Artroskopik tek bant veya üç bant tekniği ile ön çapraz bağ rekonstrüksiyonu

Öz

Amaç: Bu prospektif, randomize çalışmanın amacı artroskopik tek bant (TB) ve üç bant (ÜB) tekniği ile ön çapraz bağ (ÖÇB) rekonstrüksiyonunun klinik sonuçlarını karşılaştırmaktı.

Çalışma planı: Artroskopik TB ÖÇB veya ÜB ÖÇB rekonstrüksiyonu uygulanan 105 hasta çalışmaya alındı. Hastaların 24. ay takibinde, anterior stres grafileri ve KT-2000 artrometresi kullanılarak gerçekleştirilen maksimal manuel kas testi ile anteroposterior, pivot-shift testi ile rotasyonel stabiliteleri incelendi. Klinik sonuçlar Uluslararası Diz Dokümantasyon Komitesi (IKDC) ve Orthopädische Arbeitsgruppe Knie (OAK) skorları ile yine 24. ay takibinde değerlendirildi. Her iki grubun cerrahi sonrası uyluk çevresi, kuvveti ve eklem hareket açıklıkları (EHA) karşılaştırıldı.

Bulgular: Rotasyonel stabilite sonuçları ÜB grubunda TB grubuna kıyasla anlamlı derecede daha üstün idi. Rezidüel anteroposterior laksite açısından 24. ay takibinde gruplar arasında anlamlı bir fark yoktu. IKDC skoru, OAK skoru, uyluk çevresi, kuvvet ve EHA değerleri incelendiğinde de iki grup arasında anlamlı bir fark olmadığı görüldü.

Çıkarımlar: Hem TB hem de ÜB tekniği ile ÖÇB rekonstrüksiyonu sübjektif sonuçlar ve objektif stabilite açısından tatmin edici sonuçlar vermektedir. Üç bant grubunda elde edilen rotasyonel stabilite anlamlı derecede daha üstündür.

Anahtar Kelimeler

• Artroskopi; ön çapraz bağ; tek bant; üç bant.

Arthroscopic single-bundle versus triple-bundle anterior cruciate ligament reconstruction

Öz

Objective: The aim of this prospective, randomized study was to compare the clinical results of arthroscopic single-bundle (SB) and triple-bundle (TB) anterior cruciate ligament (ACL) reconstruction.

Methods: The study included 105 patients who underwent arthroscopic SB ACL and TB ACL reconstruction. Anterior stress radiographs and the maximal manual muscle test using a KT-2000 arthrometer were used to assess anteroposterior stability and rotational stability was investigated using the lateral pivot shift test at the 24th month follow-up. Clinical results were assessed using the International Knee Documentation Committee (IKDC) and Orthopädische Arbeitsgruppe Knie (OAK) scores preoperatively and at the 24th month follow-up. Postoperative thigh circumference, strength and range of motion (ROM) were compared between groups.

Results: Rotational stability was significantly superior in the TB group than in the SB group. There were no statistically significant differences with regard to residual anteroposterior laxity determined at the 24th month follow-up. No significant difference in terms of IKDC score, OAK score, thigh circumference, strength and ROM was detected between the two groups.

Conclusion: Both arthroscopic SB and TB ACL reconstruction resulted in satisfactory subjective outcome and objective stability. Rotational stability was significantly superior in the TB group.

Anahtar Kelimeler

• Anterior cruciate ligament
• arthroscopy
• single-bundle
• triple-bundle

Kaynakça

1. Pujol N, Colombet P, Potel JF, Cucurulo T, Graveleau N, Hulet C, et al. Anterior cruciate ligament reconstruction in partial tear: selective anteromedial bundle reconstruction conserving the posterolateral remnant versus singlebundle anatomic ACL reconstruction: preliminary 1-year results of a prospective randomized study. Orthop Traumatol Surg Res 2012;98(8 Suppl):171-7.
2. Xu Y, Ao Y, Wang J, Yu J, Cui G. Relation of tunnel enlargement and tunnel placement after single-bundle anterior cruciate ligament reconstruction. Arthroscopy 2011;27:923-32.
3. Kowalchuk DA, Harner CD, Fu FH, Irrgang JJ. Prediction of patient-reported outcome after single-bundle anterior cruciate ligament reconstruction. Arthroscopy 2009;25:457-63.
4. 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;27:380-90.
5. Markatos K, Kaseta MK, Lallos SN, Korres DS, Efstathopoulos N. The anatomy of the ACL and its importance in ACL reconstruction. Eur J Orthop Surg Traumatol 2013;23:747-52.
6. Madick S. Anterior cruciate ligament reconstruction of the knee. AORN J 2011;93:210-25.
7. Webster KE, Palazzolo SE, McClelland JA, Feller JA. Tibial rotation during pivoting in anterior cruciate ligament reconstructed knees using a single bundle technique. Clin Biomech (Bristol, Avon) 2012;27:480-4. van Eck CF, Lesniak BP, Schreiber VM, Fu FH. Anatomic single- and double-bundle anterior cruciate ligament reconstruction flowchart. Arthroscopy 2010;26:258-68.
8. Yasuda K, Tanabe Y, Kondo E, Kitamura N, Tohyama H. Anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 2010;26(9 Suppl):21-34.

