Overall, knee dislocations (KDs) and multiligamentous knee injuries (MLKIs) are rare, accounting for 0.02% to 0.2% of all musculoskeletal injuries, with 5% to 17% presenting as open injuries.39 They are often associated with vascular or neurologic injury and can be classified according to the Schenck knee dislocation (KD) classification system which categorizes by the ligament injured, number of structures injured, and presence of concomitant periarticular fracture (Table 1).47,48 Additionally, knee fracture-dislocations are often classified using the Moore classification system (Table 2).37 More recently, a 2023 multicenter retrospective study introduced a modified pathoanatomic classification for MLKIs based on injury patterns described by Schenck's KD classification (Table 3).44

While some knees may regain adequate stability to perform activities of daily living without surgical intervention, treatment following KD with associated MLKIs is typically surgical to improve stability of the knee joint and possibly resume athletic activities. However, there remains debate over most appropriate timing to surgical intervention30,36,42,52, operative sequence12,38,40, and treatment options including ligament repair versus reconstruction23,46. Even further, total knee arthroplasty is an option (acutely or delayed) for patients with preexisting osteoarthritis following KDs and MLKIs.16

This chapter provides an overview of the evaluation of KDs and MLKIs, with a focus on management strategies and outcomes in aging athletes based on the current available evidence.