Multiple ligament injuries of the knee

Multi-ligament injuries of the knee are complex. A high index of suspicion for knee dislocation having occurred at the time of injury is necessary, as many dislocations spontaneously reduce and are therefore occult. Significant vascular and neurological injuries often occur at the time of injury and need to be diagnosed and managed. Consequently, there should be a low threshold for angiography. MR imaging is a useful aid but careful clinical examination is essential. Non-surgical management is, in general, not advocated but has a role for structures that have a high chance of healing such as the medial collateral ligament. Good results from surgery can be obtained, especially when surgery occurs within 2–3 weeks post-injury, but this is only possible in uncomplicated cases. An osteotomy may be necessary in chronic cases, especially if the posterolateral corner is affected. The patient should be warned of prolonged rehabilitation, which may take up to 2 years before the full result is achieved. With appropriate treatment a majority of patients can return to pre-injury levels of work and daily activity. Higher level function is much less certain.