Patellar Tendon (PT) rupture in combination with an anterior cruciate ligament injury (ACL) +/- a Medial Collateral Ligament (MCL) injury is a rarely reported injury pattern. We report the cases of three athletes who sustained simul-taneous rupture of their PT, ACL and MCL while competing. They were treated in a staged manner with acute pri-mary repair of the patellar tendon and MCL followed by a rehabilitation period. Reconstruction of the ACL was performed once range of motion and strength of the extensor mechanism was sufficient. At one year follow up each patient had an IKDC score of > 80 and a Lysholm score ≥ 89. There are now 29 reported cases of simultaneous rupture of the patellar tendon and ipsilateral ACL and 21 reported cases of simultaneous rupture of the patellar tendon, ipsilateral ACL, and MCL. There has been no consensus on management of these complex knee injuries. We review the literature and propose a treatment algorithm for the management of these multi-ligamentous knee injuries.