External fixator for treatment of the sub-acute and chronic multi-ligament-injured knee

Angelini, Fábio Janson; Helito, Camilo Partezani; Bonadio, Marcelo Batista; Guimarães, Tales M.; Silva, Ronald Bispo Barreto da; Pécora, José Ricardo; Camanho, Gilberto Luís; Albuquerque, Roberto Freire da Mota e

doi:10.1007/s00167-015-3719-0

Cited by 22 publications

(28 citation statements)

References 33 publications

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“…The loss of some degrees of ROM is common after multiligament reconstruction. Angelini et al 35 found an average loss of 18.2 degrees in patients undergoing this type of reconstruction.…”

Section: Discussionmentioning

confidence: 93%

Clinical Outcomes of Posterolateral Complex Reconstruction Performed with a Single Femoral Tunnel

et al. 2019

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The objective of this study is to report the functional outcomes, complications, and reconstruction failure rate of patients undergoing posterolateral complex reconstruction with a single femoral tunnel technique. Patients with posterolateral complex injuries associated with injury of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), or both undergoing surgical treatment with the single femoral tunnel technique were included in the study. The International Knee Documentation Committee (IKDC) and Lysholm's scales were evaluated, in addition to age, gender, time between trauma and surgery, trauma type, range of motion (ROM) restrictions, peroneal nerve injury, and reconstruction failure. Sixty-six patients were included. Eighteen underwent ACL and posterolateral complex (PLC) reconstruction (group 1), 24 underwent ACL, PCL, and PLC reconstruction (group 2), and 24 underwent PCL and PLC reconstruction (group 3). The mean follow-up was 63 months. The subjective IKDC was 83.7 ± 14.6 for group 1, 74.3 ± 12.6 for group 2, and 66.3 ± 16.0 for group 3 (p < 0.001). The Lysholm's score was 87.1 ± 12.8 for group 1, 79.5 ± 15.0 for group 2, and 77.7 ± 15.2 for group 3 (p = 0.042). There were six reconstruction failures among the patients (9.1%) with no differences among the groups (p = 0.368). Female gender and reconstruction failure were associated with worse outcomes. Patients undergoing reconstruction of PLC structures with the single femoral tunnel technique achieved good functional outcomes and a failure rate similar to literature. Patients undergoing only combined ACL reconstruction showed better outcomes than patients undergoing combined PCL reconstruction. Female gender was associated with a worse functional outcome irrespective of the injury type.

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“…The loss of some degrees of ROM is common after multiligament reconstruction. Angelini et al 35 found an average loss of 18.2 degrees in patients undergoing this type of reconstruction.…”

Section: Discussionmentioning

confidence: 93%

Clinical Outcomes of Posterolateral Complex Reconstruction Performed with a Single Femoral Tunnel

et al. 2019

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“…[32][33][34][35] Previous studies have shown good results with the use of a hinged external fixator in multiligament knee injuries. 21,36 Regarding the use of this device, no significant differences were observed in relation to radiographic OA, KOOS, or ROM when compared to the use of the knee brace. Thus, in this study, the external fixator did not alter the clinical outcome of the patients, and its use should not be indicated as providing protection of the knee against the development of degenerative changes.…”

Section: Discussionmentioning

confidence: 94%

High Incidence of Osteoarthritis Observed in Patients at Short- to Midterm Follow-Up after Delayed Multiligament Knee Reconstruction

et al. 2021

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The aim of this study was to evaluate the incidence of knee osteoarthritis, failure rate of reconstruction, and clinical outcomes of patients with chronic multiligament knee injuries subjected to surgical treatment. Sixty-two patients with chronic knee dislocation subjected to multiligament reconstruction between April 2008 and July 2016 were evaluated, with a minimum follow-up of 24 months. Anteroposterior and lateral radiographs were performed in the pre- and last postoperative evaluation; the progression of degenerative changes according to the Kellgren-Lawrence classification (KL) was assessed. The Schenck classification, Knee Injury and Osteoarthritis Outcome Score (KOOS), time between injury and surgery, type of postoperative rehabilitation protocol (brace vs. external fixator), and physical examination for ligament instability were also evaluated. Univariate and multivariate analysis were performed, p <0.05 was considered significant. Fifty-two (83.9%) patients were men and 16.1% (n = 10) were women, with a mean age of 38.8 ± 1.3 years. The time from injury to surgery was 31.1 ± 6.1 months, and the follow-up time was 6.1 ± 0.5 years. The mean final KOOS was 79.3 ± 10.4 and the overall reconstruction failure occurred in 25.8%. Of all patients, 64.5% (n = 40) presented a KL classification of ≥2 and were defined as having radiographic osteoarthritis (OA). As 11.7% (n = 7) also presented arthritis in the contralateral knee, in 53.2% (n = 33) the progression was most likely due to the initial injury. The failure of ligament reconstruction or residual instability was present in 15 (35.7%) of patients with OA, and only one patient (4.5%) without OA. In the multivariate analysis, only reconstruction failure was an independent predictor of OA (odds ratio = 13.2 [p = 0.028]). There is a high incidence of knee OA following ligament reconstruction for chronic multiligament knee injuries. Ligament reconstruction failure was the only independent predictor for the development of OA in our study.

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“…However, applying an articulated external fixator postoperatively can also be considered as a viable option. A study by Angelini et al compared the use of rigid knee bracing versus articulated external fixator application following multiligament reconstruction [ 17 ]. The authors found that patients in the articulated external fixator group achieved significantly greater ROM with the same ligament stability, in addition to improved subjective measures of functional status [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Bilateral Knee Dislocations Treated with Acute, Single-Stage Multiligament Reconstructions

Imbergamo

Brzezinski

Smith

et al. 2021

Case Reports in Orthopedics

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Bilateral knee dislocations are exceedingly rare in orthopaedics. Managing these injuries presents a difficult task given their high complication rate and guarded prognosis. We report the case of a 21-year-old male who presented to our institution with bilateral knee dislocations sustained in a motor vehicle collision. The patient subsequently underwent multiligament knee reconstruction surgeries for each knee at one and three weeks following the initial injury. At one-year follow-up, the patient has achieved a successful outcome and has returned to regular activities which include hiking and exercising at the gym.

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External fixator for treatment of the sub-acute and chronic multi-ligament-injured knee

Abstract: Randomized controlled trial, Level I.

Cited by 22 publications

References 33 publications

Clinical Outcomes of Posterolateral Complex Reconstruction Performed with a Single Femoral Tunnel

Clinical Outcomes of Posterolateral Complex Reconstruction Performed with a Single Femoral Tunnel

High Incidence of Osteoarthritis Observed in Patients at Short- to Midterm Follow-Up after Delayed Multiligament Knee Reconstruction

Bilateral Knee Dislocations Treated with Acute, Single-Stage Multiligament Reconstructions

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