Surgical management of knee dislocations with ligament reconstruction associated with a hinged external fixator

Surgical management of knee dislocations with ligament reconstruction associated with a hinged external fixator

Abstract Introduction Knee dislocations are defined as ligament injuries involving at least two of the four most important knee ligaments. Results from recent studies have shown a tendency towards improvement of the functional outcomes with use of an articulated external fixator during the postopera...

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Published in:Orthopaedics & traumatology, surgery & research Vol. 101; no. 1; pp. 77 - 81
Main Authors: Angelini, F.J, Helito, C.P, Bonadio, M.B, da Mota e Albuquerque, R.F, Pecora, J.R, Camanho, G.L
Format: Journal Article
Language:English
Published: France Elsevier Masson SAS 01-02-2015
Subjects:
Adult
Allograft
External fixator
External Fixators
Follow-Up Studies
Humans
Knee dislocation
Knee Dislocation - physiopathology
Knee Dislocation - surgery
Knee Joint - physiology
Multiligament injury
Orthopedic Procedures - methods
Orthopedics
Posterior Cruciate Ligament - surgery
Prospective Studies
Range of Motion, Articular
Reconstructive Surgical Procedures - instrumentation
Retrospective Studies
Surgery
Young Adult
External fixator
Knee dislocation
Multiligament injury
Allograft
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Summary:Abstract Introduction Knee dislocations are defined as ligament injuries involving at least two of the four most important knee ligaments. Results from recent studies have shown a tendency towards improvement of the functional outcomes with use of an articulated external fixator during the postoperative period following multiligament reconstruction. Our hypothesis was that good knee stability and early gain of range of motion could be achieved with the use of the external fixator after ligament reconstructions. Methods Fourteen patients with knee dislocations were evaluated after multiligament reconstruction in association with use of a lateral monoplanar external fixator for six weeks. Reconstructions were performed using grafts from a tissue bank. Range of motion was measured after one, two, three, six, twelve months and at the final evaluation at a mean time of 49 months. The assessments were made using objective and subjective IKDC, Lysholm and Tegner scales. Results The mean scores were 71.7 for the subjective IKDC score, 81.5 for the Lysholm score. No patient was able to return to previous Tegner score. Out of the 45 ligament reconstructions performed, only four failed during the follow-up time. The mean range of motion of the knee presented a progressive increase from the first to the twelfth month, from 67.8° to 115.7°. Two cases of superficial infection on the site of the external fixator pins were observed. Conclusion The use of an external fixator enabled early rehabilitation with range of motion gains starting from the first postoperative month, a low rate of reconstruction failure and minimal complications. Nevertheless, none of the patients returned to the level of activity prevailing prior to the injury. Level of evidence Level IV, retrospective therapeutic case series.
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ISSN:1877-0568
1877-0568
DOI:10.1016/j.otsr.2014.11.001