The concept of multiligament knee injuries comprises a wide range of ligament and intra-articular injury patterns. These complicated injuries necessitate a methodical approach to evaluation and treatment. Management strategies for these multifaceted injuries attempt to balance the restoration of stability with maintenance of function through the mergence of operative and nonoperative means. The operative methods include repair, repair plus augmentation, or reconstruction of injured structures combined with bracing and rehabilitation in the short term. Nonoperative treatment is usually indicated for partial (grade II) ligament tears and occasionally for initial treatment in special circumstances. The ultimate goal of treatment is to return the patient to pre-injury employment or activity with the hope of delaying post-traumatic arthritis. The purpose of this manuscript is to 1) classify for the purposes of treatment for the spectrum of ligament tears included in the term “multiligamentous knee injury (MLKI),” 2) identify the reported incidence of these relatively infrequent injuries, and 3) propose a surgical treatment algorithm based upon the review of case series literature and clinical experience to assist decision-making when faced with this difficult problem.