-

Öz

Amaç: Açık tibiyal inley tekniği ile izole ya da tek aşamalı kombine arka çapraz bağ rekonstrüksiyonu uygulanan hastalarda klinik deneyimlerimizi sunmayı amaçladık.Çalışma planı: Tibiyal inley tekniği ile AÇB rekonstrüksiyonu uygulanan 17 hastanın kayıtları retrospektif olarak değerlendirilmiştir. Tek taraflı femoral ya da tibial osteokondral kopma kırığı ya da tek taraflı eşzamanlı tibia ve femur şaft kırığı olan hastalar çalışma dışı bırakılmıştır. İki hastada izole arka çapraz bağ rekonstrüksiyonu gerçekleştirilirken, 10/17 hastada posterolateral köşe rekonstrüksiyonu, 14/17 hastada ön çapraz bağ rekonstrüksiyonu ve 2/17 hastada mediyal kollateral bağ rekonstrüksiyonu ile birlikte yapılmıştır. Tüm hastalar ortalama 14.27±6.77 (6–30) ay süreyle izlenmiştir.Bulgular: Cerrahi öncesi değerlendirmelerde tüm hastalarda arka çekmece testinde arkaya gevşeklik 3 + iken son takipler sırasında yapılan değerlendirmelerde arka çekmece testi skoru 6 hastada 0 gevşeklik, 7 hastada + 1 gevşeklik ve 4 hastada + 2 gevşeklik olarak belirlenmiştir (p<0.001). IKDC objektif değerlendirmesi, preoperatif dönemde tüm hastalarda ciddi işlev kaybı göstermekle beraber, son takip değerlendirmelerde 5 dizin A düzeyde, 8 dizin B düzeyde, 3 dizin C düzeyde ve 1 dizin ise D düzeyde olduğunu göstermiştir. Ortalama IKDC subjektif skoru izlemlerde 75.22±7.53 olarak belirlenmiştir. Postoperatif dönemde, KT-1000 artrometresindeki ortalama iki taraf farkı 2.45±1.80 mm olarak ölçülmüştür. Son izlemde ortalama ROM ekstansiyonda 0 derece ve fleksiyonda 123.56±6.31 olarak saptanmıştır.Çıkarımlar: Açık tibiyal inley yaklaşımı arka çapraz bağ rekonkstrüksiyonunda yararlıdır. Fonksiyonel sonuçlar üzerindeki etkinliğini ve komplikasyonlara karşı güvenilirliğini belirlemek için yeni çalışmalara ihtiyaç vardır

Anahtar Kelimeler

• Dizde bağ yaralanmaları; arka çapraz bağ; tibiyal inley

Posterior cruciate ligament reconstruction via tibial inlay technique in multiligament knee injuries

Abstract

Objective: The aim of this study is to report our institution’s experience regarding the use of open tibial inlay technique in patients undergoing single-stage combined posterior cruciate ligament (PCL) reconstruction.
Methods: Records of 17 patients who underwent PCL reconstruction with tibial inlay technique were retrospectively reviewed. Patients with ipsilateral femoral or tibial osteochondral avulsion fractures or ipsilateral concomitant tibia and femur shaft fractures were excluded. Out of these 17 patients, six cases underwent anterior cruciate ligament (ACL) + PCL reconstruction, nine cases underwent ACL+ PCL + posterolateral corner reconstruction, one case underwent ACL + PCL + MCL reconstruction and one case underwent ACL+ PCL + posterolateral corner + MCL reconstruction. Mean follow-up was 14.27±6.77 (range: 6–30) months.
Results: In preoperative assessments, all patients had 3+ posterior laxity in posterior drawer test; at final follow-up, 6 patients had 0 laxity, 7 patients had 1+ laxity, and 4 patients had 2+ laxity (p<0.001). International Knee Documentation Committee (IKDC) objective evaluation showed severe disability in all patients preoperatively, whereas 5 knees were grade A, 8 knees were grade B, 3 knees were grade C, and 1 knee was grade D at final follow-up. Mean IKDC subjective score was 75.22±7.53 at final follow-up. Postoperatively, mean side-to-side difference in KT-1000 arthrometer measurement was 2.45±1.80 mm. At final follow-up, mean range of motion (ROM) was 0º on extension and 123.56±6.31º on flexion.
Conclusion: Open tibial inlay approach is beneficial during PCL reconstruction. Further study is warranted to establish its effectiveness on functional outcomes and prevention of complications.

Keywords

• Knee ligament injury
• posterior cruciate ligament
• tibial inlay

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