Ali ÖÇGÜDER, Barış KILINÇ, Ahmet FIRAT, Selim ŞANEL, Metin ÖZDEMİR, Ali Kağan GÖKAKIN

Early period results of arthroscopic anterior cruciate ligament reconstruction with quadrupled hamstring autograft

Amaç. Son yıllarda daha çok ön çapraz bağ rekonstrüksiyonunda otogreft kullanma eğilimindeartış vardır. Bilinen en sert ve en güçlü greft dörtlü hamstring tendonlarıdır. Amacımız dörtlühamstring tendon greftini kullanarak proksimal femoral transfix fiksasyonu ile yapılan ön çaprazbağ rekonstrüksiyonunun ilk 2 yıllık sonuçlarını yayınlamaktır. Yöntemler. Seksen dokuzhastanın [87 erkek (%97,7), 2 kadın (%2,3)] 89 dizinde dörtlü hamstring tendon otogreftikullanılmıştır. Hastaların yaş ortalaması 24 (20-34 yaş arası) idi. 5 hasta profesyonel, 35 hastaamatör sporcuydu. Subjektif, klinik, fonksiyonel, Telos stres cihazı ve radyografikdeğerlendirmeler, 1. ve 2. Yılın sonunda her hasta için uygulanmıştır. Diz fonksiyon ve aktivitesinideğerlendirmek için International Knee Documentation Committee (IKDC) ve Lysholm diz skorukullanıldı. Bulgular. Subjektif olarak hastaların %92si rekonstrükte edilen dizlerini %100stabilite ile normal kabul etmişlerdir. %87si zedelenme öncesi aktivite düzeyine dönmüşlerdir.Ortalama IKDC diz skoru olarak 89 hastanın 87sinde (%97,7) A ve B skorları elde edildi.Lysholm ortalama skoru 94 olarak bulundu. Telos stres cihazı ile ameliyat öncesi ortalama13,7mm ve ameliyat sonrası ortalama 2,8mm ölçülen laksite değerleri arasında anlamlı farkbulundu. Sonuç. Femoral transfix fiksasyonu ile dört katlı semitendinosus-grasilis otogreftikullanarak yapılan endoskopik ön çapraz bağ rekonstrüksiyonu tekniğinde erken dönemde başarılıve mükemmel subjektif, objektif, fonksiyonel ve radyolojik sonuçlar elde ettik.

Dörtlü hamstring otogref ti ile artroskop ik ön çap raz bağ rekonstrüksiyonunun erken dönem sonuçları

Aim. In recent years there has been an increase in the tendency to use autograft in anterior kneereconstruction. Quadrupled hamstring tendons are known to be the hardest and the most powerfulgrafts. This study aims to report the first two year results of anterior knee reconstructionsperformed with proximal femoral transfix fixation by using quadrupled hamstring tendon grafts.Methods. Quadrupled hamstring tendon autografts were used in 89 knees of 89 patients [87 male(97.7%), 2 female (2.3%)]. The mean age of the patients was 24 years (range 20-34 years). Fivepatients were professional and 35 patients were amateur sportsmen. Subjective, clinical,functional, Telos stress device, and radiographic evaluations were applied to all patients at the endof the first and second years. International Knee Documentation Committee (IKDC) scoring andLysholm scoring were used to assess knee function and activity. Results. Subjectively 92% of thepatients expressed their reconstructed knees to be normal with 100% stability. Eighty-sevenpercent of the patients returned to their normal daily activities and life at pre-injury level. A and Bscores were obtained in 87 of 89 patients (97.7%) as average IKDC knee score. The averageLysholm score was 94. A statistically significant difference was determined in the degree of laxitymeasured by Telos stress device which had a mean value of 13.7mm preoperatively and 2.8 mmpostoperatively. Conclusion. Successful and excellent subjective, objective, functional andradiological results were obtained in the early follow-up period with the endoscopic anteriorcruciate ligament reconstruction technique performed by using femoral transfix fixation withquadrupled semitendinosus-gracilis autograft.

