Multiple ligament knee injury is defined as rupture to at least two of the four major knee ligament structures. Three or four knee ligament injury results in knee dislocation as complete disruption of the integrity of the tibiofemoral articulation. In multiple ligament knee injury, vascular and neurologic assessment should be performed meticulously and systematically. Emergency surgery should be needed if arterial injury is suspected. Surgical treatment rather than conservative management should be done and early surgery might be better than delayed surgery. Reconstruction of ACL and PCL, repair or reconstruction of MCL, and reconstruction of posterolateral corner are recommended, although many debates have occurred. Multiple ligament knee injury requires more aggressive management than single ligament knee injury.