Use of a hinged external knee fixator after surgery for knee dislocation

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Abstract

Purpose:

This study documents short-term clinical outcomes in patients with knee dislocations after blunt trauma and evaluates the compass knee hinge (CKH) external fixator for their treatment.

Type of Study:

Nonrandomized prospective functional outcome study.

Methods:

Forty patients with 43 knee dislocations were evaluated. Twelve knees underwent ligament reconstruction followed by placement of a CKH; this was group A. Group B included 27 knees that underwent the same treatment and rehabilitation protocol except that an external brace was used rather than a CKH.

Results:

Thirty-six patients with 39 knee dislocations underwent follow-up ranging from 14 to 41 months (mean, 24). Four patients with 4 knee dislocations were lost to follow-up (1 group A, 3 group B). Group A underwent 27 knee ligament procedures with 2 (7%) failures based on clinical examination. Group B underwent 102 ligament procedures with 30 (29%) failures (P < .05). Anterior cruciate ligament (ACL) reconstruction revealed that 7 group A patients experienced 1 (14%) failure and 25 Group B patients experienced 7 (28%) failures. Posterior cruciate ligament (PCL) reconstruction in 7 group A patients included no failures, and 20 PCL reconstructions in group B included 1 failure. Reconstruction of the posterolateral corner (PLC) yielded no failures in 2 group A patients and 5 (25%) of 20 in group B. Repair of 8 PLCs in group A yielded 1 (12.5%) failure and 26 PLC repairs in group B had 14 (54%; P = .05). SF-36 data revealed low mean values with no significant differences between groups with current enrollment.

Conclusions:

Knee dislocation after blunt trauma requires aggressive surgical treatment and physical therapy. In the short-term evaluation, the CKH allows aggressive physical therapy without placing repaired or reconstructed ligaments under high stresses that can result in failure.

Section snippets

Methods

Forty patients with 43 knee dislocations were evaluated at the University of Alabama at Birmingham Hospital from August 1996 through March 2000. Thirty-six patients with 39 knee dislocations underwent follow-up ranging from 14 to 41 months (mean, 24 months). Four patients with 4 knee dislocations were lost to follow-up. All patients underwent primary evaluation, surgical treatment, and follow-up by the senior surgeon (J.P.S.). The patients were prospectively evaluated and underwent clinical

Results

Clinical follow-up in our study averaged 24 months, with a range of 14 to 41 months (Table 1). Group A patients’ average follow-up was 21 months. Group B patients’ average follow-up was 25 months. Group A patients (12 knees) underwent 27 knee ligament procedures with 2 failures. Group B patients (27 knees) underwent 102 ligament procedures with 30 failures (29%). This difference was significant with a P value less than .05. There were 7 ACL reconstructions, with one failure (14%), in group A,

Discussion

Knee dislocations are severe injuries that are being recognized with increasing frequency as the spectrum of injury is broadened and awareness of spontaneous reduction is heightened.5, 11, 13 Recent papers have noted that knee dislocations can occur without rupture of either the ACL or the PCL,3, 4 although bicruciate injuries are more common. Expanded definitions of knee dislocation often include gross or radiographically proven dislocation; injury of multiple knee ligaments with

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