Management of the multiple ligament injured knee

Purpose of review: While relatively rare injuries, knee dislocations represent true orthopaedic emergencies. Delayed diagnosis can lead to significant sequelae, especially in the face of associated neurovascular injuries. As such, all orthopaedic surgeons should be able to recognize the multiple ligament injured knee and initially manage the injury until the patient can be appropriately triaged. This review discusses the recent body of literature on management of the multiple ligament injured knee. Recent findings: The past few years have seen an increased emphasis on the initial recognition and management of the multiple ligament injured knee. Specifc research has centered the identification and management of associated vascular injuries. Some authors advocate angiography in all knee dislocations, while other studies have recommended selective angiography based on initial exam findings. This remains a topic of debate. Additionally, most authors now agree that anatomic repair/reconstruction of the supporting ligaments of the knee leads to the best outcomes. However there is still no consensus regarding the timing of surgery, which ligaments to repair or reconstruct, and which types of grafts to use. The past few years have shown encouraging results with acute repair/reconstruction of all involved ligaments. Summary: The multiple ligament inured knee is an orthopaedic emergency, requiring expeditious but thorough evaluation. Specific attention must be taken to identify and appropriately manage potential neurovascular injuries. While the specific details of surgical technique, graft selection, and timing of surgery remain topics of debate, most authors now agree that an anatomic repair or reconstruction of all ligamentous injuries will yield the best long-term functional results.