[Research progress in diagnosis and treatment of multiple ligament knee injuries]

To summarize the research progress in the diagnosis and treatment of multiple ligament knee injuries (MLKI).

Domestic and international literature related to MLKI in recent years was retrieved, and a systematic summary and analysis were conducted from the aspects of etiology, classification, diagnosis, treatment, and rehabilitation.

High-energy trauma is the main cause of MLKI, while low-energy and ultra-low-speed injuries also require attention; ultra-low-speed injuries are more common in obese individuals with a higher risk of complications. The Schenck classification is the most widely used in clinical practice, but it has limitations in describing injury energy and evaluating fracture-dislocations. The diagnosis of MLKI should follow the principle of separate management for acute and chronic conditions: acute injuries should be preferentially evaluated in accordance with Advanced Trauma Life Support principles, and chronic injuries are preferably assessed by physical examination. MRI combined with stress radiography can improve diagnostic accuracy, and neurovascular injuries such as popliteal artery and common peroneal nerve injuries should be vigilant. Surgical treatment is the mainstream treatment for MLKI, with better efficacy than nonoperative treatment. Early surgery can improve joint function but increases the risk of joint stiffness; no unified consensus has been reached on graft selection and the sequence of ligament reconstruction. The rehabilitation period of MLKI is about 9-12 months, with non-weight bearing for 4-6 weeks postoperatively and early mobilization as the core principles. The application of hinged external fixators can reduce the failure rate of ligament reconstruction. Early mobilization strategy is superior to delayed mobilization but does not reduce the rate of arthrolysis, and rehabilitation programs should be individualized.

Basic consensus has been formed on the fundamental diagnosis and treatment principles of MLKI in clinical practice. Surgery combined with individualized rehabilitation is the key to improving prognosis. However, controversies still exist in key aspects such as surgical timing, graft selection and rehabilitation strategies, and the level of existing evidence-based evidence needs to be improved. Large-sample, multicenter prospective studies are urgently needed in the future to promote the development of precise and standardized diagnosis and treatment of MLKI.