Sat., 10/10/09 Knee/Tibia, Paper #82, 4:03 pm OTA-2009
Hinged External Fixation in the Treatment of Knee Dislocations: A Prospective Randomized Study
James P. Stannard, MD (4, 5A, 7-Medtronic; 4, 7-Synthes; 5A-Osteolign; 7-Kinetic Concepts, Inc., Smith &Nephew); Kevin J. Thompson, MD (n);
David A. Volgas, MD (7-AO, Pfizer, KCI, Smith & Nephew, Synthes, Wyeth);
Rena L. Stewart, MD (5A, 7-Synthes; 7-Kinetic Concepts, Inc., Smith & Nephew, Pfizer, Wyeth);
The University of Alabama at Birmingham, Birmingham, Alabama, USA
Purpose: The hypothesis of this study was that patients treated with hinged external fixators as an adjunct to reconstruction would have fewer reconstruction failures than patients without external fixation.
Methods: This study was designed as a prospective, randomized IRB-approved study. Group A patients underwent ligament reconstruction of their knee dislocation with placement of an external hinged knee brace following surgery. Group B patients were treated with the same reconstructive procedures and postoperative care, with the exception that a hinged external fixator was placed for 6 weeks instead of the brace. Patients were followed clinically and evaluated with physical examination, Lysholm and International Knee Documentation Committee (IKDC) knee scores, KT-2000 ligament arthrometer examinations, analog pain scores, and return to work and activities.
Results: 100 patients with 103 knee dislocations were enrolled in this study. Minimum 12-month follow-up has been achieved on 77 patients with 79 dislocations (32 group A, 47 group B). Data evaluation was on these 77 patients. Mean follow-up was 39 months (range, 12-86). Group A had a total of 9 patients (28%) with failed reconstructions compared to 7 (15%) in group B. The difference was not significant (P = 0.15). Group A patients had 22 individual ligament failures (21%) compared to 11 (7%) in group B. The difference in ligament failure was significant (P <0.001, power >0.8) in favor of patients with the external fixation. However, there were trends toward better arc of motion, return to work, and return to activity in group A patients. Lysholm knee scores were a mean of 90.1 for group A and 89.9 for group B. Pain scores were higher for group B patients, with a final mean of 2.9 compared to 1.9 for group A. Final IKDC scores were similar, with 75% normal or near-normal knees in group A compared to 82% in group B.
Conclusion: Hinged external fixation as a supplement to reconstruction was associated with fewer failed ligament reconstructions following dislocation compared with external bracing. However, there were slight trends toward improved pain, motion, and return to activity in patients treated with bracing. Hinged external fixation should be considered for highly unstable (type IV) knee dislocations to supplement reconstruction.
Disclosure: (n=Respondent answered 'No' to all items indicating no conflicts; 1=Board member/owner/officer/committee appointments; 2=Medical/Orthopaedic Publications; 3=Royalties; 4=Speakers bureau/paid presentations; 5A=Paid consultant or employee; 5B=Unpaid consultant; 6=Research or institutional support from a publisher; 7=Research or institutional support from a company or supplier; 8=Stock or Stock Options; 9=Other financial/material support from a publisher; 10=Other financial/material support from a company or supplier).
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant