Modern Treatment Principles for Multiligament Knee Injuries

Multiligament knee injuries are complex injuries that must be addressed with a comprehensive diagnostic workup andtreatment plan. Multiligament injuries are commonly observed with concomitant meniscal, chondral, and neurovascularinjuries, requiring a thorough clinical assessment and radiographic evaluation. Due to the higher failure rates associatedwith knee ligament repair following multiligament knee injury, the current literature favors single-stage anatomic kneereconstructions. Recent studies have also optimized graft sequencing and reconstruction tunnel orientation to preventgraft elongation and reduce the risk of tunnel convergence. In addition, anatomic-based ligament reconstructiontechniques and the usage of suture anchors now allow for early postoperative knee motion without the risk of stretchingout the graft. Rehabilitation following multiligament knee reconstruction should begin on postoperative day one andtypically requires 9-12 months. The purpose of this article is to review the latest principles of the surgically relevantanatomy, biomechanics, evaluation, treatment, rehabilitation, and outcomes of multiligament knee injuries.Level of evidence: V