Role of osteotomy in multiligament knee injuries

This article will outline the importance of the assessment of coronal and sagittal plane alignment when dealing with complex issues such as the multiligament injured knee. We will provide an overview of how alignment affects the forces transmitted across the joint during gait, and how these forces interact with knee ligaments following injury. Readers will be guided through the assessment of limb alignment, and an overview of methods to address coronal and sagittal deformity will be provided. In the acute multiligament injured knee, realignment osteotomy is rarely performed. However, in the patient with the chronic multiligament deficient knee presenting with instability, it is of utmost importance that limb alignment as assessed and any deformity corrected so as to optimize the biomechanical environment to achieve the best possible outcome for the patient.