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Anatomik Ön Çapraz Bağ Rekonstrüksiyonun Femoral Tünel Oblisitesi İle İlişkisinin Klinik Olarak Değerlendirilmesi

Yıl 2019, Cilt: 9 Sayı: 3, 115 - 121, 30.09.2019
https://doi.org/10.33631/duzcesbed.577371

Öz

Amaç: Artroskopik ön
çapraz bağ (ÖÇB) rekonstrüksiyonlarında hamstring tendon grefti, patellar
tendon grefti, allogreft gibi çeşitli tendon greftleri kullanılmaktadır.
Çalışmamızda, Otojen Hamstring Tendonlar kullanılarak Anatomik Ön Çapraz Bağ
Rekonstrüksiyonu uygulanan hastalarda femoral tünel oblisitesinin sonuçlarını
güncel literatür eşliğinde değerlendirmeyi amaçladık.

Gereç ve Yöntemler: Ocak 2013 –
Haziran 2016 tarihleri arasında ön çapraz bağ rüptürü nedeniyle kliniğimizde
cerrahi olarak tedavi edilen hastalar telefonla aranarak hastaneye davet
edildi. Bunlar içerisinden fizik muayeneleri, grafi kontrolleri ve ölçümleri
yapılan 64 hasta çalışmaya dâhil edildi.

Bulgular: Hastalarımızın
55’i erkek, 9’u bayandı. Hastaların yaş ortalaması 29.3±8.12 (14-47) idi.
Ortalama takip süremiz 14.47±7.44 (6-36) aydır. Kontrol Lysholm ve Tegner skoru
ameliyat öncesi değerlerle karşılaştırıldığında istatistiksel açıdan ileri
derecede anlamlı farklılıklar bulundu (p<0.001). International Knee
Documentation Committee (IKDC) diz bağları değerlendirme sistemine göre
ameliyat öncesi 3 hasta (%4.7) B, 18 hasta (%28.12) C ve 43 hasta (%67.18) D
olarak saptandı. Ameliyat sonrası yapılan son kontrol muayenesinde 41 hasta
(%64.06) A, 21 hasta (%32.81) B ve 2 hasta (%3.12) C grubuna dâhil edildi.
Ortalama femur tüneli oblisitesi 41.2±7.2° bulundu.







Sonuç: Ön çapraz
bağ’ın rotasyonel stabilitesine oblik femoral tünel yerleşiminin daha fazla
yarar sağladığı düşünülmektedir. Biz bu çalışmamızın sonucunda ön çapraz bağın
otojen hamstring tendon grefti kullanarak anatomik teknikle uygulanmasının
femoral tünel oblisite artışının fonksiyonel sonuca katkısının daha yararlı
olduğu kanaatindeyiz.
 

