ÖN ÇAPRAZ BAĞ REKONSTRÜKSİYONU UYGULANMIŞ NORMAL VE OBEZ BİREYLERİN FONKSİYONEL SONUÇLARININ KARŞILAŞTIRILMASI

Öz

Amaç Obezite, ortopedik cerrahide postoperatif klinik sonuçlara etki eden bir klinik antitedir. Literatürdeki birçok çalışma obezitenin ortopedik cerrahi üzerindeki etkilerini ortaya koymuştur. Ön çapraz bağ (ÖÇB) yırtılması genellikle genç ve aktif bireylerde görülür ve genellikle cerrahi olarak tedavi edilir. Bu çalışmada obezitenin ön çapraz bağ rekonstrüksiyonunun klinik sonuçları üzerindeki etkisini araştırmak istedik. Gereç ve Yöntem Eylül 2012-Haziran 2016 yılları arasında opere edilen, 180 hasta retrospektif olarak değerlendirildi. Hastalar vücut kitle indekslerine (VKİ) göre 2 gruba ayrıldı. Tüm hastalar tek bir merkezde ve tek bir cerrah tarafından ameliyat edildi. VKİ<25 kg/m² olan hastalar Grup 1'i (n=113), VKİ>30 kg/m² olan hastalar Grup 2'yi (n=67) oluşturdu. Hastaların yaş, cinsiyet, VKİ, ameliyat için bekleme süresi, ameliyat öncesi ve ameliyat sonrası Lysholm ve modifiye Cincinnati skorları bu iki grup arasında karşılaştırıldı. Bulgular Gruplar arasında komplikasyon, takip süreleri, ameliyat öncesi bekleme süresi, ameliyat öncesi ve sonrası Lysholm skorları ve ameliyat sonrası modifiye Cincinnati skorları açısından anlamlı fark bulunamadı. Ameliyat öncesi modifiye Cincinnati skorlarında gruplar arasında istatistiksel olarak anlamlı bir fark bulundu. Komplikasyon oranları açısından iki grup arasında istatistiksel olarak anlamlı bir fark saptanmadı. Sonuç ÖÇB rekonstrüksiyon cerrahisi normal VKİ'ye sahip popülasyon ve VKİ'ye göre obez olan hastalarda fonksiyonel diz skorları açısından benzer sonuçlara sahiptir. Ancak bu sonuçları doğrulamak için daha fazla klinik çalışmaya ve başka parametrelere ihtiyaç vardır.

Anahtar Kelimeler

• Obezite
• Ön çapraz bağ
• Rekonstrüksiyon

COMPARISON OF FUNCTIONAL RESULTS OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN OBESE PATIENTS WITH NORMAL INDIVIDUALS

Öz

Objective Obesity is one of the most challenging diseases in orthopedic surgery which directly affects the clinical results of the operations. Many studies in the literature demonstrated the effects of obesity on orthopedic surgery. Anterior cruciate ligament (ACL) rupture is commonly seen in young and active individuals and generally treated surgically. In this study, we had the intention to investigate the effect of obesity on the clinical results of anterior cruciate ligament reconstruction. Material and Methods 180 patients were retrospectively evaluated whom operated between September 2012 - June 2016. The patients are divided into 2 groups according to their body mass index (BMI). All patients were operated on in a single center and by a single senior surgeon. BMI<25 kg/m2 patients formed Group 1 (n=113), BMI>30 kg/m2 patients formed the Group 2 (n=67). Age, gender, BMI of the patients, waiting time for the operation, preoperative and postoperative Lysholm and modified Cincinnati scores were compared between these two groups.A p-value less than 0.05 (typically ≤ 0.05) is statistically significant. Results There was no significant difference between the groups in terms of complication, follow-up periods, waiting time before operation, and pre-op and postop Lysholm scores, and post-op modified Cincinnati scores. A significant difference has been found between the groups in pre-op modified Cincinnati scores. Conclusion ACL reconstruction surgery has similar results in the obese population compared to the normal weight population in terms of functional further studies and other parameters are needed to verify these results.

