Serkan SİPAHİOGLU, Baran SARİKAYA

Anatomical single bundle anterior cruciate ligament reconstruction with three portal technique

Amaç: Diz anatomisi ve biyomekaniğinin daha iyi anlaşılmasıyla birlikte son zamanlarda ön çapraz bağın (ÖÇB) anatomik rekonstrüksiyonu önem kazanmıştır. Femur tünelinin anatomik açılabilmesi için tibia tünelinden bağımsız olarak ayrı drillenmesi önerilmiştir. Biz de bu çalışmada üçüncü bir anteromedial portalden femur tüneli açarak anatomik ÖÇB rekonstrüksiyonu uyguladığımız hastalarımızın klinik ve radyolojik sonuçlarını sunmayı amaçladık. Gereç ve Yöntemler: ÖÇB rekonstrüksiyonu uygulanan 43 hasta (dört kadın, 39 erkek; ortalama yaş 29,3 yıl; dağılım 18-42 yıl) çalışma grubunu oluşturdu. Tüm hastalara artroskopik üçlü portal anatomik rekonstrüksiyon tekniği ile hamstring otogrefti kullanılarak ÖÇB rekonstrüksiyonu uygulandı. Ameliyat öncesi ve sonrası klinik değerlendirme Lysholm diz skoru, Tegner aktivite skoru ve İnternasyonel Diz Dokumantasyon Komitesi Değerlendirme Formuna (IKDC) göre yapıldı. Anteroposterior stabilite değerlendirilmesi ön çekmece testi ve pivot shift testi ile yapıldı. Bulgular: Ameliyat öncesi IKDC skorlamasında 22 olgu D (%51) 21 olgu C (%49) grubundayken ameliyat sonrası 33 olgu A (%76), 10 olgu B (%23) ve 1 olgu C (%2) grubundaydı. Ameliyat öncesi ortalama 54,87 olan Lysholm skorunun son kontrolde 89,86'ya yükseldiği görüldü. Tegner aktivite skorları ortalaması ameliyat öncesi 4,70 iken ameliyat sonrası 5,22 olarak değerlendirildi. Sonuç: ÖÇB rekonstrüksiyonunda diz biyomekaniğini normale tekrar getirmek greftin anatomiye en yakın şekilde yerleştirilmesi ile mümkündür. Bu amaçla tanımlanan üçlü portal teknik hem tibial hem de femoral tüneli anatomiye yakın açılabilmektedir. Bu teknik iyi sonuçları ile uygulanabilir bir teknik olarak değerlendirilmelidir

Üçlü portal teknik ile anatomik tek bant ön çapraz bağ rekonstrüksiyonu

Objective: Anatomic reconstruction of anterior cruciate ligament is becoming more important as the knee anatomy and biomechanics are being understood much more. In order to place femoral tunnel at its original point, it should be drilled from another porta which is more medial instead of from tibial tunnel. In this article we aimed to present clinical and radiologic results of ACL reconstructions that we placed femoral tunnel from a third anteromedial portal. Material and methods: The study included 43 patients (four female, 39 males; mean age 29.3 years; range 18 to 42) with ACL injury. ACL reconstruction was performed to all of the patients with the three portal anatomic single bundle technique using hamstring autograft. Preoperative and postoperative clinical evaluation was done by Lysholm knee score, Tegner activity score, International Knee Documentation Committee (IKDC) score. Anteroposterior instability evaluation was done by anterior drawer and pivot shift tests. Results: According to IKDC score, preoperatively 22 patients were D (51%) and 21 were C (49%) and postoperatively 33 were A (%76), 10 were B (%23) and 1 was C (%2). Preoperative mean Lysholm knee score was 54,87 and increased to 89,86 at the last control. Tegner activity score was 4,70 preoperatively and 5,22 postoperatively. Conclusion: In ACL reconstruction, restoring knee biomechanics is possible by placing graft near normal anatomy. As defined for this purpose, three portal technique can place tibial and femoral tunnel as anatomic as possible. This technique is an applicable technique with good results.

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