Working Diagnosis:
Left knee posterolateral corner tear, ACL tear and lateral meniscal tear, LCL tear, PCL partial tear, popliteal fibular ligament tear, biceps femoris tear, left common peroneal palsy.

Treatment:
10 days following initial injury the patient underwent a posterolateral corner reconstruction with an allograft. The LCL and biceps femoris were also repaired. Nerve exploration demonstrated an intact common peroneal nerve with significant bruising and stretching. 2 months post-op he underwent ACL reconstruction and lateral meniscal repair. The patient tolerated both procedures well. An EMG was obtained for persistent foot drop and demonstrated severe left common peroneal mononeuropathy. 11 months after the initial injury he underwent a modified bridle procedure.

Outcome:
6 weeks post-op Posterolateral corner repair: ROM 95-0 degrees.
10 months post-ACL reconstruction and lateral meniscus repair: ROM 125-0 degrees. Knee completely stable with negative Lachman and anterior/posterior drawer sign.
3 months post-op Bridle Procedure: Motor dorsiflexion of L foot 4/5. Patient is full weight-bearing and ambulating independently. He denies any pain and has normal sensation of the LLE. Patient will continue with physical therapy three times weekly. Walker boot has been discontinued and a custom AFO will be used.

Author's Comments:
When there is concern for knee dislocation secondary to multiligamentous injury the patient should be observed in the hospital for neurovascular checks. Although this patient had palpable pulses following his injury the need for monitoring is essential with this type of injury. Intimal tears/flaps may propagate over 24-48 hours following initial injury. Routine angiography is controversial in that often times this takes longer than going to the operating room if there is legitimate concern for vascular injury.

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