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The purpose of this study is to describe cases of traumatic exposure during the early postoperative period in patients with a total knee replacement (TKR) and to report the treatments instituted and complications of this adverse event.A retrospective review of postoperative patients with TKR performed at the Universidade de São Paulo from 2001 to 2017 who subsequently were treated at the emergency room due to trauma to the TKR region accompanied by surgical wound dehiscence in deep planes and implant exposure was conducted. The initial treatment, evolution, and complications of each patient were reported.In 16 years, there were 3224 TKRs performed at the study institution. Among this population, 4 (0.1%) patients had trauma dehiscence of the surgical wound during the immediate postoperative period. All patients were women between the ages of 64 and 88 years with comorbidities (eg, diabetes mellitus and/or hypertension). The mean time between the surgery and trauma was 6.7 ± 6.2 days. All patients underwent surgical cleaning, debridement with polyethylene exchange, and primary closure of the surgical wound and received adjuvant treatment with broad-spectrum antibiotic therapy. Of the 4 patients affected, 3 developed an infection, 3 required new surgery after initial cleaning, 2 lost their prostheses, and 1 lost a limb, requiring a transfemoral amputation.Traumatic dehiscence with implant exposure during the initial postoperative period of TKR is an infrequent event (0.1%) with a high potential for complications (75%), which may lead to loss of the prosthesis and even the limb. Measures should be taken to prevent falls and gather reports from several centers to broaden the knowledge of this rare event, identify prognostic factors, and define the best treatment algorithm.

ResumoAs reconstruções ligamentares do joelho são procedimentos ortopédicos frequentes. As fixações dos enxertos são mais comumente feitas com parafusos de interferência, metálicos ou absorvíveis. Em estudo recente, somente dez relatos sobre migração de parafusos foram encontrados; somente um deles não estava relacionado ao ligamento cruzado anterior (LCA) e a maioria estava relacionada a parafusos de poly‐L‐lactic acid (PLLA). Apenas um caso da literatura reportou migração de parafuso em reconstruções do canto posterolateral, essa para a região intra‐articular. Neste artigo, os autores relatam um caso de migração extra‐articular e transcutânea de um parafuso de interferência de poly L,D‐lactide (PDLLA) após a reconstrução do tendão poplíteo. Além de ser o primeiro caso de reconstrução do tendão do poplíteo com migração extra‐articular do parafuso, não foram encontrados na literatura relatos de migração de parafusos de PDLLA.AbstractKnee ligament reconstructions are commonly performed orthopedic procedures. Graft fixation is generally performed with metal or absorbable interference screws. In a recent study, only ten reports of screw migration were retrieved; of these, only one was not related to the anterior cruciate ligament, and the majority was related to the use of poly‐L‐lactic acid (PLLA) screws. Only one case retrieved in the literature reported screw migration in reconstructions of the posterolateral corner, and that was to the intra‐articular region. In the present article, the authors report a case of extra‐articular and transcutaneous migration of a poly‐L/D‐lactide (PDLLA) interference screw following popliteal tendon reconstruction. Besides being the first case of popliteal tendon migration with extra‐articular screw migration, no reports of PDLLA screw migration were retrieved in the literature.

OBJETIVO: Analisar a experiência com transplante homologo do mecanismo extensor nas artroplastias totais do joelho e comparar resultados com experiência internacional. MÉTODOS: Foram avaliados retrospectivamente três casos de transplante homologo do mecanismo extensor após artroplastia total do joelho que foram realizados em nosso serviço com apoio de um dos poucos bancos de tecidos brasileiros e tentamos estabelecer se nossa experiência foi similar à reportada na literatura internacional quanto a indicação do paciente, técnica utilizada e resultados. RESULTADOS: Dois casos evoluíram bem com o procedimento e um caso apresentou resultado insatisfatório evoluindo para amputação. Assim como mostra a literatura, tensão adequada do enxerto, fixação tibial apropriada e principalmente seleção precisa do paciente são os melhores preditores de bom resultado. CONCLUSÃO: O procedimento em questão tem indicação precisa, apesar de incomum, tanto pela raridade da problemática quanto pela baixa demanda de enxertos devido aos poucos bancos de tecidos no Brasil. Nível de Evidência IV, Série de Casos. OBJECTIVE: To analyze the experience with allograft transplantation of the extensor mechanism in total knee arthroplasty and compare results with the international experience. METHODS: We retrospectively evaluated three cases of extensor mechanism allograft after total knee arthroplasty performed in our hospital with the aid of one of the few tissue banks in Brazil and attempted to establish whether our experiences were similar to others reported in the world literature regarding patient indication, techniques, and outcomes. RESULTS: Two cases went well with the adopted procedure, and one case showed bad results progressing to amputation. As shown in the literature, the adequate tension of the graft, appropriate tibial fixation and especially the adequate patient selection are the better predictors of good outcomes. Previous chronic infection can be a unfavorable predictor. CONCLUSION: This surgical procedure has precise indication, albeit uncommon, either because of the rarity of the problem or because of the low availability of allografts, due to the scarcity of tissue banks in Brazil. Level of Evidence IV, Case Series.

