CLINICAL AND FUNCTIONAL OUTCOMES AFTER TWO DIFFERENT ANTERIOR CRUCRIATE LIGAMENT RECONSTRUCTION TECHNIQUES: COMPARISON OF RIGIDFIX AND ENDOBUTTON

Yıl 2022, , 75 - 88, 21.03.2022

Nihan Kafa , Gamze Çobanoğlu , Coşkun Ulucaköy , Baybars Ataoglu , Nevin Atalay Güzel

https://doi.org/10.52881/gsbdergi.995391

Öz

Giriş: Endobutton ve Rigidfix ön çapraz bağ rekonstrüksiyonu (ÖÇBR) için en çok kullanılan tespit yöntemleridir. Laksite, kuvvet, yürüme ve sıçrama açısından bu iki yöntemin birbirine üstünlüğünü araştıran herhangi bir çalışmaya rastlanmamıştır.
Amaç: Bu çalışmanın amacı ACLR olan olgularda endobutton veya Rigidfix teknikleri ile laksite, tünel genişliği, izokinetik güç, yürüme ve sıçramanın karşılaştırılmasıdır.
Yöntem: Çalışmaya Endobutton (n=13) ve Rigidfix teknikleri (n=13) ile ÖÇBR uygulanan olgular dahil edildi. Kemik tünel genişlemesi BT seri kesitlerinde değerlendirildi ve ön diz laksitesi bir artrometre kullanılarak değerlendirildi. Quadriseps ve Hamstring kas kuvvetleri izokinetik sistem kullanılarak ölçüldü. Yürüyüş analizi ve sıçrama için BTS G-walk kullanıldı.
Bulgular: İki grup arasında ön diz laksitesii, tünel genişlemesi, izokinetik kas kuvveti ve sıçrama yüksekliği açısından istatistiksel olarak anlamlı bir fark yoktu. Yürüyüş analizinde, sadece etkilenmemiş yan adım uzunluğu ve pelvik tilt simetri indeksi gruplar arasında anlamlı olarak farklıydı (sırasıyla p=0.045; p=0.038).
Sonuçlar: ÖÇBR'li hastalarda hangi tip tespit yöntemi kullanılırsa kullanılsın; tüm parametre değerleri benzerdi. Ayrıca, iki yıllık ameliyattan sonra bile, etkilenen ve etkilenmeyen bacaklar arasında fonksiyonel farklılıklar tespit edildi. Ayrıca, her iki teknikte de istatistiksel olarak anlamlı tünel genişlemesi bulundu. Fiksasyon tekniğine bakılmaksızın ÖÇBR sonrası normal duruma dönmenin tam olarak sağlanamadığı sonucuna varıldı. Bu durumun zamanla bağın yapısı ve eklem kinematiği açısından sorunlara yol açabileceği ifade edilebilir.

Anahtar Kelimeler

ön çapraz bağ rekonstrüksiyonu, endobutton, rigidfix, fonksiyon

CLINICAL AND FUNCTIONAL OUTCOMES AFTER TWO DIFFERENT ANTERIOR CRUCRIATE LIGAMENT RECONSTRUCTION TECHNIQUES: COMPARISON OF RIGIDFIX AND ENDOBUTTON

Öz

Background: Endobutton and Rigidfix are the most used fixation methods for anterior cruciate ligament reconstruction (ACLR). No studies were found investigating the superiority of these two methods to each other in terms of laxity, strength, gait and jumping.
Aim: The purpose of this study is to compare laxity, tunnel enlargement, isokinetic strength, gait and jump in cases who had ACLR with Endobutton or Rigidfix techniques.
Method: The study consisted of cases who received ACLR with Endobutton (n=13) and Rigidfix techniques (n=13). Bone tunnel enlargement was assessed on CT serial sections and anterior knee laxity was evaluated using an arthrometer. Quadriceps and Hamstring muscle strengths were measured using isokinetic system. BTS G-walk was used for gait analysis and jumping.
Results: There was no statistically significant difference in anterior knee laxity, tunnel enlargement, isokinetic muscle strength and jump height between two groups. In gait analysis, only uninvolved side stride length and pelvic tilt symmetry index were significantly different between groups (p=0.045; p=0.038 respectively).
Conclusions: In patients with ACLR, whichever type of fixation method was used; all of parameter values were similar. Furthermore, even after two years of surgery, functional differences were detected between the affected and unaffected legs. Also, statistically significant tunnel enlargement was found in both techniques. It was concluded that the recovery to normal condition after ACLR is not fully achieved, regardless of the fixation technique. It can be stated that this situation may cause problems in terms of the structure of the ligament and joint kinematics over time.