9. Xu M, Gao S, Zeng C, Han R, Sun J, Li H, et al. Outcomes of anterior cruciate ligament reconstruction using single-bundle versus double-bundle technique: metaanalysis of 19 randomized controlled trials. Arthroscopy 2013;29:357-65.
10. Kondo E, Merican AM, Yasuda K, Amis AA. Biomechanical comparison of anatomic double-bundle, anatomic single-bundle, and nonanatomic single-bundle anterior cruciate ligament reconstructions. Am J Sports Med 2011;39:279-88.
11. Li YL, Ning GZ, Wu Q, Wu QL, Li Y, Hao Y, et al. Single-bundle or double-bundle for anterior cruciate ligament reconstruction: a meta-analysis. Knee 2014;21:28-37.
12. Xu M, Gao S, Zeng C, Han R, Sun J, Li H, et al. Outcomes of anterior cruciate ligament reconstruction using single-bundle versus double-bundle technique: metaanalysis of 19 randomized controlled trials. Arthroscopy 2013;29:357-65.
13. Amis AA, Dawkins GP. Functional anatomy of the anterior cruciate ligament. Fibre bundle actions related to ligament replacements and injuries. J Bone Joint Surg Br 1991;73:260-7.
14. Amis AA. The functions of the fibre bundles of the anterior cruciate ligament in anterior drawer, rotational laxity and the pivot shift. Knee Surg Sports Traumatol Arthrosc 2012;20:613-20.
15. Shino K, Nakata K, Nakamura N, Mae T, Ohtsubo H, Iwahashi T, et al. Anatomic ACL reconstruction using two double-looped hamstring tendon grafts via twin femoral and triple tibial tunnels. Oper Tech Orthop 2005;15:130
16. Tanaka Y, Yonetani Y, Shiozaki Y, Kanamoto T, Kita K, Amano H, et al. MRI analysis of single-, double-, and triple-bundle anterior cruciate ligament grafts. Knee Surg Sports Traumatol Arthrosc 2014;22:1541-8.
17. Matsuo T, Mae T, Shino K, Kita K, Tachibana Y, Sugamoto K, et al. Tibiofemoral relationship following anatomic triple-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2013 Aug 30.
18. Tanaka Y, Shino K, Horibe S, Nakamura N, Nakagawa S, Mae T, et al. Triple-bundle ACL grafts evaluated by second-look arthroscopy. Knee Surg Sports Traumatol Arthrosc 2012;20:95-101.
19. Mae T, Shino K, Matsumoto N, Yoneda K, Yoshikawa H, Nakata K. Immediate postoperative anterior knee stability: double- versus triple-bundle anterior cruciate ligament reconstructions. Arthroscopy 2013;29:213-9.
20. Stäubli HU, Jakob RP. Anterior knee motion analysis. Measurement and simultaneous radiography. Am J Sports Med 1991;19:172-7.
21. Scully WF, Fisher SG, Parada SA, Arrington ED. Septic arthritis following anterior cruciate ligament reconstruction: a comprehensive review of the literature. J Surg Orthop Adv 2013;22:127-33.
22. Hofbauer M, Muller B, Murawski CD, Baraga M, van Eck CF, Fu FH. Strategies for revision surgery after primary double-bundle anterior cruciate ligament (ACL) reconstruction. Knee Surg Sports Traumatol Arthrosc 2013;21:2072-80.
23. Asai S, Maeyama A, Hoshino Y, Goto B, Celentano U, Moriyama S, et al. A comparison of dynamic rotational knee instability between anatomic single-bundle and overthe-top anterior cruciate ligament reconstruction using triaxial accelerometry. Knee Surg Sports Traumatol Arthrosc 2014;22:972-8.
24. Norris R, Thompson P, Getgood A. The effect of anterior cruciate ligament reconstruction on the progression of osteoarthritis. Open Orthop J 2012;6:506-10.
25. Zaffagnini S, Lopomo N, Signorelli C, Marcheggiani Muccioli GM, Bonanzinga T, Grassi A, et al. Innovative technology for knee laxity evaluation: clinical applicability and reliability of inertial sensors for quantitative analysis of the pivot-shift test. Clin Sports Med 2013;32:61-70.
26. Lopomo N, Bignozzi S, Zaffagnini S, Giordano G, Irrgang JJ, Fu FH, et al. Quantitative correlation between IKDC score, static laxity, and pivot-shift test: a kinematic analysis of knee stability in anatomic double-bundle anterior cruciate ligament reconstruction. Oper Tech Orthop 2008;18:185-9. de Jong SN, van Caspel DR, van Haeff MJ, Saris DB. Functional assessment and muscle strength before and after reconstruction of chronic anterior cruciate ligament lesions. Arthroscopy 2007;23:21-8.
27. Keays SL, Bullock-Saxton J, Keays AC, Newcombe P. Muscle strength and function before and after anterior cruciate ligament reconstruction using semitendonosus and gracilis. Knee 2001;8:229-34.
28. Keays SL, Bullock-Saxton JE, Newcombe P, Keays AC. The relationship between knee strength and functional stability before and after anterior cruciate ligament reconstruction. J Orthop Res 2003;21:231-7.
29. Aglietti P, Buzzi R, D’Andria S, Zaccherotti G. Arthroscopic anterior cruciate ligament reconstruction with patellar tendon. Arthroscopy 1992;8:510-6.
30. Whitehead TS. Failure of anterior cruciate ligament reconstruction. Clin Sports Med 2013;32:177-204.