The effects of two different fixation methods on femoral bone tunnel enlargement and clinical results in anterior cruciate ligament reconstruction with hamstring tendon graft

Bekir Cinar; Sercan Akpinar; Murat Hersekli; Mustafa Uysal; Necip Cesur; Aysin Pourbagher; Alihan Derincek

doi:10.3944/aott.v43i6.4139

The effects of two different fixation methods on femoral bone tunnel enlargement and clinical results in anterior cruciate ligament reconstruction with hamstring tendon graft

Year 2009, Volume: 43 Issue: 6, 515 - 521, 29.01.2010

Bekir Cinar Sercan Akpinar Murat Hersekli Mustafa Uysal Necip Cesur Aysin Pourbagher Alihan Derincek

Abstract

Objectives: We investigated the effects of anatomic and nonanatomic tunnel fixations on femoral tunnel widening and clinical results in anterior cruciate ligament (ACL) reconstructions.
Methods: We retrospectively evaluated 35 patients who underwent arthroscopic ACL reconstruction with quadrupled hamstring tendon graft. Fixation was performed in the tunnel using the transcondylar RigidFix pin (group 1) in 18 patients (mean age 32 years), and from outside the tunnel using the EndoButton-CL device (group 2) in 17 patients (mean age 30 years). The patients were assessed using the IKDC (International Knee Documentation Committee) and Lysholm knee scores and tunnel widening was assessed by computed tomography. Ligament laxity was measured bilaterally using the Rolimeter knee tester. The mean follow-up was 24 months (range 21 to 38 months) in group 1, and 24.6 months (range 12 to 36 months) in group 2.
Results: The two groups were similar with respect to age and sex distribution, operated side, the size of the tunnel created, and follow-up period (p>0.05). Postoperative knee scores did not show a significant difference (p>0.05). There was marked and excessive tunnel enlargement in 14 patients (77.8%) in group 1, and in 15 patients (88.2%) in group 2, with no significant difference between the two groups (p>0.05). Ligament laxity exceeded 3 mm in eight patients (44.4%) in group 1, and in three patients (17.7%) in group 2 (p<0.001). There was no relationship between tunnel widening and ligament laxity (p>0.05; r=0.175 and r=-0.01 for group 1 and group 2, respectively).
Conclusion: Our results suggest that differences in the localization of the tunnel fixation have no effect on tunnel enlargement and that joint laxity may be affected by biomechanical properties of fixation materials.

Keywords

Anterior cruciate ligament/surgery; arthroscopy; knee joint/surgery; orthopedic fixation devices; tendons/transplantation

Hamstring tendon otogrefti ile yapılan ön çapraz bağ rekonstrüksiyonunda iki farklı tespit yönteminin femoral kemik tünel genişlemesi ve klinik sonuçlar üzerine etkisi

Year 2009, Volume: 43 Issue: 6, 515 - 521, 29.01.2010

Bekir Cinar Sercan Akpinar Murat Hersekli Mustafa Uysal Necip Cesur Aysin Pourbagher Alihan Derincek

Abstract

Amaç: Bu çalışmada, ön çapraz bağ (ÖÇB) rekonstrüksiyonunda tendon tespitinin tünel içinde anatomik ve tünel dışında anatomik olmayan bölgeden yapılmasının femoral tünel genişlemesine ve klinik sonuçlara etkisi araştırıldı.
Çalışma planı: Dörtlü hamstring tendon grefti kullanılarak artroskopik ÖÇB rekonstrüksiyonu uygulanan 35 hasta geriye dönük olarak değerlendirildi. On sekiz hastada (ort. yaş 32), greft tespitini tünel içinde yapan ve transkondiler olarak uygulanan RigidFix çivisi (grup 1), 17 hastada (ort. yaş 30) ise greft tespitini tünel dışında korteks üzerinde yapan EndoButton CL (grup 2) kullanıldı. Hastalar IKDC (International Knee Documentation Committee) diz skoru ve Lysholm skoru, tünel genişliği ise bilgisayarlı tomografi ile değerlendirildi. Rolimeter diz test cihazı ile iki dizde bağ gevşekliği ölçüldü. Ortalama takip süresi grup 1’de 24 ay (dağılım 21-38 ay), grup 2’de 24.6 ay (dağılım 12-36 ay) idi.
Sonuçlar: İki grup arasında yaş ve cinsiyet dağılımı, ameliyat edilen taraf, ameliyat sırasında açılan tünel boyutu ve takip süresi açısından farklılık yoktu (p>0.05). Ameliyat sonrası klinik sonuçlar iki grupta anlamlı farklılık göstermedi (p>0.05). Kemik tünel boyutları grup 1’de 14 hastada (%77.8), grup 2’de 15 hastada (%88.2) belirgin ve aşırı genişlemiş bulundu; iki grup arasında tünel genişlemesi açısından fark görülmedi (p>0.05). Bağ gevşekliği grup 1’de sekiz hastada (%44.4), grup 2’de üç hastada (%17.7) 3 mm üzerinde bulundu (p<0.001). Tünel genişlemesi ile eklem gevşekliği arasında ilişki saptanmadı (p>0.05; grup 1 için r=0.175, grup 2 için r=-0.01).
Çıkarımlar: Tespit yerinin farklı olmasının tünel genişlemesi üzerinde etkisinin olmadığı görüldü. Eklem gevşekliği açısından fark olması, materyallerin biyomekanik özelliklerinden kaynaklanmış olabilir.

