The rapid growth of an older demographic is an increasing concern around the world. Older people have been reported to suffer from physiological and neuromuscular declines in several systems including skeletal muscles, central nervous system, cardiovascular processes and respiratory function. These age-related changes are often reflected through impairments in functional performance of occupational tasks as well as activities of daily living. This may make an older population more prone to musculoskeletal disorders and injuries. In addition, health problems and injury risks are likely amplified by factors such as obesity. Obesity has emerged as a serious health concern in the United States in recent decades. However, obesity-related changes in performance and motor control as well as how they will be modified by gender, specifically among older adults, are still largely unexplored. As motor variability has recently been reported to be associated with fatigue development and may have the potential to reveal underlying mechanisms of neuromuscular control, the main goals of this study were to investigate the influence of gender and obesity on motor performance, neuromuscular control and endurance in the elderly, by examining differences in motor variability during intermittent submaximal isometric exertions of the knee and hand. Fifty-two older participants with age over 65 were recruited into four groups: obese male (9), obese female (13), non-obese male (15) and non-obese female (15). The obese groups consisted of those whose BMI was greater than 30 kg/m2. Participants were asked to perform intermittent (15s on and 15s off) isometric handgrip and knee extensions at 30% MVC until exhaustion. Force and muscle activations of the Vastus Lateralis, Rectus Femoris, Extensor Carpi Radialis and Flexor Carpi Radialis muscles were collected through the endurance task. Motor variability was quantified using the coefficient of variation (CV) and sample entropy (SaEn) of the surface electromyography (EMG) and force signals. Motor variability during exercise differed both between males and females, and between obese and non-obese people, reflecting different motor strategies employed in order to prolong endurance. Overall, across all individuals, we observed a significant positive correlation between cycle-to-cycle variability of knee extensor muscle activation during the baseline period of the task and endurance time. As for gender differences, males exhibited longer endurance times than females, and seemed to achieve that through utilizing a motor strategy involving a more variable (higher CV) and less complex (lower SaEn) agonistic muscle activity. Since this was accompanied by a lower fluctuation in the force signal (lower CV) and a higher complexity of force (SaEn), we interpreted this to be a motor strategy involving more variable recruitment of synergistic and antagonistic motor units during the knee extension task to prolong endurance time, among males compared to females. As for obesity differences, there were no obesity-related changes in endurance time. However, obese individuals exhibited a greater cycle-to-cycle variability that was positively correlated with endurance time during the knee extension task, indicating a larger alteration in the recruitment of motor units across successive contractions, which contributed to comparable endurance time and performance with their non-obese counterparts. During the hand-grip tasks, variabilities in force and muscle activity followed similar trends as the knee extension task. However, there were no significant gender or obesity differences in endurance time, and there also weren't any significant correlations between any of the dependent variables with endurance time. Thus, this study was a basic investigation into changes in motor variability and how it was associated with the development of fatigue among older adults; and the potential influences of gender and obesity on the relationships. Two tasks of high relevance to both occupational life and activities of daily living, i.e. knee extension and hand-grip were considered. Our findings enhance the theoretical understanding of the underlying neuromuscular control patterns and their relationship with fatigue for different individuals. Given that both aging and obesity rates are rising continuously and becoming a substantial health and safety problem especially in the occupational environment, the results from this study are both timely and critical for practical design applications, especially by recognizing the importance of having a variable motor pattern in task performance, even among older adults. / MS / Obesity rates in the geriatric population has emerged as serious health concern in recent decades. Yet, obesity-related differences in neuromuscular performance and neuromotor control during fatiguing tasks, as well as how they are modified by gender, specifically among older adults, are still largely unexplored. In recent decades, motor variability, referring to the natural variations in postures, movements and muscle activity, has been observed in all physical tasks and linked with fatigue development. It may have the potential to reveal underlying mechanisms of neuromuscular control. Thus, the main goals of this study were to investigate the influence of gender and obesity on motor variability and performance in the elderly, by studying intermittent isometric muscle contractions. Fifty-two older adults (Mean age: 73 (SD 6) years) were recruited into four groups: 9 obese males, 13 obese females, 15 non-obese males, and 15 non-obese females 15. Participants performed intermittent (15s contraction and 15s rest) isometric knee extensions