Uvećanje koštanog kanala nakon rekonstrukcije prednje ukrštene veze kolena upotrebom kost-tetiva-kost grafta
Sažetak
Apstrakt
Uvod/Cilj. Kost-tetiva-kost (KTK) graft jedan je od najčvršćih bioloških graftova i obezbeđuje jaku inicijalnu fiksaciju i primenu interferencijalnih zavrtanja, čime se postiže primarno zaceljenje kosti i integracija grafta za kost na mestu fiksacije tokom artroskopske rekonstrukcije prednje ukršene veze kolena. Cilj našeg istraživanja bio je da utvrdi da li KTK autokalem kod koga se tokom hirurške obrade uklanjaju meka tkiva i periost dovodi do smanjenja uvećanja kanala u butnoj kosti i golenjači nakon artroskopske rekonstrukcije prednje ukrštene veze kolena. Metode. Prva faza sastojala se od biomehaničkog ispitivanja na 12 parova kadaveričnih KTK kalemova. Testiranje smo vršili na mehaničkoj kidalici. Druga faza je podrazumevala kliničko ispitivanje. Prvu grupu činilo je 40 ispitanika sa klasično obrađenim KTK autokalemom. Drugu grupu činilo je 56 ispitanika kod kojih su sa dve trećine koštanih delova KTK autokalema odstranjena meka tkiva i periost. Merili smo rastojanje između sklerotičnih ivica tunela na golenjači i butnoj kosti u tri različite tačke: proksimalno (F1;T1), u sredini (F2;T2) i u donjem delu (F3;T3). Rezultati. Eksperimentalni deo studije pokazao je da ne postoji statistički značajna razlika u sili kidanja kalema izražene u N/mm2 između klasično obrađenog KTK kalema i KTK grafta sa delimično uklonjenim mekim tkivima i periostom. Upoređivanjem proširenja kanala u svim segmentima u oba koštana tunela između ispitivanih grupa, statistički značajno manje uvećanje kanala izmereno je u grupi sa KTK kalemom sa delimično uklonjenim mekim tkivima i periostom (p < 0.05). Zaključak. Upotreba KTK autokalema sa delimično uklonjenim mekim tkivima i periostom daje manje proširenje koštanih kanala u odnosu na klasično obrađivane kaleme prednje ukrštene veze.
Reference
REFERENCES
Jansson KA, Harilainen A, Sandelin J, Karjalainen PT, Aronen HJ, Tallroth K. Bone tunnel enlargement after anterior cruciate li-gament reconstruction with the hamstring autograft and endo-button fixation technique. A clinical, radiographic and magnetic resonance imaging study with 2 years follow-up. Knee Surg Sports Traumatol Arthrosc 1999; 7(5): 290‒5.
Simonian PT, Erickson MS, Larson RV, O'kane JW. Tunnel ex-pansion after hamstring anterior cruciate ligament reconstruc-tion with 1-incision EndoButton femoral fixation. Arthrosco-py 2000; 16(7): 707‒14.
Hogervorst T, van der Hart CP, Pels Rijcken TH, Taconis WK. Ab-normal bone scans of the tibial tunnel 2 years after patella li-gament anterior cruciate ligament reconstruction: Correlation with tunnel enlargement and tibial graft length. Knee Surg Sports Traumatol Arthrosc 2000; 8(6): 322‒8.
Fahey M, Indelicato PA. Bone Tunnel Enlargement After Ante-rior Cruciate Ligament Replacement. Am J Sports Med 1994; 22(3): 410‒4.
Buelow JU, Siebold R, Ellermann A. A prospective evaluation of tunnel enlargement in anterior cruciate ligament reconstruction with hamstrings: Extracortical versus anatomical fixation. Knee Surg Sports Traumatol Arthrosc 2002; 10(2): 80‒5.
