JBJS - 2026-04-15 - Journal Article
Multiligament Knee Injuries.
Super JT, Chahla J, Geeslin AG, Moatshe G, LaPrade RF
Topics
Key Takeaway
Early single-stage reconstruction is increasingly supported for selected MLKI patients, with contemporary evidence emphasizing that untreated posteromedial corner, posterolateral corner, and meniscal injuries directly compromise cruciate graft survival.
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Summary
This JBJS review synthesizes current evidence and expert opinion on diagnosis, classification, and surgical management of multiligament knee injuries. It emphasizes systematic detection of PLC, PMC, and meniscal pathology as essential to protecting cruciate reconstructions, and addresses tunnel convergence as a technical planning priority. Treatment timing analysis favors early comprehensive single-stage surgery in appropriately selected patients over staged or delayed reconstruction.
Key Limitation
As a narrative expert review without a registered protocol or quantitative synthesis, conclusions on treatment timing and surgical strategy are not derived from pooled Level I–II data and may reflect institutional bias.
Original Abstract
➢ Multiligament knee injuries (MLKIs) encompass a heterogeneous spectrum of severe knee trauma, presenting ongoing challenges in their diagnosis, classification, management, and postoperative rehabilitation. This review synthesizes the current evidence with expert clinical perspectives to summarize key principles in evaluation and management.➢ Thorough clinical examination, stress radiography, and magnetic resonance imaging can improve injury characterization and objective quantification of pathologic laxity to guide surgical planning.➢ Contemporary reconstruction strategies emphasize the detection of posteromedial corner, posterolateral corner, and meniscal pathologies, while recognizing that appropriate management of these associated injuries protects cruciate reconstruction grafts.➢ Treatment timing remains controversial, with increasing evidence and consensus for early, comprehensive single-stage surgery when feasible in selected patients.➢ Modern approaches to MLKI management should prioritize restoration of anatomy, biomechanical stability, meticulous planning to avoid tunnel convergence, and rehabilitation strategies.