Short Term Results of Arthroscopic Anterior Cruciate Ligament Reconstruction Applied with Autojen Hamstring Tendon Graft and Transfix Technique

Year 2018, , 175 - 181, 13.11.2018

Seçkin Basılgan Yaşar Mahsut Dinçel

https://doi.org/10.30565/medalanya.409024

Abstract

Aim: We aimed to evaluate the early
results of anterior cruciate ligament injuries (ACL) reconstruction with
autogenous hamstring tendon graft (OHTG) and transfix technique.

Patients and methods: Between 2007 and 2009, 55 of 62
patients who had postoperative 2-year follow-up of ACL reconstruction were
included in the study. Preoperative and postoperative Tegner activity scale,
Lysholm scoring system and IKDC (International Knee Documentation Committee)
knee bond evaluation systems, Lachman for stabilization tests, Pivot-Shift and
front drawer tests as well as KT- 1000 tests were used for functional
evaluation of the patients. .

Results: 
The mean preoperative Lysholm scores were 61, but they were found 94 at
the last follow-up. According to preoperative IKDC scores, 5 patients were B,
40 patients were C and 10 patients were D; however, postoperatively, 12
patients were A, 36 patients were B and 7 patients were C, respectively. The
mean preoperative value of Tegner activity scale was 3.2, but this value
increased to 6.8 postoperatively. There was a statistically significant
difference between the two groups in the t test on dependent groups (p
<0.05). In the Kt-1000 arthrometer measurement, the translation difference
was less than 3 mm in 45 patients, between 3 mm and 5 mm in 7 patients, and
over 5 mm in 3 patients.

Conclusion: As a result of the evaluations
made, it was concluded that the use of OHTG and detection with Transfix
technique was a technique that can be used for ACL in injured patients.

Keywords

Autogenous Hamstring Tendon Graft, Transfiks Technique, Anterior Cruciat Ligament

Otojen Hamstring Tendon Grefti Ve Transfiks Tekniği İle Uygulanan Artroskopik Önçapraz Bağ Rekonstrüksiyonu Kısa Dönem Sonuçları

Abstract

Amaç: Ön çapraz bağ yaralanmalarının
(ÖÇB) otojen hamstring tendon grefti (OHTG) 
ve transfiks tekniği ile rekonstrüksiyonunun erken sonuçlarını
değerlendirmeyi amaçladık.

Hastalar ve Yöntem: 2007- 2009 yılları arasında
hastanemizde ÖÇB tamiri yapılan postop 2 yıl takibi olan 62 hastanın 55’i
çalışmaya alındı. Çalışmada, hastaların fonksiyonel değerlendirmesi için
ameliyat öncesi ve sonrası Tegner aktivite skalası, Lysholm skorlama sistemi ve
IKDC (International Knee Documentation Committee) diz bağ değerlendirme
sistemleri, stabilizasyon testleri için Lachman, Pivot-Shift ve ön çekmece
testlerine ek olarak kantitatif bir sonuç veren Kt-1000 testi uygulandı.

Bulgular: 
Ameliyat öncesi Lysholm skorları ortalaması 61 iken , yapılan son
kontrolde 94 bulundu. Ameliyat öncesi IKDC skorlarına bakıldığında 5 hasta B,
40 hasta C ve 10 hasta D iken ameliyat sonrası, 12 hasta A, 36 hasta B, 7 hasta
C olarak bulundu. Tegner aktivite skalası; ameliyat öncesi ortalama 3,2 iken
ameliyat sonrası bu değer ortalama 6,8’e yükseldi. Bağımlı gruplarda t testi
ile yapılan istatiksel çalışmada iki grup arasında anlamlı fark tespit edildi (
p< 0.05). Kt-1000 artrometre ölçümünde, translasyon farkı 45 hastada 3
mm'den az, 7 hastada 3mm-5mm arasında ve 3 hastada 5 mm’nin üzerinde bulundu.

