Intermediate Term Results of Arthroscopy Assisted Anterior Cruciate Ligament Reconstruction with Quadrupled Hamstring Tendon Autograft

Yıl 2012, Cilt: 4 Sayı: 1, 10 - 13, 01.04.2012

Selim Şanel Mehmet Nurullah Ermiş Yusuf Hakan Büktel Can Solakoğlu Faik Murat Ünsal

Öz

Objectives: There is an increase in use of otograft in anterior knee reconstruction for the recent years. Quadrupled hamstring tendons are known as the hardest and the most powerful otografts. Our aim is to report the fourth years results of anterior knee reconstruction which is performed with proximal femoral transfix fixation by using quadripled hamstring tendon grafts. Methods: Quadrupled hamstring tendon otografts were used in 96 knees of 96 patients. Subjective, clinical, functional, Telos stress device, radiographic evaluations were applied to all patients at the end of the first and second years. Among 96 patients two were women and 94 were men; 5 patients were professional and 36 patients were amateur sportsman. Mean age was 24 20 to 34 . International Knee Documentation Committee IKDC scoring and a questionaire that consists of Lysholm 2 scoring were used to assess knee function and activity. Results: Ninety percent of patients expressed their reconstructed knees as normal with 100% stability subjectively. Ninety percent of the patients returned to their normal daily activities and life as before the injury. A and B scores were obtained in 82 of 96 patients 85 % as mean IKDC knee score. Mean Lysholm score was found 94. The difference measured by Telos stres device betweeen mean preoperative 13.7 mm and postoperative 2.8 mm laxity grades was statistically significant p

Anahtar Kelimeler

Anterior cruciate ligament, hamstring tendons, autograft, reconstruction

Dörtlü Hamstring Otogrefti ile Artroskopik Ön Çapraz Bağ Rekonstrüksiyonunun Orta Dönem Sonuçları

Öz

Amaç: Son yıllarda daha çok ön çapraz bağ rekonstrüksiyonunda otogreft kullanma eğiliminde artış vardır. Bilinen en sert ve en güçlü greft dörtlü hamstring tendonlarıdır. Amacımız dörtlü hamstring tendon greftini kullanarak proksimal femoral transfix fiksasyonu ile yapılan ön çapraz bağ rekonstrüksiyonunun ortama 4 yıllık sonuçlarını yayınlamaktır. Yöntem: Doksan altı hastanın dizinde dörtlü hamstring tendon otogrefti kullanılmıştır. Hastalar operasyon sonrası 1. ve 4. yılında subjektif, klinik, fonksiyonel olarak, Telos stres cihazı ve radyografik inceleme ile değerlendirilmiştir. 96 hastanın 2'si bayan, 94'ü erkek; 5 hasta profesyonel, 36 hasta amatör sporcuydu. Yaş ortalaması 24 20-34 yaş arası idi. Fonksiyon ve aktiviteyi değerlendiren skorlama sistemleri olarak preoperatif ve postoperatif kontrollerde International Knee Documentation Committee IKDC ve Lysholm-2 diz skorunu içeren sorgulama formları kullanıldı. Bulgular: Subjektif olarak hastaların %90'ı rekonstrükte edilen dizlerini %100 stabilite ile normal kabul etmişlerdir. Yüzde doksanı zedelenme öncesi aktivite düzeyine dönmüşlerdir. IKDC diz skoru ortalaması 96 hastanın 82'sinde %85 A ve B olarak saptanmıştır. Lysholm-2 skoru ortalama 94 olarak bulundu. Telos stres cihazı ile ameliyat öncesi ortalama 13.7 mm ve ameliyat sonrası ortalama 2.8 mm ölçülen laksite değerleri arasında anlamlı fark bulundu p

Anahtar Kelimeler

Ön çapraz bağ, hamstring tendonu, otogreft, rekonstrüksiyon

Kaynakça

• Butler D, Grood E, Noyes F: On the interpretation of our anterior cruciate ligament data. Clin Orthop 1985, 196:26-34.
• Barber F, Small N, Click J: Anterior cruciate ligament reconstruction by semitendinosus and gracilis tendon autograft. Am J Knee Surg 1991,4:84-89.
• Pinczewski L, Clingeleffer A, Otto D,et al: Integration of hamstring tendon graft with bone in reconstructi- on of the anterior cruciate ligament. Arthroscopy 1997, 13:641-643.
• Noyes FR, Barber-Westin SD: A comparison of results in acute and chronic anterior cruciate ligament ruptu- res of arthroscopically assisted autogenous patellar tendon reconstruction. Am J Sports Med 1997; 25:460-471.
• Can F: Ön çapraz bağ yaralanmalarında rehabilitas- yon. In: Tandoğan NR, editör. Ön çapraz bağ cerrahi- si. Ankara: Spor Yaralanmaları, Artroskopi ve Diz Cer- rahisi Derneği; 2002. p:165-191.
• Warnock M, Elkousy H: Recent issues in anterior cru- ciate ligament surgery. Curr Opin Orthop, 2004; 15:86-91.
• Brown CH, Wilson DR, Heckor AT,et al: Comparison of hamstring and patellar tendon fixation: cyclic load. Book of Abstract, 25th Annual Meeting American Orthopaedic Society of Sports Medicine, Traverse City, Michigan 1999, p:413-414.
• Barrack R, Bruckner J, Kneisl J: The outcome of non- operatively treated complete tears of the anterior cru- ciate ligament in active young adults. Clin Orthop, 1990, 259:192-199.
• Mc Guire DA, Barber FA, Milchgrub S, Wolchbok JC: A postmortem examination of poly-L-lactic acid inter- ference screws 4 months after implantation during anterior cruciate ligament reconstructıon. Arthros- copy, 2001, 17:988-1092.
• Johnson D, et al: All soft tissue graft fixation techni- ques. Which should I use? Screws, cross pins, but- tons? AANA, Specialty Day, San Fransisco 2001, Abs- tract Books; p:99-102.
• Indelicato PA, Bittar ES. : A persrective of lesions asso- ciated with ACL insufficiency of the knee. Clin Orthop Rel Res 1985; 198:77-80.
• Sgaglione NA, Del Pizzo W, Fox JM, Friedman MJ : Arthroscopically assisted anterior cruciate ligament re- constraction with the pes anserıne tendons. Compa- rison of results in acute and chronic ligament defici- ency. Am J Sports Med 1993; 21: 249-256.
• Vander Reis WL, Deffner KT, Rosenberg TD: Compa- rison of hamstring fixation devices under cyclic and other loading. AOSSM, Specialty Day. Orlando FL 2000, Abstract Books; p:88-89.
• Klein JP, Linter DM, Downs D, Vavrenka K: The inci- dence and significance of femoral tunnel widening af- ter quadrupled hamstring anterior cruciate ligament reconstruction using femoral cross pin fixation. Art- hroscopy, 2003; 19:470-476.
• Ma CB, Francis K, Towers J, Irrgang J, Fu FH, Harner CH et al: Hamstring anterior cruciate ligament recons- truction: a comparison of bioabsorbable interferance screw and endobutton-post fixation. Arthroscopy, 2004;20:122-128.