Comparision of Clinical Results between Three Different Fixation Method of Anterior Cruciate Ligament Reconstruction

Yıl 2018, Yıl: 2018 Ek Sayı: 1, 28 - 35, 01.01.2018

Barış Yılmaz , Cem Çopuroğlu Mert Özcan Mert Çiftdemir Erdi İmre Nurettin Heybeli

https://doi.org/10.5505/kjms.2017.71677

Öz

Aim: The aim of this study is to investigate the clinical results of three different fixation methods of ACL reconstruction. 
Material and Method: The 81 patients whom undergone arthroscopic ACL surgery using hamstring tendon grafts were divided to three groups. Group 1 (27 patients) was defined which graft fixation made in tunnel and using interference screw named AperFix, group 2 (24 patients) was defined which graft fixation made made in tunnel and using transcondylar nail named TransFix, group 3 (30 patients) was defined which graft fixation made outside of tunnel on cortical bone named Endobutton. All patients were evaluated by operation time, postoperative functional scores International Knee Documentation Committee (IKDC) knee score and Lysholm scoring system. 
Results: There was no statistically significant difference in mean of ages, sex, side distribution, follow-up time, IKDC scores and Lysholm scores between the groups (p>0.05). Mean operation time was 85.86±7.15 minutes. There was statistically significant difference Between the groups in surgical time (p: 0.001; p<0.05).There was statistically significant decreased surgical time in group 3 when compared to group 1 (p: 0.001) and group 2 (p: 0.003) (p<0.05). There was no statistically significant difference of surgical time between group 1 and 2 (p: 0.587; p>0.05). 
Conclusion: There was no significant difference in clinical results between three different fixation methods while Endobutton method has a advantage in decreasing of surgical time.

Anahtar Kelimeler

Anterior cruciate ligament, hamstring tendon, IKDC, Lysholm score

Ön Çapraz Bağ Rekonstrüksiyonunda Kullanılan Üç Farklı Femoral Tespit Yönteminin, Klinik Sonuçlar Üzerine Etkilerinin Karşılaştırılması

Öz

Amaç: Bu çalışmada, üç farklı femoral tespit yöntemi ile yapılan artroskopik ön çapraz bağ rekonstrüksiyonun klinik sonuçlarının araştırılması amaçlanmıştır. 
Materyal ve Metot: Hamstring tendon grefti kullanılarak artroskopik ön çapraz bağ rekonstrüksiyonu uygulanan 81 hasta 3 grub ayrıldı. Grup 1 (27 hasta); greft tespitini tünel icinde yapan ve interferans vidası olarak uygulanan AperFix grubu, Grup 2 (24 hasta); greft tespitini tünel içinde yapan ve transkondiler çivi olarak uygulanan TransFix grubu ve Grup 3 (30 hasta); greft tespitini tünel dışında korteks üzerinde yapan Endobutton grubu. Tüm hastalar operasyon süresi, komplikasyon gelişimi ve operasyon sonrası fonksiyonel sonuçlar açısından IKDC (International Knee Documentation Committee) diz skoru ve Lysholm skoru ile değerlendirildi. 
Bulgular: Gruplar arasında yaş ortalamaları, cinsiyet, taraf dağılımları, takip süreleri, IKDC ve Lysholm skorları açısından istatistiksel olarak anlamlı bir fark bulunmadı (p>0.05). Çalışmaya katılan hastaların operasyon süresi 85.86±7.15 dakikadır. Gruplar arasında operasyon süreleri açısından istatistiksel olarak anlamlı fark bulunmadı (p: 0.001; p<0.05).
anlamlı fark bulunmadı (p: 0.001; p<0.05). Anlamlılığın tespiti için yapılan ikili karşılaştırmalar sonucunda; grup 3’de operasyon süre ortalaması; grup 1 (p: 0.001) ve grup 2’den(p: 0.003) anlamlı düzeyde kısa bulundu (p<0.05). Grup 1 ve grup 2 arasında operasyon süre ortalamaları açısından anlamlı bir fark bulunmadı (p: 0.587; p>0.05). 
Sonuç: Üç farklı tespit yöntemi arasında klinik sonuçlar bakımından bir fark bulunmayıp, sadece cerrahi süre açısından endobutton yöntemi avantajlı cerrahi yöntem olarak tespit edilmiştir.