Kaynakça

  • 1. Woo SLY, Fox RJ, Sakane M, Livesay GA, Rudy TW, Fu FH. Biomechanics of the ACL: Measurements of in situ force in the ACL and knee kinematics. The Knee. 1998; 5(4): 267-88.
  • 2. Reinhardt KR, Hetsroni I, Marx RG. Graft selection for anterior cruciate ligament reconstruction: A level I systematic review comparing failure rates and functional outcomes. Orthop Clin North Am. 2010; 41(2): 249-62.
  • 3. Çetinkaya E, Mutlu H, Yavuz U, Gül M, Çetin Ü, Özkaya U. Anteromedial portal tekniği ile tek demet anatomik ön çapraz bağ rekonstrüksiyonu sonuçlarımız. Jarem. 2016; 6(2): 88-93.
  • 4. Noyes FR, Keller CS, Grood ES, Butler DL. Advances in the understanding of knee ligament injury, repair, and rehabilitation. Med Sci Sports Exerc. 1984; 16(5): 427-43.
  • 5. Calas P, Dorval N, Bloch A, Argenson JN, Parratte S. A new anterior cruciate ligament reconstruction fixation technique (quadrupled semitendinosus anterior cruciate ligament reconstruction with polyetheretherketone cage fixation). Arthrosc Tech. 2012; 1(1): e47-52.
  • 6. Darren J, Todd S, James I, Fu FH, Harner CD. Revision anterior cruciate ligament surgery: Experience from pittsburgh. Clin Orthop Relat Res. 1996; 325(2):100-9. 7. Dei Giudici L, Fabbrini R, Garro L, Arima S, Gigante A, Tucciarone A. Arthroscopic transphyseal anterior cruciate ligament reconstruction in adolescent athletes. J Orthop Surg (Hong Kong). 2016; 24(3): 307-11.
  • 8. Shelbourne KD, Patel DV. Timing of surgery in anterior cruciate ligament injured knees. Knee Surg Sports Traumatol Arthrosc. 1995; 3(3): 148-56.
  • 9. Shelbourne KD, Gray T. Results of anterior cruciate ligament reconstruction based on meniscus and articular cartilage status at the time of surgery. Five- to fifteen-year evaluations. Am J Sports Med. 2000; 28(4): 446-52.
  • 10. Levy BA, Dajani KA, Whelan DB, Stannard JP, Fanelli GC, Stuart MJ, et al. Decision making in the multiligamnet –injured knee:an evidence-based systematic review. Arthroscopy. 2009; 25(4): 430-8.
  • 11. Gupta R, Bahadur R, Malhotra A, Masih GD, Gupta P. Anterior cruciate ligament reconstruction using hamstring tendon autograft with preserved insertions. Arthrosc Tech. 2016; 5(2): e269-74.
  • 12. Darnley JE, Léger-St-Jean B, Pedroza AD, Flanigan DC, Kaeding CC, Magnussen RA. Anterior cruciate ligament reconstruction using a combination of autograft and allograft tendon: A moon cohort study. Orthop J Sports Med. 2016; 4(7): 2325967116662249.
  • 13. Vaishya R, Agarwal AK, Ingole S, Vijay V. Current trends in anterior cruciate ligament reconstruction: A Review. Cureus. 2015; 7(11): e378. doi: 10.7759/cureus.378. Review.
  • 14. Musil D, Sadovsky P, Filip L, Vodicka Z, Stehlík J. Anterior cruciate ligament reconstruction using hamstring tendon autograft with reserved ınsertions. Arthrosc Tech. 2016; 5(2): 269-74
  • 15. Luo H, Yu JK, Ao YF, Yu CL, Peng LB, Lin CY, et. al. Relationship between different skin incisions and the injury of the infrapatellar branch of the saphenous nerve during anterior cruciate ligament reconstruction. Chin Med J (Engl). 2007; 120(13): 1127-30.
  • 16. Wolf MR, Murawski CD, van Diek FM, van Eck CF, Huang Y, Fu FH. Intercondylar notch dimensions and graft failure after single-and double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2015; 23(3): 680-6.
  • 17. Gadikota HR, Sim JA, Hosseini A, Gill TJ, Li G. The relationship between femoral tunnels created by the transtibial, anteromedial portal, and outside-in techniques and the anterior cruciate ligament footprint. Am J Sports Med. 2012; 40(4): 882-8.
  • 18. Panni AS, Milano G, Tartarone M, Demontis A, Fabbriciani C. Clinical and radiographic results of ACL reconstruction: A 5 to 7 year follow-up study of outside in versus insideout reconstruction techniques. Knee Surg Sports Traumatol Arthrosc. 2001; 9(2): 77-85.
  • 19. Hefzy MS, Grood ES, Noyes FR. Factors affecting the region of most isometric femoral attachments. Part II: the anterior cruciate ligament. Am J Sports Med. 1989; 17(2): 208-16.
  • 20. Shantanu K, Kushwaha SS, Kumar D, Kumar V, Singh S, Sharma V. A Comparative study of the results of the anatomic medial portal and all-inside arthroscopic ACL reconstruction. J Clin Diagn Res. 2016; 10(11): RC01-3.
  • 21. Harner CD, Giffin JR, Dunteman RC, Annunziata CC, Friedman MJ. Evaluation and treatment of recurrent instability after anterior cruciate ligament reconstruction. Instr Course Lect. 2001; 50(1): 463-74.
  • 22. Allen Cr, Giffin JR, Harner CD. Revision anterior cruciate ligament reconstruction. Orthop Clin North Am. 2003; 34(1): 79-98.
  • 23. Jackson DW, Gasser SI. Tibial tunnel placement in ACL reconstructıon. Arthroscopy. 1994; 10(2): 124-31.
  • 24. Takeda Y, Iwame T, Takasago T, Kondo K, Goto T, Fujii K, et al. Comparison of tunnel orientation between transtibial and anteromedial portal techniques for anatomic double-bundle anterior cruciate ligament reconstruction using 3-dimensional computed tomography. Arthroscopy. 2013; 29(2): 195-204.
  • 25. Taketomi S, Inui H, Nakamura K, Yamagami R, Tahara K, Sanada T, et. al. Secure fixation of femoral bone plug with a suspensory button in anatomical anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft. Joints. 2016; 3(3):102-8.
  • 26. Klein JP, Linter DM, Downs D, Vavrenka K. The incidence and significance of femoral tunnel widening after quadrupled hamstring anterior cruciate ligament reconstruction using femoral cross pin fixation. Arthroscopy. 2003; 19(5): 470-76.
  • 27. Mologne TS, Friedman MJ. Anterior cruciate ligament reconstruction with bone-patella tendon-bone autograft: Indications, technique, complications, and management. In: Insall JN, Scott WN, editors. Surgery of the knee. Philadelphia: Churchill Livingstone; 2001. p. 681-93.
  • 28. van der Hart CP, van den Bekerom MP, Patt TW. The occurrence of osteoarthritis at a minimum of ten years after reconstruction of the anterior cruciate ligament. J Orthop Surg. 2008; 3: 1-9. doi:10.1186/1749-799X-3-24.
  • 29. Değirmenci E, Yücel İ, Özturan K. Hamstring tendon otogrefti ile ön çapraz bağ rekonstrüksiyonu. Bakırköy Tıp Dergisi. 2010; 6(1): 29-34.
  • 30. Howell SM, Taylor MA. Brace-free rehabilitation, with early return to activity, for knees reconstructed with a double-looped semitendinosus and gracilis graft. J Bone Joint Surg Am. 1996; 78(6): 814-25.

