Patellar tendon rüptürlerinde tamir ve augmentasyon tekniklerinin biyomekanik karşılaştırılması

Öz

AMAÇ: Bu çalışmanın amacı patellar tendonun farklı tamir ve augmentasyon tekniklerinin biyomekanik olarak karşılaştırılmasıdır.

YÖNTEM: Biyomekanik test, 60 adet dana dizi ile gerçekleştirildi. Dizler tenotomi sonrası titanyum sütür ankor ve polyester sütür ile Krackow ve modifiye Kessler sütürasyon yapılarak transosseoz tünel tekniği ile tamir edildi. Augmentasyon için Ethibond, Dall-Miles kablo ve tel serklaj kullanıldı. Her bir örnek, siklik yüklenme ve statik çekme ile biyomekanik olarak değerlendirildi.

BULGULAR: Primer tamir gruplarının karşılaştırılmasında, Krackow sütür ile transosseoz tamir grubunda anlamlı olarak daha düşük siklik uzama değerleri kaydedildi (p <0.05). Dall-Miles kablosu veya serklaj teli ile augmentasyon yapılanlarda diğer gruplara göre daha düşük siklik uzama ve daha yüksek maksimal gerilme kuvveti değerleri ölçüldü. Augmentasyon grupları, augmentasyon yapılmayan gruplardan daha yüksek maksimal gerilme direnci ve daha düşük gap oluşumu sergilemiştir.

ÇIKARIMLAR: Patellar tendon yırtıklarının tedavisinde kullanılan augmentasyon teknikleri tespitin stabilitesini kuvvetlendirmektedir. Dall-Miles kablosu veya serklaj teli ile augmente edilen transosseoz onarımın biyomekanik olarak en stabil teknik olduğu söylenebilir.

Anahtar Kelimeler

• patellar tendon rüptürü; transosseoz onarım; augmentasyon; biyomekanik

Biomechanical comparison of repair and augmentation techniques in patellar tendon ruptures

Öz

PURPOSE: The aim of this study is to biomechanically compare the augmentation techniques used in the surgical treatment of patellar tendon ruptures.

MATERIAL AND METHODS: The study was carried out with sixty fresh-frozen bovine knees. Patellar tendon repair was performed with transosseous repair with Krackow or modified - Kessler suturing or suture anchor repair techniques. Dall-Miles cable, cerclage wire or polyester suture material was used for augmentation. each specimen was evaluated biomechanically by cyclic loading and static pullout tests.

RESULTS: Significantly lower cyclic elongation values were recorded in the transosseous repair with Krackow suture group (p <0.05) in the comparison of primary repair groups. Lower cyclic elongation and higher maximal tensile strength values were measured in the augmentation with Dall-Miles cable or cerclage wire groups than the other groups. Augmentation groups had higher maximal tensile strength values and lower gap formation than non-augmented groups.

CONCLUSIONS: In the surgical treatment of patellar tendon ruptures, augmentation biomechanically strengthens the initial stability of primary repair.   The transosseous repair augmented with the Dall-Miles cable or cerclage wire can be said to be the most biomechanically stabilizing technique.

Anahtar Kelimeler

• patellar tendon ruptures; transosseous repair; augmentation; biomechanics

Kaynakça

1. Clayton RA, Court-Brown CM (2008) The epidemiology of musculoskeletal tendinous and ligamentous injuries. Injury 39:1338-1344. doi:10.1016/j.injury.2008.06.021
2. Lanzi JT, Jr., Felix J, Tucker CJ, Cameron KL, Rogers J, Owens BD, Svoboda SJ (2016) Comparison of the Suture Anchor and Transosseous Techniques for Patellar Tendon Repair: A Biomechanical Study. Am J Sports Med 44:2076-2080. doi:10.1177/0363546516643811
3. Sanchez G, Ferrari MB, Sanchez A, Moatshe G, Chahla J, DePhillipo N, Provencher MT (2017) Proximal Patellar Tendon Repair: Internal Brace Technique With Unicortical Buttons and Suture Tape. Arthrosc Tech 6:e491-e497. doi:10.1016/j.eats.2016.11.004
4. Roudet A, Boudissa M, Chaussard C, Rubens-Duval B, Saragaglia D (2015) Acute traumatic patellar tendon rupture: Early and late results of surgical treatment of 38 cases. Orthop Traumatol Surg Res 101:307-311. doi:10.1016/j.otsr.2014.12.017
5. Marder RA, Timmerman LA (1999) Primary repair of patellar tendon rupture without augmentation. Am J Sports Med 27:304-307. doi:10.1177/03635465990270030601
6. Otsubo H, Kamiya T, Suzuki T, Kuroda M, Ikeda Y, Matsumura T, Yamashita T (2017) Repair of Acute Patellar Tendon Rupture Augmented with Strong Sutures. J Knee Surg 30:336-340. doi:10.1055/s-0036-1586725
7. Ettinger M, Dratzidis A, Hurschler C, Brand S, Calliess T, Krettek C, Jagodzinski M, Petri M (2013) Biomechanical properties of suture anchor repair compared with transosseous sutures in patellar tendon ruptures: a cadaveric study. Am J Sports Med 41:2540-2544. doi:10.1177/0363546513500633
8. Bushnell BD, Byram IR, Weinhold PS, Creighton RA (2006) The use of suture anchors in repair of the ruptured patellar tendon: a biomechanical study. Am J Sports Med 34:1492-1499. doi:10.1177/0363546506287489

