Artroskopik ön çapraz bağ onarımı için hamstring tendon otogreftine kıyasla kuadriseps tendon kullanımı: Klinik sonuçların karşılaştırmalı analizi

Abstract

Knee ligament injuries are among the most frequently encountered injuries. [1,2] Although different types of surgical techniques with excellent clinical results have been reported for the reconstruction of a ruptured anterior cruciate ligament (ACL), graft selection is still a controversial issue. Every particular graft type Amaç: Bu çalışmada, iki otojen greft türünün kullanımına ilişkin orta dönem klinik sonuçlar değerlendirildi. Hastalar ve yöntemler: Haziran 2005 -Kasım 2010 tarihleri arasında ameliyat edilen 44 hastanın klinik verileri retrospektif olarak incelendi. Onarım cerrahisi için 23 hastada (QT-PB grubu) kuadriseps tendon-patella kemiği otogrefti, 21 hastada (HT grubu) ise dört katlı hamstring tendon otogrefti kullanıldı. Veri toplamada Tegner aktivite skalası, Lysholm skorlama sistemi, tek bacak sıçrama testi ve KT-2000 artrometrik ölçümleri kullanıldı. Bulgular: Ortalama takip süresi 37.6 aydı. Ortalama Lysholm skoru her iki grupta da artmasına rağmen, HT grubunda elde edilen mükemmel sonuçlar QT-PB grubundakinin iki katı kadardı. Ortalama laksite miktarı QT-PB grubunda 5.65 mm (3.5-8.0 mm) iken HT grubunda 3.67 mm (3.0-5.5 mm) olarak ölçüldü. KT-2000 artrometre kullanıla-rak yapılan bire bir analizde QT-PB grubunda 12 hastada (%52.1) ve HT grubunda iki hastada (%9.6) 3 mm'den fazla ön laksite farkı saptandı. Sonuç: Artroskopik ön çapraz bağ onarım cerrahisinde dört katlı hamstring tendon otogrefti, santral kuadriseps tendonpatella kemiği otogreftinden üstündür.Anahtar sözcükler: Ön çapraz bağ onarımı; ön çapraz bağ; artroskopi; kuadriseps kası; tendon.Objectives: This study aims to evaluate midterm clinical results of the use of two autogenous graft types. Patients and methods: Between June 2005 and November 2010, clinical data of 44 patients who were operated were retrospectively analyzed. Quadriceps tendon-patellar bone autograft was used for reconstruction surgery in 23 patients (QT-PB group), while quadrupled hamstring tendon autograft was used in 21 patients (HT group). The Tegner's activity scale, Lysholm scoring system, single-leg-hop test and KT-2000 arthrometric measurements were used for data collection. Results: The mean length of follow-up was 37.6 months. Although the mean Lysholm score increased in both groups, excellent results in HT group were two-fold higher compared to QT-PB group. The mean laxity for the operated knee joint was 5.65 mm (3.5 to 8.0 mm) in QT-PB group and 3.67 mm (3.0 to 5.5 mm) in HT group. Head-to-head analysis using KT-2000 arthrometer demonstrated that 12 patients (52.1%) in QT-PB group and two patients (9.6%) in HT group had more than 3 mm of anterior laxity difference. Conclusion: Quadrupled hamstring tendon autograft is superior to central quadriceps tendon-patellar bone in arthroscopic anterior cruciate ligament reconstruction surgery.

Comparison of knee sonography and pressure pain threshold after anterior cruciate ligament reconstruction with quadriceps tendon versus hamstring tendon autografts in soccer players

“…Controversial results have been reported about the best graft choice for ACL reconstruction when QT grafts and HT grafts were compared. A less residual laxity of QT graft was reported by Sofu et al, 11 and recent study have reported similar results between these autograft modalities using a cohort design 12 . In a previous randomised controlled trial we found that QT grafts had similar functional results with a better isokinetic ratio compared to HT grafts 13 …”

ACL reconstruction with quadriceps tendon graft and press-fit fixation versus quadruple hamstring graft and interference screw fixation – a matched pair analysis after one year follow up

“…Both authors achieved comparable results to our study regarding knee stability at the time of follow up (QT graft at FU: instrumental measurement 1.1 ± 0.9 mm vs. 2.1 ± 1.9 mm vs. 1.6 ± 0.2 mm side-to-side difference; 93% vs. 67% vs. 80% negative pivot shift). Sofu et al did not achieve similar results [19]. In their study, 21% of QT graft recipients suffered from persistent symptoms of knee instability, and only 48% had side-to-side difference of < 3 mm.…”

“…Few previous studies have directly compared the clinical data of primary ACLR with QT grafts to that of ACLR with HT grafts, but the results are inconsistent (Table 5) [16–19].…”