Abstract
Multiligamentous knee injuries represent complex reconstructive challenges, and graft selection for these injuries has not been directly compared across graft types. The purpose of this review is to discuss the existing literature regarding graft selection and to explore whether there is sufficient evidence to support this surgical decision-making. Much of current graft selection guidance and decision-making is extrapolated from single-ligament reconstruction literature, particularly from anterior cruciate ligament studies, despite the complexity added by multiple ligament involvement. While robust anterior cruciate ligament reconstruction studies support autograft over allograft use in young, active patients, evidence for other knee ligament reconstruction is far more limited. Current posterior cruciate ligament studies demonstrate overall comparable outcomes for allograft versus autograft, but lateral and medial collateral ligament studies are even more limited and typically confounded by concomitant injuries. The few studies examining multiligament knee injury and graft selection focus entirely on utilization patterns rather than comparison of outcomes, limiting their utility in driving surgical decision-making. In conclusion, the current literature regarding graft selection in multiligamentous knee injury is insufficient in guiding surgical decision-making and may benefit from studies specific to this pathology. Future research directions should also utilize standardized injury classification and patient-reported outcomes to clarify whether reconstruction should continue to be guided by single-ligament evidence or considered a distinct surgical problem.