Anahtar Kelimeler

anterior cruciate ligament reconstruction, endobutton, rigidfix, function

Kaynakça

• 1. Khan R, Prasad V, Gangone R, Kinmont J. Anterior cruciate ligament reconstruction in patients over 40 years using hamstring autograft. Knee Surg Sports Traumatol Arthrosc. 2010;18(1):68-72.
• 2. Mousavi H, Maleki A, Nobakht A. Comparative Study after Hamstring Anterior Cruciate Ligament Reconstruction with Endobutton and Rigidfix: A Clinical Trial Study. Adv. Biomed. Res. 2017;6.
• 3. Saccomanno MF, Shin JJ, Mascarenhas R, Haro M, Verma NN, Cole BJ, et al. Clinical and functional outcomes after anterior cruciate ligament reconstruction using cortical button fixation versus transfemoral suspensory fixation: a systematic review of randomized controlled trials. Arthroscopy. 2014;30(11):1491-8.
• 4. Ahmad CS, Gardner TR, Groh M, Arnouk J, Levine WN. Mechanical properties of soft tissue femoral fixation devices for anterior cruciate ligament reconstruction. Am J Sports Med. 2004;32(3):635-40.
• 5. Castoldi F, Bonasia DE, Marmotti A, Dettoni F, Rossi R. ACL reconstruction using the Rigidfix femoral fixation device via the anteromedial portal: a cadaver study to evaluate chondral injuries. Knee Surg Sports Traumatol Arthrosc. 2008;16(3):275-8.
• 6. Nebelung W. Bone tunnel enlargement after anterior cruciate ligament reconstruction with semitendinosus tendon using Endobutton fixation on the femoral side. Arthroscopy. 1998;14(8):810-5.
• 7. Milano G, Mulas PD, Ziranu F, Piras S, Manunta A, Fabbriciani C. Comparison between different femoral fixation devices for ACL reconstruction with doubled hamstring tendon graft: a biomechanical analysis. Arthroscopy. 2006;22(6):660-8.
• 8. Cha PS, Chhabra A, Harner CD. Single-bundle anterior cruciate ligament reconstruction using the medial portal technique. Oper Tech Orthop. 2005;15(2):89-95.
• 9. Persson A, Gifstad T, Lind M, Engebretsen L, Fjeldsgaard K, Drogset JO, et al. Graft fixation influences revision risk after ACL reconstruction with hamstring tendon autografts: A study of 38,666 patients from the Scandinavian knee ligament registries 2004–2011. Acta Orthop. 2018;89(2):204-10.
• 10. Cinar BM, Akpinar S, Hersekli MA, Uysal M, Cesur N, Pourbagher A, 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 Orthop Traumatol Turc. 2009;43(6):515-21.
• 11. Laudner K, Evans D, Wong R, Allen A, Kirsch T, Long B, et al. Relationship between isokinetic knee strength and jump characteristics following anterior cruciate ligament reconstruction. Int J Sports Phys Ther. 2015;10(3):272.
• 12. Eajazi A, Madadi F, Madadi F, Boreiri M. Comparison of different methods of femoral fixation anterior cruciate ligament reconstruction. Acta Med Iran. 2013:444-8.
• 13. Lopes OV, de Freitas Spinelli L, Leite LHC, Buzzeto BQ, Saggin PRF, Kuhn A. Femoral tunnel enlargement after anterior cruciate ligament reconstruction using RigidFix compared with extracortical fixation. Knee Surg Sports Traumatol Arthrosc. 2017;25(5):1591-7.
• 14. Ibrahim SAR, Abdul Ghafar S, Marwan Y, Mahgoub AM, Al Misfer A, Farouk H, et al. Intratunnel versus extratunnel autologous hamstring double-bundle graft for anterior cruciate ligament reconstruction: a comparison of 2 femoral fixation procedures. Am J Sports Med. 2015;43(1):161-8.
• 15. Robert H, Nouveau S, Gageot S, Gagniere B. A new knee arthrometer, the GNRB®: experience in ACL complete and partial tears. Orthop Traumatol-Sur. 2009;95(3):171-6.
• 16. Zwolski C, Schmitt LC, Quatman-Yates C, Thomas S, Hewett TE, Paterno MV. The influence of quadriceps strength asymmetry on patient-reported function at time of return to sport after anterior cruciate ligament reconstruction. Am J Sports Med. 2015;43(9):2242-9.
