Comparison of Outcomes of Anterior Cruciate Ligament Reconstructions Using Patellar Tendon or Hamstring Tendon Autografts with Femoral Cross-pin Fixation

Yıl 2020, Cilt: 25 Sayı: 3, 192 - 199, 29.10.2020

Ömer Kays Unal , Ülkü Sur , Mirza Zafer Dağtaş , Burak Demirağ

https://doi.org/10.21673/anadoluklin.735533

Öz

Aim: In this study, we aimed to compare outcomes of anterior cruciate ligament (ACL) reconstructions using bone–patellar tendon–bone graft (BPTG) or hamstring tendon graft (HTG) with cross-pin fixation at the femoral side.

Materials and Methods: The retrospective observational study included records of 100 patients who underwent ACL reconstruction with femoral cross-pin fixation between May 2008 and August 2012. The patients were divided into two groups according to the graft type used: the BPTG group and the HTG group. The preoperative and postoperative 6th-month Tegner Lysholm Knee Scoring Scale (TLKS) scores, International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC-SKF) scores, and Lachman test results were compared. The effects of meniscus lesion presence on the outcomes were also investigated.

Results: Of the 100 patients, 93 were male and 7 female. The HTG and BPTG groups consisted of 62 and 38 patients, respectively. The mean age was 24.1±4.9 (18–38) years for the HTG group and 32.1±6.8 (21–54) years for the BPTG group. The mean pre- and postoperative TLKS scores were respectively 50.5 and 94.3 in the BPTG group, and 49.9 and 95.2 in the HTG group. The mean pre- and postoperative IKDC-SKF scores were 51.3 and 95.6 in the BPTG group, and 51.8 and 95.6 in the HTG group. The postoperative score improvement was statistically significant in all patients (p<0.05), but there was no significant difference between the two groups. The postoperative improvement in knee stability was statistically significant in all patients (p<0.05). The postoperative score improvement was less in patients with meniscal injury (p<0.05).

Discussion and Conclusion: We found no significant difference between the two groups in terms of functional knee scores. However, the presence of meniscus lesions negatively affects the postoperative outcomes.

Anahtar Kelimeler

Anterior Cruciate Ligament Reconstruction, Orthopedic Fixation Devices, bone–patellar tendon–bone autograft, hamstring autograft

Femoral Cross-pin Fiksasyonu ile Patellar Tendon veya Hamstring Tendon Otogrefti Kullanılan Ön Çapraz Bağ Rekonstrüksiyonlarının Sonuçlarının Karşılaştırılması

Öz

Amaç: Bu çalışmada femoral tarafta cross-pin fiksasyonu ile kemik–patellar tendon–kemik grefti (KPTG) veya hamstring tendon grefti (HTG) kullanılan ön çapraz bağ (ÖÇB) rekonstrüksiyonlarının sonuçlarını karşılaştırmak amaçlanmıştır.

Gereç ve Yöntemler: Retrospektif gözlemsel çalışmamız Mayıs 2008—Ağustos 2012 döneminde femoral cross-pin fiksasyonlu ÖÇB rekonstrüksiyonu uygulanmış olan 100 hastanın kayıtlarını kapsadı. Hastalar, kullanılan greft türüne göre iki gruba ayrıldı: KPTG grubu ve HTG grubu. Preoperatif ve postoperatif 6. ay Tegner Lysholm Diz Skorlama Skalası (TLDS) skorları, Uluslararası Diz Dokümantasyon Komitesi Subjektif Diz Değerlendirme Formu (UDDK-SDF) skorları ve Lachman test sonuçları karşılaştırıldı. Ayrıca menisküs lezyonu varlığının sonuçlar üzerindeki etkisi incelendi.

Bulgular: Yüz hastanın 93’ü erkek, 7’si kadındı. HTG ve KPTG grupları sırasıyla 62 ve 38 hastadan oluştu. Ortalama yaş HTG grubu için 24,1±4,9 (18–38) yıl, KPTG grubu için 32,1±6,8 (21–54) yıl idi. Sırasıyla operasyon öncesi ve sonrası ortalama TLDS skorları KPTG grubu için 50,5 ve 94,3, HTG grubu için 49,9 ve 95,2 idi. Operasyon öncesi ve sonrası ortalama UDDK-SDF skorları KPTG grubu için 51,3 ve 95,6, HTG grubu için 51,8 ve 95,6 idi. Postoperatif skorlardaki yükseliş tüm hastalarda istatistiksel olarak anlamlıydı (p<0,05); fakat iki grup arasında anlamlı fark yoktu. Diz stabilitesindeki postoperatif artış tüm hastalarda istatistiksel olarak anlamlıydı (p<0,05). Menisküs yaralanması olan hastalarda postoperatif skorlardaki yükseliş daha azdı (p<0,05).

Tartışma ve Sonuç: İki grup arasında fonksiyonel diz skorları açısından anlamlı bir fark tespit edilmemiştir. Fakat menisküs lezyonu varlığı postoperatif sonuçları negatif etkilemektedir.

Anahtar Kelimeler

hamstring otogrefti, kemik–patellar tendon–kemik otogrefti, ortopedik fiksasyon cihazları, ön çapraz bağ rekonstrüksiyonu

Kaynakça

• 1. Siegel L, Vandenakker-Albanese C, Siegel D. Anterior cruciate ligament injuries: anatomy, physiology, biomechanics, and management. Clin J Sport Med. 2012;22(4):349–55.
• 2. Mahapatra P, Horriat S, Anand BS. Anterior cruciate ligament repair—past, present and future. J Exp Orthop. 2018;5(1):20.
• 3. Duchman KR, Lynch TS, Spindler KP. Graft selection in anterior cruciate ligament surgery: who gets what and why? Clin Sports Med. 2017;36(1):25–33.
• 4. Holm I, Øiestad BE, Risberg MA, Gunderson R, Aune AK. No differences in prevalence of osteoarthritis or function after open versus endoscopic technique for anterior cruciate ligament reconstruction: 12-year follow-up report of a randomized controlled trial. Am J Sports Med. 2012;40(11):2492–8.
• 5. Vyas D, Rabuck SJ, Harner CD. Allograft anterior cruciate ligament reconstruction: indications, techniques, and outcomes. J Orthop Sports Phys Ther. 2012;42(3):196–207.
• 6. Pinczewski L, Roe J, Salmon L. Why autologous hamstring tendon reconstruction should now be considered the gold standard for anterior cruciate ligament reconstruction in athletes. Br J Sports Med. 2009;43(5):325–7.
• 7. Phillips BB, Mihalko MJ. Arthroscopy of the lower extremity. In: Campbell’s Operative Orthopaedics, 13. ed. Philedelphia: Elsevier; 2013.
• 8. Samuelsen BT, Webster KE, Johnson NR, Hewett TE, Krych AJ. Hamstring autograft versus patellar tendon autograft for ACL reconstruction: is there a difference in graft failure rate? A meta-analysis of 47,613 patients. Clin Orthop Relat Res. 2017;475(10):2459–68.
• 9. Gifstad T, Foss OA, Engebretsen L, Lind M, Forssblad M, Albrektsen G, et al. Lower risk of revision with patellar tendon autografts compared with hamstring autografts. Am J Sports Med. 2014;42(10):2319–28.
• 10. Coffey R, Bordoni B. Lachman test. In: Rheumatology and Immunology Therapy. Berlin: Springer-Verlag; 2006.
• 11. Lin KM, Boyle C, Marom N, Marx RG. Graft selection in anterior cruciate ligament reconstruction. Sports Med Arthrosc Rev. 2020;28(2):41–8.
• 12. Stańczak K, Zielińska M, Synder M, Domżalski M, Polguj M, Sibiński M. Comparison of hamstring and patellar tendon grafts in anterior cruciate ligament reconstruction: a prospective randomized study. J Int Med Res. 2018;46(2):785–91.
• 13. Xie X, Liu X, Chen Z, Yu Y, Peng S, Li Q. A meta-analysis of bone-patellar tendon-bone autograft versus four-strand hamstring tendon autograft for anterior cruciate ligament reconstruction. Knee. 2015;22(2):100–10.
• 14. Kovindha K, Ganokroj P, Lertwanich P, Vanadurongwan B. Quantifying anterior knee pain during specific activities after using the bone-patellar tendon-bone graft for arthroscopic anterior cruciate ligament reconstruction. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2018;15:6–12.
• 15. Lu H, Chen C, Xie S, Tang Y, Qu J. Tendon healing in bone tunnel after human anterior cruciate ligament reconstruction: a systematic review of histological results. J Knee Surg. 2019;32(5):454–62.
• 16. Webster KE, Feller JA, Hartnett N, Leigh WB, Richmond AK. Comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction. Am J Sports Med. 2016;44(1):83–90.
• 17. Rahr-Wagner L, Thillemann TM, Pedersen AB, Lind M. Comparison of hamstring tendon and patellar tendon grafts in anterior cruciate ligament reconstruction in a nationwide population-based cohort study: results from the Danish registry of knee ligament reconstruction. Am J Sports Med. 2014;42(2):278–84.
• 18. Freedman KB, D’Amato MJ, Nedeff DD, Kaz A, Bach BR. Arthroscopic anterior cruciate ligament reconstruction: a meta-analysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med. 2003;31(1):2–11.
• 19. Yunes M, Richmond JC, Engels EA, Pincweski LA. Patellar versus hamstring tendons in anterior cruciate ligament reconstruction: a meta-analysis. Arthroscopy. 2001;17(3):248–57.
• 20. Moré ADO, Pizzolatti ALA, Fancello EA, Roesler CRM. Biomechanical performance of Bio Cross-Pin and EndoButton for ACL reconstruction at femoral side: a porcine model. Res Biomed Eng. 2016;32(1):28–34.
• 21. Zantop T, Ruemmler M, Welbers B, Langer M, Weimann A, Petersen W. Cyclic loading comparison between biodegradable interference screw fixation and biodegradable double cross-pin fixation of human bone-patellar tendon-bone grafts. Arthroscopy. 2005;21(8):934–41.
• 22. Gorschewsky O, Stapf R, Geiser L, Geitner U, Neumann W. Clinical comparison of fixation methods for patellar bone quadriceps tendon autografts in anterior cruciate ligament reconstruction: absorbable cross-pins versus absorbable screws. Am J Sports Med. 2007;35(12):2118–25.
• 23. Marder RA, Raskind JR, Carroll M. Prospective evaluation of arthroscopically assisted anterior cruciate ligament reconstruction. Patellar tendon versus semitendinosus and gracilis tendons. Am J Sports Med. 1991;19(5):478–84.
• 24. Aglietti P, Buzzi R, Zaccherotti G, de Biase P. Patellar tendon versus doubled semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction. Am J Sports Med. 1994;22(2):211–8.
• 25. Lee BI, Yoo JH, Chun DI, Choi HS, Min KD, Jeen YM. Delayed foreign body reaction due to bioabsorbable pins used for femoral fixation in anterior cruciate ligament reconstruction: a case report. Am J Sports Med. 2010;38(1):176–80.
• 26. Hasan S, Nayyar S, Onyekwelu I, Kalra K, Gyftopoulos S, Jazrawi LM. Complications using bioabsorbable cross–pin femoral fixation: a case report and review of the literature. Case Rep Radiol. 2011;2011:349230.
• 27. Forkel P, Reuter S, Sprenker F, Achtnich A, Herbst E, Imhoff A, et al. Different patterns of lateral meniscus root tears in ACL injuries: application of a differentiated classification system. Knee Surg Sports Traumatol Arthrosc. 2015;23(1):112–8.
• 28. Ichiba A, Kishimoto I. Effects of articular cartilage and meniscus injuries at the time of surgery on osteoarthritic changes after anterior cruciate ligament reconstruction in patients under 40 years old. Arch Orthop Trauma Surg. 2009;129(3):409–15.
• 29. Williams A, Winalski CS, Chu CR. Early articular cartilage MRI T2 changes after anterior cruciate ligament reconstruction correlate with later changes in T2 and cartilage thickness. J Orthop Res. 2017;35(3):699–706.
• 30. Cinque ME, Chahla J, Mitchell JJ, Moatshe G, Pogorzelski J, Murphy CP, et al. Influence of meniscal and chondral lesions on patient-reported outcomes after primary anterior cruciate ligament reconstruction at 2-year follow-up. Orthop J Sports Med. 2018;6(2):232596711775418.