Patellar tendon rüptürlerinde tamir ve augmentasyon tekniklerinin biyomekanik karşılaştırılması

Abstract

AMAÇ: Bu çalışmanın amacı patellar tendonun farklı tamir ve augmentasyon tekniklerinin biyomekanik olarak karşılaştırılmasıdır.

YÖNTEM: Biyomekanik test, 60 adet dana dizi ile gerçekleştirildi. Dizler tenotomi sonrası titanyum sütür ankor ve polyester sütür ile Krackow ve modifiye Kessler sütürasyon yapılarak transosseoz tünel tekniği ile tamir edildi. Augmentasyon için Ethibond, Dall-Miles kablo ve tel serklaj kullanıldı. Her bir örnek, siklik yüklenme ve statik çekme ile biyomekanik olarak değerlendirildi.

BULGULAR: Primer tamir gruplarının karşılaştırılmasında, Krackow sütür ile transosseoz tamir grubunda anlamlı olarak daha düşük siklik uzama değerleri kaydedildi (p <0.05). Dall-Miles kablosu veya serklaj teli ile augmentasyon yapılanlarda diğer gruplara göre daha düşük siklik uzama ve daha yüksek maksimal gerilme kuvveti değerleri ölçüldü. Augmentasyon grupları, augmentasyon yapılmayan gruplardan daha yüksek maksimal gerilme direnci ve daha düşük gap oluşumu sergilemiştir.

ÇIKARIMLAR: Patellar tendon yırtıklarının tedavisinde kullanılan augmentasyon teknikleri tespitin stabilitesini kuvvetlendirmektedir. Dall-Miles kablosu veya serklaj teli ile augmente edilen transosseoz onarımın biyomekanik olarak en stabil teknik olduğu söylenebilir.

Keywords

• patellar tendon rüptürü; transosseoz onarım; augmentasyon; biyomekanik

Biomechanical comparison of repair and augmentation techniques in patellar tendon ruptures

Abstract

PURPOSE: The aim of this study is to biomechanically compare the augmentation techniques used in the surgical treatment of patellar tendon ruptures.

MATERIAL AND METHODS: The study was carried out with sixty fresh-frozen bovine knees. Patellar tendon repair was performed with transosseous repair with Krackow or modified - Kessler suturing or suture anchor repair techniques. Dall-Miles cable, cerclage wire or polyester suture material was used for augmentation. each specimen was evaluated biomechanically by cyclic loading and static pullout tests.

RESULTS: Significantly lower cyclic elongation values were recorded in the transosseous repair with Krackow suture group (p <0.05) in the comparison of primary repair groups. Lower cyclic elongation and higher maximal tensile strength values were measured in the augmentation with Dall-Miles cable or cerclage wire groups than the other groups. Augmentation groups had higher maximal tensile strength values and lower gap formation than non-augmented groups.

CONCLUSIONS: In the surgical treatment of patellar tendon ruptures, augmentation biomechanically strengthens the initial stability of primary repair.   The transosseous repair augmented with the Dall-Miles cable or cerclage wire can be said to be the most biomechanically stabilizing technique.

Keywords

• patellar tendon ruptures; transosseous repair; augmentation; biomechanics

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