Despite the recent focus on the limited use of urgent arteriograms in the evaluation of acute knee dislocations, physical examination remains the cornerstone of assessment. Several clinical scenarios dictate an orthopedic emergency: vascular disruption, open wound, compartment syndrome, or an irreducible joint/dimple sign. In the acute setting, every attempt should be made to rule out associated injuries and the need for intervention. The multiple ligament knee injury or knee dislocation is a complex dilemma that requires close attention. Concomitant injuries about the knee often arise and must be addressed prior to ligamentous repair, and therefore the orthopedic surgeon must maintain a high index of suspicion for associated injuries in the evaluation of a multiple ligament knee injury.