Multiligament Knee Injuries and Their Treatment

Multiligament knee injuries are rare but potentially devastating. They require expeditious and thorough evaluation and treatment for best outcomes. Management consists of a careful history and physical examination, including a complete assessment of the neurovascular status with ankle-brachial indexes ± magnetic resonance angiography. Imaging should include plain radiographs, stress radiography as necessary, and possibly computed tomography scans if fracture is suspected. Magnetic resonance imaging is the modality of choice for evaluating the ligaments and soft tissues. Once evaluation is complete, the decision to proceed with surgery versus conservative management is made. We favor surgery in patients who are able to tolerate the procedure, are relatively high functioning, and are not obese. Surgery is performed at 10 to 14 days if repair is possible or it is delayed until at least 4 to 6 weeks from the time of injury if reconstructions are to be performed to minimize the risk of arthrofibrosis. We prefer allografts for our reconstructions rather than autografts to minimize morbidity and operative time. After surgery, patients may be anticoagulated with either aspirin or coumadin. With extensive, focused rehabilitation, patients can return to heavy labor and/or sports beginning at 9 to 12 months postoperatively.