How I Manage the Multiple-Ligament Injured Knee

The key to successful treatment of the multi-ligament injured knee is to identify and treat all pathology step by step. In an emergency, if necessary, the knee has to be reduced and a ligamentous examination has to be performed, but a vascular and neurologic examination is also of great priority. Concerning surgical timing, we try to perform our reconstruction 2 to 3 weeks after injury. We prefer the use of an allograft for anterior and posterior cruciate ligament reconstruction. Cases requiring collateral ligament reconstruction may necessitate primary repair, reconstruction, or both and also incorporate allograft tissues. The posterior cruciate ligament is reconstructed first, followed by the anterior cruciate ligament, the lateral side of the knee, and the medial side. Postoperatively, we use a hinged brace with no weightbearing for the first 6 weeks. Passive and active range of motion in the brace is begun immediately.