How I Manage the Multiple-Ligament Injured (Dislocated) Knee

Knee dislocations are relatively rare injuries but necessitate immediate and appropriate management. The prompt reduction of the dislocation and detailed evaluation of the neurovascular status of the limb are required to avoid limb-threatening complications. Although there remains considerable controversy over the ideal management of the multiple-ligamentous injured knee, here we present our preferred approach to the treatment of this injury. Important principles begin with a detailed and specific diagnosis, including the timing, grade, and associated injuries. Next, operative management should be performed only after thorough preoperative planning, timed electively, and performed within an inpatient setting. Although we still operate on complete grade III lateral corner and medial collateral ligament injuries acutely, delayed and/or staged surgery is acceptable in many cases of cruciate reconstruction. Generally speaking, the postoperative rehabilitation and return to work/sports is slower in these patients compared with those undergoing primary anterior cruciate ligament surgery. Nevertheless, adherence to strict surgical principles of anatomic repair/reconstruction of all ligamentous injuries can result in regaining adequate knee function. We present important considerations in surgical indications, timing, graft selections, anatomic reconstruction, and postoperative rehabilitation.