Knee Dislocation - Clinical Evaluation of the Use of Hinged External Fixator After Ligament Reconstruction

NCT ID: NCT02290197

Last Updated: 2014-11-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

40 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-08-31

Study Completion Date

2015-03-31

Brief Summary

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Knee dislocation is a serious injury, usually caused by high-energy trauma. It is classically defined as complete loss of articular congruence between the femur and the tibia, confirmed by radiography. However it is common that the reduction happens spontaneously. For this reason, today the investigators also consider a patient suffered knee dislocation in the presence of multi-ligament injury involving the posterior cruciate ligament, often in association with anterior cruciate ligament, lateral and/or medial ligamentous complex.

It is considered a serious injury, because both the strong association with vascular and nerve damage, which can lead to the need for limb amputation, such as the difficulty in obtaining a good functional outcome even after treatment of all ligament injuries.

The treatment of these injuries aims to achieve knee stability. Joint mobility is often sacrificed in the postoperative period, with the use of immobilizations such as casts, splints or bracing. Unfavorable clinical outcomes with high rates of stiffness and joint pain are very common in these patients. In attempts to improve these results, rehabilitation protocols with early range of motion can be employed. However, results may remain unsatisfactory, predominantly because of knee instability recurrence.

Stannard and Zaffagnini proposed a new model for treatment of acute knee dislocations. In this model, after multi-ligament reconstruction or repair, a knee articulated external fixator is used. Such external fixator allows early and aggressive joint mobility in the sagittal plane only. Flexion and extension are permitted, but rotational movements, translations in the anterior-posterior plane, lateral (varus) and medial (valgus) openings are not allowed. Thus protective stability is ensured for ligament reconstruction procedures. Simultaneously the investigators allow immediate joint mobilization, reducing the risk of arthrofibrosis, joint stiffness and postoperative ligament laxity.

There is no consensus regarding the use of hinged external fixator postoperatively in multiple ligament reconstruction procedures for treatment of knee dislocations.

The objective of this study is comparing functional outcomes after ligament reconstruction in patients with knee dislocation, with or without the use of hinged external fixator.

Detailed Description

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Conditions

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Knee Dislocation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Hinged External Fixator

Hinged external fixator allows early and aggressive joint mobility in the sagittal plane only. Flexion and extension are permitted, but rotational movements, translations in the anterior-posterior plane, lateral (varus) and medial (valgus) openings are not allowed. Thus protective stability is ensured for ligament reconstruction procedures. Simultaneously we allow immediate joint mobilization, reducing the risk of arthrofibrosis, joint stiffness and postoperative ligament laxity.

Group Type EXPERIMENTAL

Surgery

Intervention Type PROCEDURE

Surgical reconstruction of all injured ligaments.

Hinged External Fixator

Intervention Type DEVICE

Hinged external fixator is used postoperatively for 6 weeks. Early joint mobility in the sagittal plane is encouraged.

Cast Immobilization

In these patients we used cast postoperatively for 3 weeks. After this period we use a removable bracing and initiate rehabilitation with physical therapy.

Group Type ACTIVE_COMPARATOR

Surgery

Intervention Type PROCEDURE

Surgical reconstruction of all injured ligaments.

Cast Immobilization

Intervention Type DEVICE

Cast is used postoperatively for 3 weeks. After this period we use a removable bracing and initiate rehabilitation with physical therapy.

Interventions

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Surgery

Surgical reconstruction of all injured ligaments.

Intervention Type PROCEDURE

Hinged External Fixator

Hinged external fixator is used postoperatively for 6 weeks. Early joint mobility in the sagittal plane is encouraged.

Intervention Type DEVICE

Cast Immobilization

Cast is used postoperatively for 3 weeks. After this period we use a removable bracing and initiate rehabilitation with physical therapy.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* adults aged between 18 and 50 years old, diagnosed with knee dislocation, classified as KD-III and KD-IV
* absence of knee arthritis in initial radiographs
* absence of systemic diseases or disorders of collagen altering bone quality
* absence of previous surgical interventions in the knee
* possibility of using medications
* maximum of three months of injury to treatment
* understanding and acceptance by the patient to participate

Exclusion Criteria

* abandoning medical care
* inability to follow the treatment plan
Minimum Eligible Age

18 Years

Maximum Eligible Age

50 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University of Sao Paulo General Hospital

OTHER

Sponsor Role lead

Responsible Party

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Fábio Janson Angelini

Assistant Physician

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Fabio J Angelini, M.D.

Role: PRINCIPAL_INVESTIGATOR

University of Sao Paulo

Roberto F Mota e Albuquerque, Ph.D.

Role: STUDY_DIRECTOR

University of Sao Paulo

Gilberto L Camanho, Ph.D.

Role: STUDY_CHAIR

University of Sao Paulo

Locations

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Hospital das Clinicas - University of Sao Paulo

São Paulo, São Paulo, Brazil

Site Status

Countries

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Brazil

Other Identifiers

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0886-09

Identifier Type: -

Identifier Source: org_study_id