and handgrips at 30% maximum voluntary contraction (MVC) until exhaustion. Force and muscle activations of the Vastus Lateralis (VL), Rectus Femoris (RF), Extensor Carpi Radialis (ECR) and Flexor Carpi Radialis (FCR) muscles were collected during knee extension and handgrip tasks. Performance was quantified using endurance time and force fluctuations. Motor variability was quantified using the coefficient of variation (CV) and sample entropy (SaEn) of the muscle activation signals (surface electromyography (EMG)). The CV is a linear estimator that quantified the size of motor variability. The SaEn is the non-linear estimator that can show the complexity of the signal. Across all individuals, larger cycle-to-cycle variability of baseline muscle activation was associated with longer endurance time during the knee extension task. Males exhibited longer endurance times than females, and probably achieved that by utilizing a motor strategy involving more variable recruitment of synergistic and antagonistic motor units during the knee extension task. No obesity-related changes in endurance time were found. However, obese individuals exhibited a greater cycle-to-cycle variability during the knee extension task, indicating a larger alteration in the recruitment of motor units across successive contractions, which contributed to comparable endurance time and performance with their non-obese counterparts. This study was a basic investigation into changes in motor variability and how it was associated with the development of fatigue among older adults; and the potential influences of gender and obesity on the relationships. Given that obesity rates in the older population is rising continuously and becoming a substantial health and safety problem especially in the occupational environment, the results from this study are both timely and critical for practical design applications, especially by recognizing the importance of having a variable motor pattern in task performance, particularly among older adults.

Yes / Walking down ramps is a demanding task for transfemoral-amputees and terminating gait on ramps is even more challenging because of the requirement to maintain a stable limb so that it can do the necessary negative mechanical work on the centre-of-mass in order to arrest (dissipate) forward/downward velocity. We determined how the use of a microprocessor-controlled limb system (simultaneous control over hydraulic resistances at ankle and knee) affected the negative mechanical work done by each limb when transfemoral-amputees terminated gait during ramp descent. Methods: Eight transfemoral-amputees completed planned gait terminations (stopping on prosthesis) on a 5-degree ramp from slow and customary walking speeds, with the limb's microprocessor active or inactive. When active the limb operated in its ‘ramp-descent’ mode and when inactive the knee and ankle devices functioned at constant default levels. Negative limb work, determined as the integral of the negative mechanical (external) limb power during the braking phase, was compared across speeds and microprocessor conditions. Findings: Negative work done by each limb increased with speed (p < 0.001), and on the prosthetic limb it was greater when the microprocessor was active compared to inactive (p = 0.004). There was no change in work done across microprocessor conditions on the intact limb (p = 0.35). Interpretation: Greater involvement of the prosthetic limb when the limb system was active indicates its ramp-descent mode effectively altered the hydraulic resistances at the ankle and knee. Findings highlight participants became more assured using their prosthetic limb to arrest centre-of-mass velocity. / ZA is funded by the Higher Committee of Education Development in IRAQ (HCED student number D13 626).

The natural history of spinal muscular atrophy (SMA) is characterized by progressive muscle weakness and subsequent functional decline. Limited joint range of motion (ROM) and the development of contractures is common and known to negatively impact function. While joint hypermobility (JH) is clinically observed in SMA, its presence and relationship to function remain under-explored, as does the coexistence of normal ROM. Hypermobility has been described in other neuromuscular diseases (NMDs) and is seen to co-exist with contractures. Therefore, characterizing the presence of lower limb joint hypermobility in SMA warrants investigation. Evaluation of the sagittal arc of ROM, combining both flexion and extension, may provide a more meaningful depiction of ROM in SMA. With the knowledge of the importance of the contribution of extension ROM to the sagittal arc, the trajectory of extension ROM over time and the factors influencing its progression, such as age, baseline ROM, SMA type and disease modifying therapy (DMT) duration deserves investigation.The objectives were to (1) characterize lower-limb joint hypermobility and its relationship to gross motor and ambulatory function; (2) evaluate the contributions of hip and knee extension and ankle dorsiflexion to the sagittal ROM arc and its classification; and (3) describe the trajectory of extension ROM over time and identify factors influencing its change. This is a secondary analysis of data collected at 4 US sites in a prospective SMA natural history registry. Passive range of motion was assessed in individuals with a confirmed diagnosis using standardized procedures. Measures exceeding normative values were considered hypermobile and used to establish whether hypermobility was associated to measures of function including the 6-minute walk test (6MWT) and the Hammersmith Functional Motor Scale-Expanded (HFMSE). Flexion and extension