ANATOMİK ENDOBUTTON YÖNTEMİ İLE TEK BAND ARTROSKOPİK ÖÇB REKONSTRÜKSİYONU UYGULANAN HASTALARIMIZIN ORTA DÖNEM TAKİP SONUÇLARI

Yıl 2014, Cilt: 3 Sayı: 3, 155 - 160, 31.12.2014

Burak Günaydın Ali Turgut Hasan Öztürk Seydi Ahmet Eren Mehmet Korkmaz Tayfun Bacaksız Önder Kalenderer

Öz

AMAÇ: Çalışmamızda, ön çapraz bağ yırtığı sonrasında anatomik Endobutton (Smith & Nephew, Andover, MA) yöntemi ile tek band rekonstrüksiyon uygulanan hastaların orta dönem takip sonuçları incelendi.

YÖNTEMLER: Kliniğimizde Ocak 2008–Aralık 2012 yılları arasında 85 hastaya anatomik Endobutton yöntemi ile tek band artroskopik ÖÇB rekonstrüksiyonu uygulanmıştır ve yeterli takibi olan 36 hasta retrospektif olarak incelenerek çalışmaya dahil edilmiştir. Hastaların 32'si (%89) erkek, dördü (%11) kadın idi. 23'ünün (%64) sağ dizine, 13'ünün(%36) sol dizine rekonstrüksiyon ameliyatı uygulandı. Olgu serimizde ortalama yaş 26.7 idi (dağılım: 17–37). Hastalarımız ameliyat öncesinde ve en az bir yıl takip sonrasında yapılan kontrollerinde; Lysholm Skorlaması sonuçları, IKDC skorlaması, IKDC üç zamanlı aktivite skalası, Modifiye Cincinnati Skorlaması, uyluk çevresi ve klinik muayene ile değerlendirilmişlerdir. Son kontrollerde tek bacakla uzun atlama testi yapılmıştır.

BULGULAR: Olgu serimizde ortalama takip süresi 28.1 ay (12–39) olarak saptandı. Hastaların ameliyat öncesi 57.1 (39-88) olan Lysholm skoru ortalamasının son kontrollerde 93.8 (dağılım 82–100) olduğu saptandı. Ameliyat öncesi 18.9 (11-24) olan Modifiye Cincinnati skoru ortalaması son kontrollerde 28.5 (dağılım 23–30 ) saptandı. Son kontrollerinde uygulanan IKDC skorlamasında hastalarının %97’sinin skoru A veya B olarak değerlendirildi. Hastaların aktivite durumları IKDC aktivite skalasına göre değerlendirildi. Ameliyat öncesi seviye IV grubunda 18 hasta (%50) yer alırken, son kontroller sırasında hiçbir hastanın bu grupta yer almadığı tespit edildi. Ameliyat sonrası hiçbir hastamızın klinik muayenesinde 10 mm üzerinde deplasman tespit edilmedi. Hastalarımızın ameliyat öncesi uyluk atrofisi ortalaması 23 mm (dağılım 5 \ 60 mm) iken ameliyat sonrası ortalama atrofi değeri 9 mm (dağılım –5 \ 40 mm) saptandı. Tek bacakla uzun atlama testinde hastaların 32'sinde (%89) %85'in üzerinde değerlere ulaşıldı.

SONUÇ: Ön çapraz bağ rekonstrüksiyonunda anatomik tek band Endobutton yöntemi ile yapılan cerrahi tedavinin güvenli ve orta dönem sonuçlarının başarılı olduğu kanısına varmaktayız.

Anahtar Kelimeler

Artroskopi, Ön çapraz bağ

MIDTERM RESULTS OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION BY ENDOBUTTON TECHNIQUE WITH SINGLE BUNDLE

Öz

OBJECTIVE: The purpose of this study is to evaluate clinical and functional midterm results of Endobutton (Smith & Nephew, Andover, MA) technique with single bundle.

