Clinical Orthopaedics and Related Research®

, Volume 470, Issue 3, pp 869–876

Surgical Technique: Articulated External Fixator for Treatment of Complex Knee Dislocation

  • Maurilio Marcacci
  • Stefano Zaffagnini
  • Tommaso Bonanzinga
  • Andrea Pizzoli
  • Mario Manca
  • Enzo Caiaffa
Symposium: Complex Knee Ligament Surgery



Knee dislocation is a severe but relatively uncommon injury caused by violent trauma that can result in long-term complications, such as arthrofibrosis, stiffness, instability, and pain. Perhaps owing in part to its rarity, treatment of this injury is controversial. We therefore describe a treatment approach for these complex cases involving a novel dynamic knee external fixator.

Description of Technique

We performed open PCL reconstruction when possible and/or repair of other associated lesions. At the end of the surgical procedure, the surgeon applied an external fixator that reproduced normal knee kinematics, allowing early motion exercises and reducing the risk of joint stiffness while protecting the bony and soft tissue structures involved in the repair during the first healing phase.

Patients and Methods

We retrospectively reviewed eight patients treated with this approach, four of whom had the PCL reconstructed and four of whom had only associated injuries reconstructed. We evaluated all patients with clinical scores (subjective International Knee Documentation Committee form, Lysholm score, and Tegner level), physical examination (objective International Knee Documentation Committee form), and KT-1000™ arthrometer for AP laxity. Minimum followup was 10 months (mean, 26 months; range, 10–45 months).


One patient had manipulation under anesthesia. The median Lysholm score was 76, Tegner level was 4, and subjective International Knee Documentation Committee was 73. All patients recovered to their preinjury work activity, except one unemployed patient. Stability was normal or nearly normal in five patients; the mean side-to-side difference in AP displacement with manual maximum force was 2.9 mm.


This approach with an external fixator allowed staged reconstruction and early motion and provided reasonable stability, ROM, and activity level at followup in patients with complex injuries.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.


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Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Maurilio Marcacci
    • 1
    • 2
  • Stefano Zaffagnini
    • 1
    • 2
  • Tommaso Bonanzinga
    • 1
    • 2
  • Andrea Pizzoli
    • 3
  • Mario Manca
    • 4
  • Enzo Caiaffa
    • 5
  1. 1.3rd Orthopaedics and Traumatologic ClinicRizzoli Orthopaedic InstituteBolognaItaly
  2. 2.Biomechanics and Technologic Innovation LaboratoryCodivilla-Putti Research Center, Bologna UniversityBolognaItaly
  3. 3.Department of OrthopaedicsC Poma HospitalMantovaItaly
  4. 4.Department of OrthopaedicsVersilia Hospital USL12Viareggio ToscanaItaly
  5. 5.Department of OrthopaedicsTaranto HospitalTarantoItaly

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