PDF

___

1. Butler DL, Grood ES, Noyes FR, Sodd AN. On the interpretation of our anterior cruciate ligament data. Clin Orthop Relat Res 1985; 196: 26-34.
2. Barber FA, Small N, Click J. Anterior cruciate ligament reconstruction by semitendinosus and gracilis tendon autograft. Am J Knee Surg 1991; 4: 84-9.
3. Karahan M: Ön çapraz bağ yaralanmalarında dörtlü hamstring tendonları (semitendinosus/gracilis) ile rekonstrüksiyon. In: Tandoğan NR, editör. Ön çapraz bağ cerrahisi. Ankara: Spor yaralanmaları, Artroskopi ve Diz Cerrahisi Derneği; 2002; ss: 91-8.
4. Pinczewski LA, Clingeleffer AJ, Otto DD, Bonar SF, Corry IS. Integration of hamstring tendon graft with bone in reconstruction of the anterior cruciate ligament. Arthroscopy 1997; 13: 641-3.
5. Noyes FR, Barber-Westin SD. A comparison of results in acute and chronic anterior cruciate ligament ruptures of arthroscopically assisted autogenous patellar tendon reconstruction. Am J Sports Med 1997; 25: 460-71.
6. Seo SS, Kim CW, Nam TS, Choi SY. ACL Reconstruction with Autologous Hamstring Tendon: Comparison of Short Term Clinical Results between Rigid-fix and PINN-ACL Cross Pin. Knee Surg Relat Res 2011; 23: 208-12.
7. Paxton ES, Stock MV, Brophy RH. Meniscal repair versus partial meniscectomy: a systematic review comparing reoperation rates and clinical outcomes. Arthroscopy 2011; 27: 1275-88.
8. Sekiya I, Muneta T, Ogiuchi T, Yagishita K, Yamamoto H. Significance of the single-legged hop test to the anterior cruciate ligament-reconstructed knee in relation to muscle strength and anterior laxity. Am J Sports Med 1998; 26: 384-8.
9. Warnock M, Elkousy H. Recent issues in anterior cruciate ligament surgery. Curr Opin Orthop 2004; 15: 86-91.
10. Brown CH, Wilson DR, Heckor AT, Ferragamo, M. Comparison of hamstring and pateller tendon fixation: cyclic load. Book of Abstract, 25th Annual Meeting American Orthopaedic Society of Sports Medicine, Traverse City, Michigan 1999; pp: 413-4.
11. Barrack RL, Bruckner JD, Kneisl J, Inman WS, Alexander AH. The outcome of non-operatively treated complete tears of the anterior cruciate ligament in active young adults. Clin Orthop Relat Res 1990; 259: 192-9.
12. McGuire DA, Barber FA, Milchgrub S, Wolchbok JC. A postmortem examination of poly-L-lactic acid interference screws 4 months after implantation during anterior cruciate ligament reconstruction. Arthroscopy, 2001; 17: 988-92.
13. Atik OS. Is reconstruction of the anterior cruciate ligament a prerequisite for restoring muscle function? Eklem Hastalık Cerrahisi 2009; 20: 125-6.
14. Johnson D, et al. All soft tissue graft fixation techniques. Which should I use? Screws, cross pins, buttons? AANA, Specialty Day, San Francisco 2001, Abstract Books; pp: 99-102.
15. Indelicato PA, Bittar ES. A perspective of lesions associated with ACL insufficiency of the knee. A review of 100 cases. Clin Orthop Relat Res 1985; 198: 77-80.
16. Sgaglione NA, Del Pizzo W, Fox JM, Friedman MJ. Arthroscopically assisted anterior cruciate ligament reconstruction with the pes anserine tendons. Comparison of results in acute and chronic ligament deficiency. Am J Sports Med 1993; 21: 249-56.
17. Vander Reis WL, Deffner KT, Rosenberg TD. Comparison of hamstring fixation devices under cyclic and other loading. AOSSM, Specialty Day. Orlando FL 2000, Abstract Books; pp: 88-9.
18. Klein JP, Linter DM, Downs D, Vavrenka K. The incidence and significance of femoral tunnel widening after quadrupled hamstring anterior cruciate ligament reconstruction using femoral cross pin fixation. Arthroscopy 2003; 19: 470-6.
19. Goradia VK, Grana WA. A comparison of outcomes at 2 to 6 years after acute and chronic anterior cruciate ligament reconstructions using hamstring tendon grafts. Arthroscopy 2001; 17: 383-92.
20. Ma CB, Francis K, Towers J, Irrgang J, Fu FH, Harner CH. Hamstring anterior cruciate ligament reconstruction: a comparison of bioabsorbable interference screw and endobutton-post fixation. Arthroscopy 2004; 20: 122-8.