What question did this study set out to answer?

The study aims to evaluate whether initial immobilization with knee-spanning external fixation results in inferior outcomes compared to hinged knee bracing after multiligament reconstruction following knee dislocation.

April 1, 2026Open Access

Initial external fixation after knee dislocation is associated with inferior outcomes following delayed multiligament reconstruction: a retrospective single-surgeon cohort study

Key Points

The study aims to evaluate whether initial immobilization with knee-spanning external fixation results in inferior outcomes compared to hinged knee bracing after multiligament reconstruction following knee dislocation.
Retrospective cohort study design
Reviewed patients treated at a Level 1 trauma center from 2015 to 2023
Categorized patients by initial immobilization: KSEF or HKB
Collected demographic, injury characteristics, and associated injuries data
Analyzed functional outcomes using IKDC and MTLKS scores, along with knee flexion
Patients with KSEF had lower IKDC scores (mean difference -16.1) versus HKB
KSEF patients also showed lower MTLKS (mean difference -20.5) compared to HKB
Reduced knee flexion was noted in the KSEF group (mean difference -18.9)
Similar outcomes were observed when excluding vascular injuries from the analysis

Abstract

Purpose: Optimal initial immobilization after knee dislocation (KD) remains controversial, particularly whether knee-spanning external fixation (KSEF) contributes to long-term stiffness following multiligament knee reconstruction (MLKR).No prior study has directly compared outcomes based on initial immobilization method.This retrospective singlesurgeon cohort study evaluated whether initial KSEF versus hinged knee bracing (HKB) was associated with differences in functional outcomes after delayed (>6 weeks) MLKR.Methods: We retrospectively reviewed skeletally mature patients with radiographically confirmed KD treated at a Level 1 trauma center from 2015 to 2023 who subsequently underwent delayed MLKR.Patients were categorized by initial immobilization method (KSEF vs HKB).Demographics, injury characteristics, and associated injuries were collected.The primary outcomes were the International Knee Documentation Committee (IKDC) score and included the modified Tegner-Lysholm Knee Score (MTLKS) and final knee flexion.A subgroup analysis excluding vascular injuries was performed to explore the influence of injury severity.Results: Twenty knees in 19 patients met inclusion criteria (mean follow-up, 3.2 2.1 yea rs).Compared with patients treated initially with HKB (n = 12), those treated with KSEF (n = 8) demonstrated lower IKDC scores (mean difference -16.1; 95% CI -32.0 to -1.8), lower MTLKS (mean difference -20.5; 95% CI -35.4 to -5.4), and reduced knee flexion (mean difference -18.9; 95% CI -32.1to -6.2).Similar associations persisted in the subgroup analysis excluding vascular injuries.Conclusion: Initial external fixation was associated with lower functional scores and decreased knee flexion after delayed MLKR.These findings are hypothesis-generating given the small sample size and confounding by injury severity.

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