Dear Editor, Quadriceps tendon rupture is an uncommon injury in orthopedic traumatology and is usually associated with chronic diseases, or the use of systemic or local corticosteroids (1,2). Simultaneous bilateral lesions are even more uncommon, with few cases described in the literature since 1949, when the first description was made by Steiner and Palmer (3). Although bilateral lesions have been described in patients without predisposing factors, the most common scenario is patients with pathologies such as diabetes, renal failure, and autoimmune diseases. One of the problems of bilateral lesions is their delayed diagnosis. Neubauer et al. showed that diagnoses are performed on average more than two months after the injury, which hinders patient recovery, as functional recovery is correlated with the time elapsed between the injury and the surgical procedure (4). Due to the high rate of functional losses after isolated repairs of quadriceps tendon lesions, particularly in chronic lesions, some alternatives have been created with the intention of obtaining a functional improvement in these patients. Alternatives include the Codivilla technique, reinforcement using steel wires and allografts, and even the use of platelet-rich plasma with the goal of achieving better healing of the tendon (4-6). The use of fascia lata allografts is becoming increasingly common in reconstructions around the shoulder and knee due to their material, structural, and biomechanical properties that resemble the original tendon tissue (7). In this letter we present a report on a patient with chronic bilateral quadriceps tendon tear treated surgically with repair of the tendon using transosseous sutures associated with reinforcement using two flexor tendons and coverage of the repair using fascia lata graft, simulating the retinaculum in the anterior region of the knee. A 56-year-old male patient who smoked, suffered from hypertension, diabetes, and had been undergoing dialysis treatment for chronic kidney failure for 9 years, felt both knees snap when descending a ladder. He denied a history of falls or trauma in the knee during the episode. After the incident he presented functional impotence of the lower limbs and was unable to walk. He sought medical attention at a secondary hospital where he was examined, had frontal and lateral radiographs taken of both knees and was released with referral to a basic health care unit for physiotherapy with a diagnosis of arthralgia of the knees. The patient maintained functional impotence, pain, and edema in the anterior region of the knee even after physiotherapy treatment. The patient was unable to work after the episode and was restricted to a wheelchair. Eight months after the onset of the condition, he once again visited the medical service at our hospital where he presented with a gap in the suprapatellar region and functional impotence of the extensor mechanism of both knees. The patient had an ultrasound scan which showed complete rupture of the bilateral quadriceps tendon with retraction of 7.3 cm between the stumps on the right side and 7.4 cm on the left side. The patient also had an MRI scan after diagnostic confirmation. At the time of diagnosis, the patient exhibited decompensated diabetes and poor clinical control of his other systemic pathologies which ruled out an immediate surgical procedure. Perfect control of the co-morbidities, necessary for a safe surgical procedure with a lower risk of healing complications, only occurred after three months, totaling 11 months after the initial injury. Immediately before the surgery the patient presented a score of 32 on the KSS scale. The chosen surgical treatment was the simultaneous repair of the bilateral quadriceps tendon with extensive anterior approach, transosseous sutures through the patella, and reinforcement with flexor tendons from a tissue bank associated with coverage of the repair using a fascia lata graft with the intention of imitating the anterior retinaculum of the knee. The reinforcement with flexor tendons was performed in a circumferential shape, or ‘O’ shape, splicing the tendons in the remaining portion of the quadriceps tendon and passing it under the patella, without making tunnels in the patella so as to preserve it (Figure 1A). The graft was tensioned with the knee in full extension. The fascia lata graft then had its ends sutured on the anterior tuberosity of the tibia and on the quadriceps tendon (Figure 1B). Figure 1. A) Clinical photo showing circumferential reinforcement of the left quadriceps tendon repair with allograft tendons. The asterisk shows the patella. B) Clinical photo showing the final aspect of the coverage of the repair with fascia lata graft from a ... The patient used a long orthosis in extension for 6 weeks. During the first six weeks activity was limited to isometric exercise for the quadriceps, glutei, adducers, and abductors. Gain in passive range of motion (ROM) started at three weeks from 0–45°, developing to 60° in the fourth week, and then in the sixth week the active gain of ROM was released, reaching 0–130° in the tenth week. Sutures were removed three weeks after surgery, and the patient did not have any healing problems. Prophylactic anticoagulant medication was maintained until the knee orthosis was removed. In week eight the patient started orthostatism exercises and gait training with the assistance of parallel bars, subsequently a walking frame, a cane, and later on without support. As the patient was having dialysis on alternate days, he found it hard to cope with the physiotherapy follow-up treatment, only managing to perform exercises no more than twice a week. Six months after surgery the patient is very satisfied with his level of activity and function, presenting a KSS of 80. Fascia lata grafts have recently been used to reconstruct the anterior cruciate ligament, the patellar tendon, and for other procedures with good results (7). Aurora et al. (8) showed that the material, biomechanical, and structural properties of fascia lata grafts are similar to tendon tissue, which acts as an incentive for their use on a larger scale in these types of reconstruction. Even in the absence of any healing complication, which would be quite possible on account of the patient’s clinical co-morbidities, we decided to exercise great caution when starting rehabilitation, avoiding forcing the repair at first. Even if it takes 6 months to restore pre-injury function, we believe that recovery of the total range of motion, without extension lag and with normal strength of the quadriceps, was an excellent result due to the patient’s age and co-morbidities and the time elapsed between the injury and the surgical treatment, which prevented the patient from walking for 11 months. Neubauer et al. showed total recovery in just 3 of 14 patients operated more than 14 days after lesion (4). In short, we believe that surgical treatment of chronic lesions can present good results provided that the rehabilitation is performed carefully and additional methods of reinforcement are used besides simple surgical repair. To our knowledge, the fascia lata graft has not yet been used for that purpose and may be yet another option for health care services that have a tissue bank available.

