Controversies in the Treatment of Knee Dislocations and Multiligament Reconstruction

Bruce A. Levy, MD, Gregory C. Fanelli, MD, Daniel B. Whelan, MD, James P. Stannard, MD, Peter A. MacDonald, MD, Joel L. Boyd, MD, Robert G. Marx, MD, Michael J. Stuart, MD and The Knee Dislocation Study Group

A systematic approach to evaluation and treatment is needed for the patient with knee dislocation. There is a paucity of high-level evidence on which to base treatment decisions. Reported controversies related to the treatment of the multiligament-injured knee include the selective use of arteriography for vascular assessment, serial physical examination with the ankle-brachial index, acute surgical treatment of all damaged structures, the selective application of preoperative and postoperative joint-spanning external fixation, arthroscopic reconstruction of the anterior cruciate ligament and posterior cruciate ligament, simultaneous open reconstruction with repair of the posterolateral corner, reconstruction and/or repair of the posteromedial corner, and the use of allograft tissue.