Mehmet Uğur ÖZBAYDAR, CEM ZEKİ ESENYEL, ÖNDER İSMET KILIÇOĞLU, ATA CAN ATALAR, Ergün BOZDAĞ, EMİN SÜNBÜLOĞLU, Ayşim ÖZAĞRI, MEHMET SELAHATTİN DEMİRHAN

Plikasyondan önce debridman uygulamasının diz kapsülünün biyomekanik özelliklerine etkisi: Tavşanda deneysel çalışma

Amaç: Plikasyon uygulanan eklem kapsülünde ameliyat sonrası erken dönemde meydana gelen biyomekanik değişimler araştırıldı ve debridman ile kapsül iç yüzünde kanamalı bir yüzey oluşturulmasının iyileşme üzerine etkisi değerlendirildi. Çalışma planı: Elli dört yetişkin Yeni Zelanda beyaz tavşanının 48'inin tek taraf diz medial eklem kapsülüne tek başına (n=24) ya da debridmanla kapsül iç yüzünde kanamalı bir yüzey oluşturulduktan sonra (n=24) plikasyon yapıldı. Altı tavşanın sağlam dizi kontrol grubunu oluşturdu. Ameliyat sonrasında tavşanların dizleri tespit edildi. Debridman uygulanan ve uygulanmayan gruplarda altışar tavşanın yaşamı sırasıyla ameliyattan hemen sonra, birinci ikinci ve üçüncü haftalarda sonlandırıldı. Her altgrupta beş tavşan mekanik testler için, bir tavşan ise histolojik değerlendirme için kullanıldı. Sonuçlar: Deney gruplarında kopma kuvveti üçüncü haftaya kadar kontrol grubundan yüksek bulundu (p0.05). Ayrıca, birinci haftadaki kopma kuvveti, ikinci ve üçüncü hafta sonuçlarından anlamlı derecede yüksekti (p0.05). Debridman uygulanmayan gruba göre, debridman uygulanan grubun birinci haftadaki kopma kuvveti belirgin olarak daha azdı (p0.05). Histolojik örneklerde deney gruplarında tüm haftalarda benzer bulgular elde edildi; birinci haftadan itibaren her iki grupta da artan fibrozisle birlikte iyileşme gözlendi. Çıkarımlar: Plikasyondan sonra kapsül, sağlam kapsülden daha zayıf değildir. Debridmanla daha hızlı veya daha iyi iyileşme olduğu gösterilememiştir. Debridman kapsülün biyomekanik özelliklerini olumsuz etkileyebilir.

Anahtar Kelimeler:

Tavşanlar, Rastgele seçim, Stres, mekanik, Gerilme kuvveti, Yara iyileşmesi, Eklem kapsülü, Debridman, Biyomekanik, Artroskopi, Modeller, hayvan, Diz eklemi

The effect of debridement performed before capsular plication on biomechanical properties of the knee joint capsule: An experimental study in rabbits

Objectives: The purpose of this study was to evaluate early postoperative biomechanical changes in plicated joint capsules and to determine the effect of debridement to create a bleeding inner capsular surface on the healing process. Methods: Fifty-four mature New Zealand white rabbits were used. Plication was performed in unilateral medial knee joint capsules of 48 rabbits either alone (n=24) or following debridement (n=24) to create a bleeding inner capsular surface. Six rabbits remained untreated for the control group. The operated knee joints were immobilized in flexion postoperatively. The rabbits from the two study groups were sacrificed in groups of six immediately after operation, in the first, second, and third weeks, of which five were evaluated in tensile tests and one was evaluated histologically. Results: Compared to the controls, tensile strengths were significantly higher in both study groups until the third week (p<0.01), after which the difference became insignificant (p>0.05). The strength of the plicated capsules was significantly higher in the first week in both study groups than those measured in subsequent weeks (p<0.01), whereas similar tensile strengths were recorded in the second and third weeks (p>0.05). Compared to its absence, the use of debridement was associated with a significantly lower strength in the first week (p<0.01), but this difference was not observed afterwards (p>0.05). Histological findings were similar in the two study groups and were characterized by healing with increased fibrosis starting from the first week. Conclusion: A plicated capsule would not be weaker than an intact one. Our findings do not favor debridement for a more rapid and better healing process. Rather, it might have adverse effects on the biomechanical properties of the capsule.

Keywords:

Rabbits, Random Allocation, Stress, Mechanical, Tensile Strength, Wound Healing, Joint Capsule, Debridement, Biomechanics, Arthroscopy, Models, Animal, Knee Joint,

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