Ömer TAŞER, Yavuz KOCABEY, Mahmut Nedim DORAL, Mehmet DEMİRHAN, Erdem Uğur IŞIKAN, John NYLAND, Sezgin SARBAN, Ergun BOZDAĞI, Emin SÜNBÜLOĞLU

Ön çapraz bağ rekonstrüksiyonunda tibial tünel tespit seviyesinin tekrarlayıcı yüklenme testi sonuçlarına etkisi

Amaç: Bu çalışmada, ön çapraz bağ (ÖÇB) rekonstrüksiyonunda yumuşak doku tendon greftinin, tibial tünelde yumuşak doku interferans vidası ile anatomik olmayan (eklemden uzak) ve anatomik (ekleme yakın) seviyede tespiti biyomekanik olarak karşılaştırıldı. Çalışma planı: On iki adet dana tibiası ve dana ekstansör digitorum süperfisialis tendonu, yumuşak dokulardan temizlenerek altışarlı iki homojen gruba ayrıldı. Kırk beş dereceye ayarlanmı ş ÖÇB kılavuzu yardımıyla tibialara 7 mm çapında tüneller açıldı. Her bir tünel, genişleticilerin çapı 0.5 mm artırılarak 9 mm’ye kadar genişletildi. Tendonlar 9x30 mm’lik yumuşak doku interferans vidası ile tibial tünele anatomik olmayan (grup I) ve anatomik (grup II) seviyede tespit edildi. Tüm örneklere, servo-hidrolik test cihazında önce 500 kez 50-250 N arasında değişen sinüzoidal kuvvetle 1 Hz frekansı ile tekrarlı yük verildi, sonra 20 mm/dk hızla en yüksek dayanma kuvveti (load to failure) belirlenmek üzere gerilme testi uygulandı. ‹statistiksel analizler Mann-Whitney U-testi ile yapıldı. Sonuçlar: Ortalama vida ilerleme torku I. ve II. gruplarda sı- rasıyla 8.2±2.4 Nm ve 7.8±2.3 Nm bulundu (p=0.88). Tekrarlayı cı yüklenme testi uygulandıktan sonra greftlerde ortalama yer değiştirme sırasıyla 1.9±0.75 mm ve 2.2±1.2 mm (p=0.63), sertlik (stiffness) ise sırasıyla 132.72±10.93 N/mm ve 125.14±15.93 N/mm (p=0.63) bulundu. Çıkarımlar: Ön çapraz bağ rekonstrüksiyonunda kullanılan yumuşak doku tendon greftinin tibial tünelde interferans vidası ile anatomik olmayan ve anatomik seviyede tespitinin biyomekanik olarak farklılık oluşturmadığı sonucuna varıldı.

Anahtar Kelimeler:

Kemik vidaları, Tork, Gerilme kuvveti, Nakil, Tendonlar, Sığır, Kemik yoğunluğu, Ön çapraz bağ, Emilebilir implantlar, Biyomekanik

The effect of the tibial tunnel fixation level on the results of cyclic loading in anterior cruciate ligament reconstruction

Objectives: This study was designed to compare the biomechanical characteristics of non-anatomic (far from joint) and anatomic (close to joint) levels of tibial tunnel fixation with soft tissue graft using a soft tissue interference screw in anterior cruciate ligament (ACL) reconstruction. Methods: Twelve bovine tibiae and digital extensor tendons were divided into two homogeneously equal groups after removing soft tissues. Tibial tunnels were prepared with a 7-mm drill with the use of an ACL guide adjusted to 45°. Each tunnel was then dilated to 9 mm in 0.5 mm increments. Digital extensor tendons were fixed at non-anatomic (group I) or anatomic (group II) tibial tunnel levels with a soft tissue metal interference screw, 9x30 mm in size. All the specimens were cycled 500 times from 50 to 250 N with 1 Hz frequency in a servo-hydraulic testing machine followed by ultimate load at-failure testing at a rate of 20 mm/min. Statistical analyses were made using the Mann-Whitney U-test. Results: The mean screw insertion torque values were 8.2±2.4 Nm and 7.8±2.3 Nm in groups I and II, respectively (p=0.88). The mean values of graft displacement (1.9±0.75 mm versus 2.2±1.2 mm, p=0.63) and stiffness (132.72±10.93 N/mm versus 125.14±15.93 N/mm, p=0.63) did not differ significantly, either. Conclusion: The biomechanical properties of ACL reconstruction with soft tissue graft fixation using a soft tissue interference screw are not influenced by the level of tibial tunnel fixation.

Keywords:

Bone Screws, Torque, Tensile Strength, Transplantation, Tendons, Cattle, Bone Density, Anterior Cruciate Ligament, Absorbable Implants, Biomechanics,

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