Abstract
Background: Knee dislocation is a severe but relatively uncommon injury caused by violent trauma that can result in long-term complications, such as arthrofibrosis, stiffness, instability, and pain. Perhaps owing in part to its rarity, treatment of this injury is controversial. We therefore describe a treatment approach for these complex cases involving a novel dynamic knee external fixator. Description of Technique: We performed open PCL reconstruction when possible and/or repair of other associated lesions. At the end of the surgical procedure, the surgeon applied an external fixator that reproduced normal knee kinematics, allowing early motion exercises and reducing the risk of joint stiffness while protecting the bony and soft tissue structures involved in the repair during the first healing phase. Patients and Methods: We retrospectively reviewed eight patients treated with this approach, four of whom had the PCL reconstructed and four of whom had only associated injuries reconstructed. We evaluated all patients with clinical scores (subjective International Knee Documentation Committee form, Lysholm score, and Tegner level), physical examination (objective International Knee Documentation Committee form), and KT-1000™ arthrometer for AP laxity. Minimum followup was 10 months (mean, 26 months; range, 10-45 months). Results: One patient had manipulation under anesthesia. The median Lysholm score was 76, Tegner level was 4, and subjective International Knee Documentation Committee was 73. All patients recovered to their preinjury work activity, except one unemployed patient. Stability was normal or nearly normal in five patients; the mean side-to-side difference in AP displacement with manual maximum force was 2.9 mm. Conclusions: This approach with an external fixator allowed staged reconstruction and early motion and provided reasonable stability, ROM, and activity level at followup in patients with complex injuries. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
| Original language | English |
|---|---|
| Pages (from-to) | 869-876 |
| Number of pages | 8 |
| Journal | Clinical Orthopaedics and Related Research |
| Volume | 470 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Mar 2012 |
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ASJC Scopus subject areas
- Orthopedics and Sports Medicine
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Articulated external fixator for treatment of complex knee dislocation. / Marcacci, Maurilio; Zaffagnini, Stefano; Bonanzinga, Tommaso; Pizzoli, Andrea; Manca, Mario; Caiaffa, Enzo.
In: Clinical Orthopaedics and Related Research, Vol. 470, No. 3, 03.2012, p. 869-876.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Articulated external fixator for treatment of complex knee dislocation
AU - Marcacci, Maurilio
AU - Zaffagnini, Stefano
AU - Bonanzinga, Tommaso
AU - Pizzoli, Andrea
AU - Manca, Mario
AU - Caiaffa, Enzo
PY - 2012/3
Y1 - 2012/3
N2 - Background: Knee dislocation is a severe but relatively uncommon injury caused by violent trauma that can result in long-term complications, such as arthrofibrosis, stiffness, instability, and pain. Perhaps owing in part to its rarity, treatment of this injury is controversial. We therefore describe a treatment approach for these complex cases involving a novel dynamic knee external fixator. Description of Technique: We performed open PCL reconstruction when possible and/or repair of other associated lesions. At the end of the surgical procedure, the surgeon applied an external fixator that reproduced normal knee kinematics, allowing early motion exercises and reducing the risk of joint stiffness while protecting the bony and soft tissue structures involved in the repair during the first healing phase. Patients and Methods: We retrospectively reviewed eight patients treated with this approach, four of whom had the PCL reconstructed and four of whom had only associated injuries reconstructed. We evaluated all patients with clinical scores (subjective International Knee Documentation Committee form, Lysholm score, and Tegner level), physical examination (objective International Knee Documentation Committee form), and KT-1000™ arthrometer for AP laxity. Minimum followup was 10 months (mean, 26 months; range, 10-45 months). Results: One patient had manipulation under anesthesia. The median Lysholm score was 76, Tegner level was 4, and subjective International Knee Documentation Committee was 73. All patients recovered to their preinjury work activity, except one unemployed patient. Stability was normal or nearly normal in five patients; the mean side-to-side difference in AP displacement with manual maximum force was 2.9 mm. Conclusions: This approach with an external fixator allowed staged reconstruction and early motion and provided reasonable stability, ROM, and activity level at followup in patients with complex injuries. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
AB - Background: Knee dislocation is a severe but relatively uncommon injury caused by violent trauma that can result in long-term complications, such as arthrofibrosis, stiffness, instability, and pain. Perhaps owing in part to its rarity, treatment of this injury is controversial. We therefore describe a treatment approach for these complex cases involving a novel dynamic knee external fixator. Description of Technique: We performed open PCL reconstruction when possible and/or repair of other associated lesions. At the end of the surgical procedure, the surgeon applied an external fixator that reproduced normal knee kinematics, allowing early motion exercises and reducing the risk of joint stiffness while protecting the bony and soft tissue structures involved in the repair during the first healing phase. Patients and Methods: We retrospectively reviewed eight patients treated with this approach, four of whom had the PCL reconstructed and four of whom had only associated injuries reconstructed. We evaluated all patients with clinical scores (subjective International Knee Documentation Committee form, Lysholm score, and Tegner level), physical examination (objective International Knee Documentation Committee form), and KT-1000™ arthrometer for AP laxity. Minimum followup was 10 months (mean, 26 months; range, 10-45 months). Results: One patient had manipulation under anesthesia. The median Lysholm score was 76, Tegner level was 4, and subjective International Knee Documentation Committee was 73. All patients recovered to their preinjury work activity, except one unemployed patient. Stability was normal or nearly normal in five patients; the mean side-to-side difference in AP displacement with manual maximum force was 2.9 mm. Conclusions: This approach with an external fixator allowed staged reconstruction and early motion and provided reasonable stability, ROM, and activity level at followup in patients with complex injuries. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
UR - http://www.scopus.com/inward/record.url?scp=84856947605&partnerID=8YFLogxK
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U2 - 10.1007/s11999-011-2062-0
DO - 10.1007/s11999-011-2062-0
M3 - Article
C2 - 21989782
AN - SCOPUS:84856947605
VL - 470
SP - 869
EP - 876
JO - Clinical Orthopaedics and Related Research
JF - Clinical Orthopaedics and Related Research
SN - 0009-921X
IS - 3
ER -