Multi-Ligament Knee Reconstruction in Reading — Complex Knee Surgery
A multi-ligament knee injury occurs when more than one of the major stabilising ligaments of the knee is damaged — typically involving the Anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), or posterolateral corner (PLC). These injuries are often caused by high-energy trauma such as sporting collisions, road traffic accidents, or falls, and require expert assessment and reconstruction to restore full stability and function.
Mr Sam Nahas, consultant knee surgeon at Circle Reading Hospital, specialises in the management of these complex injuries using advanced reconstructive techniques, staged surgical planning, and multidisciplinary rehabilitation.
Understanding multi-ligament knee injuries
The knee is stabilised by four main ligaments:
Anterior cruciate ligament (ACL): stops your shin bone from sliding too far forward and keeps your knee stable when you twist or pivot
Posterior cruciate ligament (PCL): stops your shin bone from sliding too far backward
Medial collateral ligament (MCL): stops your knee from bending inward
Posterolateral corner (PLC): prevents your knee from twisting and bending outward
When two or more of these are torn, the knee becomes profoundly unstable, and early recognition is essential to avoid long-term damage to cartilage, menisci, and surrounding structures.
Diagnosis and imaging
Accurate diagnosis requires detailed examination and advanced imaging.
MRI confirms which ligaments are torn and identifies associated meniscal or chondral injury
CT scans may be used to assess bone alignment or avulsion fractures
X-rays help rule out fractures and assess joint congruency
At Circle Reading Hospital, patients benefit from MRI within a week and rapid specialist review, ensuring no delay in diagnosis or decision-making.
Treatment approach
Multi-ligament injuries are complex, and treatment is highly individualised.
Some cases can be treated in a single stage, while others are best managed in staged procedures, allowing initial healing of some tissues before reconstruction of others.
Mr Nahas uses an evidence-based, stepwise approach that prioritises safety, alignment, and function.
Surgical options include:
ACL reconstruction with different graft options available
PCL reconstruction (often with autograft or allograft)
MCL repair with synthetic augmentation
PLC reconstruction to restore rotational control
Osteotomy in chronic cases with alignment abnormalities
Where the knee has dislocated, urgent reduction and stabilisation are performed before definitive reconstruction once swelling has subsided. This should be performed in an emergency department or acute hospital theatre setting.
Graft options
Mr Nahas uses a combination of autografts (patient's own tissue) and allografts (donor tendon) depending on the number of structures needing reconstruction and patient preference.
Allograft use can reduce surgical morbidity and allow multiple ligaments to be reconstructed in one sitting, particularly in revision cases.
Rehabilitation and recovery
Recovery from multi-ligament reconstruction is gradual and carefully structured:
Hospital stay: typically 1–2 nights, depending on the surgery
Weight bearing: usually restricted initially but depends on the surgery undertaken
Range of motion: may be protected depending on the surgery undertaken
Return to work: 6–12 weeks depending on occupation
Return to sport: after 12 months
Each patient follows a personalised recovery pathway to ensure safe restoration of stability and confidence. These numbers will vary greatly between patients and are not guaranteed. Return to play rates are lower in multi-ligament injuries than isolated ACL tears for example.
Evidence and outcomes
Recent studies and registry data show that reconstruction of multiple ligaments offers the best chance of regaining stability and returning to sport.
Key findings include:
Improved stability and function when all injured structures are addressed in a single or planned staged procedure
Low graft failure rates when modern techniques are used
Better long-term outcomes compared to non-operative treatment in high-grade injuries
Mr Nahas' approach reflects the latest consensus guidelines for multi-ligament knee injury management.
Why choose Mr Sam Nahas
Consultant knee-only surgeon with fellowship training in complex ligament reconstruction
Expertise in ACL, PCL, MCL, and PLC injury reconstruction
Access to advanced surgical equipment and rehabilitation protocols
Evidence-based practice, transparent outcome tracking, and 5★ patient ratings on Doctify
Collaborative care with top physiotherapists and sports medicine specialists across Berkshire
Self-pay and appointments
Self-pay consultations are available with access to MRI within a week and surgical planning. No GP referral is required for self-pay patients.
Location
Procedures are performed at Circle Reading Hospital, serving patients from Reading, Berkshire, Wokingham, Henley, Oxford, and surrounding areas.