Multi-ligament injury patterns are graded by the injury pattern of the central column (anterior cruciate ligament; posterior cruciate ligament—PCL) and injury patterns of the peripheral column with regard to the collateral ligaments (medial collateral ligament—MCL; lateral collateral ligament—LCL) and peripheral capsule—ligament structures (anteromedial and posteromedial corner complex; anterolateral and posterolateral corner complex). The initial detailed clinical and radiological examination remains mandatory and should be based on standardized parameters: central and peripheral ligament injuries, bony frontal and sagittal displacements, and nerve and vascular co-injuries. Acute multi-ligament injuries require immediate clarification of the vascular-nerve injuries, osseous fractures, and visualization of the capsular ligament complex injury pattern to plan the prompt therapeutic strategy (conservative ligament healing, surgical ligament repair, and primary surgical ligament reconstruction). In the context of chronic ligament injury, the capsuloligamentous instability pattern and the leg axis alignment are primarily assessed to determine the combined ligament-reconstructive surgical strategy. Standardized classifications should be used for both acute and chronic instability situations. Follow-up treatment is carried out using individualized, specific follow-up treatment plans. Due to the complexity of the procedure, this should be carried out in close consultation between the patient, therapist, and surgeon. The more experienced surgeon should initially inform the patient about the course of the ligament healing phases and the long functional neuromuscular rehabilitation process, with any remaining deficits and sports psychology support.