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ACL, PCL, and multiligament knee injuries

ACL, PCL, and multiligament knee injuries involve disruption of the major stabilizing ligaments of the knee, usually following sports trauma, road traffic accidents, or high-energy knee dislocation. ACL injuries commonly cause rotational instability and giving way, while PCL injuries are often caused by posteriorly directed force on the tibia. Multiligament injuries may involve the cruciate and collateral ligaments and can be associated with neurovascular injury, making early assessment essential.

Anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and multiligament knee injuries are important causes of knee instability and may occur in isolation or in combination. The ACL primarily resists anterior translation and rotational instability of the tibia, whereas the PCL is the main restraint to posterior tibial translation. The medial and lateral collateral ligament complexes provide additional coronal and rotational stability. ACL injuries commonly occur during non-contact pivoting, sudden deceleration, landing, or twisting injuries and may present with an audible pop, rapid swelling, pain, and a feeling of instability. Clinical assessment includes the Lachman test, anterior drawer test, and pivot-shift test. PCL injuries are often caused by a dashboard-type injury, fall onto a flexed knee, or hyperflexion, and are assessed using the posterior drawer test, posterior sag sign, and quadriceps active test. Multiligament knee injury usually refers to injury of at least two major ligament complexes and may occur following knee dislocation or high-energy trauma. These injuries require careful assessment because of the risk of associated popliteal artery injury, common peroneal nerve injury, meniscal damage, and cartilage injury. A complete neurovascular examination is therefore mandatory, with vascular imaging when indicated. MRI is useful for defining the pattern and severity of ligament, meniscal, and soft-tissue injury, while stress radiographs may assist in assessing ligamentous instability. Treatment depends on the ligaments involved, degree of instability, patient age, activity level, associated injuries, and chronicity. Partial or low-grade injuries may sometimes be managed with bracing, rehabilitation, and structured physiotherapy, whereas symptomatic complete tears, particularly in active patients, may require ligament reconstruction. Multiligament injuries often need staged or combined surgical reconstruction, followed by carefully supervised rehabilitation. The goals of treatment are to restore knee stability, protect neurovascular structures, regain range of motion and strength, and allow safe return to daily activities or sport.

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