How We Manage the Multiple-Ligament Injured (Dislocated) Knee

Abstract

Treating mulitligament knee dislocations can be difficult. Initial treatment should consist of immediate reduction and care for limb-threatening injuries. Physical examination, x-rays, and magnetic resonance imaging are often necessary to clearly define the injury pattern. Occasionally, a computed tomography scan is beneficial to better characterize fractures. Timing for definitive treatment of the multiligament knee injury depends on associated injuries at the time of injury, the integrity of the soft tissues, the vascular status of the limb, and the condition of the knee at presentation. In general, early surgery is indicated in patients with associated fractures, vascular compromise, and patellar or quadriceps tendon ruptures. We also tend to favor acute repair of lateral-sided injuries with or without graft augmentation. Medial collateral ligament (MCL) injuries can be treated with immobilization unless the MCL is displaced or if there is associated meniscal extrusion. The condition of the knee largely determines whether the cruciate ligaments should be acutely reconstructed or reconstructed in a staged procedure. We treat complete posterior cruciate ligament injuries with a double-bundle arthroscopic inlay technique. The decision to use allograft or autograft depends on the severity of the knee injury, the demands that will be placed on the knee, and patient wishes. The return to a high level of sports participation after this injury is challenging and usually takes at least 9 to 12 months.