Clinical Evaluation of the Relationship of Anatomical Anterior Cruciate Ligament Reconstruction with Femoral Tunnel Obliquity

Yıl 2019, Cilt: 9 Sayı: 3, 115 - 121, 30.09.2019
https://doi.org/10.33631/duzcesbed.577371

Öz

Aim: Various tendon
grafts such as hamstring tendon graft, patellar tendon graft, allograft are
used in arthroscopic anterior cruciate ligament (ACL) reconstructions. In our
study, we aimed to evaluate in the light of the updated literature, femoral
tunnel obliquity results of anterior cruciate ligament (ACL) reconstruction
using autogenous hamstring tendon graft.

Material and Methods: Between January 2013 and June 2016, the surgically treated patients in
our clinic who had anterior cruciate ligament (ACL) rupture were called and
invited to hospital by telephone. 64 patients whose physical examinations,
radiographs and measurements were completed have been included in the study.

Results: 55 of
our patients were male and 9 were female. The mean age of the patients was
29.3±8.12 (14-47) years. Total follow-up time was 14.47±7.44 (6-36) months.
There were statistically significant difference between control and follow-up
Lysholm and Tegner activity scores (p<0.001). According to the International
Knee Documentation Committee (IKDC) knee ligation evaluation system, 3 patients
(4.7%) were B, 18 patients (28.12%) were C and 43 patients (67.18%) were
revealed as D in preoperative term. In the last postoperative examination, 41
patients (64.06%) were included in the group A, 21 patients (32.81%) B and 2
patients (3.12%) were included in the group C. The mean
femoral tunnel obliquity was found as 41.2±7.2°.







