Modern Treatment Principles for Multiligament Knee Injuries



1 1 Twin Cities Orthopedics, Edina-Crosstown, 4010 W 65th St, Edina, MN 55435, USA 2 University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455 USA

2 1 Twin Cities Orthopedics, Edina-Crosstown, 4010 W 65th St, Edina, MN 55435, USA 3 University of North Dakota School of Medicine and Health Sciences, 1301 N Columbia Rd, Grand Forks, ND 58203, USA

3 1 Twin Cities Orthopedics, Edina-Crosstown, 4010 W 65th St, Edina, MN 55435, USA 4 Georgetown University School of Medicine, 3900 Reservoir Rd NW, Washington, DC 20007, USA

4 5 Twin Cities Orthopedics, 2700 Vikings Cir, Eagan, MN 55121, USA 6 Training Haus, 2645 Vikings Cir Suite 200, Eagan, MN 55121, USA

5 Twin Cities Orthopedics, Edina-Crosstown, 4010 W 65th St, Edina, MN 55435, USA


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


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