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Diagnoses are confirmed with magnetic resonance imaging as well as stress radiographs (posterior, varus, and valgus) when indicated. Multiple systematic reviews have reported that early (&lt;3 weeks after injury) single\u2010stage surgery and early knee motion improves patient\u2010reported outcomes. Anatomic\u2010based reconstructions of the torn primary static stabilizers and repair of the capsular structures and any tendinous avulsions are performed in a single\u2010stage. Open anteromedial or posterolateral incisions are preferentially performed first to identify the torn structures and to prepare the posterolateral corner (PLC) and medial knee reconstruction tunnels. Next, arthroscopy allows preparation of the anterior cruciate ligament (ACL) and double\u2010bundle (DB) posterior cruciate ligament (PCL) tunnels. Careful attention to tunnel trajectory minimizes the risk for convergence. Meniscal tears are preferentially repaired (root and ramp tears are commonly seen in this patient group). Graft passage is performed after all tunnels are reamed. The graft tensioning and fixation sequence is as follows: anterolateral bundle of the PCL to restore the central pivot, posteromedial bundle of the PCL, ACL, PLC (including fibular [lateral] collateral ligament), and posteromedial corner (including medial collateral ligament). Graft integrity and full knee range of motion should be verified before closure. Physical therapy commences on postoperative day 1 with immediate knee motion (flexion from 0\u00b0\u201090\u00b0; prone for DB\u2010PCL reconstruction) and quadriceps activation. Patients are nonweightbearing for 6 weeks. Patients with ACL\u2010based reconstructions wear an immobilizer for 6 weeks then transition to a hinged ACL brace. Patients with PCL\u2010based reconstructions transition into a dynamic PCL brace once swelling subsides and wear it routinely for 6 months. Functional testing and stress radiography are performed to validate return to sports.<\/jats:p>","DOI":"10.1016\/j.arthro.2021.03.033","type":"journal-article","created":{"date-parts":[[2021,4,22]],"date-time":"2021-04-22T20:19:14Z","timestamp":1619122754000},"page":"1378-1380","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":23,"title":["Multiple Ligament Knee Reconstructions"],"prefix":"10.1002","volume":"37","author":[{"given":"Edward R.","family":"Floyd","sequence":"first","affiliation":[{"name":"Twin Cities Orthopedics Edina\u2010Crosstown. Edina Minnesota U.S.A."},{"name":"Georgetown University School of Medicine Washington District of Columbia U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill K.","family":"Monson","sequence":"additional","affiliation":[{"name":"Twin Cities Orthopedics Edina\u2010Crosstown. Edina Minnesota U.S.A."},{"name":"TrainingHaus Twin Cities Orthopedics Viking\u2010Lakes Eagan Minnesota U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert F.","family":"LaPrade","sequence":"additional","affiliation":[{"name":"Twin Cities Orthopedics Edina\u2010Crosstown. Edina Minnesota U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,5,1]]},"reference":[{"key":"e_1_2_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eats.2015.10.014"},{"key":"e_1_2_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eats.2017.04.001"},{"key":"e_1_2_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2020.11.001"},{"key":"e_1_2_2_5_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.J.01639"},{"key":"e_1_2_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2017.06.011"},{"key":"e_1_2_2_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546519864539"},{"key":"e_1_2_2_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546516673616"},{"key":"e_1_2_2_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546517751917"},{"key":"e_1_2_2_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546516656371"}],"container-title":["Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0749806321002565?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0749806321002565?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.arthro.2021.03.033","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1016\/j.arthro.2021.03.033","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.arthro.2021.03.033","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T08:50:07Z","timestamp":1773564607000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/10.1016\/j.arthro.2021.03.033"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5]]},"references-count":9,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2021,5]]}},"alternative-id":["10.1016\/j.arthro.2021.03.033"],"URL":"https:\/\/doi.org\/10.1016\/j.arthro.2021.03.033","archive":["Portico"],"relation":{},"ISSN":["0749-8063","1526-3231"],"issn-type":[{"value":"0749-8063","type":"print"},{"value":"1526-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Multiple Ligament Knee Reconstructions","name":"articletitle","label":"Article Title"},{"value":"Arthroscopy: The Journal of Arthroscopic & Related Surgery","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.arthro.2021.03.033","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2021 by the Arthroscopy Association of North America","name":"copyright","label":"Copyright"}]}}