Multiligament Knee Injuries: An Evidence-Based Review of Surgical and Non-Surgical Management

Abstract

Multiligament knee injuries (MLKIs), involving damage to two or more major knee ligaments, are complex injuries typically caused by high-energy trauma. They often present with associated soft tissue, neurovascular, or joint instability issues, making diagnosis and treatment particularly challenging. Management options range from non-operative approaches in select cases to stage or single-stage surgical reconstructions in active individuals. Non-surgical management is considered in specific situations, such as in patients with low functional demands, severe co-morbidities that preclude surgery, or extensive soft tissue damage. While conservative management is possible, it is generally not expected to produce the same level of functional recovery or stability as surgical treatment. Decisions depend on factors like patient activity level, injury severity, and timing. However, due to the rarity of MLKIs and limited high-level evidence, standardized treatment protocols remain unclear. This review provides an evidence-based overview of both surgical and non-surgical management strategies, aiming to guide clinicians in optimizing care for this challenging condition.