Our Approach to the Management of the Multiple-Ligament Knee Injury

Multiple-ligament knee injuries require prompt recognition, awareness of associated potential limb-threatening conditions, accurate diagnosis of functional ligament deficiency, careful surgical planning, and dedicated rehabilitation. In this article, we summarize our approach to these serious injuries and how it has evolved with our experience. To establish the diagnosis, we rely on a thorough knee examination with adjunctive stress radiographs. Although we routinely use magnetic resonance imaging to characterize these injuries, we recognize that the intense signal generated by excessive edema may overcall injury. We advocate single-stage reconstruction of all injured structures at the index procedure pursuing early surgical intervention within 2 weeks if the pattern includes an injury to either corner/collateral. Except in some medial collateral ligament injuries amenable to primary repair, we augment corner/collateral repairs with free graft reconstruction to protect the repair and allow early motion. Our postoperative rehabilitation protocol emphasizes early protected range of motion to prevent stiffness. Using these principles, we have been able to reliably restore function and stability after these potentially devastating injuries. Although we have been pleased with our results, we acknowledge the ongoing evolution in the treatment of multiple-ligament knee injuries and will continue to refine our technique to improve our outcomes.