INTRODUÇÃO: A precisão no posicionamento dos túneis ósseos na reconstrução do ligamento cruzado anterior do joelho (LCA) é considerado um dos fatores fundamentais para o bom resultado dessa cirurgia. A cirurgia ortopédica auxiliada por computador (computer aided orthopedic surgery CAOS) é um avanço tecnológico que tem como um dos principais objetivos exatamente o aumento da precisão. OBJETIVO: comparar o posicionamento do centro dos túneis e a isometria do enxerto obtidos com o uso de um sistema de navegação computadorizada (Orthopilot) e com o uso de guias cirúrgicos convencionais. MÉTODOS: 36 joelhos pareados de cadáveres tiveram o LCA ressecado por artroscopia no Laboratório de Artroscopia do Departamento de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo. Um joelho de cada par foi ramdomizado para o grupo 1 (guias cirúrgicos convencionais) e o outro para o grupo 2 (Orthopilot). Um fio de sutura inelástico foi passado pelo centro dos túneis tibial e femoral confeccionados para a reconstrução do LCA, sem que os túneis fossem finalmente brocados. Todos os joelhos foram então analisados quanto ao posicionamento do centro do túnel tibial (distância do LCP, distância da tubérculo intercondilar medial da tíbia e distância do corno anterior do menisco lateral), do centro do túnel femoral (distância da cortical posterior e angulação coronal na fossa intercondilar do fêmur) e a variação da distância entre os pontos centrais do túnel femoral para o túnel tibial em flexão de 90º e em extensão (isometria). Os dados foram analisados segundo o teste de Wilcoxon para comparação de duas amostras pareadas. RESULTADOS: A variação da distância entre o tunel femoral e tibial em flexão e extensão (isometria) foi maior no grupo 1 convencional, do que no grupo 2 Orthopilot (grupo 1: média 4,2mm com intervalo de 1,1mm a 9,4mm versus grupo 2: média 2,8mm com intervalo de 0,3mm a 6,7mm; p