Milankov M, Kecojević V, Stanković M, Pejić D, Miljkovć N. Mea-surement of knee instability: A new version of rolimeter. Acta Orthop Traumatol Hellenica 2002; 53: 88‒92
Linn RM, Fischer DA, Smith JP, Burstein DB, Quick DC. Achilles tendon allograft reconstruction of the anterior cruciate ligament-deficient knee. Am J Sports Med 1993; 21(6): 825‒31.
Jackson DW, Windler GE, Simon TM. Intraarticular reaction as-sociated with the use of freeze-dried, ethylene oxide-sterilized bone-patella tendon-bone allografts in the reconstruction of the anterior cruciate ligament. Am J Sports Med 1990; 18(1): 1‒10; discussion 10‒1.
Cameron ML, Fu FH, Pässler HH, Schneider M, Evans CH. Syn-ovial fluid cytokine concentrations as possible prognostic indi-cators in the ACL-deficient knee. Knee Surg Sports Traumatol Arthrosc 1994; 2(1): 38‒44.
Vergis A, Gillquist J. Graft failure in intra-articular anterior cruciate ligament reconstructions: A review of the literature. Arthroscopy 1995; 11(3): 312‒21.
L'Insalata JC, Klatt B, Fu FH, Harner CD. Tunnel expansion following ACL reconstruction: A comparison of hamstring and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc 1997; 5(4): 234‒8.
Shelbourne KD, Nitz P. Accelerated rehabilitation after anterior cruciate ligament reconstruction. Am J Sports Med 1990; 18(3): 292‒9.
Vadalà A, Iorio R, de Carli A, Argento G, Di Sanzo V, Conteduca F, et al. The effect of accelerated, brace free, rehabilitation on bone tunnel enlargement after ACL reconstruction using ham-string tendons: A CT study. Knee Surg Sports Traumatol Arthrosc 2007; 15(4): 365‒71.
Halewood C, Hirschmann MT, Newman S, Hleihil J, Chaimski G, Amis AA. The fixation strength of a novel ACL soft-tissue graft fixation device compared with conventional interference screws: A biomechanical study in vitro. Knee Surg Sports Traumatol Arthrosc 2011; 19(4): 559‒67.
Paschos NK, Gartzonikas D, Barkoula NM, Moraiti C, Paipetis A, Matikas TE, et al. Cadaveric study of anterior cruciate ligament failure patterns under uniaxial tension along the ligament. Arthroscopy 2010; 26(7): 957‒67.
Hantes ME, Mastrokalos DS, Yu J, Paessler HH. The effect of early motion on tibial tunnel widening after anterior cruciate ligament replacement using hamstring tendon grafts. Arthros-copy 2004; 20(6): 572‒80.
Franke K. Clinical experience in 130 cruciate ligament recon-structions. Orthop Clin North Am 1976; 7(1): 191‒3.
Eriksson E. Reconstruction of the anterior cruciate ligament. Orthop Clin North Am 1976; 7(1): 167‒79.
Clancy WG. Intra-articular reconstruction of the anterior cru-ciate ligament. Orthop Clin North Am 1985; 16(2): 181‒9.
Reinhardt KR, Hetsroni I, Marx RG. Graft selection for anterior cruciate ligament reconstruction: a level I systematic review comparing failure rates and functional outcomes. Orthop Clin North Am 2010; 41(2): 249‒62.
Duquin TR, Wind WM, Fineberg MS, Smolinski RJ, Buyea CM. Current trends in anterior cruciate ligament reconstruction. J Knee Surg 2009; 22(1): 7‒12.
Pujol N, Fong O, Karoubi M, Beaufils P, Boisrenoult P. Anatomic double-bundle ACL reconstruction using a bone-patellar ten-don-bone autograft: A technical note. Knee Surg Sports Traumatol Arthrosc 2010; 18(1): 43‒6.
Shino K, Nakata K, Nakamura N, Toritsuka Y, Horibe S, Nakaga-wa S, et al. Rectangular tunnel double-bundle anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft to mimic natural fiber arrangement. Arthroscopy 2008; 24(10): 1178‒83.
