Articular cartilage injuries are frequently encountered in the setting of a multiligament injured knee. Despite the typically higher energy mechanism, chondral injury patterns seem to be similar to isolated anterior cruciate ligament injured knees. Current treatment management of the multiligament knee typically includes surgical intervention to include repair and reconstruction within 3 weeks of injury. Since we still do not have an understanding as to the natural history of most chondral lesions, it can be impossible to determine which lesions will cause persistent symptoms and which will remain asymptomatic, even without treatment. No studies have evaluated concomitant multiligament surgery and articular cartilage restoration procedures. In ours and in others experience, only a small subset of these lesions may cause persistent symptoms directly attributable to the defect. However, this subset may benefit from articular resurfacing procedures in a secondary setting. We offer acute and secondary treatment considerations that stress minimizing morbidity in a highly traumatized joint. Unfortunately, the development of progressive degenerative changes is often ubiquitous with time. This degenerative course is felt to be multifactorial and not primarily attributable to the acute chondral injury. Many patients may ultimately require arthroplasty procedures to address advanced posttraumatic arthritis.