OBJECTIVES: Healing is an event that is fundamental to the success of total knee arthroplasty. The aims of the present study were to compare the rates of complications related to wound healing between two groups of volunteers submitted to total knee arthroplasty and to evaluate the effects of postoperative oxygen supplementation by means of a nasal catheter. METHOD: A total of 109 patients who underwent total knee arthroplasty were randomized into two groups, namely, groups that did and did not receive postoperative oxygen supplementation via a nasal catheter. The surgical wound was monitored every day during the hospital stay and on the 7th, 14th, 21st, 30th and 42nd postoperative days. Characteristics related to healing were observed, including hyperemia, dehiscence, necrosis, phlyctenules and deep and superficial infection. RESULTS: There were no cases of deep infection. Hyperemia was statistically correlated with the total number of complications in the groups, with oxygen demonstrated to be a protective factor against hyperemia. Approximately 30% of the patients who exhibited hyperemia had other complications, independent of oxygen supplementation. CONCLUSION: Oxygen supplementation following total knee arthroplasty was shown to be effective in diminishing hyperemia around the operative wound. The development of hyperemia was a precursor to other complications, irrespective of whether oxygen supplementation was used.

A technique for combined reconstruction of the anterior cruciate ligament (ACL) and posterolateral corner (PLC) with a single femoral tunnel was recently described. This technique aims to avoid tunnel confluence in the lateral femoral condyle. Because there have been no studies on the functional outcomes and possible complications of this technique, our goal is to demonstrate a two-year minimum follow-up of patients who underwent this type of reconstruction. Nine patients were prospectively evaluated. The ACL was reconstructed with an anatomic single bundle, and the PLC structures reconstructed were the lateral collateral ligament, the popliteus tendon, and the popliteofibular ligament. Patients were evaluated using the objective and subjective International Knee Documentation Committee (IKDC) and the Lysholm and Tegner scales before and after the surgical procedure. The mean follow-up period of the studied patients was 27.3 months. The mean subjective IKDC score rose from 43.6 to 84.0, and the Lysholm score rose from 62.1 to 90.8. In the final assessment, six patients were classified as IKDC A and three as IKDC B. According to the Tegner scale, five patients were able to return to their level of activity prior to the injury. There were no reconstruction failures. One patient experienced postoperative infection and pain in the lateral scar. The results of the reconstruction of ACL injuries associated with PLC with a single femoral tunnel produced a good functional outcome and a low incidence of complications.

Injury to the posterolateral corner (PLC) is difficult to diagnose; most lesions of this type are included within the context of complex knee injuries. Study of the posterolateral complex is growing in importance because of the complex instability generated by these injuries. Although various physical examination tests are described for the diagnosis of PLC lesions, in 72% of cases these lesions are not identified at their initial presentation, which shows the difficulty in both performing these tests and interpreting the results. The maneuver described in this report is performed by executing external rotation of the leg. With the thumb of the proximally positioned hand, the examiner evaluates the positioning of the lateral tibial plateau in relation to the femoral condyle. With this maneuver, in lesions of the PLC and particularly lesions of its external rotation–restricting structures, we observe external rotation of the tibia and posterior subluxation of the lateral tibial plateau that cause the anterior edge of the tibial plateau to be posteriorized in relation to the anterior edge of the lateral femoral condyle. The idea behind this maneuver is not to eliminate the use of other tests but, rather, to add it to a diagnostic arsenal that still has interpretation flaws.

OBJECTIVE: Evaluate the correlation between magnetic resonance imaging, clinical examination and intraoperative identification of posterolateral corner injuries of the knee. METHODS: We compared the findings of physical examination under anesthesia and intraoperative findings as the gold standard for the posterolateral corner injury with the reports of the MRIs of patients who underwent reconstruction of the posterolateral corner. Thus, we evaluated the use of MRI for the diagnosis of lesions. RESULTS: We found a sensitivity of 100% in lesions of the anterior cruciate ligament (ACL), 86.96% in lesions of the posterior cruciate ligament (PCL), 57.58% in lesions of the lateral collateral ligament (LCL) and 24.24 % in tendon injuries of the popliteal muscle (PMT). CONCLUSION: Posterolateral corner injury is difficult to visualize and interpret; therefore, MRI imaging should not be used alone for diagnosis. Level of Evidence II. Diagnostic Studies.

