Multiligament Knee Injuries: Updates of the Debates

Multiligament knee injuries (MLKI) constitute a complex and challenging problem. They can have life-modifying consequences, such as the development of osteoarthritis, and an inability to return to work or sport. At present, there is insufficient high-level evidence or expert consensus to support one management strategy over another.

The purpose of this article is to review the updates of the debates about multiligament knee injuries, diagnosis, treatment options, and rehabilitation protocols. This article also aimed to elucidate expert opinions on controversial issues in MLKI from scholars from Egypt and the Arab world.

Comprehensive review; Level of evidence, 5.

Medline, Embase, PubMed, and Physiotherapy Evidence Database (PEDro) databases were searched between inception and February 2024. The terms: 'multi-ligament' OR 'multiligament' OR 'multi ligament' OR multiple ligaments' AND 'knee' were used to extract relevant studies.

Overall, 1009 eligible studies were identified. After applying inclusion and exclusion criteria, there were 251 articles; of which there were 24 systematic reviews and 227 clinical studies.

The relative rarity of MLKI makes it difficult to perform good-powered prospective randomized studies evaluating these injuries. The debates are expected due to the diversity of presentations of MLKI with regard to types of injured ligaments, site of injury within the ligament, time of presentation, and the different management methods. Thorough knowledge and experience are mandatory to tailor a diagnostic workup and management plan for each case.