Cutting edge Orthopedics

46 • CUTTING EDGE - ORTHOPEDICS of 42 months. Average Lysholm scores were 83 for both reconstructed and repaired knees, and average IKDS scores for reconstruction and repair were 68 and 71, respectively. Overall, the group observed no significant difference between postoperative evaluation for posterolateral knee injuries undergoing reconstruction versus repair, suggesting an inconclusive recommendation regarding PLC treatment [34]. Stannard and coworkers in 2012 conducted another retrospective analysis comparing the out- comes of repair to reconstruction in 73 knee dislocations involving posteromedial corner (PMC) injuries, which included both medial collateral and posterior oblique ligament injuries. Patients were followed for a mean of 43 months. Twenty-five patients had a PMC repair, with failure in 5 (20%) cases, whereas 48 patients had reconstruction with only 2 failures (4%). The group deter- mined that reconstruction of the PMC using a technique that reestablished the MCL, POL, and semitendinosus yielded better stability than repair in patients experiencing similar injury [35]. This group also had a significant delay in the staged procedures. Hinged External Fixator Some surgeons advocate the placement of a hinged knee external fixator after reconstruction of the knee ligaments to provide stability but simultaneously allow for early motion. Stannard and associates performed a prospective case control study involving the placement of compass knee hinge (CKH) external fixators postoperatively [36]. In their study, they followed 39 knee dislo- cations undergoing reconstruction of all torn ligaments. Twelve of these were placed in a CKH and 27 were placed in a hinged knee external brace. They found that the patients placed in a hinged knee brace had a much higher ligament failure rate at 29% than patients placed in a CKH at 7%. However, they found that SF-36 scores were not significantly different in the two groups. Their group advocated the use of the hinged knee external fixators as they protect the ligaments while allowing for early postoperative knee range of motion. In the case of open knee ligamentous repair, postoperative hinged external fixators have not been investigated. These data indicate that if reconstruction of all injured ligaments is utilized, surgeons should consider a hinged external fixator. Literature Inconsistencies Many inconsistencies remain in the literature over treatment of acute knee dislocations. Much of this is due to the relatively low incidence of these injuries and the bias of the treating physician. Because of this, a lack of randomized prospective data on these questions exists. Adequate results have been reported using different protocols and combinations of open versus arthroscopically aided treatment and repair versus reconstruction. The problem with many of these studies is both the lack of uniformity and the low number of patients in each study. The studies presented above vary widely on timing and staging of operative treatment. They also lack a uniform postoperative rehabilitation protocol. Many of the Lysholm and Tegner knee scores reported were obtained at different times. Moreover, most of the studies presented above include outcomes based on low numbers of patients, commonly between 20 and 50 patients.