Dr. Marx recently published an article in Clinics in Sports Medicine outlining the indications for an osteotomy in the setting of a multiligament knee injury. Multiligament knee injuries are commonly the result of knee dislocations. Since this is a very traumatic injury and the presentation varies, making the surgical approach for reconstruction unique from patient to patient. An osteotomy is a surgical procedure where the bone is reshaped to change the leg alignment. It is often used to correct leg alignment that is valgus (knock kneed) or varus (bow legged). Malalignment is a risk factor for failure of reconstructive knee ligament surgery. For example, in a varus knee, the lateral side of the knee is stretched and may therefore compromise lateral ligament reconstruction. Conversely, in a valgus knee, the tensile forces are increased on the medial side of the knee, which can compromise medial ligament stability. Failure of any ligament increases stress throughout the knee, which may result in failure of the entire multiligament reconstruction. Additionally, malalignment causes uneven weight distribution, which can negatively impact long-term knee health. Osteotomies can be done alone or in combination with multiligament reconstructions. In some cases, ligament reconstruction is not necessary after an osteotomy, as sufficient stability, functionality, and pain reduction are achieved with the realignment procedures only.