Multiligament knee injuries (MLKIs) are more than 60 times less common than ACL reconstructions in the practice of sports surgeons, but the estimated incidence is still 0.072 events per 100 person-years. Their potential to cause serious short-term and long-term consequences such as persistent instability with functional limitations, chronic pain and stiffness, and accelerated posttraumatic osteoarthritis underscores the importance of understanding and expert management of this severe and career-threatening injury in athletes. This chapter addresses prevention techniques for multiligament knee injuries, particularly in skiing and other pivot sports to create a safer sports environment. We will also discuss acute treatment and review surgical principles and techniques for the repair and reconstruction of injured ligaments. Special attention will also be given to the postoperative rehabilitation and return to sports after MLKI.