External fixator for treatment of the sub-acute and chronic multi-ligament-injured knee.
OBJECTIVE
To assess whether the use of an articulated external fixator provides improvements in the mobility, stability and subjective function of patients undergoing ligament reconstruction.


METHODS
Thirty-three patients with sub-acute and chronic knee dislocation were subjected to multi-ligament reconstruction surgery. These patients were randomly allocated to two groups for immobilization after reconstruction: group 0-control (18 patients), with rigid knee bracing, and group 1-articulated external fixator (15 patients). The stability of the reconstructed ligaments was assessed after at least 14 months (26.6-month average) postoperatively by physical examination. Deficit of extension and flexion was measured in relation to the unaffected contralateral knee, and the Lysholm knee scoring scale questionnaire was applied.


RESULTS
There was no difference in the assessment of joint stability between the groups. In group 1, patients showed less flexion deficit (4.8° ± 5.4° vs. 18.2° ± 14.8°, p < 0.05), and the percentage of patients with a flexion deficit of 5° or less were higher compared with group 0 (64 vs. 18 %, p < 0.05). There was no difference between groups in relation to extension loss. Group 1 also presented better Lysholm scores, with 73 % of patients rated as excellent or good compared with 35 % in group 0 (p < 0.05).


CONCLUSIONS
Compared with the control rehabilitation protocol with rigid knee bracing in extension, the use of an articulated external fixator in the treatment of chronic multi-ligament-injured knees provided the same ligament stability, better final range of motion and improved Lysholm score. Patients presenting with chronic multi-ligament instability should be considered for articulated external fixation to supplement reconstruction procedures.


METHODS
Randomized controlled trial, Level I.
Knee Surgery Division, Department of Orthopedics and Traumatology, University of São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, São Paulo, SP, CEP 05403-010, Brazil. angelini@usp.br.
Fabio Janson
FJ
Angelini
Knee Surgery Division, Department of Orthopedics and Traumatology, University of São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, São Paulo, SP, CEP 05403-010, Brazil.
Camilo Partezani
CP
Helito
Knee Surgery Division, Department of Orthopedics and Traumatology, University of São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, São Paulo, SP, CEP 05403-010, Brazil.
Marcelo Batista
MB
Bonadio
Knee Surgery Division, Department of Orthopedics and Traumatology, University of São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, São Paulo, SP, CEP 05403-010, Brazil.
Tales Molica
TM
Guimarães
Knee Surgery Division, Department of Orthopedics and Traumatology, University of São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, São Paulo, SP, CEP 05403-010, Brazil.
Ronald Bispo
RB
Barreto
Knee Surgery Division, Department of Orthopedics and Traumatology, University of São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, São Paulo, SP, CEP 05403-010, Brazil.
José Ricardo
JR
Pécora
Knee Surgery Division, Department of Orthopedics and Traumatology, University of São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, São Paulo, SP, CEP 05403-010, Brazil.
Gilberto Luis
GL
Camanho
Knee Surgery Division, Department of Orthopedics and Traumatology, University of São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, São Paulo, SP, CEP 05403-010, Brazil.
Roberto Freire
RF
da Mota E Albuquerque
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D016267:External Fixators; D005260:Female; D006801:Humans; D031221:Knee Dislocation / Q000209:etiology / Q000601:surgery*; D007718:Knee Injuries / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008023:Ligaments, Articular / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000295:instrumentation*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods*
External fixators; Knee dislocation/rehabilitation; Knee dislocation/surgery; Posterior cruciate ligament/injury; Posterior cruciate ligament/surgery; Restraints