Sonuç: Yapılan değerlendirmeler sonucunda
OHTG kullanımı ve transfix tekniği ile tespitin, ÖÇB yaralanmalı hastalarda
kullanılabilecek bir teknik olduğu sonucuna varılmıştır.

Keywords

Otojen Hamstring Tendon Grefti, Transfiks Tekniği, Ön Çapraz Bağ

References

• 1. Doral MN, Bozkurt M, Atay ÖA, Tetik O. Çapraz bağ yaralanmaları. Turkiye Klinikleri J Surg Med Sci 2006;2:31- 4
• 2. Ekstrand J, Gillquist J. Soccer injuries and their mechanisms: a prospective study Med Sci Sports Exerc. 1983;15(3):267-70.
• 3. Laura L. Tosi, Barbara D. Boyan, and Adele L. Boskey: Does Sex Matter in Musculoskeletal Health? The Influence of Sex and Gender on Musculoskeletal Health.J Bone Joint Surg. Am. Jul 2005; 87: 1631 - 1647.
• 4. Liu SH. Estrogen Affects The Celluler Metabolism of The Anterior Cruciate Ligaments. A potential Explanation for Female Athletic Injury, Am J sports Med.1997; 25-5; 704-709.
• 5. Noyes FR, Mooar PA, Matthews DS, Butler DL: The symptomatic anterior cruciate deficient knee: part l: the long term functional disability in athletically active individuals. J Bone Joint Surg. 1983; 65-A: 154-62.
• 6. Marder RA, Raskind JR, Carroll M. Prospective evaluation of arthroscopically assisted anterior cruciate ligament reconstruction: Patellar tendon versus semitendinosus and gracilis tendons. Am J Sports Med. 1991;19: 479-484, 1991.
• 7. Kampen V.A., Wymerya A.B., Huub J.L., Barkens H.J.A.M.: The Effect of Different Graft Tensioning in Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study. Artroscopy. 1992; 14:62-65.
• 8. U. Insall-Sicott: Surgery of the Knee 4th Edition Hardcover 2005. 607-712.
• 9. Howell SM, Deutsch ML. Comparison of endoscopic and two-incision techniques for reconstruction a torn anterior cruciate ligament using hamstring tendons. Arthroscopy.1999; 15:594-606.
• 10. Tandoğan RN, Taser Ö, Kayaalp A et al. Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time from injury, and level of sport. Knee Surg Sports Traumatol Arthrosc. 2004;12: 262-270.
• 11. Viola RW, Steadman RJ, Mair SD, Briggs KK, Sterett Wl. Anterior cruciate ligament injury incidence among male and female Professional alpine skiers. Am J Sports Med.1999; 27:792-5. 12. Noyes FR, Mooar PA, Matthews DS, Butler DL: The symptomatic anterior cruciate deficient knee: part l:the long term functional disability in athletically active individuals. J Bone Joint Surg. 1983; 65-A: 154-62.
• 13. Marom N, Ruzbarsky JJ, Roselaar N, Marx RG. Knee MLI Injuries: Common Problems and Solutions. Clin Sports Med.2018 ;37(2):281-291.
• 14. Baker CL, Norwood LA, Hugston JC. Anterior Cruciate Ligament Reconstruction. J Bone Joint Surg. 1983; 65A: 614-620.
• 15. Hunter RE, Mastrangelo J. Freeman JR, Purnell ML, Jones RH. The Impact of Surgical Timing on Postoperative Motion and Stability Following Anterior Cruciate Ligament Reconstruction. Arthroscopy. 1996; 2:667-674.
• 16. Cerabona F, Sherman MF, Bonamo JR, Sklar J.Patterns of meniscal injury with acute anterior cruciate ligament tears Am J Sports Med. 1988 ;16(6):603-9.
• 17. Lynch M, Henning C, Glick K . Knee joint surface changes: long-term follow-up meniscus tear treatment in stable anterior cruciate ligament reconstructions. Clin Orthop Rel Res.1983; 172: 148-153.
• 18. 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.
