DR. ONG KEE LEONG
Multiligament Knee Reconstruction
Multiligament knee reconstruction is a surgical procedure that addresses injury to multiple ligaments in the knee joint simultaneously. When two or more knee ligaments are torn, typically the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and/or lateral collateral ligament (LCL), this procedure repairs or rebuilds these structures to restore knee stability and function. Multiligament injuries often result from high-energy trauma such as motor vehicle accidents, sports injuries, or falls, and require specialised surgical techniques to effectively treat the complex damage.
Book AppointmentPotential Risks and Complications
Multiligament knee reconstruction carries several risks, including infection, which may require antibiotics or additional procedures, and blood clots, which can develop despite preventive measures. Stiffness may necessitate extended therapy or further procedures, while graft failure is more likely with high-demand activities or inadequate rehabilitation. Hardware issues may require removal, and persistent instability can result from technical problems or poor healing. Nerve injury, particularly to the peroneal nerve, may cause foot drop or numbness. Additionally, post-traumatic arthritis remains a long-term concern due to initial cartilage damage, even with successful reconstruction.
Indications for Multiligament Knee Reconstruction
The following conditions may necessitate multiligament knee reconstruction surgery when conservative treatments prove insufficient.
- Knee Dislocation: This occurs when the tibia (shin bone) becomes displaced relative to the femur (thigh bone), causing multiple ligament tears. Knee dislocations typically damage at least two major ligaments, creating significant instability.
- Multiple Ligament Tears: When diagnostic imaging confirms damage to two or more knee ligaments, reconstruction may be needed. Combined injuries to the ACL and MCL or PCL and LCL are common patterns requiring surgical intervention.
- Chronic Instability: Patients who experience recurrent giving way or buckling of the knee during daily activities often have underlying multiligament laxity. This instability can prevent return to normal function and cause progressive joint damage.
- Failed Conservative Management: Non-surgical options like bracing, physical therapy, and activity modification may be tried for some multiligament injuries. Surgery is considered when these methods do not provide sufficient stability or relief from symptoms.
- High Activity Requirements: Athletes or individuals with physically demanding occupations may require surgical reconstruction to meet their functional needs. These patients typically cannot perform at their required level with persistent ligament instability.
Benefits of Multiligament Knee Reconstruction
- Restored Joint Stability: The procedure re-establishes the normal restraining function of damaged ligaments. This stability prevents abnormal motion between the femur and tibia during walking, running, and pivoting activities.
- Prevention of Secondary Damage: Untreated ligament injuries can lead to accelerated cartilage wear and meniscal tears. Reconstruction helps protect these structures by normalising joint biomechanics and load distribution.
- Improved Functional Capacity: Patients typically experience enhanced ability to perform daily activities, recreational pursuits, and occupational tasks following successful reconstruction. Many can resume pre-injury activity levels after completing rehabilitation.
- Reduced Pain: By correcting abnormal joint mechanics, reconstruction often diminishes knee pain that results from instability. Patients report decreased discomfort with weight-bearing and movement following surgery and rehabilitation.
- Long-term Joint Preservation: Proper ligament function helps maintain normal joint alignment and mechanics. This may reduce the risk of post-traumatic arthritis that commonly develops after untreated multiligament injuries.
Surgical Techniques
Autograft Reconstruction
This technique uses the patient’s own tissue, typically harvested from the hamstring tendons, patellar tendon, or quadriceps tendon. The surgeon removes the selected tendon, shapes it to the proper dimensions, and positions it to replace the damaged ligament. Autografts provide good biological incorporation and avoid rejection risk, though they require additional surgical site and can cause donor site morbidity.
Allograft Reconstruction
This method utilises tissue from a donor (cadaver) to replace damaged ligaments. The surgeon selects appropriately sized grafts, prepares them on a side table, and then implants them in the positions of the injured ligaments. Allografts eliminate donor site issues and reduce surgical time but may have slower biological incorporation.
Staged Versus Single-Stage Approach
Some surgeons prefer to address all ligament injuries in a single operation, while others recommend a staged approach for complex cases. The single-stage approach allows for earlier rehabilitation but can be technically challenging. A staged approach may begin with repairing or reconstructing certain ligaments, followed by addressing others after initial healing has occurred, potentially reducing surgical complexity.
Repair Versus Reconstruction
When ligaments avulse (tear off) from their attachment sites with good tissue quality, direct repair may be possible. This involves reattaching the ligament to bone using sutures and anchors. For midsubstance tears or poor-quality tissue, complete reconstruction with replacement grafts becomes necessary, requiring bone tunnels and fixation devices to secure the new ligament.
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Preparing for Surgery
- Medical Evaluation: Patients undergo comprehensive assessment including physical examination, imaging studies, and laboratory tests. This evaluation confirms the extent of ligament damage, identifies any associated injuries, and assesses overall health status for anaesthesia clearance.