Anahtar Kelimeler

Ön çapraz bağ, Hamstring tendonu, IKDC, Lysholm skoru

Kaynakça

• 1- Woo, SLY, Fox RJ, Sakane M, Livesay GA, Rudy TW, Fu FH. Biomechanics of the ACL: Measurements of in situ force in the ACL and knee kinematics. The Knee 1998; 5 (4): 267- 88.
• 2- Noyes, FR. The function of the human anterior cruciate ligament and analysis of single- and double-bundle graft reconstructions. Sports Health 2009; 1 (1): 66- 75.
• 3- Grinsven S, Cingel REH, Holla CJM, Loon CJM. Evidence-based rehabilitation followinganterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2010;18(8):1128-44.
• 4- Fu FH, Bennett CH, Lattermann C, Berjamin C. Current Concept current Trends in Anterior Cruciate Ligament Reconstruction Am J Sports Med. 1999;27-6: 821-30.
• 5- Frank CB, Alberta C, Jackson DW. Current Concepts Review the Science of Reconstruction of the Anterior Cruciate Ligament J Bone Joint Surg. 1997; 79- A/10:1556-76.
• 6- Anderson MJ, Browning WM 3rd, Urband CE, Kluczynski MA, Bisson LJ. A Systematic Summary of Systematic Reviews on the Topic of the Anterior Cruciate Ligament. Orthop J Sports Med. 2016 Mar 15;4(3):2325967116634074.
• 7- Brand J, Weiler A, Caborn D, Brown CH, Johnson DL,: Current Concept Graft Fixation in Cruciate Ligament Reconstruction. Am J Sports Med 2000; 28-5: 761-74.
• 8- Chadwick CP, Yung SH, Brett L,: Stability Results of Hamstring Anterior Cruciate Ligament Reconstructions at 2 to 8 year follw up; Arthroscopy, J Arthrosc Rel Surg, 2005; 21(2): 138-46.
• 9- Martin SD, Martin TL, Brown CH. Anterior cruciate ligament graft fixation. Orthop Clin North Am 2002; 33: 685–96.
• 10- De Wall M, Scholes CJ, Patel S, Coolican MR, Parker DA. Tibial fixation in anterior cruciate ligament reconstruction: a prospective randomized study comparing metal interference screw and staples with a centrally placed polyethylene screw and sheath. Am J Sports Med 2011;39(9):1858-64.
• 11- Harvey A, Thomas NP, Amis AA. Review Article: Fixation of the graft in reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 2005;87(5):593-603.
• 12- Kousa P, Jarvinen T, Vihavainen M, Kannus P, Jarvinen M. The fixation strength of six hamstring tendon graft fixation devices in anterior cruciate ligament reconstruction part I: femoral site. Am J Sports Med 2003;31(2):174-81.
• 13- Ozyurek S, Atik A, Turgut H, Akyildiz F. Different femoral fixation techniques in reconstruction of anterior cruciate ligament. Acta Med Iran. 2015;53(7):452-3
• 14- Kampen VA, Wymerya AB, Huub JL, Barkens HJAM. The Effect of Different Graft Tensioning in Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study. Artroscopy. 1992;14:62-5.
• 15- Kurtz SM, Devine JN. PEEK biomaterials in trauma, orthopedic and spinal implants. Biomaterials 2007;28(32):4845-69.
• 16- Kim MM, Boahene KD, Byrne PJ. Use of customized polyetheretherketone (PEEK) implants in the reconstruction of complex maxillofacial defects. Arch Facial Plast Surg. 2009;11(1):53-7.
• 17- Uribe JW, Arango D, Frank J, Kiebzak GM. Two-year outcome with the AperFix system for ACL reconstruction. Orthopedics. 2013;36(2):159-64.
• 18- Plaweski S, Rossi J, Merloz P. Anterior cruciate ligament reconstruction: Assessment of the hamstring autograft femoral fixation using the EndoButton CL. Orthop Traumatol Surg Res 2009;95(8):606-13.
• 19- Fan H, Wang J, Fu Y, Dong H, Wang J, Tang C, Huang C, Shi Z. A security evaluation of the Rigid-fix crosses pin system used for anterior cruciate ligament reconstruction in tibial fixation site. Int J Clin Exp Med. 2014; 7(11):4597-606.
• 20- Hapa O, Barber FA. ACL fixation devices.Sports Med Arthrosc. 2009 Dec; 17(4):217-23.
• 21- Hamid M, Majid M. Anterior cruciate ligament reconstruction using autologous hamstring single-bundle Rigidfix technique compared with single-bundle Transfix technique. Adv Biomed Res 2012;1:32.
• 22- Frank CB, Jackson DW. Current concepts review-the science of reconstruction of the anterior cruciate ligament. J Bone Joint Surg Am 1997;79(10):1556-76.
• 23- Middleton KK, Hamilton T, Irrgang JJ, Karlsson J, Harner CD, Fu FH. Anatomic anterior cruciate ligament (ACL) reconstruction: a global perspective. Part 1.Knee Surg Sports Traumatol Arthrosc. 2014;22(7):1467-82