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Hinged External Fixation in the Treatment of Knee Dislocations: A Prospective Randomized Study

Stannard, James P. MD; Nuelle, Clayton W. MD; McGwin, Gerald PhD; Volgas, David A. MD

Journal of Bone & Joint Surgery - American Volume: 5 February 2014 - Volume 96 - Issue 3 - p 184–191
doi: 10.2106/JBJS.L.01603
Scientific Articles
Supplementary Content

Background: Our hypothesis was that patients treated with hinged external fixators as an adjunct to multiple-ligament reconstruction would have fewer reconstruction failures than patients treated without external fixation.

Methods: In this prospective randomized study, patients with a knee dislocation either underwent ligament reconstruction with placement of an external hinged knee brace following surgery (Group A) or underwent ligament reconstruction with placement of a hinged external fixator (Compass Knee Hinge) for six weeks instead of the brace (Group B). The patients were followed clinically and were evaluated with physical examination, Lysholm and International Knee Documentation Committee knee scores, visual analog scale pain scores, and status regarding return to work and activities.

Results: One hundred patients with 103 knee dislocations were enrolled. Seventy-seven patients with seventy-nine dislocations (thirty-two in Group A and forty-seven in Group B), with a minimum follow-up interval of twelve months, were available for evaluation. The mean duration of follow-up was thirty-nine months (range, twelve to eighty-six months). Nine patients (29%) in Group A had failed reconstructions compared with seven (15%) in Group B (p = 0.15). Group-A patients had twenty-two (21%) of 105 reconstructed individual ligaments fail compared with eleven (7%) of 157 reconstructed ligaments in Group B. The difference in ligament failure was significant (p < 0.001; power > 0.8), with more favorable results for the patients managed with the external fixation.

Conclusions: Hinged external fixation as a supplement to reconstruction following knee dislocation was associated with fewer failed ligament reconstructions compared with external bracing. Patients presenting with highly unstable knee dislocations should be considered for hinged external fixation to supplement initial reconstructive procedures.

Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Peer Review: This article was reviewed by the Editor-in-Chief and one Deputy Editor, and it underwent blinded review by two or more outside experts. The Deputy Editor reviewed each revision of the article, and it underwent a final review by the Editor-in-Chief prior to publication. Final corrections and clarifications occurred during one or more exchanges between the author(s) and copyeditors.

1Department of Orthopaedic Surgery, University of Missouri, 1100 Virginia Avenue, DC953.00, Columbia, MO 65212. E-mail address for J.P. Stannard:

2University of Alabama at Birmingham, 510 South 20th Street, FOT 960, Birmingham, AL 35294-3409

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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