Multiligament knee injuries present a clinically complex and challenging pathology from a management standpoint. To be classified as a multiligament injury, a minimum of two of the four major ligament groups (ACL, PCL, PMC, and PLC) of the knee must be torn. This injury mechanism is typically from acute high-energy trauma resulting in an articular dislocation or low-energy sport-related trauma. Beyond musculoskeletal injury, neurovascular structures are at significant risk and should be urgently attended to, preventing life-threatening or permanently debilitating conditions. Clinical assessment should include observation of peripheral pulses, neural sensation, and ligament stability. An ankle brachial index and CT angiogram ensure proper perfusion, and sensory palpation assesses peroneal innervation. Lachman’s, pivot shift, varus and valgus stress, posterior drawer, posterolateral drawer, and dial exams can clinically assess the four major ligamentous groups. Diagnostic imaging is a critical component to understanding the complete extent of a multiligament knee injury. Plain radiographs assess acute osseous damage (fracture or contusion), varus and valgus coronal malalignment, and posterior tibial slope. Stress radiographs can assess lateral and medial compartment gapping and PCL/PLC stability. The uninjured contralateral knee is an excellent comparison to assess baseline laxity. MRI is the gold standard for diagnosis and can help determine the condition of the menisci, articular cartilage, and surrounding ligaments. Current trends for treating multiligament injuries aim to improve both the operative and rehabilitative aspects of injury management. Acute treatment, single-stage procedures, selective graft choice, fixation methods, and early postoperative range of motion encompass areas of interest.