Conclusion: The oblique femoral tunnel placement is thought to be of greater
benefit to the rotational stability of the ACL. As a result of this study, we
are of the opinion that the application of anterior cruciate ligament with an
anatomical technique using an autogenous hamstring tendon graft is more
beneficial to the functional outcome of femoral tunnel obliquity increase.

Kaynakça

  • 1. Woo SLY, Fox RJ, Sakane M, Livesay GA, Rudy TW, Fu FH. Biomechanics of the ACL: Measurements of in situ force in the ACL and knee kinematics. The Knee. 1998; 5(4): 267-88.
  • 2. Reinhardt KR, Hetsroni I, Marx RG. Graft selection for anterior cruciate ligament reconstruction: A level I systematic review comparing failure rates and functional outcomes. Orthop Clin North Am. 2010; 41(2): 249-62.
  • 3. Çetinkaya E, Mutlu H, Yavuz U, Gül M, Çetin Ü, Özkaya U. Anteromedial portal tekniği ile tek demet anatomik ön çapraz bağ rekonstrüksiyonu sonuçlarımız. Jarem. 2016; 6(2): 88-93.
  • 4. Noyes FR, Keller CS, Grood ES, Butler DL. Advances in the understanding of knee ligament injury, repair, and rehabilitation. Med Sci Sports Exerc. 1984; 16(5): 427-43.
  • 5. Calas P, Dorval N, Bloch A, Argenson JN, Parratte S. A new anterior cruciate ligament reconstruction fixation technique (quadrupled semitendinosus anterior cruciate ligament reconstruction with polyetheretherketone cage fixation). Arthrosc Tech. 2012; 1(1): e47-52.
  • 6. Darren J, Todd S, James I, Fu FH, Harner CD. Revision anterior cruciate ligament surgery: Experience from pittsburgh. Clin Orthop Relat Res. 1996; 325(2):100-9. 7. Dei Giudici L, Fabbrini R, Garro L, Arima S, Gigante A, Tucciarone A. Arthroscopic transphyseal anterior cruciate ligament reconstruction in adolescent athletes. J Orthop Surg (Hong Kong). 2016; 24(3): 307-11.
  • 8. Shelbourne KD, Patel DV. Timing of surgery in anterior cruciate ligament injured knees. Knee Surg Sports Traumatol Arthrosc. 1995; 3(3): 148-56.
  • 9. Shelbourne KD, Gray T. Results of anterior cruciate ligament reconstruction based on meniscus and articular cartilage status at the time of surgery. Five- to fifteen-year evaluations. Am J Sports Med. 2000; 28(4): 446-52.
  • 10. Levy BA, Dajani KA, Whelan DB, Stannard JP, Fanelli GC, Stuart MJ, et al. Decision making in the multiligamnet –injured knee:an evidence-based systematic review. Arthroscopy. 2009; 25(4): 430-8.
  • 11. Gupta R, Bahadur R, Malhotra A, Masih GD, Gupta P. Anterior cruciate ligament reconstruction using hamstring tendon autograft with preserved insertions. Arthrosc Tech. 2016; 5(2): e269-74.
  • 12. Darnley JE, Léger-St-Jean B, Pedroza AD, Flanigan DC, Kaeding CC, Magnussen RA. Anterior cruciate ligament reconstruction using a combination of autograft and allograft tendon: A moon cohort study. Orthop J Sports Med. 2016; 4(7): 2325967116662249.
  • 13. Vaishya R, Agarwal AK, Ingole S, Vijay V. Current trends in anterior cruciate ligament reconstruction: A Review. Cureus. 2015; 7(11): e378. doi: 10.7759/cureus.378. Review.
  • 14. Musil D, Sadovsky P, Filip L, Vodicka Z, Stehlík J. Anterior cruciate ligament reconstruction using hamstring tendon autograft with reserved ınsertions. Arthrosc Tech. 2016; 5(2): 269-74
  • 15. Luo H, Yu JK, Ao YF, Yu CL, Peng LB, Lin CY, et. al. Relationship between different skin incisions and the injury of the infrapatellar branch of the saphenous nerve during anterior cruciate ligament reconstruction. Chin Med J (Engl). 2007; 120(13): 1127-30.
