Multiligamentous knee injuries - surgical treatment algorithm.

The concept of multiligamentous knee injuries encompasses a large variety of presenting combinations, and the existing published literature lacks adequately sized prospective comparative patient-reported outcome studies to guide clinical decision making. The decisions of operative versus nonoperative management, timing of surgery, repair versus reconstruction, use of allograft versus auto-graft, choice of which ligaments to treat, and rehabilitation protocols remain controversial despite the fact that multiligament injuries have been shown to represent approximately 11-20% of knee ligament sprains presenting for treatment. For the purposes of this manuscript, a multiligamentous knee injury is defined as one complete cruciate tear (grade III) plus a partial or complete collateral tear (grade II or III) or a partial or complete tear of the other cruciate (grade II or III). A surgical treatment algorithm is proposed based upon a review of case series literature and clinical experience in an academic sports medicine practice setting. Use of our proposed surgical algorithms may facilitate clinical decision making in an attempt to restore stability, preserve function, and maximize return to activity.