Background Many reconstruction techniques have already been developed for treating posterolateral corner (PLC) injuries, with still no consensus regarding what would be the best option. Some techniques use non-bone tunnel fixation, attaching the graft to the femur using a cortical screw with toothed washer. The main objective of the present study is to evaluate complications related to fixation performed by a screw and toothed washer technique. Methods A prospective study with surgical reconstruction of the PLC structures of the knee between January 2008 and December 2009 was performed. PLC reconstruction included reconstruction of the lateral collateral ligament, popliteofibular ligament and popliteal muscle tendon. Fixation of the grafts in the femur was achieved by means of a 4.5 mm screw with a toothed washer. The assessments were done using the following methods: objective IKDC, subjective IKDC, Lysholm and Tegner. Radiographic evaluations were performed immediately after the operation, at 3, 6 and 12 months after surgery, and yearly thereafter. Complications were documented. Results The mean subjective IKDC score after the operation was 69.2; Lysholm scale was 80.7. Two patients presented failure of reconstructions of the PLC. In the radiographic evaluations, signs of loosening of the screw with toothed washer in the femur were observed in eight cases (66.6%). Six patients (50%) complained of lateral pain after the operation. Conclusion The technique of femoral fixation was shown to be efficient in restoration of stability. However there was a high rate of complications secondary to implant, such as loosening of the screws and iliotibial tract friction. Level of evidence Case series, Leve IV.

OBJECTIVE: Describe the knee anterolateral ligament (ALL) and establish its anatomical marks of origin and insertion. METHODS: Dissection of the anterolateral aspect of the knee was performed in six cadavers. After isolation of the ALL, its lenght, width and thickness were measured as its places of origin and insertion. The ALL origin was documented in relation to the lateral collateral ligament (LCL) origin and the insertion was documented in relation to the Gerdy tubercle, fibullar head and lateral meniscus. After the first two dissections, the ligament was removed and sent to histologycal analysis. RESULTS: The ALL was clearly identified in all knees. Its origin in the lateral epycondile was on average 0.5 mm distal and 2.5 mm anterior to the LCL. In the tibia, two insertions were observed, one in the lateral meniscus and another in the proximal tibia, about 4.5 mm distal to the articular cartilage, between the Gerdy tubercle and the fibullar head. The average measures obtained were: 35.1 mm lenght, 6.8 mm width and 2.6 mm thickness. In the ligament histological analysis, dense connective tissue was observed. CONCLUSION: The ALL is a constant structure in the knee anterolateral region. Its origin is anterior and distal to the LCL origin. In the tibia, it has two insertions, one in the lateral meniscus and another in the proximal tibia between the Gerdy tubercle and the fibullar head. OBJETIVO: Descrever o ligamento anterolateral (LAL) do joelho e estabelecer seus pontos anatômicos de origem e inserção e suas medidas. MÉTODOS: Foram feitas dissecções da região anterolateral do joelho em seis cadáveres. Após isolamento do LAL, medidas de comprimento, espessura e largura foram feitas, assim como seus locais de origem e inserção. A origem do LAL foi documentada com base na sua distância ântero-posterior e proximal-distal em relação à origem do ligamento colateral lateral. A inserção foi documentada com base no tubérculo de Gerdy, a cartilagem do planalto tibial lateral e o menisco lateral. Nas duas primeiras dissecções, o ligamento foi removido e enviado para análise histológica. RESULTADOS: O LAL foi observado com clareza nas dissecções de todos os seis joelhos. Sua origem no epicôndilo lateral apresentou uma média 0,5 mm distal e 2,5 mm anterior à origem do LCL. Na tíbia foram observadas duas inserções, uma mais proximal no menisco lateral e outra mais distal entre o tubérculo de Gerdy e a cabeça da fíbula, cerca de 4,5 mm distal à cartilagem articular da tíbia. As medidas encontradas do ligamento foram: comprimento médio de 35,1 mm, largura média de 6,8 mm e espessura média de 2,6 mm. Na análise histológica dos ligamentos foi observada presença de tecido conectivo denso. CONCLUSÃO: O LAL do joelho é uma estrutura constante na região anterolateral. Sua origem no fêmur é anterior e distal à origem do LCL. Na tíbia, apresenta duas inserções, no menisco lateral e entre o tubérculo de Gerdy e a cabeça da fíbula.

OBJECTIVE: To compare the accuracy of positioning of the femoral tunnel in reconstructing the anterior cruciate ligament by means of 2 techniques: tibial tunnel and anteromedial portal. METHOD: Femoral tunnels were drilled in 20 knees from human cadavers by means of arthroscopy. Group I had the femoral tunnel drilled via a trans-tibial tunnel, and Group II via the anteromedial portal. Four variables were measured: A) posterior wall thickness; B) tunnel positioning at the notch; C) tunnel inclination in relation to the femoral axis; and D) distance between the wire guide exit and the lateral epicondyle. RESULTS: As above, respectively, A) 2.23 mm for group I and 2.36 mm for group II (P =.54); B) 25.5° for group I and 30.0° for group II (P =.23); C) 23.9° for group I and 32.0° for group II (P =.02); D) 7.8 cm for group I and 3.9 cm for group II (P