at the hip, knee, and ankle were combined to determine the sagittal arc ROM. The arc ROM were categorized as hypomobile (HYPO), normal (NORM), or hypermobile (HYPER) based on comparison to normative ROM values. Longitudinal analyses assessed the trajectory of hip and knee extension and ankle dorsiflexion ROM over time, and included factors which may influence the trajectory including age at baseline, SMA type and DMT treatment duration. Joint hypermobility was prevalent across lower-limb joints but varied by joint and SMA type classification. Most sagittal ROM arcs were hypomobile at the hip (70%), normal at the knee (37%), and normal at the ankle (44%). Extension ROM strongly contributed to the total arc at all joints (hip: rs = .91, knee: rs = .88, ankle: rs = .79; all p < .001) and discriminated between hypomobile and non-hypomobile classifications. Longitudinal analyses revealed that baseline hip extension was the sole significant predictor of its trajectory, with implications for the preservation of knee and ankle ROM. No other variable included (SMA type, baseline age, arc classification and treatment duration) significantly influenced ROM trajectories. The outcome of this study will guide future treatment decisions and indicate the potential for gains in ROM which is known to impact function. This dissertation contributes to understanding ROM in SMA by highlighting the clinical relevance of using ROM arc classification, the contribution of extension ROM driving arc classification and the pivotal role of baseline hip extension in preserving mobility. Findings underscore the importance of early identification and holistic ROM assessment to inform therapeutic strategies and early intervention. Future research should incorporate additional clinical factors, such as SMN2 copy number and functional trajectories, to enhance the applicability of results in the era of disease-modifying therapies. This work provides a foundation for optimizing clinical care and improving functional outcomes in individuals with SMA.

A mixed-methods design consisting of two phases was adopted. In Phase I, a purposive sample of 31 older Clnnese people with KOA was invited for a semi-structured interview to explore their perceptions and experiences of exercise. Five major categories emerged: typical living pattern with KOA, self-management of KOA, the practice of exercise, views about exercise, and preferences for learning exercise. The findings were used in the development of an exercise programme for this client group. / Knee osteoarthritis (KOA) is prevalent in the growing older Chinese population in Hong Kong. Therapeutic exercise for KOA has strong empirical evidence of its effectiveness on reducing knee pain and physical disability in people with KOA provided that they persists in practising the recommended exercise regimen. However, few previous studies have incorporated the client's perspectives into the design of an exercise programme for promoting continual practice of exercise. This study aimed to develop a new therapeutic exercise programme and pilot its acceptability to promote continual practice for older Chinese people with KOA. / The Phase II study used both quantitative and qualitative approaches to examine participants' satisfaction with the new exercise programme, adherence to the prescribed exercises, mastering of the exercise movements and health outcomes (knee pain, stiffness and range-of-motion, physical function, muscle strength and endurance of the lower extremities, and quality of life). A convenience sample of 33 older Chinese people with KOA participated in the programme. Seven measurement tools in Chinese versions (if applicable) were used to collect quantitative data from the participants: the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the 12-item Short Form of the Medical Outcome Study Questionnaire (SF-12), a goniometer, the Timed-Stands Test (TST), a satisfaction questionnaire, an exercise diary, and a return-demonstration performance record sheet. Six of the participants were invited for a semi-structured interview to explore their experience of the programme. / The quantitative results showed that the participants were highly satisfied with the exercise programme with a mean score of 90.15 out of 100 (SD = 8.05). Their average exercise adherence was high with a mean percentage of 91.04% (SD = 14.54) and their overall performance in mastering of the exercise movements was good with a mean score of 76.71 out of 100 (SD = 21.75). Most participants' health outcomes significantly improved at three months after the exercise programme, except for the SF-12 physical health summary score. The qualitative findings revealed four major categories: satisfaction with the exercise programme, mastering of the exercise movements, experience of the exercise's effects, and integration of the exercises into the daily routine. These findings were mainly consistent with the quantitative results of the study. / The results of this study showed that the exercise programme was acceptable to the participants in terms of satisfaction with the programme, adherence to the prescribed exercises and mastering of the exercise movements. Therefore, adopting a client-centred approach is likely to be a way forward in the development of exercise programmes for promoting continual practice of therapeutic exercise regimens by older Chinese people with KOA. / Lee, Fung Kam. / Advisers: Tak Ying Ann Shiu; Tze Fan Diana Lee; Kwok Wei Winnie So. / Source: Dissertation Abstracts International, Volume: 73-06, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 332-369). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; some appendixes in Chinese.

