Diagnosis and management of the multiligament-injured knee

Knee injuries involving multiple ligaments, which are often associated with tibiofemoral joint dislocations, are complex injuries that are challenging to evaluate and treat. The clinician must have a thorough understanding of knee anatomy and be capable of a detailed physical examination to determine the extent and pattern of injury. Accurate interpretation of imaging studies is crucial but cannot replace the physical examination. The magnitude of deforming forces and amount of translation and rotation of the tibia in relation to the femur determine the risk for neurovascular injury. Most patients with multiligament knee injuries undergo surgical management; however, some patients may be best served by a nonoperative approach. Successful rehabilitation consists of achieving good range of motion and strength, as well as normal gait mechanics, while respecting the stages of healing.