Herbort M, Tecklenburg K, Zantop T, Raschke MJ, Hoser C, Schulze M, et al. Single-bundle anterior cruciate ligament reconstruction: A biomechanical cadaveric study of a rectangular quadriceps and bone-patellar tendon-bone graft configuration versus a round hamstring graft. Arthroscopy 2013; 29(12): 1981‒90.
Yoo JH, Yi SR, Kim JH. The geometry of patella and patellar tendon measured on Knee MRI. Surg Radiol Anat 2007; 29(8): 623‒8.
Tuncyurek O, Ozkol M, Ozic U, Pabuscu Y. The role of patellar tendon morphometry on anterior knee pain. Surg Radiol Anat 2010; 32(6): 539‒43.
Iriuchishima T, Yorifuji H, Aizawa S, Tajika Y, Murakami T, Fu FH. Evaluation of ACL mid-substance cross-sectional area for reconstructed autograft selection. Knee Surg Sports Traumatol Arthrosc 2014; 22(1): 207‒13.
Yanke AB, Bell R, Lee AS, Shewman E, Wang VM, Bach BR. Central-Third Bone-Patellar Tendon-Bone Allografts Demon-strate Superior Biomechanical Failure Characteristics Com-pared With Hemi-Patellar Tendon Grafts. Am J Sports Med 2013; 41(11): 2521‒6.
Handl M, Drzík M, Cerulli G, Povýsil C, Chlpík J, Varga F, et al. Reconstruction of the anterior cruciate ligament: Dynamic strain evaluation of the graft. Knee Surg Sports Traumatol Arthrosc 2007; 15(3): 233‒41.
Torg JS, Conrad W, Kalen V. Clinical diagnosis of anterior cru-ciate ligament instability in the athlete. Am J Sport Med 1976; 4(2): 84‒93.
Galway RD, Beaupre A, Macintosh DL. Pivot shift: a clinical sign of symptomatic anterior cruciate insufficiency. J Bone Join Surg Br 1972; 54(4): 763‒4.
Lysholm J, Gillquist J. Evaluation of knee ligament surgery re-sults with special emphasis on use of a scoring scale. Am J Sports Med 1982; 10(3): 150‒4.
Tegner Y, Lysholm J, Odensten M, Gillquist J. Evaluation of cru-ciate ligament injuries. A review. Acta Orthop Scand 1988; 59(3): 336‒41.
Hefti F, Muller W, Jakob RP, Staubli HU. Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1993; 1(3‒4): 226‒34.
Peyrache MD, Dijan P, Christel P, Witvoet J. Tibial tunnel en-largement after anterior cruciate ligament reconstruction by autogenous bonepatellar tendon-bone graft. Knee Surg Sports Traumatol Arthrosc 1996; 4(1): 2‒8.
Fink C, Zapp M, Benedetto KP, Hackl W, Hoser C, Rieger M. Tibial tunnel enlargement following anterior cruciate ligament reconstruction with patellar tendon autograft. Arthroscopy 2001; 17(2): 138‒43.
Siebold R, Cafaltzis K. Differentiation between intraoperative and postoperative bone tunnel widening and communication in double-bundle anterior cruciate ligament reconstruction: A prospective study. Arthroscopy 2010; 26(8): 1066‒73.
Silva A, Sampaio R, Pinto E. Femoral tunnel enlargement after anatomic ACL reconstruction: a biological problem? Knee Surg Sports Traumatol Arthrosc 2010; 18(9): 1189‒94.
Jaureguito JW, Paulos LE. Why grafts fail. Clin Orthop Relat Res 1996; 325: 25‒41.
Harner CD, Olson E, Irrgang JJ, Silverstein S, Fu FH, Silbey M. Allograft vs autograft anterior cruciate ligament reconstruc-tion. Clin Orthop Relat Res 1996; 324: 134‒44.