METHODS: 36 patients who had been operated between january 2008 and december 2012 were included in this study. 32 of them were male (%89) and four of them were female (%11). 23 of the lesions were on the right knee (%64) and 13 of them were on the left knee (%36). The average age of the patients was 26.7 (17-37). The patients were evaluated by the following criterias preoperatively and at the time of last examination; by physical examination (thigh atrophy, range of motion, grade of anterior instability), Lysholm Knee Scores (LNS),Modified Cincinnati Scores (MCS). At the time of last examination; International Knee Documentation Committee Scores (IKDC), IKDC three season activity scales and single leg jump distances were evaluated. RESULTS: Mean Follow-up time was 28.1 months (12-39), Preoperatively; average LNS was 57.1 (39-88), average MCS was 18.9 (11-24) postoperatively these scores were evaluated averagely as following; 93.8 (82-100), 28.5 (23-30). At the time of last examination % 97 of patients were in groups A and B according to IKDC. Preoperatively there were 18 patients (%50) in level 4 activity group but at the time of last examination there were not any patients in this group. All of the patients anterior instability was under 10 millimeters (mm) at last visit. Average thigh atrophy was 23 mm (5 \ 60) preoperatively and 9 mm (-5 \ 40) at last visit. 32 of patients (%89) had achieved over %85 values after single leg jumping distance testing.

CONCLUSION: Clinical and functional midterm results of Endobutton technique with single bundle are successfully. We think that this method is safe and the results are encouraging.