Keywords

Ön çapraz bağ/cerrahi; artroskopi; diz eklemi/cerrahi; ortopedik tespit materyali; tendon/transplantasyon.

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Details

Primary Language	English
Journal Section	Original Article
Authors	Bekir Cinar This is me Sercan Akpinar This is me Murat Hersekli This is me Mustafa Uysal This is me Necip Cesur This is me Aysin Pourbagher This is me Alihan Derincek This is me
Publication Date	January 29, 2010
Published in Issue	Year 2009 Volume: 43 Issue: 6

Cite

APA	Cinar, B., Akpinar, S., Hersekli, M., Uysal, M., et al. (2010). The effects of two different fixation methods on femoral bone tunnel enlargement and clinical results in anterior cruciate ligament reconstruction with hamstring tendon graft. Acta Orthopaedica Et Traumatologica Turcica, 43(6), 515-521. https://doi.org/10.3944/aott.v43i6.4139
AMA	Cinar B, Akpinar S, Hersekli M, Uysal M, Cesur N, Pourbagher A, Derincek A. The effects of two different fixation methods on femoral bone tunnel enlargement and clinical results in anterior cruciate ligament reconstruction with hamstring tendon graft. Acta Orthopaedica et Traumatologica Turcica. January 2010;43(6):515-521. doi:10.3944/aott.v43i6.4139
Chicago	Cinar, Bekir, Sercan Akpinar, Murat Hersekli, Mustafa Uysal, Necip Cesur, Aysin Pourbagher, and Alihan Derincek. “The Effects of Two Different Fixation Methods on Femoral Bone Tunnel Enlargement and Clinical Results in Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Graft”. Acta Orthopaedica Et Traumatologica Turcica 43, no. 6 (January 2010): 515-21. https://doi.org/10.3944/aott.v43i6.4139.
EndNote	Cinar B, Akpinar S, Hersekli M, Uysal M, Cesur N, Pourbagher A, Derincek A (January 1, 2010) The effects of two different fixation methods on femoral bone tunnel enlargement and clinical results in anterior cruciate ligament reconstruction with hamstring tendon graft. Acta Orthopaedica et Traumatologica Turcica 43 6 515–521.
IEEE	B. Cinar, S. Akpinar, M. Hersekli, M. Uysal, N. Cesur, A. Pourbagher, and A. Derincek, “The effects of two different fixation methods on femoral bone tunnel enlargement and clinical results in anterior cruciate ligament reconstruction with hamstring tendon graft”, Acta Orthopaedica et Traumatologica Turcica, vol. 43, no. 6, pp. 515–521, 2010, doi: 10.3944/aott.v43i6.4139.
ISNAD	Cinar, Bekir et al. “The Effects of Two Different Fixation Methods on Femoral Bone Tunnel Enlargement and Clinical Results in Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Graft”. Acta Orthopaedica et Traumatologica Turcica 43/6 (January 2010), 515-521. https://doi.org/10.3944/aott.v43i6.4139.
JAMA	Cinar B, Akpinar S, Hersekli M, Uysal M, Cesur N, Pourbagher A, Derincek A. The effects of two different fixation methods on femoral bone tunnel enlargement and clinical results in anterior cruciate ligament reconstruction with hamstring tendon graft. Acta Orthopaedica et Traumatologica Turcica. 2010;43:515–521.
MLA	Cinar, Bekir et al. “The Effects of Two Different Fixation Methods on Femoral Bone Tunnel Enlargement and Clinical Results in Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Graft”. Acta Orthopaedica Et Traumatologica Turcica, vol. 43, no. 6, 2010, pp. 515-21, doi:10.3944/aott.v43i6.4139.
Vancouver	Cinar B, Akpinar S, Hersekli M, Uysal M, Cesur N, Pourbagher A, Derincek A. The effects of two different fixation methods on femoral bone tunnel enlargement and clinical results in anterior cruciate ligament reconstruction with hamstring tendon graft. Acta Orthopaedica et Traumatologica Turcica. 2010;43(6):515-21.