State of the Art Regarding the Management of Multiligamentous Injuries of the Knee

Nigel T Mabvuure 1, Marco Malahias 2, Behrooz Haddad 4, Sandip Hindocha*, 3, Wasim S Khan 4
1 Brighton and Sussex Medical School, Brighton, BN2 5XL,UK
2 Department of Plastic Surgery, Countess of Chester Hospital, Chester, CH2 1UL, UK
3 Department of Plastic Surgery, Whiston Hospital, Merseyside, L35 5DR, UK
4 University College London Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK

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© Mabvuure et al.; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License ( which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the Department of Plastic Surgery, Whiston Hospital, Merseyside, L35 5DR, UK; Tel: 01244366265; Fax: 01244366266; E-mail:


Multiligamentous knee injuries are rare but serious injuries that can threaten limb viability. As such, they require careful management to give patients the best chance of immediate and ultimate functional recovery. However, as these injuries are rare, there is paucity in prospective comparative studies large enough to provide high level evidence for best practice. This lack of comprehensive and convincing evidence has made the management of multiligamentous knee injuries an area of active debate and controversy. The debate on whether surgical management leads to better outcomes than non-operative management, the optimal timing of surgery after injury and whether repair is better than reconstruction is still ongoing. Using the Oxford Levels of Evidence, this review summarises the latest high level evidence to provide answers to these issues. Recommendations for practice have also been offered and assigned a grade using a published scale.

Keywords: Best practice, knee injuries, ligaments, management, Oxford levels of evidence..