INTRODUÇÃO: A instabilidade multiligamentar do joelho, normalmente, é provocada por um trauma que determina sua luxação, um evento pouco frequente, mas, que pode trazer sequelas devastadoras. Mesmo com o tratamento cirúrgico preconizado é alto o índice de complicações. A mobilização precoce no pósoperatório provoca afrouxamento dos ligamentos reconstruídos, o que leva à instabilidade residual. A imobilização melhora a estabilidade, mas provoca dor e rigidez. Este trabalho tem o objetivo de avaliar se o uso do fixador externo articulado proporciona melhora na mobilidade, estabilidade e na função subjetiva de pacientes submetidos à reconstrução ligamentar. MÉTODOS: Neste ensaio clínico randomizado com grupos paralelos, 33 pacientes do ambulatório do Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Universidade de São Paulo com mais que 3 semanas de lesão dos ligamentos cruzados anterior e posterior associado à lesão de ligamento colateral fibular e/ ou ligamento colateral tibial foram submetidos à cirurgia de reconstrução multiligamentar, após alocação cega aleatória ao grupo 0 - controle (18 pacientes), com órtese rígida ou ao grupo 1 - fixador externo articulado por 6 semanas (15 pacientes), no período entre novembro de 2010 e novembro de 2013. Após seguimento mínimo de um ano de pós-operatório, a estabilidade dos ligamentos reconstruídos foi avaliada ao exame físico, foram mensurados os déficits de extensão e de flexão residual em relação ao joelho contralateral não acometido e foi aplicado o questionário específico para sintomas do joelho de Lysholm. RESULTADOS: Não houve diferença na avaliação da estabilidade articular nem na extensão entre os grupos. No grupo 1, o déficit de flexão passiva foi menor (4,8º +- 5,4º contra 18,2 +- 14,8º, p < 0,05) com mais pacientes, obtendo déficit de flexão considerado normal, de até 5º (64% contra 18%, p < 0,05) e com classificação excelente ou boa no questionário de Lysholm (73% contra 35%, p < 0,05). CONCLUSÕES: Comparado ao protocolo de reabilitação com órtese rígida removível, o uso do fixador externo articulado no tratamento cirúrgico das lesões multiligamentares do joelho proporciona os mesmos resultados de estabilidade ligamentar, aumenta a amplitude de movimento final, com manutenção da extensão e redução do déficit de flexão e proporciona melhores resultados funcionais / INTRODUCTION: Multiligament knee instability is normally caused by a trauma which results in its dislocation, an infrequent event, but one which can have devastating aftereffects. Even with the recommended surgical treatment the rate of complications is high. Early post-operative mobilization provokes loosening of the reconstructed ligaments, which leads to residual instability. Immobilization improves the stability, but causes pain and stiffness. This study aims to assess whether the use of an articulated external fixator provides improvements in the mobility, stability and the subjective function of the patients submitted to ligament reconstruction. METHODS: In this randomized clinical trial with parallel groups, 33 patients of the outpatient clinic of the Institute of Orthopaedics and Traumatology of the Hospital das Clínicas of the University of Sao Paulo with more than 3 weeks of injury to the anterior cruciate ligaments and the posterior cruciate ligaments associated with injury to the fibular collateral ligament and/or medial collateral ligament, were submitted to multiligament reconstruction surgery, after blind random allocation to either: Group 0 - control (18 patients), with rigid bracing, or to Group 1 - articulated external fixator for 6 weeks (15 patients), in the period from November, 2010 to November 2013. The stability of the reconstructed ligaments were assessed after 1 year postoperatively by physical examination, the deficit of residual extension and flexion was measured in relation to the unaffected contralateral knee and the Lysholm knee scoring scale questionnaire was applied. RESULTS: There was no difference in the assessment of joint stability or of the extension between the groups. In group 1 the passive flexion deficit was less (4.8º +- 5.4º versus 18.2 +- 14.8º, p<0.05) with more patients obtaining a flexion deficit considered normal, or up to 5º (64% versus 18%, p<0.05) and with excellent or good classification in the Lysholm knee scoring scale questionnaire (73% versus 35%, p<0.05). CONCLUSIONS: Compared to the rehabilitation protocol with removable rigid bracing, the use of an articulated external fixator in the treatment of multiligament knee injuries provides equal results for ligament stability, increases the amplitude of the Range of Motion, maintains the extension and reduces the flexion deficit, and provides better functional result

