İbrahim TUNCAY, Nihat TOSUN, FUAT AKPINAR

Otojen patellar ve hamstring tendon ile ön çapraz bağ rekonstrüksiyonunun karşılaştırılması

Amaç: Ön çapraz bağ (ÖÇB) rekonstrüksiyonunda otojen patellar tendon (PT) ile semitendinosus (ST) ve gracilis (G) tendonlarının kullanımı karşılaştırıldı. Çalışma planı: Kronik ÖÇB yetersizliği olan 56 erkek hastanın rekonstrüksiyonunda otojen PT (n=32, ort. yaş 25) ve dört kat olarak otojen ST-G tendonları (n=24, ort. yaş 24) kullanıldı. Sonuçlar Lysholm skorlama sistemi ve Uluslararası Diz Dokümantasyon Komitesi’nin (IKDC) skorlama sistemine göre değerlendirildi. Ortalama takip süreleri PT grubunda 15 ay, ST-G grubunda 14 ay idi. Sonuçlar: Lysholm skorlama sistemine göre, iyi ve mükemmel sonuç oranları PT grubunda %84 (n=27), ST-G grubunda %83 (n=20) bulundu. IKDC skorlarına göre A ve B skorlarına ulaşan hastalar PT grubunda %94 (n=30), ST-G grubunda %92 (n=23) idi. Takip sonunda değerlendirme kriterlerine göre PT ve ST-G grupları arasında anlamlı fark saptanmadı (p>0.05). Komplikasyon olarak, PT grubunda üç hastada (%5) refleks sempatik distrofi, iki hastada yüzeyel enfeksiyon, bir hastada popliteal ven trombozu, bir hastada patellar tendinit gözlendi; ST-G grubunda ise bir hastada gelişen cyclops sendromu nedeniyle ikincil artroskopiyle debridman uygulandı. Çıkarımlar: Ön çapraz bağ rekonstrüksiyonunda otojen PT altın standart olarak kullanılmasına rağmen, otojen dört kat ST-G ile de benzer sonuçlara ulaşılmakta ve göreceli olarak daha az komplikasyon meydana gelmektedir.

Anahtar Kelimeler:

Tendon transferi, Artroskopi, Eklem instabilitesi, Patella, Ameliyat sonrası komplikasyonlar, Ön çapraz bağ, Nakil, otolog, Diz yaralanmaları

Comparison of patellar tendon and hamstring tendon autografts in arthroscopic anterior cruciate ligament reconstruction

Objectives: We compared the use of autogenous patellar tendon (PT) and semitendinosus (ST) and gracilis (G) tendons in anterior cruciate ligament (ACL) reconstruction. Methods: Fifty-six male patients underwent arthroscopic ACL reconstruction using autogenous PT (n=32, mean age 25 years) and autogenous four-strand ST-G tendons (n=24, mean age 24 years). The results were evaluated according to the Lysholm scores and the International Knee Documentation Committee scale (IKDC). Mean follow-ups were 15 months and 14 months in PT and ST-G groups, respectively. Results: Excellent or good results according to the Lysholm scores were achieved in 84% (n=27) and 83% (n=20) in PT and ST-G groups, respectively. Similarly, excellent or good results according to the IKDC scale accounted for 94% (n=30) with PT and 92% (n=23) with ST-G. No significant differences were found between the two treatment groups (p>0.05). Complications encountered in the PT group included reflex symphatic dystrophia (n=3, %5), minimal soft tissue infection (n=2), popliteal vein thrombosis (n=1), and patellar tendonitis (n=1). On the other hand, one patient in the ST-G group developed cyclops syndrome which required a subsequent arthroscopic release. Conclusion: Our study shows that, although PT is widely used in ACL reconstruction, similar results may be obtained using four-strand autogenous ST-G tendons, with relatively fewer complications.

Keywords:

Tendon Transfer, Arthroscopy, Joint Instability, Patella, Postoperative Complications, Anterior Cruciate Ligament, Transplantation, Autologous, Knee Injuries,

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