- Medication Adjustments: Patients may need to discontinue blood-thinning medications including aspirin, NSAIDs, and certain supplements 7-10 days before surgery. This reduces bleeding risk during the procedure.
- Lifestyle Modifications: Smoking cessation is advised at least 4 weeks before surgery as tobacco use impairs healing and increases complication rates. Patients should maintain proper nutrition and hydration prior to surgery to optimise recovery potential.
Post-Surgical Care and Recovery
- Immediate Post-operative Care: Patients undergo monitoring with multimodal pain management including nerve blocks and medications. The leg is elevated with ice to reduce swelling, and patients begin basic exercises while using crutches with weight-bearing restrictions and a hinged knee brace to protect the surgical site.
- Early to Intermediate Rehabilitation: Physical therapy advances from gentle motion exercises to progressive strengthening as weight-bearing increases. The brace is adjusted for greater movement, and therapy focuses on muscle activation, balance, and normalising gait patterns.
- Advanced Rehabilitation and Return to Activity: Training emphasises strength, coordination, and functional movements specific to patient goals. Activities progress from straight-line jogging (around 4-5 months) to sport-specific drills, with full return to unrestricted activities typically requiring 9-12 months based on objective testing.
Step-by-Step Procedure
Anaesthesia Administration
The procedure begins with either general anaesthesia or regional nerve blocks. The anaesthesiologist administers medication through an IV line, and the patient is positioned supine on the operating table. Complete muscle relaxation helps the surgeon assess ligament laxity during the procedure.
Diagnostic Arthroscopy
The surgeon creates small portals (incisions) around the knee and inserts an arthroscope to visualise the joint. This step confirms the diagnosis, identifies additional injuries to cartilage or menisci, and allows for treatment of these associated problems. The arthroscope provides magnified views of all joint compartments.
Graft Harvesting
If using autografts, the surgeon makes additional incisions to harvest the selected tendons. For hamstring grafts, a vertical incision on the medial tibia allows access to the semitendinosus and gracilis tendons. The tendons are separated from their muscular attachments, removed, and prepared for use.
Tunnel Creation
The surgeon drills tunnels through the femur and tibia at the anatomic attachment sites of the damaged ligaments. These tunnels serve as pathways for the replacement grafts. Proper tunnel position is necessary for restoring normal knee kinematics and preventing graft failure.
Graft Passage and Fixation
The prepared grafts are passed through the tunnels and secured with fixation devices such as interference screws, buttons, or staples. The surgeon applies appropriate tension to each graft before final fixation. Fluoroscopic imaging may confirm proper hardware placement.
Collateral Ligament Repair/Reconstruction
The surgeon addresses MCL and LCL injuries through separate incisions on the medial and lateral aspects of the knee. These ligaments may be repaired to their bony attachments using suture anchors or reconstructed with additional grafts depending on tissue quality.
Wound Closure
After completing all ligament procedures, the surgeon irrigates the joint to remove debris and closes the incisions in layers. Sutures or staples close the skin, and sterile dressings are applied. A hinged knee brace is typically placed to protect the reconstructed ligaments.
Why Do Patients Choose Dr Ong Kee Leong?
- Dr. Ong Is Passionate In Sports, Giving Him A Deep Understanding Of Sports-Related Injuries And How They Can Be Treated
- Personalised And Professional Approach To Deliver High-Quality Orthopaedic Care Based On The Most Up-To-Date Literature
- Detailed Aftercare Plan To Ensure Smooth, Long-Term Recovery
- Fellowship Trained Surgeon With 15 Years Of Experience In Orthopaedic Conditions
- Problem-Oriented, Well-Organised and Individualized Treatment Plans Catered To Your Specific Needs
- Specialist In The Management Of Sports Injuries And Degenerative Conditions Of The Shoulder And Knee Joints
- Knowledgeable And Pleasant Clinical Staff To Assist You With Your Every Need Detailed Aftercare Plan To Ensure
- Our Care Is Conveniently Accessible At Mount Elizabeth Novena and Farrer Park Hospital
- Minimal Waiting Time For Initial Consultation
- Assistance With Medical Claims (e.g. Medisave & Integrated Shield Plans)
About Dr. Ong Kee Leong
Senior Consultant, MBBS (Singapore), MMed (Ortho), FRCSEd (Ortho)
Dr. Ong Kee Leong is a fellowship-trained orthopaedic surgeon. He subspecializes in shoulder and knee, foot and ankle, hand wrist and elbow surgeries, arthroscopic sports surgery, and the management of sports-related injuries.
He has been registered with the Singapore Medical Council as a specialist in Orthopaedic Surgery since 2011.