  • 16. Wolf MR, Murawski CD, van Diek FM, van Eck CF, Huang Y, Fu FH. Intercondylar notch dimensions and graft failure after single-and double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2015; 23(3): 680-6.
  • 17. Gadikota HR, Sim JA, Hosseini A, Gill TJ, Li G. The relationship between femoral tunnels created by the transtibial, anteromedial portal, and outside-in techniques and the anterior cruciate ligament footprint. Am J Sports Med. 2012; 40(4): 882-8.
  • 18. Panni AS, Milano G, Tartarone M, Demontis A, Fabbriciani C. Clinical and radiographic results of ACL reconstruction: A 5 to 7 year follow-up study of outside in versus insideout reconstruction techniques. Knee Surg Sports Traumatol Arthrosc. 2001; 9(2): 77-85.
  • 19. Hefzy MS, Grood ES, Noyes FR. Factors affecting the region of most isometric femoral attachments. Part II: the anterior cruciate ligament. Am J Sports Med. 1989; 17(2): 208-16.
  • 20. Shantanu K, Kushwaha SS, Kumar D, Kumar V, Singh S, Sharma V. A Comparative study of the results of the anatomic medial portal and all-inside arthroscopic ACL reconstruction. J Clin Diagn Res. 2016; 10(11): RC01-3.
  • 21. Harner CD, Giffin JR, Dunteman RC, Annunziata CC, Friedman MJ. Evaluation and treatment of recurrent instability after anterior cruciate ligament reconstruction. Instr Course Lect. 2001; 50(1): 463-74.
  • 22. Allen Cr, Giffin JR, Harner CD. Revision anterior cruciate ligament reconstruction. Orthop Clin North Am. 2003; 34(1): 79-98.
  • 23. Jackson DW, Gasser SI. Tibial tunnel placement in ACL reconstructıon. Arthroscopy. 1994; 10(2): 124-31.
  • 24. Takeda Y, Iwame T, Takasago T, Kondo K, Goto T, Fujii K, et al. Comparison of tunnel orientation between transtibial and anteromedial portal techniques for anatomic double-bundle anterior cruciate ligament reconstruction using 3-dimensional computed tomography. Arthroscopy. 2013; 29(2): 195-204.
  • 25. Taketomi S, Inui H, Nakamura K, Yamagami R, Tahara K, Sanada T, et. al. Secure fixation of femoral bone plug with a suspensory button in anatomical anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft. Joints. 2016; 3(3):102-8.
  • 26. Klein JP, Linter DM, Downs D, Vavrenka K. The incidence and significance of femoral tunnel widening after quadrupled hamstring anterior cruciate ligament reconstruction using femoral cross pin fixation. Arthroscopy. 2003; 19(5): 470-76.
  • 27. Mologne TS, Friedman MJ. Anterior cruciate ligament reconstruction with bone-patella tendon-bone autograft: Indications, technique, complications, and management. In: Insall JN, Scott WN, editors. Surgery of the knee. Philadelphia: Churchill Livingstone; 2001. p. 681-93.
  • 28. van der Hart CP, van den Bekerom MP, Patt TW. The occurrence of osteoarthritis at a minimum of ten years after reconstruction of the anterior cruciate ligament. J Orthop Surg. 2008; 3: 1-9. doi:10.1186/1749-799X-3-24.
  • 29. Değirmenci E, Yücel İ, Özturan K. Hamstring tendon otogrefti ile ön çapraz bağ rekonstrüksiyonu. Bakırköy Tıp Dergisi. 2010; 6(1): 29-34.
  • 30. Howell SM, Taylor MA. Brace-free rehabilitation, with early return to activity, for knees reconstructed with a double-looped semitendinosus and gracilis graft. J Bone Joint Surg Am. 1996; 78(6): 814-25.
Toplam 29 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makaleleri
Yazarlar

