The multiple ligament injured knee.

Knee dislocations are complex cases requiring careful initial management to prevent devastating consequences caused by limb ischemia from vascular injury. Initial treatment includes gentle reduction and neurovascular assessment including an arteriogram and vascular reconstruction when necessary. Evaluation by examination and MR imaging will help define all ligamentous and associated pathology. All combined instabilities are repaired or reconstructed at the time of surgery. Early intervention within 3 weeks is preferred, as acute reconstruction is technically easier and more predictable than chronic reconstruction. Allografts are particularly helpful in these complex and time consuming knee injuries. Postoperative rehabilitation consists of initial immobilization followed by a supervised rehabilitation program emphasizing range of motion and strengthening.