Anahtar Kelimeler

Artroscopy, Anterior cruciate ligament

Kaynakça

• 1. Hungston JC, Andrew JR, Cross MJ, et al. Clasification of Knee Ligament İnjuries. The Medical Compartment and Cruciate Ligaments. J Bone Joint Surg. 1976;58A: 173–9.
• 2. May Arna Risberg, Arne Ekeland; Assesment of functional tests after anterior cruciate ligament surgery. Journal of Orthopaedic & Sports Physical Therapy 1994;(19)4: 212-217.
• 3. A Reznik, Sachs RA, Daniel DM, Stone ML. Complications of The Knee Ligament Surgery in Knee Ligaments Structure, Function, Injury and Repair. NewYork 1990: 505-20
• 4. James G. Garrick. Orthopaedic Knowledge Update; Sports Medicine 3 2004:169–81.
• 5. Sports Injury; Biomechanics of ligaments in sports medicine; Chapter 5; 83–5.
• 6. Noyes FR, Magine RE. Early Knee Motion After Open and Arthroscopic Anterior Cruciate Ligament Reconstruction. Am J Sports Med. 1987; 15: 149–55.
• 7. M. A. Kessler, H. Behrend, S. Henz, G. Stutz, A. Rukavina, M. S. Kuster. Function, Osteoarthritis and activity after ACL–rupture: 11 years follow-up results of conservative versus reconstructive treatment. Knee Surgery Sports Traumatol Arthroscopy 2008;16: 442-8.
• 8. Miller MD,Cole BD, textbook of arthroscopy, Philadelphia: Elsevier; knee arthroscopy 2006: 467–765
• 9. Allen F. Anderson. Transepiphyseal Replacement of the Anterior Cruciate Ligament Using Quadruple Hamstring Grafts in Skeletally Immature Patients J. Bone Joint Surg. Am. 2004; 86: 201 – 09.
• 10. Harner MD., Olson Eric, Irrgang James J., Silverstein Scott BS,: Allograft Versus Autograft Anterior CruciateLigament Reconstruction: 3– to 5–Year Outcome. Clinical Orthopaedics and Related Research. 1996; 324: 134–44.
• 11. Bruks TR, Leand R. Determination of Graft Tension Before Fixation in Anterior Cruciate Ligament Reconstruction. Arthroscopy. 2000;4: 260–6.
• 12. Hoffmann RFG, Peine R, Bail HJ, Südkamp NP, Weiler A. Initial Fixation Strenght of Modified Patellar Tendon Grafts for Anatomic Fixation in Anterior Cruciate Ligament Reconstruction. Arthroscopy. 1999; 15: 392–9.
• 13. McGinty J.B, Burkhart S.S. Arthroscopic treatment of anterior cruciate ligament injuries, Operative Arthroscopy Third edition: knee arthroscopy. 347–65.
• 14. Indelli P, Pier Francesco MD, Michael F, Gary S ; Schurman: Monopolar Thermal Treatment of Symptomatic Anterior Cruciate Ligament Instability. Clinical Orthopaedics and Related Research. February 2003; (407): 139–47.
• 15. U.Insall-Scott: Surgery of the Knee 2005;Churcill Livingstone, Philadelphia 607–712.
• 16. Chen L, Colley V, Rosenberg T,: ACL reconstruction with hamstring tendon. Orthop Clin North Am 2003;34(1):9-18
• 17. Chadwick CP, Yung SH, Brett L: Stability result of hamstring anterior cruciate ligament reconstructions at 2 to 8 year follow up; Arthroscopy, The Journal of Arthroscopic and related surgery. 2005; 21(2): 138-46.
• 18. Eriksson K, Hamberg P, Jansson E et al,; Semitendinosus muscle in anterior crusiate ligament surgery, Morphology and Function, Arthroscopy: The Journal of Arthroscopic and related surgery. 2001;17:801-17
• 19. Gobbi A, Tuy B, Mahajan S, et al,:Quadrupled bone-semitendinosus anterior cruciate ligament reconstruction: Clinical investigation in group A of athletes, Arthroscopy, 2003; 19(7): 691-9
• 20. Shino K, Nakata K, Horibe S, Inoue M, Nakagawa S. Quantitative evaluation after artroscopic anteriaor cruciate ligament reconstruction. Am J Sport Med,1993; 21: 609–16.
• 21. David J. Stewart, Edward W. Lambert, Kimberly M. Stack, Joseph Pellegrini, Daniel V. Unger, and Raymond J. Hood: The Effect of Intra-Articular Methadone on Postoperative Pain Following Anterior Cruciate Ligament Reconstruction J. Bone Joint Surg. Am. Jan 2005; 87: 140–4.
• 22. Majima Tokifumi, Yasuda Kazunori, Tago Hidenobu, Minami: Rehabilitation After Hamstring Anterior Cruciate Ligament Reconstruction. Clinical Orthopaedics and Related Research. April 2002;(397):370–80.
• 23. Eastlack, Robert K; Hargens, Alan R; Groppo, Eli R BS; Steinbach: Lower Body Positive-pressure Exercise after Knee Surgery. Clinical Orthopaedics and Related Research. 2005;(431): 213–9.
• 24. Howell SM, Taylor MA. Brace-free rehabilitation wiht early return to activity, for knees reconstructed with a double-looped semitendinosus and gracilis graft. J Bone Joint Surg. 1996;78: 814–25.
• 25. Fithian DC, Paxton EW, Stone ML, et al. Prospective trial of a treatment algorithm for the management of the anterior cruciate ligament-injured knee. Am J Sports Med 2005;33: 335–46.
• 26. Schutte MJ, Dabezies EJ, Zimny ML, Happel LT. Neuralanatomy of the human anterior cruciate ligament. J BoneJoint Surg. 1987; 69-A: 243–9.
• 27. Tashman S, Collon D, Anderson K et al. Abnormal rotational knee motion during running after anterior cruciate ligament reconstruction. Am J Sports Med 2004; 32: 975–98.
• 28. Aglietti P, Buzzi R, Giron F, Simeone AJ, Zaccherotti G. Arthroscopic-assisted anterior cruciate ligament reconstruction with the central third patellar tendon. A 5-8-year followup. Knee Surg Sports Traumatol Arthrosc 1997;5: 138-44.
• 29. Hui C, Salmon LJ, Kok A, Maeno S, Linklater J, Pinczewski LA. Fifteen-year outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft for "isolated" anterior cruciate ligament tear. Am J Sports Med 2010;39: 89-98.
• 30. Biau DJ, Katsahian S, Kartus J, Harilainen A, Feller JA, Sajovic M, et al. Patellar tendon versus hamstring tendon autografts for reconstructing the anterior cruciate ligament: a meta-analysis based on individual patient data. Am J Sports Med 2009;37: 2470-8.