Angelini F J, Helito C P, Bonadio M B, da Mota E Albuquerque R F, Pecora J R, Camanho G L
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.
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.
Orthop Traumatol Surg Res. 2015 Feb;101(1):77-81. doi: 10.1016/j.otsr.2014.11.001. Epub 2014 Dec 17.
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.
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.
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.
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.
Level IV, retrospective therapeutic case series.
膝关节脱位被定义为涉及四条最重要膝关节韧带中至少两条的韧带损伤。近期研究结果表明，在多韧带重建术后的康复期使用关节式外固定器，功能预后有改善的趋势。我们的假设是，韧带重建后使用外固定器可实现良好的膝关节稳定性和早期活动范围增加。
对14例膝关节脱位患者在多韧带重建并使用外侧单平面外固定器六周后进行评估。重建使用组织库提供的移植物。在术后1个月、2个月、3个月、6个月、12个月以及平均49个月的最终评估时测量活动范围。使用客观和主观的国际膝关节文献委员会（IKDC）、Lysholm和Tegner量表进行评估。
主观IKDC评分的平均分为71.7分，Lysholm评分为81.5分。没有患者能够恢复到之前的Tegner评分。在进行的45次韧带重建中，随访期间仅有4次失败。膝关节的平均活动范围从第1个月到第12个月呈逐渐增加趋势，从67.8°增加到115.7°。观察到2例外固定器针道浅表感染病例。
使用外固定器可实现早期康复，术后第1个月即可开始增加活动范围，重建失败率低且并发症最少。然而，没有患者恢复到受伤前的活动水平。
IV级，回顾性治疗病例系列。
