Knee dislocations and posterior cruciate ligament (PCL)-based multiple ligament knee injuries are complex injuries that can result in significant functional instability for the affected individual. The purpose of this article is to present a review of the literature, and the authors' experience treating knee dislocations and PCL-based multiple ligament knee injuries in patients 18 years of age and younger. This article will discuss patient age at the time of surgery, mechanisms of injury, surgical techniques, considerations in patients with open growth plates, a review of the literature, and the authors' surgical outcomes in these complex knee ligament instabilities.

Combined anterior cruciate ligament (ACL) and posterolateral injury of the knee can result in significant functional instability for the affected individual. Both components of the instability must be treated to maximize the probability of success for the surgical procedure. Higher failure rates of the ACL reconstruction have been reported when the posterolateral instability has been left untreated. The purpose of this article is to describe our surgical technique, and present the results of 34 chronic combined ACL posterolateral reconstructions in 34 knees using allograft tissue, and evaluating these patient outcomes with KT 1000 knee ligament arthrometer, Lysholm, Tegner, and Hospital for Special Surgery knee ligament rating scales. In addition, observations regarding patient demographics with combined ACL posterolateral instability, postoperative range of motion loss, postinjury degenerative joint disease, infection rate, return to function, and the use of radiated and nonirradiated allograft tissues will be presented.

This data shows pediatric temporal bone thickness is frequently greater than the recommended 3 mm, even in patients as young as one. Anatomically, concerns regarding temporal bone thickness in patients younger than five could be reliably addressed with imaging typically obtained in workup of hearing loss.

Posterolateral instability (PLI) is common with posterior cruciate ligament tears, is less common with anterior cruciate ligament tears, and isolated PLI is rare. There are varying degrees of PLI with respect to pathologic external tibial rotation and varus laxity. Surgical treatment of PLI must address all components of the PLI (popliteus tendon, popliteofibular ligament, lateral collateral ligament, and the lateral-posterolateral capsule), the abnormal planes of motion, as well as other structural injuries. Successful posterior cruciate ligament and anterior cruciate ligament surgery depends upon recognition and treatment of posterolateral corner injuries.

The posterior cruciate ligament (PCL)-based multiple ligament injury, or dislocated knee, is often part of a multisystem injury complex that not only includes the knee ligaments, but may also include blood vessels, skin, nerves, fractures, and other organ system trauma. These factors must be considered in the scope of treating this complex knee injury. These complex knee ligament injuries can result in significant functional instability for the affected individual. This article will discuss multiple ligament knee injuries evaluation, treatment, and special considerations in the pediatric and adolescent population.