• 17. Ross MD, Irrgang JJ, Denegar CR, McCloy CM, Unangst ET. The relationship between participation restrictions and selected clinical measures following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2002;10(1):10-9.
• 18. Oliveira AK, Borges DT, Lins CA, Cavalcanti RL, Macedo LB, Brasileiro JS. Immediate effects of Kinesio Taping® on neuromuscular performance of quadriceps and balance in individuals submitted to anterior cruciate ligament reconstruction: a randomized clinical trial. J Sci Med Sport. 2016;19(1):2-6.
• 19. Awotidebe TO, Ativie RN, Oke KI, Akindele MO, Adedoyin RA, Olaogun MO, et al. Relationships among exercise capacity, dynamic balance and gait characteristics of Nigerian patients with type-2 diabetes: an indication for fall prevention. J Exerc Rehabil. 2016;12(6):581.
• 20. Rodríguez-Rosell D, Mora-Custodio R, Franco-Márquez F, Yáñez-García JM, González-Badillo JJ. Traditional vs. sport-specific vertical jump tests: Reliability, validity, and relationship with the legs strength and sprint performance in adult and teen soccer and basketball players. J Strength Cond Res. 2017;31(1):196-206.
• 21. Carson EW. Fact, myth, or common sense: anterior cruciate ligament reconstruction graft selection. Orthopedics. 1999;22(6):567-8.
• 22. Jun T, Bin X, Hong-Gang X, Rui W. Endobutton CL versus Rigidfix fixation systems for fixation of autologous quadrupled hamstring tendon in anterior cruciate ligament reconstruction. J Clin Rehabil Tissue Eng Res. 2011;15:633-8.
• 23. Shelbourne KD, Nitz P. Accelerated rehabilitation after anterior cruciate ligament reconstruction. Am J Sports Med. 1990;18(3):292-9.
• 24. Höher J, Möller H, Fu F. Bone tunnel enlargement after anterior cruciate ligament reconstruction: fact or fiction? Knee Surg Sports Traumatol Arthrosc. 1998;6(4):231-40.
• 25. To JT, Howell LCSM, Hull ML. Contributions of femoral fixation methods to the stiffness of anterior cruciate ligament replacements at implantation. Arthroscopy. 1999;15(4):379-87.
• 26. Petersen W, Laprell H. Insertion of autologous tendon grafts to the bone: a histological and immunohistochemical study of hamstring and patellar tendon grafts. Knee Surg Sports Traumatol Arthrosc. 2000;8(1):26-31.
• 27. Zaffagnini S, De Pasquale V, Reggiani LM, Russo A, Agati P, Bacchelli B, et al. Electron microscopy of the remodelling process in hamstring tendon used as ACL graft. Knee Surg Sports Traumatol Arthrosc. 2010;18(8):1052-8.
• 28. Meike E, Howell S, Hull M. Anterior laxity and patient-reported outcomes 7 years after ACL reconstruction with a fresh-frozen tibialis allograft. Knee Surg Sports Traumatol Arthrosc. 2017;25(5):1500-9.
• 29. Ibrahim S, Hamido F, Al Misfer A, Mahgoob A, Ghafar S, Alhran H. Anterior cruciate ligament reconstruction using autologous hamstring double bundle graft compared with single bundle procedures. J Bone Joint Surg Br. 2009;91(10):1310-5.
• 30. Achtnich A, Stiepani H, Forkel P, Metzlaff S, Hänninen EL, Petersen W. Tunnel widening after anatomic double-bundle and mid-position single-bundle anterior cruciate ligament reconstruction. Arthroscopy. 2013;29(9):1514-24.
• 31. Fauno P, Kaalund S. Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used: a prospective randomized study. Arthroscopy. 2005;21(11):1337-41.
• 32. Jacopetti M, Pasquini A, Costantino C. Evaluation of strength muscle recovery with isokinetic, squat jump and stiffness tests in athletes with ACL reconstruction: a case control study. Acta Biomed. 2016;87(1):76-80.