title: Surgical management of knee dislocations with ligament reconstruction associated with a hinged external fixator.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Level IV, retrospective therapeutic case series.
authors.affiliation: Department of Orthopaedics and Traumatology, Institute of Orthopedics and Traumatology, Hospital and Clinics, Faculty of Medicine, University of São Paulo (IOT-HCFMUSP), 04078011 São Paulo, Brazil.
authors.forename: F J
authors.initials: FJ
authors.lastname: Angelini
authors.affiliation: Department of Orthopaedics and Traumatology, Institute of Orthopedics and Traumatology, Hospital and Clinics, Faculty of Medicine, University of São Paulo (IOT-HCFMUSP), 04078011 São Paulo, Brazil. Electronic address: Camilo_helito@yahoo.com.br.
authors.forename: C P
authors.initials: CP
authors.lastname: Helito
authors.affiliation: Department of Orthopaedics and Traumatology, Institute of Orthopedics and Traumatology, Hospital and Clinics, Faculty of Medicine, University of São Paulo (IOT-HCFMUSP), 04078011 São Paulo, Brazil.
authors.forename: M B
authors.initials: MB
authors.lastname: Bonadio
authors.affiliation: Department of Orthopaedics and Traumatology, Institute of Orthopedics and Traumatology, Hospital and Clinics, Faculty of Medicine, University of São Paulo (IOT-HCFMUSP), 04078011 São Paulo, Brazil.
authors.forename: R F
authors.initials: RF
authors.lastname: da Mota E Albuquerque
authors.affiliation: Department of Orthopaedics and Traumatology, Institute of Orthopedics and Traumatology, Hospital and Clinics, Faculty of Medicine, University of São Paulo (IOT-HCFMUSP), 04078011 São Paulo, Brazil.
authors.forename: J R
authors.initials: JR
authors.lastname: Pecora
authors.affiliation: Department of Orthopaedics and Traumatology, Institute of Orthopedics and Traumatology, Hospital and Clinics, Faculty of Medicine, University of São Paulo (IOT-HCFMUSP), 04078011 São Paulo, Brazil.
authors.forename: G L
authors.initials: GL
authors.lastname: Camanho
mesh_terms: D000328:Adult; D016267:External Fixators; D005500:Follow-Up Studies; D006801:Humans; D031221:Knee Dislocation / Q000503:physiopathology / Q000601:surgery*; D007719:Knee Joint / Q000502:physiology; D019637:Orthopedic Procedures / Q000379:methods*; D016119:Posterior Cruciate Ligament / Q000601:surgery*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000295:instrumentation*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Allograft; External fixator; Knee dislocation; Multiligament injury