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[Truncated abstract] Measuring the kinematics of joints and implants following orthopaedic surgery is important since joint motion directly influences the functional outcome of the patient and the longevity of the implant. Radiostereometric Analysis (RSA) has been used to assess the motion over time of various joints and implant designs following corrective orthopaedic and joint replacement surgery for more than 20 years in more than 10,000 patients around the world. While the use of RSA reduces the risk of implanting potentially inferior prostheses on a large scale, conventional methodological procedures are based on the acquisition of static, stereographic x-ray images that are not suitable for measuring skeletal kinematics in a dynamic manner. The purpose of this thesis was to design, validate and test a novel technique for dynamically assessing the skeletal motion of human subjects using RSA and single-plane digital x-ray video fluoroscopy. The validation procedure utilised two in-vitro phantom models of human joints capable of simulating normal kinematic motion. These phantom models were supplied with realistic spatial displacement protocols derived from cadaveric specimens. The spatial positions of a series of tantalum markers that were implanted in each skeletal segment were measured using RSA. Skeletal motion was determined in x-ray fluoroscopy images by minimising the difference between the markers measured and projected in the single image plane. Accuracy was determined in terms of bias and precision by analysing the deviation between the applied displacement protocol and measured pose estimates. ... The RSA and low dose single-plane fluoroscopy technique developed, validated and tested in this thesis is capable of dynamically measuring the kinematics of any joint in the human body, following the implantation of small metallic markers in the surrounding bone during corrective orthopaedic surgery. The kinematics of joints with replacement prostheses, such as the total knee replacement (TKR), can be analysed in addition to the kinematics of joints without replacement prostheses, such as the sacroiliac joint. The technique may be used in the future on groups of human subjects enrolled in controlled trials that are designed to analyse the kinematics of the shoulder, spine, hip, knee, patella or ankle joints for the purposes of quantitatively comparing the kinematics of different prosthesis designs and various corrective orthopaedic procedures.

La pose d’une prothèse totale de genou (PTG) se fait selon la technique d’alignement mécanique (AM) qui corrige les déformations constitutionnelles du membre pour créer un membre rectiligne. La survie à long terme des implants est excellente mais les résultats fonctionnels sont décevants avec notamment de nombreux symptômes résiduels. Une nouvelle technique chirurgicale, l’alignement cinématique (AC), vise à rétablir l’anatomie constitutionnelle pré-arthrosique du genou, et permet une amélioration des résultats fonctionnels des PTG. Cette technique est actuellement réalisée avec des implants destinés à un positionnement mécanique, et qui ont un design trochléen ne reproduisant pas l'anatomie trochléaire native. Ceci pourrait affecter la biomécanique de l’articulation patello-fémorale et donc rendre les résultats fonctionnels des PTG cinématiques non optimal. Ce travail vise à démontrer 1) les limitations de la technique mécanique, 2) la fiabilité de la technique cinématique pour le positionnement de l’implant fémoral, et 3) que les implants actuels ne permettent pas une restauration de l’anatomie trochléenne des patients. / The conventional technique for TKA, namely mechanical alignment (MA), does not preserve the constitutional limb anatomy but systematically creates a straight limb. Excellent long-term implant survivorship has been reported, but functional outcomes are disappointing. To solve this problem, an alternative technique for TKA, namely kinematic alignment (KA), has recently been promoted and aims at restoring the constitutional (pre-arthritic) knee anatomy and laxity. Mid-term outcomes have shown excellent functional outcomes with this new KA technique. However, KA technique is currently done with TKA implants designed to be mechanically inserted. Their trochlea design does not reproduce the native trochlear anatomy, which could lead to increased rate of patellar complications with KA TKA. This work aims at demonstrating technical limitations of MA technique, good reproducibility of KA technique, and inappropriateness of current implant to restore patient trochlea anatomy.