• 19. Kurosaka M, Yoshiya S, Andrish JT. A biomechanical comparison of different surgical techniques of graft fixation in anterior cruciate ligament reconstruction. Am J Sports Med 1987;15:225-229.
• 20. James G. Garrick American Academy of Orthopaedic Surgeons Orthopaedic Knowledge Update; Sports Medicine 3. 169-181.
• 21. Kessler MA, Behrend H, Henz S, Stutz G, Rukavina A, Kuster MS. Function, Osteoarthritis and activity after ACL-rupture: 11 years follow-up results of conservative versus reconstructive treatment. Knee Surg Sports Traumatol Arthrosc. 2008; 16: 442-448.
• 22. Noyes FR, Butler DL, Paulos LE, Grood ES. Intra-articuler Cruciate Reconstruction. I: Respectives on Graft Strength, Vascularization, and Immediate Motion After Replacement, Clin Orthop Relat Res.1983 ; (172): 71-7.
• 23. Graham SM, Parker RD. Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Grafts. Clinical Orthopaedics & Related Research.2002; (402):64-75.
• 24. Keith L. Markolf, Daniel M. Burchfield, Matheww M. Shapiro, Biomechanical Consequences of Replacement of the Anterior Cruciate Ligament with a Patellar Ligament Allograft. Part I: Insertion of the Graft and Anterior-Posterior Testing. J. Bone Joint Surg. Am. 1996;78:1720- 7.
• 25. Kurt PS, Todd AW, J. Claiborne C Jr., Michelle Secic, Sheryl B. Clinical Outcome at a Minimum of Five Years After Reconstruction of the Anterior Cruciate Ligament, J. Bone Joint Surg. Am, 2005; 87: 1673 - 1679.
• 26. Pierce E. Jr. Quadruple Hamstring Anterior Cruciate LigamentReconstruction : A Multicenter Study Arthroscopy .2002 : pp 715 – 724.
• 27. Kumar K. The Ligament Augmentation Device: An Historical Perspective Arthroscopy. 1999: pp 422 – 432.
• 28. Mikami S, Yasuda K, Katsuragi R. Reduction of Initial Tension in the In Situ Frozen Anterior Cruciate Ligament. Clinical Orthopaedics & Related Research. 2004;(419):207-213.
• 29. Aslan A, Özer Ö, Baydar M L, Yorgancıgil H, Özerdemoğlu R A, Aydoğan N H. Anterior cruciate ligament injuries: do affect surgical treatment with otograft and allograft options, clinical results ?. Ulus Travma Acil Cerrahi Derg. 2012; 18(2): 153-161.
• 30. Kampen V.A., Wymerya A.B., Huub J.L., Barkens H.J.A.M.: The Effect of Different Graft Tensioning in Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study. Artroscopy. 1992; 14:62-65.
• 31. Scott W.N. Insall-Sicott: Surgery of the Knee 4th Edition Hardcover. 2005. 607-712.
• 32. Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop.1985; 198:43-49.
• 33. Gobbi A, Tuy B, Panuncialman et al. Quadrupled bone semitendinosus ACL reconstruction : a clinical investigation in a group of athletes . Arthroscopy bone-reconstruction: athletes. Arthroscopy.2003; 691-699.
• 34. Eriksson K, Anderberg P, Hamberg P, Olerud P, Wredmark T. There are differences in early morbidity after ACL reconstruction when comparing patellar tendon and semitendinosus tendon graft. A prospective randomized study of 107 patients. Scand J Med Sci Sports. 2001;11(3):170-7.
• 35. Fauno P, Kaalund S. Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used: a prospective randomized study. Arthroscopy. 2005;21:1337-41.
• 36. Clark R, Olsen RE, Larson BJ, Goble EM, Farrer RP. Cross-pin femoral fixation: a new technique for hamstring anterior cruciate ligament reconstruction of the knee. Arthroscopy. 1998;14(3):258-67.
• 37. O.Şahap Atik.Does Surgical Treatment of Anterior Cruciate Ligament Tear Prevent Osteoarthritis? Acta Medica Alanya. 2017; (1 ) : 2.