Multiligamentous Injuries in the Aging Athlete, to Reconstruct or Replace?

Multiligamentous knee injuries (MLKIs) are a rare, devastating, heterogenous group of injuries defined by injury to at least 2 of the 4 major ligaments in the knee and are often associated with a knee dislocation (KD). They can result from high-velocity accidents, pivoting knee injuries during athletic activity, or even ultra-low velocity mechanisms in older, obese individuals. Management is complex and should be centered around re-establishing stability of the knee joint. Surgical intervention is considered standard, however, the type and timing of intervention are heavily studied and debated, especially as athletic individuals continue to age. Traditional options include both ligament repair and reconstruction; however, total knee arthroplasty (TKA) with revision-type, constrained prosthetic components may also have a role. This chapter provides an overview of the evaluation of KDs and MLKIs, with a focus on management strategies and outcomes and complications in aging athletes based on the current available evidence.