Ön Çapraz Bağ Tamirinde Otojen Hamstring Tendon Grefti Kullanılarak Uygulanan Transtibial ve Anteromedial Portal Tekniklerin Karşılaştırılması

Year 2019, , 197 - 203, 30.12.2019

Zekeriya Okan Karaduman , Ozan Turhal , Yalçın Turhan , Mehmet Arıcan , Şengül Cangür

https://doi.org/10.18678/dtfd.629638

Abstract

Amaç: Bu çalışmada, ön çapraz bağ tamirinde kullanılan transtibial (TT) ile anteromedial portal (AMP) teknik arasındaki farklılıkların, ön çapraz bağ rekonstrüksiyonu sonrası hastaların diz eklemi fonksiyonları üzerine etkilerinin araştırılması amaçlanmıştır.

Gereç ve Yöntemler: Çalışmamıza kliniğimizde ön çapraz bağ yırtığı nedeniyle cerrahi olarak tedavi edilen 60 hasta dahil edildi. Otuz hastaya TT teknik, 30 hastaya AMP teknik uygulandı. Fonksiyonel değerlendirmelerde Lysholm, Uluslararası Diz Belgelendirme Komitesi (International Knee Documentation Committee, IKDC) ve Tegner skoru preop ve postop olarak bakıldı. Postoperatif anteroposterior ve lateral diz grafilerinde femur tüneli ile distal eklem yüzü arasındaki açı ölçüldü ve diz eklemi fonksiyonel sonucu üzerine etkisi incelendi.

Bulgular: Çalışmaya dahil edilen hastaların %80’i erkek (n=47) ve %20’si kadındır (n=13). Gruplara göre cinsiyet dağılımı homojendir (p=0.476). Bireylerin ortalama yaşı 32.75±8.81 (16-53) olarak tespit edildi. AMP uygulanan grupta ölçülen operasyon sonrası Lysholm skor değeri, TT teknik uygulanan grupta ölçülen değerinden anlamlı düzeyde daha yüksek bulunmuştur (p<0.001). AMP tekniği uygulanan grupta ölçülen operasyon sonrası Tegner skoru değer, TT teknik uygulanan grupta ölçülen değerinden anlamlı düzeyde daha yüksek bulunmuştur (p<0.001). Ortalama femur tüneli oblikitesi TT grubunda 59,3°, AMP grubunda ise 41,4° bulunmuştur.

Sonuç: Oblik femoral tünel yerleşiminin, ön çapraz bağın rotasyonel stabilitesine daha fazla yarar sağladığı düşünülmektedir. Çalışmamızda AMP teknik uygulanmasının TT tekniğe göre femoral oblisite artışının fonksiyonel sonuca katkısının daha yararlı olduğu kanaatindeyiz.

Keywords

anatomik ön çapraz bağ rekonstrüksiyonu, otojen hamstring, anteromedial portal, trans tibial teknik

Comparison of Transtibial and Anteromedial Portal Techniques Used in Anterior Cruciate Ligament Repair Using Autogenous Hamstring Tendon Graft

Abstract

Aim: The aim of this study was to investigate the effects of transtibial (TT) and anteromedial portal (AMP) techniques used in anterior cruciate ligament repair on knee joint function after anterior cruciate ligament reconstruction.

Material and Methods: Sixty patients who were surgically treated in our clinic for anterior cruciate ligament tear were included in the study. Thirty patients underwent TT technique and 30 patients underwent AMP. Functional evaluations were performed according to Lysholm, International Knee Documentation Committee (IKDC) and Tegner scoring preop and postop. The angle between the femoral tunnel and the distal joint face was measured in postoperative Anteroposterior and Lateral knee graphs and its effect on the knee joint functional outcome was examined.

Results: Eighty percent of the patients included in the study were male (n=47) and 20% were female (n=13). The gender distribution according to the groups was homogeneous (p=0.476). The mean age of the subjects was 32.75±8.81 (16-53) years. The postoperative Lysholm score was significantly higher in the AMP group than in the TT group (p<0.001). The postoperative Tegner score was significantly higher in the AMP group than in the TT group (p<0.001). Mean femoral tunnel obliquity was 59.3° in the TT group and 41.4° in the AMP group.

Conclusion: It is thought that oblique femoral tunnel placement is more beneficial for the rotational stability of anterior cruciate ligament. In our study, we think that AMP technique is more beneficial than femoral obliquity in terms of functional outcome.

