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

Öz

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.

Anahtar Kelimeler

• Anterior cruciate ligament tear
• arthroscopic ACL reconstruction
• femoral remnant

Proje Numarası

15064

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

Öz

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.

Anahtar Kelimeler

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

Destekleyen Kurum

HARRAN ÜNİVERSİTESİ BİLİMSEL ARAŞTIRMA KOORDİNATÖRLÜĞÜ

Proje Numarası

15064

Kaynakça

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