INTRODUÇÃO: A instabilidade multiligamentar do joelho, normalmente, é provocada por um trauma que determina sua luxação, um evento pouco frequente, mas, que pode trazer sequelas devastadoras. Mesmo com o tratamento cirúrgico preconizado é alto o índice de complicações. A mobilização precoce no pósoperatório provoca afrouxamento dos ligamentos reconstruídos, o que leva à instabilidade residual. A imobilização melhora a estabilidade, mas provoca dor e rigidez. Este trabalho tem o objetivo de avaliar se o uso do fixador externo articulado proporciona melhora na mobilidade, estabilidade e na função subjetiva de pacientes submetidos à reconstrução ligamentar. MÉTODOS: Neste ensaio clínico randomizado com grupos paralelos, 33 pacientes do ambulatório do Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Universidade de São Paulo com mais que 3 semanas de lesão dos ligamentos cruzados anterior e posterior associado à lesão de ligamento colateral fibular e/ ou ligamento colateral tibial foram submetidos à cirurgia de reconstrução multiligamentar, após alocação cega aleatória ao grupo 0 - controle (18 pacientes), com órtese rígida ou ao grupo 1 - fixador externo articulado por 6 semanas (15 pacientes), no período entre novembro de 2010 e novembro de 2013. Após seguimento mínimo de um ano de pós-operatório, a estabilidade dos ligamentos reconstruídos foi avaliada ao exame físico, foram mensurados os déficits de extensão e de flexão residual em relação ao joelho contralateral não acometido e foi aplicado o questionário específico para sintomas do joelho de Lysholm. RESULTADOS: Não houve diferença na avaliação da estabilidade articular nem na extensão entre os grupos. No grupo 1, o déficit de flexão passiva foi menor (4,8º +- 5,4º contra 18,2 +- 14,8º, p < 0,05) com mais pacientes, obtendo déficit de flexão considerado normal, de até 5º (64% contra 18%, p < 0,05) e com classificação excelente ou boa no questionário de Lysholm (73% contra 35%, p < 0,05). CONCLUSÕES: Comparado ao protocolo de reabilitação com órtese rígida removível, o uso do fixador externo articulado no tratamento cirúrgico das lesões multiligamentares do joelho proporciona os mesmos resultados de estabilidade ligamentar, aumenta a amplitude de movimento final, com manutenção da extensão e redução do déficit de flexão e proporciona melhores resultados funcionais / INTRODUCTION: Multiligament knee instability is normally caused by a trauma which results in its dislocation, an infrequent event, but one which can have devastating aftereffects. Even with the recommended surgical treatment the rate of complications is high. Early post-operative mobilization provokes loosening of the reconstructed ligaments, which leads to residual instability. Immobilization improves the stability, but causes pain and stiffness. This study aims to assess whether the use of an articulated external fixator provides improvements in the mobility, stability and the subjective function of the patients submitted to ligament reconstruction. METHODS: In this randomized clinical trial with parallel groups, 33 patients of the outpatient clinic of the Institute of Orthopaedics and Traumatology of the Hospital das Clínicas of the University of Sao Paulo with more than 3 weeks of injury to the anterior cruciate ligaments and the posterior cruciate ligaments associated with injury to the fibular collateral ligament and/or medial collateral ligament, were submitted to multiligament reconstruction surgery, after blind random allocation to either: Group 0 - control (18 patients), with rigid bracing, or to Group 1 - articulated external fixator for 6 weeks (15 patients), in the period from November, 2010 to November 2013. The stability of the reconstructed ligaments were assessed after 1 year postoperatively by physical examination, the deficit of residual extension and flexion was measured in relation to the unaffected contralateral knee and the Lysholm knee scoring scale questionnaire was applied. RESULTS: There was no difference in the assessment of joint stability or of the extension between the groups. In group 1 the passive flexion deficit was less (4.8º +- 5.4º versus 18.2 +- 14.8º, p<0.05) with more patients obtaining a flexion deficit considered normal, or up to 5º (64% versus 18%, p<0.05) and with excellent or good classification in the Lysholm knee scoring scale questionnaire (73% versus 35%, p<0.05). CONCLUSIONS: Compared to the rehabilitation protocol with removable rigid bracing, the use of an articulated external fixator in the treatment of multiligament knee injuries provides equal results for ligament stability, increases the amplitude of the Range of Motion, maintains the extension and reduces the flexion deficit, and provides better functional result