Anahtar Kelimeler

• Obesity
• Anterior cruciate ligament
• Reconstruction

Kaynakça

1. 1. Fukubayashi T, Torzilli P, Sherman M, Warren R. An in vitro biomechanical evaluation of anterior-posterior motion of the knee. Tibial displacement, rotation, and torque. The Journal of bone and joint surgery American volume. 1982;64(2):258-64.
2. 2. Bisciotti GN, Chamari K, Cena E, Bisciotti A, Bisciotti A, Corsini A, et al. Anterior cruciate ligament injury risk factors in football. J Sports Med Phys Fitness. 2019;59(10):1724-38.
3. 3. Sonesson S, Kvist J, Ardern C, Österberg A, Silbernagel KG. Psychological factors are important to return to pre-injury sport activity after anterior cruciate ligament reconstruction: expect and motivate to satisfy. Knee surgery, sports traumatology, arthroscopy. 2017;25(5):1375-84.
4. 4. Wang LJ, Zeng N, Yan ZP, Li JT, Ni GX. Post-traumatic osteoarthritis following ACL injury. Arthritis research & therapy. 2020;22(1):57.
5. 5. Costa-Paz M, Ayerza MA, Tanoira I, Astoul J, Muscolo DL. Spontaneous healing in complete ACL ruptures: a clinical and MRI study. Clinical Orthopaedics and Related Research®. 2012;470(4):979-85.
6. 6. Bojicic KM, Beaulieu ML, Imaizumi Krieger DY, Ashton-Miller JA, Wojtys EM. Association between lateral posterior tibial slope, body mass index, and ACL injury risk. Orthopaedic journal of sports medicine. 2017;5(2):2325967116688664.
7. 7. Lysholm J, Tegner Y. Knee injury rating scales. Acta orthopaedica. 2007;78(4):445-53.
8. 8. Agel J, LaPrade RF. Assessment of differences between the modified Cincinnati and International Knee Documentation Committee patient outcome scores: a prospective study. The American journal of sports medicine. 2009;37(11):2151-7.

9. 9. Arendt EA, Agel J, Dick R. Anterior cruciate ligament injury patterns among collegiate men and women. Journal of athletic training. 1999;34(2):86.
10. 10. Laxdal G, Kartus J, Ejerhed L, Sernert N, Magnusson L, Faxén E, et al. Outcome and risk factors after anterior cruciate ligament reconstruction: a follow-up study of 948 patients. Arthroscopy: the journal of arthroscopic & related surgery: official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2005;21(8):958-64.
11. 11. Thorburn A, Proietto J. Biological determinants of spontaneous physical activity. Obesity Reviews. 2000;1(2):87-94.
12. 12. McCullough KA, Phelps KD, Spindler KP, Matava MJ, Dunn WR, Parker RD, et al. Return to high school–and college-level football after anterior cruciate ligament reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) cohort study. The American journal of sports medicine. 2012;40(11):2523-9.
13. 13. Almeida A, Valin MR, Ferreira R, Roveda G, Almeida NCd, Agostini AP. Evaluation of the results of arthroscopic ACL reconstruction with autogenous flexor tendons. Revista brasileira de ortopedia. 2010;45(4):404-8.
14. 14. Adala R, Anand A, Kodikal G. Deep vein thrombosis and thromboprophylaxis in arthroscopic anterior cruciate ligament reconstruction. Indian J Orthop. 2011;45(5):450-3.
15. 15. Cvetanovich GL, Chalmers PN, Verma NN, Cole BJ, Bach BR. Risk Factors for Short-term Complications of Anterior Cruciate Ligament Reconstruction in the United States. The American journal of sports medicine. 2016;44(3):618-24.
16. 16. Rothman KJ. BMI-related errors in the measurement of obesity. International Journal of Obesity. 2008;32(3):S56-S9.