Ön Çapraz Bağ Rekonstrüksiyonu Sırasında Femoral Kalıntıların Korunmasının Fonksiyonel ve Klinik Sonuçlar Üzerine Etkisi

Year 2022, Volume: 19 Issue: 2, 370 - 377, 28.08.2022

Baki Volkan Çetin , Mehmet Akif Altay , Serkan Sipahioğlu , İzzettin Yazar

https://doi.org/10.35440/hutfd.1137590

Abstract

Amaç: Bu çalışmanın amacı, ön çapraz bağ (ÖÇB) yırtıklarının cerrahi tedavisinde, femoral kalıntıların korunduğu rekonstrüksiyon tekniği ile standart tekniğin fonksiyonel ve klinik sonuçlarının karşılaştırılmasıdır.
Hastalar ve yöntemler: İleriye dönük randomize olarak planlanan çalışmaya, ÖÇB yırtığı nedeniyle cerrahi uygulanan 150 hasta (tamamı erkek) dahil edildi. Hastalar randomize olarak iki gruba ayrıldı. Grup A’da (n=75) hastalara hamstring tendon otogrefti kullanılarak tibial ve femoral kalıntıların korunduğu ÖÇB rekonstrüksiyonu uygulandı. Grup B’de (n=75) ise hamstring tendon otogrefti ile standart rekonstrüksiyon tekniği uygulandı ve tibial kalıntılar korunurken femoral kalıntılar temizlendi. Grup A hastaların yaş ortalaması, 27,23±5,64 yıl, Grup B’de ise 26,72±5,82 yıldı. Travma-operasyon arası geçen süre, Grup A’da 4,36±3,21 ay, Grup B’de 3,56±3,08 aydı. Hastaların takip süresi, Grup A için 38,05±6,11 ay, Grup B için ise 36,86±8,04 ay olarak hesaplandı. Her iki grup arasında, hastaların yaşları, travma-operasyon arası geçen süre ve takip süreleri açısından farklılık yoktu (p˃0,05). Cerrahinin klinik sonuçları Lysholm skorlaması, Uluslararası Diz Dokümantasyon Komitesi (IKDC) skoru, Subjektif IKDC 2000 diz skorlaması ve fiziksel instabilite testleriyle değerlendirildi.
Bulgular: Grup A ve Grup B hastaların ameliyat öncesi Lysholm, sübjektif ve objektif IKDC diz skorlarında, eklem hareket açıklıklarında ve diz stabilite testlerinde ( Lachman, Pivot Şift, Öne Çekmece) ameliyat sonrası istatistiksel olarak anlamlı düzelme tespit edildi (p<0,001). Erken dönem (18 ay) kontrollerde gruplar arasında ameliyat öncesi ve sonrası karşılaştırma yapıldığında Lysholm, sübjektif ve objektif IKDC diz skorlarında Grup A lehine anlamlı yükseklik saptansa da (p˂0.05) hastaların son kontrollerinde Lysholm, sübjektif ve objektif IKDC diz skorlarında, eklem hareket açıklıklarında ve diz stabilite testleri (Lachman, Pivot Şift, Öne çekmece) açısından anlamlı farklılık izlenmedi (p˃0.05).
Sonuç: ÖÇB yırtıklarının cerrahi tedavisinde, femoral kalıntılar korunarak yapılan ÖÇB rekonstrüksiyonunda, ÖÇB femoral kalıntıların histolojik olarak tespit edilen teorik katkısı, klinik ve fonksiyonel sonuçlarda belirgin olarak izlenmemektedir.

Keywords

Ön çapraz bağ yırtığı, artroskopik ÖÇB rekonstrüksiyonu, femoral kalıntı.

Supporting Institution

HARRAN ÜNİVERSİTESİ BİLİMSEL ARAŞTIRMA KOORDİNATÖRLÜĞÜ

Project Number

15064

Effects of Femoral Remnant Preservation During Anterior Cruciate Ligament Reconstruction on the Clinical and Functional Outcomes

Abstract

Background: The aim of this study is to compare the functional and clinical results of the femoral remnant-sparing reconstruction technique with the standard technique in the surgical reconstruction of anterior cruciate ligament (ACL) tears.
Materials and Methods: 150 patients (all men) who underwent surgery for ACL tear were included in the pros-pective randomized study. The patients were randomly divided into two groups. In Group A (n=75), ACL reconst-ruction with preservation of tibial and femoral remnants was performed using hamstring tendon autograft. In group B (n=75), standard reconstruction technique was performed with hamstring tendon autograft and femoral remnants were removed while tibial remnants were preserved. The mean age of patients in Group A was 27.23±5.64 years, and 26.72±5.82 years in Group B. The interval between trauma and operation was 4.36±3.21 months in Group A and 3.56±3.08 months in Group B. The mean follow-up period of the patients was 38.05±6.11 months for Group A and 36.86±8.04 months for Group B. There was no difference between the two groups in terms of age of the patients, interval between trauma and operation and follow-up periods (p˃0.05). Clinical outcomes of surgery were evaluated using Lysholm score, International Knee Documentation Committee (IKDC) score, Subjective IKDC 2000 knee score, and physical instability tests.
Results: Statistically significant improvement was detected in the preoperative Lysholm, subjective and objective IKDC knee scores, joint range of motion and knee stability tests (Lachman, Pivot Shift, Anterior Drawer) of Group A and Group B patients (p<0.001). When preoperative and postoperative comparisons were made between the groups in early (18 months) controls, a significant increase was found in favor of Group A in Lysholm, subjective and objective IKDC knee scores (p˂0.05). There were no significant differences in Lysholm, subjective and objecti-ve IKDC knee scores, joint range of motion, and knee stability tests (Lachman, Pivot Shift, Forward drawer) at the last follow-up of the patients (p˃0.05).
Conclusions: In the surgical reconstruction of ACL tears, the histologically determined theoretical contribution of ACL femoral remnants in ACL reconstruction performed by preserving the femoral remnants is not clearly obser-ved in clinical and functional results.

Keywords

Anterior cruciate ligament tear, arthroscopic ACL reconstruction, femoral remnant

Project Number

15064

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