuries to the collateral ligaments, the posterior cruciate and the posterolateral corner are less common and more often missed, and getting the diagnosis right determines whether treatment works.
Book a ConsultationBeyond the ACL: the other knee ligaments
The ACL receives most of the attention, but it is one of four main ligaments stabilising the knee. Injuries to the medial collateral ligament (MCL), the posterior cruciate ligament (PCL), the lateral collateral ligament (LCL) and the posterolateral corner are less common, less well recognised, and more often missed, particularly when they occur alongside an ACL rupture.
Getting the diagnosis right matters. An unrecognised posterolateral corner injury is one of the more common reasons an ACL reconstruction fails, because the graft is left to control rotational forces it was never designed to resist alone.
The individual ligaments
Medial collateral ligament (MCL)
The MCL runs along the inner side of the knee and resists forces pushing the knee inward. It is the most commonly injured knee ligament, and it is also the one with the best capacity to heal without surgery. The great majority of isolated MCL injuries are managed in a hinged brace with a graded rehabilitation programme. Surgery is reserved for a small group: injuries that remain unstable after appropriate non-operative treatment, certain avulsion patterns, and MCL injuries occurring as part of a multiligament injury.
Posterior cruciate ligament (PCL)
The PCL stops the tibia sliding backward on the femur. It is typically injured by a direct blow to the front of the shin, such as a dashboard injury in a car accident or a fall onto a bent knee. Isolated PCL injuries are frequently managed non-operatively with a specific brace and a quadriceps-focused rehabilitation programme. Reconstruction is considered for higher-grade injuries, for knees that remain symptomatic after rehabilitation, and where the PCL is injured together with other ligaments.
Lateral collateral ligament and posterolateral corner
The outer side of the knee is stabilised by the LCL together with a group of structures known collectively as the posterolateral corner: the popliteus tendon, the popliteofibular ligament and the surrounding capsule. Unlike the MCL, these structures heal poorly. An untreated posterolateral corner injury leaves the knee with rotational instability and a varus thrust when walking, and it places any ACL or PCL graft at high risk of failure. Injuries here are usually better addressed surgically, and the timing matters. Acute repair within the first two to three weeks is often possible, whereas later presentations generally require reconstruction with a graft.
Multiligament knee injury
When two or more major ligaments are torn, the injury is treated as a distinct and more serious problem. These injuries can follow a knee dislocation, and they carry a risk of damage to the popliteal artery and the common peroneal nerve. That risk makes early, thorough assessment essential, including a vascular examination and, where indicated, angiography. Surgical planning for these knees is individualised and often staged.
Assessment
Ligament injuries of the knee are diagnosed clinically and confirmed on imaging, not the other way round. Assessment covers the mechanism of injury, a systematic examination of each ligament with the relevant stress tests, and a neurovascular examination. MRI defines the ligaments, the menisci and the articular cartilage. Standing and long-leg alignment X-rays are important where there is a chronic injury or a varus knee, because malalignment that is not corrected will overload any reconstruction.
Surgical approach
Where surgery is indicated, the aim is to restore the anatomy of the injured structures rather than to substitute a generic graft. In practice this means anatomic reconstruction using autograft or allograft tissue as appropriate, addressing every injured structure in the same operation where it is safe to do so, and correcting alignment where a varus or valgus deformity would otherwise place the reconstruction under continuing strain.
Rehabilitation after multiligament surgery is longer and more carefully staged than after an isolated ACL reconstruction, with a period of protected weight bearing and controlled range of movement before strengthening begins.
Recovery
These are general ranges. Recovery after ligament surgery varies considerably with which structures were injured, whether the injury was acute or chronic, and how the knee responds to rehabilitation. Dr Mooney and the Orthopaedics 360 team will provide a personalised plan, and progression is governed by meeting objective milestones rather than by elapsed time.
Frequently asked questions
No. The medial collateral ligament has a good blood supply and heals reliably. Most isolated MCL injuries, including many complete tears, are managed successfully in a hinged brace with a graded rehabilitation programme. Surgery is considered where the knee remains unstable after appropriate non-operative treatment, for certain avulsion patterns, or where the MCL is injured as part of a multiligament injury.
The posterolateral corner is a group of structures on the outer side of the knee, including the lateral collateral ligament, the popliteus tendon and the popliteofibular ligament, that together control rotation and resist the knee opening outward. Unlike the MCL, these structures heal poorly. An unrecognised posterolateral corner injury is one of the more common reasons an ACL or PCL reconstruction fails, because the graft is left resisting forces it cannot control on its own.
Often, yes. Many isolated PCL injuries are managed non-operatively with a specific PCL brace and a rehabilitation programme focused on quadriceps strength. Reconstruction is considered for higher-grade injuries, for knees that remain symptomatic after a proper trial of rehabilitation, and where the PCL is torn together with other ligaments.
It depends on which structures are involved. Posterolateral corner and multiligament injuries are generally better addressed early. Direct repair is often possible within the first two to three weeks, whereas later presentations usually require reconstruction with a graft. Isolated ACL injuries are different; a period of rehabilitation before surgery does not compromise the result and frequently improves it.
Yes. A knee dislocation, or a multiligament injury that may represent a knee that dislocated and reduced itself, carries a risk of injury to the popliteal artery and the common peroneal nerve. It requires urgent assessment including a vascular examination. Anyone with a grossly unstable knee after a significant injury should be seen in an emergency department.
Where reconstruction rather than repair is needed, tissue is taken either from your own body (autograft, commonly hamstring, quadriceps or patellar tendon) or from a tissue bank (allograft). Multiligament injuries frequently require more graft tissue than one knee can supply, so allograft is often used. The choice is discussed with you before surgery.
Dr Luke Mooney
Dr Luke Mooney is an Adelaide orthopaedic surgeon whose practice covers hip and knee surgery, including sports injuries of the knee. He consults at Orthopaedics 360 in Eastwood and operates at Eastwood Private Hospital, with regional clinics in Mount Gambier and Naracoorte.
Dr Mooney is a Clinical Senior Lecturer at the University of Adelaide. He holds the qualifications MBBS, FRACS, and FAOrthA. When you see Dr Mooney, you see Dr Mooney: at every appointment, at surgery, and at every follow-up.
About Dr Mooney →- MBBS · FRACS · FAOrthA
- Clinical Senior Lecturer, University of Adelaide
- Orthopaedics 360, Eastwood SA
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