Estabilidad de la rodilla después de fijación externa articulada. (Inglés)

Daniel C. Fitzpatrick, MD*, Mark B. Sommers, MS, Benjamin C. C. Kam, MD, J. Lawrence Marsh, MD and Michael Bottlang, PhD,||

From * Orthopedic Healthcare Northwest, Eugene, Oregon, the Biomechanics Laboratory, Legacy Research & Technology Center, Portland, Oregon, Oregon Health & Science University, Portland, Oregon, and the University of Iowa Hospitals and Clinics, Iowa City, Iowa

|| Address correspondence to Michael Bottlang, PhD, Legacy Biomechanics Laboratory, 1225 NE 2nd Avenue, Portland, OR 97232 (e-mail: mbottlang@biomechresearch.org).

Background: Articulated external fixation has been proposed as a method to protect ligament reconstructions while allowing aggressive and early postoperative rehabilitation after knee dislocation. However, the ability of these fixators to protect and stabilize the knee joint has not been clearly determined.

Hypothesis: Articulated external fixation can reduce anteroposterior translation in the cruciate-deficient knee and reduce cruciate ligament strain in cases of intact or reconstructed ligaments.

Study Design: Controlled laboratory study.

Methods: Knee stability was assessed by 3 standard clinical stability tests (Lachman, anterior drawer, and posterior drawer) on 7 human cadaveric lower extremities. Instrumented forces of 100 N were applied to the tibia to measure cruciate ligament forces and tibiofemoral displacement in intact and cruciate-deficient specimens with and without articulated external fixation to determine the degree to which a fixator can protect cruciate ligaments and stabilize the knee. Articulated external fixation was applied using monolateral and bilateral fixators to comparatively analyze the effectiveness of each construct. Statistical analysis was performed using 2-tailed, paired Student t tests.

Results: Application of the monolateral articulated external fixator to specimens with intact ligaments significantly reduced cruciate ligament forces by 1.0 N (P = .011), 1.7 N (P = .046), and 1.4 N (P = .009) for Lachman, anterior drawer, and posterior drawer tests, respectively. In the cruciate ligament–deficient knees, the application of a monolateral fixator significantly reduced tibiofemoral translation by 49%, 70%, and 46% for Lachman, anterior drawer, and posterior drawer tests, respectively. No significant differences between the monolateral and bilateral fixator frames, in terms of ligament protection and joint stabilization, were observed.

Conclusion and Clinical Relevance: Articulated external fixation of the knee can reduce stress in the cruciate ligaments after multiligament reconstructions and can decrease anteroposterior translation in the cruciate-deficient knee.

Daniel C. Fitzpatrick, MD*, Mark B. Sommers, MS, Benjamin C. C. Kam, MD, J. Lawrence Marsh, MD and Michael Bottlang, PhD,|| From * Orthopedic Healthcare Northwest, Eugene, Oregon, the Biomechanics Laboratory, Legacy Research & Technology Center, Portland, Oregon, Oregon Health & Science University, Portland, Oregon, and the University of Iowa Hospitals and Clinics, Iowa City, Iowa || Address correspondence to Michael Bottlang, PhD, Legacy Biomechanics Laboratory, 1225 NE 2nd Avenue, Portland, OR 97232 (e-mail: mbottlang@biomechresearch.org). Background: Articulated external fixation has been proposed as a method to protect ligament reconstructions while allowing aggressive and early postoperative rehabilitation after knee dislocation. However, the ability of these fixators to protect and stabilize the knee joint has not been clearly determined. Hypothesis: Articulated external fixation can reduce anteroposterior translation in the cruciate-deficient knee and reduce cruciate ligament strain in cases of intact or reconstructed ligaments. Study Design: Controlled laboratory study. Methods: Knee stability was assessed by 3 standard clinical stability tests (Lachman, anterior drawer, and posterior drawer) on 7 human cadaveric lower extremities. Instrumented forces of 100 N were applied to the tibia to measure cruciate ligament forces and tibiofemoral displacement in intact and cruciate-deficient specimens with and without articulated external fixation to determine the degree to which a fixator can protect cruciate ligaments and stabilize the knee. Articulated external fixation was applied using monolateral and bilateral fixators to comparatively analyze the effectiveness of each construct. Statistical analysis was performed using 2-tailed, paired Student t tests. Results: Application of the monolateral articulated external fixator to specimens with intact ligaments significantly reduced cruciate ligament forces by 1.0 N (P = .011), 1.7 N (P = .046), and 1.4 N (P = .009) for Lachman, anterior drawer, and posterior drawer tests, respectively. In the cruciate ligament–deficient knees, the application of a monolateral fixator significantly reduced tibiofemoral translation by 49%, 70%, and 46% for Lachman, anterior drawer, and posterior drawer tests, respectively. No significant differences between the monolateral and bilateral fixator frames, in terms of ligament protection and joint stabilization, were observed. Conclusion and Clinical Relevance: Articulated external fixation of the knee can reduce stress in the cruciate ligaments after multiligament reconstructions and can decrease anteroposterior translation in the cruciate-deficient knee. Daniel C. Fitzpatrick, MD*, Mark B. Sommers, MS, Benjamin C. C. Kam, MD, J. Lawrence Marsh, MD and Michael Bottlang, PhD,|| From * Orthopedic Healthcare Northwest, Eugene, Oregon, the Biomechanics Laboratory, Legacy Research & Technology Center, Portland, Oregon, Oregon Health & Science University, Portland, Oregon, and the University of Iowa Hospitals and Clinics, Iowa City, Iowa || Address correspondence to Michael Bottlang, PhD, Legacy Biomechanics Laboratory, 1225 NE 2nd Avenue, Portland, OR 97232 (e-mail: mbottlang@biomechresearch.org). Background: Articulated external fixation has been proposed as a method to protect ligament reconstructions while allowing aggressive and early postoperative rehabilitation after knee dislocation. However, the ability of these fixators to protect and stabilize the knee joint has not been clearly determined. Hypothesis: Articulated external fixation can reduce anteroposterior translation in the cruciate-deficient knee and reduce cruciate ligament strain in cases of intact or reconstructed ligaments. Study Design: Controlled laboratory study. Methods: Knee stability was assessed by 3 standard clinical stability tests (Lachman, anterior drawer, and posterior drawer) on 7 human cadaveric lower extremities. Instrumented forces of 100 N were applied to the tibia to measure cruciate ligament forces and tibiofemoral displacement in intact and cruciate-deficient specimens with and without articulated external fixation to determine the degree to which a fixator can protect cruciate ligaments and stabilize the knee. Articulated external fixation was applied using monolateral and bilateral fixators to comparatively analyze the effectiveness of each construct. Statistical analysis was performed using 2-tailed, paired Student t tests.

Results: Application of the monolateral articulated external fixator to specimens with intact ligaments significantly reduced cruciate ligament forces by 1.0 N (P = .011), 1.7 N (P = .046), and 1.4 N (P = .009) for Lachman, anterior drawer, and posterior drawer tests, respectively. In the cruciate ligament–deficient knees, the application of a monolateral fixator significantly reduced tibiofemoral translation by 49%, 70%, and 46% for Lachman, anterior drawer, and posterior drawer tests, respectively. No significant differences between the monolateral and bilateral fixator frames, in terms of ligament protection and joint stabilization, were observed.

Conclusion and Clinical Relevance: Articulated external fixation of the knee can reduce stress in the cruciate ligaments after multiligament reconstructions and can decrease anteroposterior translation in the cruciate-deficient knee.

The American Journal of Sports Medicine 33:1735-1741 (2005).

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