The role of the musculoskeletal radiologist of the twenty-first century is not satisfied by the simple enumeration of findings on imaging studies. In this day of turf battles over the right to interpret images, in the interest of service to referring clinicians, and the optimal care of the patient, it is the responsibility of the radiologist to ascend to a higher level of sophistication in the understanding of the pathology encountered and the implications of our diagnoses. As demonstrated in this overview of the clinical and imaging approach to complex injuries of the knee, it is clear that the physical examination assessment of this patient population can be quite challenging. With a detailed understanding of anatomy, pathology, and what abnormalities change the management of the patient, the radiologist can alert the clinician to potential pitfalls in diagnosis. Neither the clinician nor the radiologist should be satisfied with a single diagnosis, for this introduces the potential of overlooking an associated injury that could preclude the return of a normally functioning articulation.