Yavuz KOCABEY, Ömer TAŞER, Mahmut Nedim DORAL, MEHMET SELAHATTİN DEMİRHAN, Erdem Uğur IŞIKAN, John NYLAND, Sarban SEZGİN, David CABORN, M. Emin SÜNBÜLOĞLU

Ön çapraz bağ rekonstrüksiyonunda tendon greftinin yumuşak doku interferans vidası ile tibial tünelde öne veya arkaya tespitinin biyomekanik etkisi

Amaç: Ön çapraz bağ (ÖÇB) rekonstrüksiyonunda kullanılan yumuşak doku tendon greftinin tibial tünelde, yumuşak doku interferans vidası ile öne veya arkaya tespitinin biyomekanik etkileri araştırıldı. Çalışma planı: On iki adet dana tibiası ve dana ekstansör digitorum süperfisialis tendonu, yumuşak dokulardan temizlenerek altışarlı homojen iki gruba ayrıldı. Hazırlanan tendonlar, tibialarda açılan tünellere 9x30 mm’lik yumuşak doku interferans vidası ile tespit edildi. Tibial tüneldeki tespit, greftin anatomik olmayan (eklemden uzak) pozisyonda önüne (n=6, grup I) veya arkasına (n=6, grup II) uygulandı. Tüm örneklere, Servo-Hidrolik makinede önce 500 defa 50-250 N arasında değişen sinüzoidal kuvvetle 1 Hz frekansta tekrarlı yük verildi, sonra en yüksek dayanma kuvvetinin (load to failure) belirlenmesi için 20 mm/dak hızla gerilme testi uygulandı. Sonuçlar: Ortalama vida ilerleme torku I. ve II. grupta sırasıyla 8.2±2.4 Nm ve 8.4±2.8 Nm bulundu (p=0.88). Tekrarlayıcı yüklenme testi uygulandıktan sonra, iki grup arasında greftlerde yer değiştirme (1.9±0.8 mm ve 2.3±0.4 mm; p=0.38) ve sertlik (132.7±10.9 N/mm ve 126.4±8.5 N/mm, p=0.98) açısından anlamlı farklılık görülmedi. Çıkarımlar: Ön çapraz bağ rekonstrüksiyonunda kullanılan yumuşak doku tendon greftinin interferans vidası ile tibial tünelde öne veya arkaya tespitinin biyomekanik açıdan farklı olmadığı sonucuna varıldı.

Anahtar Kelimeler:

Kemik yoğunluğu, Kemik vidaları, Sığır, Tendonlar, Ön çapraz bağ, Tibia, Biyomekanik

The effect of anterior or posterior tibial tunnel placement of a soft tissue graft with a soft tissue interference screw on fixation biomechanics

Objectives: We investigated the biomechanical characteristics of anterior or posterior tibial tunnel placement of the soft tissue graft with a soft tissue interference screw in anterior cruciate ligament (ACL) reconstruction. Methods: Twelve bovine tibiae and digital extensor tendons were divided into two homogeneously equal groups after they were stripped of all soft tissues. Tibial tunnels were prepared and digital extensor tendons were fixed at nonanatomic (apart from the joint) anterior (n=6, group I) or posterior (n=6, group II) tibial tunnel positions with a soft tissue metal interference screw, 9x30 mm in size. All the specimens were cycled 500 times from 50 to 250 N at 1 Hz frequency in a servo hydraulic test device, after which ultimate load-at-failure testing was performed at a rate of 20 mm/min. Results: The mean screw insertion torque values were 8.2±2.4 Nm and 8.4±2.8 Nm in groups I and II, respectively (p=0.88). No significant differences were found between the two groups with respect to graft displacement (1.9±0.8 mm vs 2.3±0.4 mm; p=0.38) and stiffness (132.7±10.9 N/mm vs 126.4±8.5 N/mm, p=0.98) at the end of cyclic loading. Conclusion: Our results show that the site of nonanatomic soft tissue graft fixation in the tibial tunnel (anterior or posterior) with a soft tissue interference screw do not affect the biomechanical parameters in ACL reconstruction.

Keywords:

Bone Density, Bone Screws, Cattle, Tendons, Anterior Cruciate Ligament, Tibia, Biomechanics,

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