Ligamentous knee injuries in amputees.

Combat-related musculoskeletal injuries occur commonly during military conflicts, as in Iraq and Afghanistan, and are caused by high-energy blasts. Ligamentous knee injuries resulting from these blasts are often associated with lower extremity fractures or traumatic, transtibial amputations. Ligamentous knee injuries in amputees are often difficult to diagnose for a variety of reasons, including massive soft tissue trauma and delayed ambulation. While the algorithm for treatment is similar in non-combat, multi-ligamentous knee injuries, the timing of surgical intervention, graft choices, and methods of fixation are more limited. Additionally, the presence of traumatic brain injury and associated extremity trauma make rehabilitation of these injuries much more complicated. Despite these challenges, the recognition and treatment of ligamentous knee injuries in amputees is critical to returning these patients to an active lifestyle.