Järvelä T, Moisala AS, Paakkala T, Paakkala A. Tunnel en-largement after double-bundle anterior cruciate ligament re-construction: A prospective, randomized study. Arthroscopy 2008; 24(12): 1349‒57.
Miller MD, Olszewski AD. Cruciate ligament graft intra-articular distances. Arthroscopy 1997; 13(3): 291‒5.
Ito MM, Tanaka S. Evaluation of tibial bone-tunnel changes with X-ray and computed tomography after ACL reconstruc-tion using a bone-patella tendon-bone autograft. Int Orthop 2006; 30(2): 99‒103.
Volpi P, Marinoni L, Bait C, Galli M, de Girolamo L. Tibial fixation in anterior cruciate ligament reconstruction with bone-patellar tendon-bone and semitendinosus-gracilis autografts: A comparison between bioabsorbable screws and bioabsorbable cross-pin fixation. Am J Sports Med 2009; 37(4): 808‒12.
Drogset O, Strand T, Uppheim G, Odegard B, Boe A, Grontvedt T. Autologous patellar tendon and quadrupled hamstring grafts in anterior cruciate ligament reconstruction: A prospective randomized multicenter review of different fixation methods. Knee Surg Sports Traumatol Arthrosc 2010; 18(8): 1085‒93.
Shelbourne KD, Whitaker HJ, Mccarroll JR, Rettig AC, Hirschman LD. Anterior cruciate ligament injury: Evaluation of intraarti-cular reconstruction of acute tears without repair. Two to sev-en year followup of 155 athletes. Am J Sports Med 1990; 18(5): 484‒8; discussion 488‒9.
Kobayashi M, Nakagawa Y, Suzuki T, Okudaira S, Nakamura T. A retrospective review of bone tunnel enlargement after anterior cruciate ligament reconstruction with hamstring tendons fixed with a metal round cannulated interference screw in the femur. Arthroscopy 2006; 22(10): 1093‒9.
Klein JP, Lintner DM, Downs D, Vavrenka K. The incidence and significance of femoral tunnel widening after quadrupled ham-string anterior cruciate ligament reconstruction using femoral cross pin fixation. Arthroscopy 2003; 19(5): 470‒6.
Colvin A, Sharma C, Parides M, Glashow J. What is the best fe-moral fixation of hamstring autografts in anterior cruciate li-gament reconstruction?: a meta-analysis. Clin Orthop Relat Res 2011; 469(4): 1075‒81.
Maloney WJ, Jasty M, Harris WH, Galante JO, Callaghan JJ. En-dosteal erosion in association with stable uncemented femoral components. J Bone Joint Surg Am 1990; 72(7): 1025‒34.
Wilson TC, Kantaras A, Atay A, Johnson DL. Tunnel enlarge-ment after anterior cruciate ligament surgery. Am J Sports Med 2004; 32(2): 543‒9.
Panni AS, Milano G, Tartarone M, Demontis A, Fabbriciani C. Clinical and radiographic results of ACL reconstruction: A 5- to 7-year follow-up study of outside-in versus inside-out re-construction techniques. Knee Surg Sports Traumatol Arth-rosc 2001; 9(2): 77‒85.
Specchiulli F, Laforgia R, Mocci A, Miolla L, Scialpi L, Solarino G. Anterior cruciate ligament reconstruction. A comparison of 2 techniques. Clin Orthop Relat Res 1995; 311: 142‒7.
Webster KE, Feller JA, Elliott J, Hutchison A, Payne R. A comparison of bone tunnel measurements made using computed tomography and digital plain radiography after anterior cruciate ligament reconstruction. Arthroscopy 2004; 20(9): 946‒50.
Jo H, Jun DS, Lee DY, Lee SH, Seong SC, Lee MC. Tibial tunnel area changes following arthroscopic anterior cruciate ligament reconstructions with autogenous patellar tendon graft. Knee Surg Sports Traumatol Arthrosc 2004; 12(4): 311‒16.