Multiligament Knee Injuries: ACL and MCL Tears

The anterior cruciate and medial collateral ligaments (ACL and MCL) cross the knee joint to attach the tibia (shinbone) to the femur (thighbone). These ligaments help to stabilize and protect the knee by preventing back-and-forth and side-to-side motions of the bones while allowing the movements necessary for walking, running, and jumping. ACL injuries occur most frequently from shear forces caused by pivoting or changing directions quickly or other sports injuries. The MCL is most often injured from a direct blow to the outside of the knee, usually while playing sports. Ligament injuries in the knee are common, vary in severity, and may include injury to multiple ligaments at the same time. Depending upon the severity of the ligamentous injury, the knee may become very unstable and require surgical repair. Our teams of specialists use specialized imaging to diagnose the severity of the injury and determine the most effective, least invasive specialized treatment option for you.


  • A painful snap in the knee at the time of injury
  • Knee pain
  • Swelling in and around the knee

Patient Story

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Leah – ACL Reconstruction CMC

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Soccer Mom – Minimally Invasive ACL Reconstruction


There are nonsurgical and surgical treatments options available for knee ligament injuries such as ACL and MCL tears. Both treatment types are performed by our knee specialists at Orthopaedic Specialists.

Nonsurgical Treatments

Depending on the severity and location of the injury, knee ligaments may respond well to nonsurgical treatments such as resting, icing, wearing a knee brace, taking anti-inflammatories, physical therapy, and/or cortisone injections. While nonsurgical treatment can relieve mild cases of the condition, surgery may be necessary if it continues to worsen.

Surgical Treatment

One or more small incisions are made at the site of injury. Depending on the location, severity, and type of ligamentous injury, the surgeon will use stitches, metal screws, or bone staples to reattach the torn ligament back to its proper location on the bone or to sew the torn ligament back together. The minimally invasive methods performed by our surgeons at Orthopaedic Specialists along with the customized physical therapy treatment plans allow our patients to experience faster pain relief, shorter recovery times, and minimal scarring.

State-of-the-Art ACL Grafts

Replacing tissue in the case of an ACL tear is also possible. These procedures are known as ACL grafts, where your surgeon reconstructs the torn ACL from tendon tissues. Our expert surgeons at Orthopaedic Specialists offer options using patellar tendon, quadricep tendon, and hamstring autograft (your own) tissue. Dr. Kristyn Darmafall is the ONLY surgeon in the area offering quadricep ACL grafts, and she is the ONLY area surgeon offering ACL reconstruction for pediatric patients.

Innovative, Individualized Rehabilitation Program

Multiligament knee injuries (MLKI) are defined as injuries to at least two of the four major ligaments in the knee: anterior cruciate ligament, posterior cruciate ligament, lateral collateral ligament (and posterolateral corner), and medial collateral ligament (and posteromedial corner). These injuries can be a result of either low- or high-energy mechanisms. They can also be associated with cartilage, meniscal, and nerve injuries.

Once stabilized, physical therapy is started for the knee's range of motion and quadriceps' function, if appropriate. Timing of surgery depends on the type of injury and associated structures involved. Surgery includes complex arthroscopic reconstruction of the torn ligaments with either repair or reconstruction (replacement) and repair of the associated damaged meniscus, tendons, or cartilage. In the setting of a nerve injury, a decompression or neurolysis is also performed.