Background <p>Multiligament knee injuries (MLKI) are rare but severe, often associated with knee dislocation and carry a high risk of neurovascular complications. Although ligamentous reconstruction has been widely studied, there is limited evidence addressing the incidence and specific patterns of meniscal injuries in this setting.</p> Methods <p>We retrospectively analyzed skeletally mature patients admitted to a Level I trauma center between January 2022 and December 2024 with MLKI, with or without knee dislocation. Demographics, trauma mechanism, ligamentous, and meniscal injury patterns were reviewed on the basis of magnetic resonance imaging (MRI) and surgical records. Meniscal tears were classified by location and morphology. Statistical analysis included Fisher’s exact test, chi-square tests, and univariate logistic regression with significance set at <i>p</i> &lt; 0.05.</p> Results <p>A total of patients were included: 35 (63.6%) with knee dislocation and 20 (36.4%) without. Mean age was 36.8 ± 13.2&#xa0;years, and 81.8% were male. Magnetic resonance imaging was performed at a mean of 28.1 ± 7.3&#xa0;days after injury. High-energy trauma accounted for 69.1% of cases and was significantly associated with dislocation (<i>p</i> = 0.001). Medial meniscus tears in patients with dislocation were predominantly radial/complex/oblique (72.7% versus 0% in nondislocated, <i>p</i> = 0.004; OR not calculable due to perfect separation), while all nondislocated patients had longitudinal tears. Lateral meniscus tears showed a similar pattern, with radial/complex/oblique tears more frequent in dislocation (80.0% versus 20.0%, OR = 16.00, 95% CI 1.27–200.92, <i>p</i> = 0.031).</p> Conclusions <p>Knee dislocations demonstrate distinct meniscal tear patterns compared with nondislocated MLKI, with radial and complex tears predominating in dislocated knees. Recognition of these differences may assist in accurate diagnosis and individualized surgical planning.</p>