Ozan Turhal 0000-0002-1514-5574

Zekeriya Okan Karaduman 0000-0002-7441-6442

Yalçın Turhan 0000-0002-1440-9566

Cemal Güler Bu kişi benim

Şengül Cangür 0000-0002-0732-8952

Mehmet Arıcan 0000-0002-0649-2339

Yayımlanma Tarihi 30 Eylül 2019
Gönderilme Tarihi 13 Haziran 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 9 Sayı: 3

Kaynak Göster

APA Turhal, O., Karaduman, Z. O., Turhan, Y., Güler, C., vd. (2019). Anatomik Ön Çapraz Bağ Rekonstrüksiyonun Femoral Tünel Oblisitesi İle İlişkisinin Klinik Olarak Değerlendirilmesi. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 9(3), 115-121. https://doi.org/10.33631/duzcesbed.577371
AMA Turhal O, Karaduman ZO, Turhan Y, Güler C, Cangür Ş, Arıcan M. Anatomik Ön Çapraz Bağ Rekonstrüksiyonun Femoral Tünel Oblisitesi İle İlişkisinin Klinik Olarak Değerlendirilmesi. DÜ Sağlık Bil Enst Derg. Eylül 2019;9(3):115-121. doi:10.33631/duzcesbed.577371
Chicago Turhal, Ozan, Zekeriya Okan Karaduman, Yalçın Turhan, Cemal Güler, Şengül Cangür, ve Mehmet Arıcan. “Anatomik Ön Çapraz Bağ Rekonstrüksiyonun Femoral Tünel Oblisitesi İle İlişkisinin Klinik Olarak Değerlendirilmesi”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 9, sy. 3 (Eylül 2019): 115-21. https://doi.org/10.33631/duzcesbed.577371.
EndNote Turhal O, Karaduman ZO, Turhan Y, Güler C, Cangür Ş, Arıcan M (01 Eylül 2019) Anatomik Ön Çapraz Bağ Rekonstrüksiyonun Femoral Tünel Oblisitesi İle İlişkisinin Klinik Olarak Değerlendirilmesi. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 9 3 115–121.
IEEE O. Turhal, Z. O. Karaduman, Y. Turhan, C. Güler, Ş. Cangür, ve M. Arıcan, “Anatomik Ön Çapraz Bağ Rekonstrüksiyonun Femoral Tünel Oblisitesi İle İlişkisinin Klinik Olarak Değerlendirilmesi”, DÜ Sağlık Bil Enst Derg, c. 9, sy. 3, ss. 115–121, 2019, doi: 10.33631/duzcesbed.577371.
ISNAD Turhal, Ozan vd. “Anatomik Ön Çapraz Bağ Rekonstrüksiyonun Femoral Tünel Oblisitesi İle İlişkisinin Klinik Olarak Değerlendirilmesi”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 9/3 (Eylül 2019), 115-121. https://doi.org/10.33631/duzcesbed.577371.
JAMA Turhal O, Karaduman ZO, Turhan Y, Güler C, Cangür Ş, Arıcan M. Anatomik Ön Çapraz Bağ Rekonstrüksiyonun Femoral Tünel Oblisitesi İle İlişkisinin Klinik Olarak Değerlendirilmesi. DÜ Sağlık Bil Enst Derg. 2019;9:115–121.
MLA Turhal, Ozan vd. “Anatomik Ön Çapraz Bağ Rekonstrüksiyonun Femoral Tünel Oblisitesi İle İlişkisinin Klinik Olarak Değerlendirilmesi”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, c. 9, sy. 3, 2019, ss. 115-21, doi:10.33631/duzcesbed.577371.
Vancouver Turhal O, Karaduman ZO, Turhan Y, Güler C, Cangür Ş, Arıcan M. Anatomik Ön Çapraz Bağ Rekonstrüksiyonun Femoral Tünel Oblisitesi İle İlişkisinin Klinik Olarak Değerlendirilmesi. DÜ Sağlık Bil Enst Derg. 2019;9(3):115-21.