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Table 1 The 10 recommendations for the Orthopedist dealing with the Treatment of Acute MLKI Injuries

From: Controversies in acute multiligamentary knee injuries (MLKI)

1 Always work as a team In the Emergency Room. Two heads think more than one.
2 Always, in all cases, rule out a Vascular lesion with accurate tests. Pedal pulse may not be your best friend.
3 Always in all cases, rule out a Peroneal Nerve injury with clinical test. The exam of the other leg will help you to diagnose partial injuries.
4 Always use an external fixator after a vascular repair. Use hinged if is available. Control Motion is better than not.
5 Always accompany yourself in surgery with trained personnel. This is not a 5 min surgery.
6 Always reinsert/repair the ligaments avulsions early. The best graft will never be better than the original tissue. Have high strength sutures, tapes, anchors, knotless on hand.
7 Always use appropriate measures to reduce surgical trauma in acute surgery. Use allografts instead autografts. Apply anatomical principles to repair /reconstructed ligaments. Remember than in this complex situation, the simple is better.
8 Always recover joint motion as soon as possible. Stiffness has a worse prognosis than residual instability.
9 Always Correct dynamic or severe angular deformity in chronic cases, before ligaments reconstruction. A varus knee deformity will spoil out your best PLC reconstruction.
10 Always remember that these lesions are not comparable in their results with mono-ligamentary surgery. Probably patients never will go back to their same level work and sports. Do not forget to explain them and family.