Assessment of the Multiligament Knee

Multiligament knee injuries (MLKIs) can be associated with neurovascular injuries and limb-threatening complications. Therefore, a prompt, accurate and comprehensive physical exam is essential to identify possible complications and guide management accordingly. Standard radiographs combined with MRI are often identified as the gold-standard imaging for assessing MLKIs. However, CT scans, vascular studies and specialty radiographs all have a role in the acute and chronic evaluation of an MLKI. In cases of open dislocations, vascular reconstruction or grossly unstable MLKIs, external fixation is the method of choice. Surgical treatment of MLKIs should provide a functional, pain-free and stable knee. The current controversies pertaining to surgical treatment include: early versus late ligament reconstruction, ligament repair versus reconstruction, and rehabilitation after MLKIs. Within this chapter, we present and discuss the current evidence on either side of the debate. Knowledge of the basic principles surrounding initial and definitive management of knee dislocations, and MLKIs, should help the treating surgeons in managing these complex injuries.