RESUMEN
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.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Fijadores Externos , Luxación de la Rodilla/terapia , Articulación de la Rodilla/fisiología , Anciano , Anciano de 80 o más Años , Ligamento Cruzado Anterior/cirugía , Fenómenos Biomecánicos , Cadáver , Fémur/fisiología , Humanos , Inestabilidad de la Articulación , Tibia/fisiologíaRESUMEN
OBJECTIVES: To establish a laboratory model of implant cutout, which can evaluate the effect of implant design on cutout resistance in a clinically realistic "worst case" scenario. SETTING: Orthopaedic biomechanics laboratory. DESIGN: Implant cutout was simulated in an unstable pertrochanteric fracture model, which accounted for dynamic loading, osteoporotic bone, and a defined implant offset. For model characterization, lag screw cutout was simulated in human cadaveric specimens and in polyurethane foam surrogates. Subsequently, foam surrogates were used to determine differences in cutout resistance between 2 common lag screws (dynamic hip screw, Gamma) and 2 novel blade-type implant designs (dynamic helical hip system, trochanteric fixation nail). MAIN OUTCOME MEASURES: Implant migration was continuously recorded with a spatial motion tracking system as a function of the applied loading cycles. In addition, the total number of loading cycles to cutout failure was determined for specific load amplitudes. RESULTS: Implant migration in polyurethane surrogates closely correlated with that in cadaveric specimens, but yielded higher reproducibility and consistent cutout failure. The cutout model was able to delineate significant differences in cutout resistance between specific implant designs. At any of 4 load amplitudes (0.8 kN, 1.0 kN, 1.2 kN, 1.4 kN) dynamic hip screw lag screws failed earliest. The gamma nail lag screw could sustain significantly more loading cycles than the dynamic hip screw. Of all implants, trochanteric fixation nail implants demonstrated the highest cutout resistance. CONCLUSIONS: Implant design can significantly affect the fixation strength and cutout resistance of implants for pertrochanteric fracture fixation. The novel cutout model can predict differences in cutout resistance between distinct implant designs.