Hayri Baran YOSMAOĞLU, Gül BALTACI, DEFNE KAYA, HAMZA ÖZER, Ahmet ATAY

Hamstring tendon grefti ile yapılan ön çapraz bağ cerrahisinde iki farklı tespit yönteminde fonksiyonel sonuçların karşılaştırılması

Amaç: Çalışmamızda Endobutton postfiksasyon ve femoral transfiksasyon yöntemleri kullanılarak ön çapraz bağ (ÖÇB) rekonstrüksiyonu yapılan kişilerin, alt ekstremite kas kuvveti, eklem pozisyon hissi ve diz stabilitesi sonuçlarını karşılaştırmayı amaçladık. Çalışma planı: Hamstring tendon grefti kullanılarak Endobutton postfiksasyon (n=20; ortalama yaş: 26.5) ve femoral transfiksasyon (n=20; ortalama yaş: 29.9) yöntemleri ile ameliyat edilmiş bireyler klinik ÖÇB rehabilitasyon programına alındı. Ameliyat sonrası 12. ayda izokinetik dinamometre ile kas testi yapılarak, kuadriseps ve hamstring kas kuvvetleri değerlendirildi. Diz eklemi pozisyon hissi kayıplarını belirlemek için bilgisayarlı koordinasyon ve propriosepsiyon testleri (Functional Squat System; Monitored Rehab System) yapıldı. Diz laksitesini belirlemek için ön çekmece testi, Kneelax 3 artrometre kullanılarak yapıldı. Bulgular: İki grup arasında hamstring ve kuadriseps kas kuvvetleri, konsantrik ve egzantrik motor koordinasyon ve ön tibial laksite parametrelerinde istatistiksel açıdan anlamlı bir fark bulunmadı (p>0.05). Çıkarımlar: Çalışmamız femoral transfiksasyon ve Endobutton postfiksasyon cerrahi tekniği ile ÖÇB rekonstrüksiyonu yapılan bireylerin ameliyat sonrası 1. yıl itibarıyla fonksiyonel sonuçları arasında istatistiksel açıdan anlamlı bir fark olmadığını göstermiştir. Ancak her iki grupta da hamstring-kuadriseps kas kuvveti, motor koordinasyon ve propriosepsiyon yetersizliği devam etmektedir. Bu yüzden nöromusküler egzersizler içeren rehabilitasyon programı ve takibin, cerrahi sonrası 1 yıldan az sürmeyecek şekilde devam etmesini tavsiye etmekteyiz.

Anahtar Kelimeler:

Tendonlar, Diz yaralanmaları, Kemik çivileri, Ön çapraz bağ, Ön çarpraz bağ onarımı, Hareket açıklığı, eklem, Tedavi sonucu

Comparison of functional outcomes of two anterior cruciate ligament reconstruction methods with hamstring tendon graft

Objective: The aim of this study was to compare the effects of Endobutton post-fixation and femoral (TransFix) transfixation in ACL reconstruction on lower extremity muscle strength, joint position sense, and knee stability. Methods: Subjects who had undergone ACL reconstruction with hamstring tendon using Endobutton post-fixation (n=20, mean age: 26.5 years) or femoral transfixation (n=20, mean age: 29.9 years) were recruited to an ACL rehabilitation program. Twelve months after surgery, quadriceps and hamstring torque values were recorded using an isokinetic dynamometer. Computerized coordination and proprioception tests (Functional Squat System; Monitored Rehab System) were performed to determine the deficits in joint position sense. The anterior translation test was performed using a Kneelax 3 arthrometer to determine knee laxity. Results: Side-to-side differences between groups for hamstring and quadriceps muscle strength, concentric and eccentric motor coordination and anterior tibial laxity were not significantly dif ferent (p>0.05). Conclusion: No statistically significant differences in functional outcome were found 1 year after the ACL reconstruction using Endobutton post-fixation and femoral transfixation with ham string tendon graft. Deficits in hamstring-quadriceps muscle strength, motor coordination and proprioception were still found in both groups. We therefore recommend that long-term follow up and rehabilitation including neuromuscular exercises should be continued for longer than one year after ACL reconstruction.

Keywords:

Tendons, Knee Injuries, Bone Nails, Anterior Cruciate Ligament, Anterior Cruciate Ligament Reconstruction, Range of Motion, Articular, Treatment Outcome,

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