- MBBS, National University of Singapore (NUS) Faculty of Medicine 2001
- Member of the Royal College of Surgeons of Edinburgh 2007
- Master of Medicine in Orthopaedic Surgery (NUS) 2007
- Fellow of the Royal College of Surgeons of Edinburgh in Orthopaedic Surgery 2011
- Health Manpower Development Plan (HMDP) Scholarship, Ministry of Health 2012-2013:
- Sports Surgery and Arthroscopy in Germany (Hannover)
- Adjunct Assistant Professor, Lee Kong Chian School Of Medicine, Nanyang Technological University
- Senior Clinical Lecturer, Yong Loo Lin School of Medicine, NUS
Awards & Teaching
- Dr. Ong had received numerous awards such as Best Service and Eastern Health Alliance Caring (Gold) Awards.
- He also has an interest in clinical research and has written papers in multiple peer-review journals. As a Core Faculty of Singhealth Orthopaedic Surgery Residency Program, he oversees the training of junior orthopaedic surgeons.
- Regularly invited to teach local and regional surgeons in Shoulder and Knee Surgery Courses.
- He is a recipient of multiple teaching awards including the Singhealth Residency Outstanding Faculty Awards from 2014-2016 and Changi General Hospital Outstanding Educator Awards 2015-2016.
Frequently Asked Questions
Will I need a brace after completing rehabilitation?
Functional bracing is often recommended during high-risk activities for 1-2 years following multiligament reconstruction. The brace provides extra support as the grafts continue to mature. Athletes returning to pivoting sports may use custom functional braces to reduce the risk of reinjury.
What long-term limitations might I experience after multiligament reconstruction?
Most people can return to normal daily activities and moderate recreation, but some may face ongoing limitations with high-impact or pivoting sports. Many return to sports, though some at a reduced level compared to before the injury. Some alterations in knee mechanics may persist, causing activity-related swelling or discomfort.
How does age affect recovery from multiligament knee reconstruction?
Although healing capacity declines with age, older individuals can still achieve good results. Younger individuals tend to recover more quickly and return to higher levels of activity, while older individuals may need longer rehabilitation but still see significant functional improvement.
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Mt Elizabeth Novena
- 38 Irrawaddy Road #06-59/60/61 Mt Elizabeth Novena Specialist Centre Singapore 329563
- klong@sog.sg
- (65) 6884 6788
- (Ask for Dr Ong)
- (65) 9652 5022
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Mon – Fri : 9:00 am – 5:00 pm
Sat : 9:00 am – 1:00 pm
other practice locations
Farrer Park Hospital
- 1 Farrer Park Station Road #14-06 Connexion Singapore 217562
- klong@sog.sg
- (65) 6884 6788
- (Ask for Dr Ong)
- (65) 9652 5022
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Mon – Fri : 9:00 am – 5:00 pm
Sat : 9:00 am – 1:00 pm
Mt Alvernia Medical Centre
- 820 Thomson Road #07-53 Mt Alvernia Medical Centre D Singapore 574623
- klong@sog.sg
- (65) 6884 6788
- (Ask for Dr Ong)
- (65) 9652 5022
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Mon – Fri : 9:00 am – 5:00 pm
Sat : 9:00 am – 1:00 pm
"Moving your body the way nature intended is a freedom not well appreciated until it is lost. We are passionate about getting you back in the game, and staying in the game. Our team is fully committed to returning you to the life and activities you love."
Billing & Payment
Consultation fees are charged based on length of consultation, and start from SGD$200 (within 30 minutes).
Modes of Payment
We accept the following modes of payment:
- Cash
- PayNow & PayLah
- All major Credit Cards
If you are insured and would like to use a Letter of Guarantee (LOG) from the major insurers in Singapore, please contact us and our friendly clinic staff will assist you and provide more information if required.
Can I Claim Through My Medisave Account? (For Singaporeans and PR)
Yes, you can. Our Clinic is an accredited day surgery clinic by the Ministry of Health. Singaporeans and Permanent Residents may use their Medisave for eligible orthopaedic inpatient procedures and hospitalizations.
The exact amount would depend on the complexity of the procedure. If you have any enquiries, feel free to speak to our friendly clinic staff about using your Medisave account.
Integrated Shield Plans (Singaporeans and PRs)
Yes, patients who have purchased Integrated Shield plans with riders for co-insurance and deductibles will be able to use them in our clinic for eligible procedures. For more information, contact us to find out if your procedure is claimable.
The 5 Approved Integrated Shield Insurers are:
- NTUC Income’s IncomeShield and Enhanced IncomeShield
- American International Assurance International Co’s (AIA) HealthShield Gold
- Great Eastern Life Assurance Co’s SupremeHealth and SupremeHealth Plus
- Prudential Assurance Co’s PRUShield
- AXA Shield