How We Manage the Multiple Ligament Injured (Dislocated) Knee

Multiple-ligament knee injuries are increasingly recognized and require a multidisciplinary approach to treatment. Emergency department evaluation should focus on life- and limb-threatening issues with a high degree of suspicion for associated neurovascular injuries. The initial management should focus on emergent reduction with treatment priority given to vascular injuries. The management of ligamentous injuries should be undertaken after the treatment of vascular and bony injuries. After appropriate physical examination and imaging studies, an experienced surgeon will direct the surgical repair or reconstruction of the damaged ligaments. Our philosophy for surgical treatment of the knee with multiple-ligament injuries emphasizes the anatomic repair or reconstruction of each torn ligament and that ligament healing and stability take priority over knee range of motion. Indeed, in these complex injuries, stiffness is easier to address than recurrent instability.