Keywords

anatomic anterior cross ligament reconstruction, autogenous hamstring, anteromedial portal, trans tibial technique

References

• Butler DL, Noyes FR, Grood ES. Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. J Bone Joint Surg Am. 1980;62(2):259-70.
• Markolf KL, Mensch JS, Amstutz HC. Stiffness and laxity of the knee--the contributions of the supporting structures. A quantitative in vitro study. J Bone Joint Surg Am. 1976;58(5):583-94.
• Murrell GA, Maddali S, Horovitz L, Oakley SP, Warren RF. The effects of time course after anterior cruciate ligament injury in correlation with meniscal and cartilage loss. Am J Sports Med. 200;29(1):9-14.
• Tandogan RN, Taşer O, Kayaalp A, Taşkiran E, Pinar H, Alparslan B, et al. Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time from injury, and level of sport. Knee Surg Sports Traumatol Arthrosc. 2004;12(4):262-70.
• Kim MK, Lee BC, Park JH. Anatomic single bundle anterior cruciate ligament reconstruction by the two anteromedial portal method: the comparison of transportal and transtibial techniques. Knee Surg Relat Res. 201;23(4):213-9.
• Franceschi F, Papalia R, Rizzello G, Del Buono A, Maffulli N, Denaro V. Anteromedial portal versus transtibial drilling techniques in anterior cruciate ligament reconstruction: any clinical relevance? A retrospective comparative study. Arthroscopy. 2013;29(8):1330-7.
• Morgan CD, Kalman VR, Grawl DM. Definitive landmarks for reproducible tibial tunnel placement in anterior cruciate ligament reconstruction. Arthroscopy. 1995;11(3):275-88.
• Kopf S, Forsythe B, Wong AK, Tashman S, Anderst W, Irrgang JJ, et al. Nonanatomic tunnel position in traditional transtibial single-bundle anterior cruciate ligament reconstruction evaluated by three-dimensional computed tomography. J Bone Joint Surg Am. 2010;92(6):1427-31.
• Bedi A, Musahl V, Steuber V, Kendoff D, Choi D, Allen AA, et al. Transtibial versus anteromedial portal reaming in anterior cruciate ligament reconstruction: an anatomic and biomechanical evaluation of surgical technique. Arthroscopy. 2011;27(3):380-90.
• Jorge PB, Escudeiro D, Severino NR, Santili C, de Paula Leite Cury R, Junior AD, et al. Positioning of the femoral tunnel in anterior cruciate ligament reconstruction: functional anatomical reconstruction. BMJ Open Sport Exerc Med. 2018;4(1):e000420.
• Ferretti M, Ekdahl M, Shen W, Fu FH. Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy. 2007;23(11):1218-25.
• Goncharov EN, Koval OA, Dubrov VE, Bezuglov EN, Filimonova AM, Goncharov NG. Clinical experience with combined reconstruction of the anterior cruciate and anterolateral ligaments of the knee in sportsmen. Int Orthop. 2019;43(12):2781-8.
• Relph N, Herrington L. The effect of conservatively treated ACL injury on knee joint position sense. Int J Sports Phys Ther. 2016;11(4):536-43.
• Ucay O, Renault A, Gleizes Cervera SG, Gasq D. How to evaluate precisely return to sport after anterior cruciate ligament tear with operative or conservative treatment on patients with moderate sport level?. Ann Phys Rehabil Med. 2016;59(Suppl):e15-e23.
• Howell SM, Deutch ML. Comparison of endoscopic and two-incision techniques for reconstructing a torn anterior cruciate ligament using hamstring tendons. Arthroscopy. 1999;15(6):594-606.
• Indelli PF, Dillingham MF, Fanton GS, Schurman DJ. Anterior cruciate ligament reconstruction using cryopreserved allografts. Clin Orthop Relat Res. 2004;420:268-75.
• Eriksson K, Anderberg P, Hamberg P, Löfgren AC, Bredenberg M, Westman I, et al. A comparison of quadruple semitendinosus and patellar tendon grafts in reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br. 2001;83(3):348-54.
• Tuncay İ, Tosun N, Akpınar F. Comparison of patellar tendon and hamstring tendon autografts in arthroscopic anterior cruciate ligament reconstruction. Acta Orthop Traumatol Turc. 2001;35(1):48-55.
• Dei Giudici L, Fabbrini R, Garro L, Arima S, Gigante A, Tucciarone A. Arthroscopic transphyseal anterior cruciate ligament reconstruction in adolescent athletes. J Orthop Surg (Hong Kong). 2016;24(3):307-11.
• Alentorn-Geli E, Lajara F, Samitier G, Cugat R. The transtibial versus the anteromedial portal technique in the arthroscopic bone-patellar tendon-bone anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2010;18(8):1013-37.
• Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL. Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o'clock and 10 o'clock femoral tunnel placement. 2002 Richard O'Connor Award paper. Arthroscopy. 2003;19(3):297-304.
• O'Neill DB. Arthroscopically assisted reconstruction of the anterior cruciate ligament. A prospective randomized analysis of three techniques. J Bone Joint Surg Am. 1996;78(6):803-13.
• Tompkins M, Cosgrove CT, Milewski MD, Brockmeier SF, Hart JM, Miller MD. Anterior cruciate ligament reconstruction femoral tunnel characteristics using an accessory medial portal versus traditional transtibial drilling. Arthroscopy. 2013;29(3):550-5.
• Eysturoy NH, Nielsen TG, Lind MC. Anteromedial portal drilling yielded better survivorship of anterior cruciate ligament reconstructions when comparing recent versus early surgeries with this technique. Arthroscopy. 2019;35(1):182-9.