Ön Çapraz Bağ Tamirinde Otojen Hamstring Tendon Grefti Kullanılarak Uygulanan Transtibial ve Anteromedial Portal Tekniklerin Karşılaştırılması

Year 2019, Volume: 21 Issue: 3, 197 - 203, 30.12.2019

Zekeriya Okan Karaduman , Ozan Turhal , Yalçın Turhan , Mehmet Arıcan , Şengül Cangür

https://doi.org/10.18678/dtfd.629638

Abstract

Amaç: Bu çalışmada, ön çapraz bağ tamirinde kullanılan transtibial (TT) ile anteromedial portal (AMP) teknik arasındaki farklılıkların, ön çapraz bağ rekonstrüksiyonu sonrası hastaların diz eklemi fonksiyonları üzerine etkilerinin araştırılması amaçlanmıştır.

Gereç ve Yöntemler: Çalışmamıza kliniğimizde ön çapraz bağ yırtığı nedeniyle cerrahi olarak tedavi edilen 60 hasta dahil edildi. Otuz hastaya TT teknik, 30 hastaya AMP teknik uygulandı. Fonksiyonel değerlendirmelerde Lysholm, Uluslararası Diz Belgelendirme Komitesi (International Knee Documentation Committee, IKDC) ve Tegner skoru preop ve postop olarak bakıldı. Postoperatif anteroposterior ve lateral diz grafilerinde femur tüneli ile distal eklem yüzü arasındaki açı ölçüldü ve diz eklemi fonksiyonel sonucu üzerine etkisi incelendi.

Bulgular: Çalışmaya dahil edilen hastaların %80’i erkek (n=47) ve %20’si kadındır (n=13). Gruplara göre cinsiyet dağılımı homojendir (p=0.476). Bireylerin ortalama yaşı 32.75±8.81 (16-53) olarak tespit edildi. AMP uygulanan grupta ölçülen operasyon sonrası Lysholm skor değeri, TT teknik uygulanan grupta ölçülen değerinden anlamlı düzeyde daha yüksek bulunmuştur (p<0.001). AMP tekniği uygulanan grupta ölçülen operasyon sonrası Tegner skoru değer, TT teknik uygulanan grupta ölçülen değerinden anlamlı düzeyde daha yüksek bulunmuştur (p<0.001). Ortalama femur tüneli oblikitesi TT grubunda 59,3°, AMP grubunda ise 41,4° bulunmuştur.

Sonuç: Oblik femoral tünel yerleşiminin, ön çapraz bağın rotasyonel stabilitesine daha fazla yarar sağladığı düşünülmektedir. Çalışmamızda AMP teknik uygulanmasının TT tekniğe göre femoral oblisite artışının fonksiyonel sonuca katkısının daha yararlı olduğu kanaatindeyiz.

Keywords

anatomik ön çapraz bağ rekonstrüksiyonu, otojen hamstring, anteromedial portal, trans tibial teknik

Comparison of Transtibial and Anteromedial Portal Techniques Used in Anterior Cruciate Ligament Repair Using Autogenous Hamstring Tendon Graft

Abstract

Aim: The aim of this study was to investigate the effects of transtibial (TT) and anteromedial portal (AMP) techniques used in anterior cruciate ligament repair on knee joint function after anterior cruciate ligament reconstruction.

Material and Methods: Sixty patients who were surgically treated in our clinic for anterior cruciate ligament tear were included in the study. Thirty patients underwent TT technique and 30 patients underwent AMP. Functional evaluations were performed according to Lysholm, International Knee Documentation Committee (IKDC) and Tegner scoring preop and postop. The angle between the femoral tunnel and the distal joint face was measured in postoperative Anteroposterior and Lateral knee graphs and its effect on the knee joint functional outcome was examined.

Results: Eighty percent of the patients included in the study were male (n=47) and 20% were female (n=13). The gender distribution according to the groups was homogeneous (p=0.476). The mean age of the subjects was 32.75±8.81 (16-53) years. The postoperative Lysholm score was significantly higher in the AMP group than in the TT group (p<0.001). The postoperative Tegner score was significantly higher in the AMP group than in the TT group (p<0.001). Mean femoral tunnel obliquity was 59.3° in the TT group and 41.4° in the AMP group.

Conclusion: It is thought that oblique femoral tunnel placement is more beneficial for the rotational stability of anterior cruciate ligament. In our study, we think that AMP technique is more beneficial than femoral obliquity in terms of functional outcome.

Keywords

anatomic anterior cross ligament reconstruction, autogenous hamstring, anteromedial portal, trans tibial technique

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