9. Schliemann B, Gruneweller N, Yao D, Kosters C, Lenschow S, Rosslenbroich SB, Raschke MJ, Weimann A (2016) Biomechanical evaluation of different surgical techniques for treating patellar tendon ruptures. Int Orthop 40:1717-1723. doi:10.1007/s00264-015-3003-4
10. Gilmore JH, Clayton-Smith ZJ, Aguilar M, Pneumaticos SG, Giannoudis PV (2015) Reconstruction techniques and clinical results of patellar tendon ruptures: Evidence today. Knee 22:148-155. doi:10.1016/j.knee.2014.10.007
11. Chen B, Li R, Zhang S (2012) Reconstruction and restoration of neglected ruptured patellar tendon using semitendinosus and gracilis tendons with preserved distal insertions: two case reports. Knee 19:508-512. doi:10.1016/j.knee.2011.07.007
12. Gaines RJ, Grabill SE, DeMaio M, Carr D (2009) Patellar tendon repair with suture anchors using a combined suture technique of a Krackow-Bunnell weave. J Orthop Trauma 23:68-71. doi:10.1097/BOT.0b013e318191c353
13. Ravalin RV, Mazzocca AD, Grady-Benson JC, Nissen CW, Adams DJ (2002) Biomechanical comparison of patellar tendon repairs in a cadaver model: an evaluation of gap formation at the repair site with cyclic loading. Am J Sports Med 30:469-473. doi:10.1177/03635465020300040301
14. Black JC, Ricci WM, Gardner MJ, McAndrew CM, Agarwalla A, Wojahn RD, Abar O, Tang SY (2016) Novel Augmentation Technique for Patellar Tendon Repair Improves Strength and Decreases Gap Formation: A Cadaveric Study. Clin Orthop Relat Res 474:2611-2618. doi:10.1007/s11999-016-5009-7
15. Bushnell BD, Tennant JN, Rubright JH, Creighton RA (2008) Repair of patellar tendon rupture using suture anchors. J Knee Surg 21:122-129
16. West JL, Keene JS, Kaplan LD (2008) Early motion after quadriceps and patellar tendon repairs: outcomes with single-suture augmentation. Am J Sports Med 36:316-323. doi:10.1177/0363546507308192
17. Massoud EI (2010) Repair of fresh patellar tendon rupture: tension regulation at the suture line. Int Orthop 34:1153-1158. doi:10.1007/s00264-009-0879-x
18. Flanigan DC, Bloomfield M, Koh J (2011) A biomechanical comparison of patellar tendon repair materials in a bovine model. Orthopedics 34:e344-348. doi:10.3928/01477447-20110627-13
19. Mihalko WM, Vance M, Fineberg MJ (2010) Patellar tendon repair with hamstring autograft: a cadaveric analysis. Clin Biomech (Bristol, Avon) 25:348-351. doi:10.1016/j.clinbiomech.2010.01.003
20. Hoechel S, Schulz G, Muller-Gerbl M (2015) Insight into the 3D-trabecular architecture of the human patella. Ann Anat 200:98-104. doi:10.1016/j.aanat.2015.02.007
21. Krackow KA, Thomas SC, Jones LC (1986) A new stitch for ligament-tendon fixation. Brief note. J Bone Joint Surg Am 68:764-766
22. Maffulli N (2016) CORR Insights((R)): Novel Augmentation Technique for Patellar Tendon Repair Improves Strength and Decreases Gap Formation: A Cadaveric Study. Clin Orthop Relat Res 474:2619-2621. doi:10.1007/s11999-016-5065-z
23. Kuechle DK, Stuart MJ (1994) Isolated rupture of the patellar tendon in athletes. Am J Sports Med 22:692-695. doi:10.1177/036354659402200519
24. Lionberger DR, Correia N (2011) Protection of repaired patellar tendons a surgical technique. J Arthroplasty 26:969-971. doi:10.1016/j.arth.2011.04.005
25. Capiola D, Re L (2007) Repair of patellar tendon rupture with suture anchors. Arthroscopy 23:906 e901-904. doi:10.1016/j.arthro.2006.10.023
26. Benthien RA, Aronow MS, Doran-Diaz V, Sullivan RJ, Naujoks R, Adams DJ (2006) Cyclic loading of Achilles tendon repairs: a comparison of polyester and polyblend suture. Foot Ankle Int 27:512-518. doi:10.1177/107110070602700706
27. Norris JB, Smith RT, White KL, Parks BG, O'Donnell JB (2010) Effect of suture size and type on bone cutout in transosseous tendon repairs. Arthroscopy 26:324-327. doi:10.1016/j.arthro.2009.08.020