Rationale and Treatment of Multiple-Ligament Injured Knees: The Seattle Perspective

The senior author (CJW) is the primary surgeon for the management of multiple-ligament knee injuries at Harborview Medical Center and the University of Washington. These injuries are usually the result of high-energy mechanisms, and the patients often have multiple other injuries and difficult social situations. The workup of these patients is very important and involves coordination of multiple services, including the orthopedic traumatologists, general surgeons, and vascular specialists. Surgical management revolves around a few basic principles including early motion of the knee, early surgical reconstruction if possible, and reconstruction of the central pivot as well as the medial and lateral structures during a single procedure. The detailed steps of the workup and surgical management are detailed in this article. We also discuss surgical consideration as related to concomitant injuries and our rehabilitation protocol.