ResumoObjetivo: Descrever o ligamento anterolateral (LAL) do joelho e estabelecer seus pontos anatômicos de origem e inserção e suas medidas.Métodos: Foram feitas dissecções da região anterolateral do joelho em seis cadáveres. Após isolamento do LAL, medidas de comprimento, espessura e largura foram feitas, assim como seus locais de origem e inserção. A origem do LAL foi documentada com base na sua distância ântero-posterior e proximal- distal em relação à origem do ligamento colateral lateral. A inserção foi documentada com base no tubérculo de Gerdy, a cartilagem do planalto tibial lateral e o menisco lateral. Nas duas primeiras dissecções, o ligamento foi removido e enviado para análise histológica.Resultados: O LAL foi observado com clareza nas dissecções de todos os seis joelhos. Sua origem no epicôndilo lateral apresentou uma média 0,5mm distal e 2,5mm anterior à origem do LCL. Na tíbia foram observadas duas inserções, uma mais proximal no menisco lateral e outra mais distal entre o tubérculo de Gerdy e a cabeça da fíbula, cerca de 4,5mm distal à cartilagem articular da tíbia. As medidas encontradas do ligamento foram: comprimento médio de 35,1mm, largura média de 6,8mm e espessura média de 2,6mm. Na análise histológica dos ligamentos foi observada presença de tecido conectivo denso.Conclusão: O LAL do joelho é uma estrutura constante na região anterolateral. Sua origem no fêmur é anterior e distal à origem do LCL. Na tíbia, apresenta duas inserções, no menisco lateral e entre o tubérculo de Gerdy e a cabeça da fíbula.AbstractObjectiveDescribe the knee anterolateral ligament (ALL) and establish its anatomical marks of origin and insertion.MethodsDissection of the anterolateral aspect of the knee was performed in six cadavers. After isolation of the ALL, its lenght, width and thickness were measured as its places of origin and insertion. The ALL origin was documented in relation to the lateral collateral ligament (LCL) origin and the insertion was documented in relation to the Gerdy tubercle, fibullar head and lateral meniscus. After the first two dissections, the ligament was removed and sent to histologycal analysis.ResultsThe ALL was clearly identified in all knees. Its origin in the lateral epycondile was on average 0.5mm distal and 2.5mm anterior to the LCL. In the tibia, two insertions were observed, one in the lateral meniscus and another in the proximal tibia, about 4.5mm distal to the articular cartilage, between the Gerdy tubercle and the fibullar head. The average measures obtained were: 35.1mm lenght, 6.8mm width and 2.6mm thickness. In the ligament histological analysis, dense connective tissue was observed.ConclusionThe ALL is a constant structure in the knee anterolateral region. Its origin is anterior and distal to the LCL origin. In the tibia, it has two insertions, one in the lateral meniscus and another in the proximal tibia between the Gerdy tubercle and the fibullar head.

Introduction Knee dislocations are defined as ligament injuries involving at least two of the four most important knee ligaments. Results from recent studies have shown a tendency towards improvement of the functional outcomes with use of an articulated external fixator during the postoperative period following multiligament reconstruction. Our hypothesis was that good knee stability and early gain of range of motion could be achieved with the use of the external fixator after ligament reconstructions. Methods Fourteen patients with knee dislocations were evaluated after multiligament reconstruction in association with use of a lateral monoplanar external fixator for six weeks. Reconstructions were performed using grafts from a tissue bank. Range of motion was measured after one, two, three, six, twelve months and at the final evaluation at a mean time of 49 months. The assessments were made using objective and subjective IKDC, Lysholm and Tegner scales. Results The mean scores were 71.7 for the subjective IKDC score, 81.5 for the Lysholm score. No patient was able to return to previous Tegner score. Out of the 45 ligament reconstructions performed, only four failed during the follow-up time. The mean range of motion of the knee presented a progressive increase from the first to the twelfth month, from 67.8° to 115.7°. Two cases of superficial infection on the site of the external fixator pins were observed. Conclusion The use of an external fixator enabled early rehabilitation with range of motion gains starting from the first postoperative month, a low rate of reconstruction failure and minimal complications. Nevertheless, none of the patients returned to the level of activity prevailing prior to the injury. Level of evidence Level IV, retrospective therapeutic case series.