Ertogrul R, Varol A, Oc Y, Kilinc B E
Surp Pirgic Private Hospital, Orthopaedic Surgery and Traumatolohy Department, Istanbul, Turkey.
Silopi State Hospital, Orthopaedic Surgery and Traumatology Department, Sirnak, Turkey.
Acta Chir Orthop Traumatol Cech. 2021;88(1):58-62.
PURPOSE OF THE STUDY To compare the early clinical results of patients who had anterior cruciate ligament (ACL) reconstruction with peroneus longus allograft versus hamstring tendon autograft. MATERIAL AND METHODS Forty patients who underwent ACL reconstruction were included in the study. Patients were grouped by their graft preference. Lachman and Pivot-shift tests were performed to the patients. Laxity was measured by KT-1000 arthrometer test with 15, 20 and 30 pound power. The maximum force values of nonoperated knee and the operated knee were recorded with Cybex II isokinetic dynamometer (HUMAC) and compared to each other. International Knee Documentation Committee (IKDC) form, modified Lysholm and Cincinnati evaluation forms were compared between two groups. RESULTS Twenty patients included into peroneus longus allograft (Group 1) and 20 patients were included into hamstring autograft group (Group 2). The mean age of patients Group 1 and 2 were 34.25 ± 6.73, and 29.6 ± 4.55, respectively. No significant difference was noted between two groups at modified Lysholm, Cincinati and IKDC scores (p > 0.01). There was no statistically significant difference between the Lachman and Pivot hift levels (p > 0.01). No significant difference was found in KT-1000 device measurements between groups according to the performed techniques (p > 0.01). There was no statistically significant difference between Cybex extension-flexion 60 /sec measurement and extension 240 /sec measurement of the patients (p > 0.01). DISCUSSION Allografts can be preferred because of the advantages, such as lack of donor site morbidity, short operative time, large graft, small incision, minimal scar, good cosmetic appearance, less postoperative pain, less movement restriction, and less arthrofibrosis. However, there are disadvantages, such as disease transmission, low biocompatibility, immune response, long recovery time, and high cost. Although it is difficult to compare the stability and functionality of allografts and autografts because of the differences in graft processing, fixation methods, and surgical techniques in studies, similar clinical results are reported in long-term follow-ups CONCLUSIONS Graft preference is dependent on surgical experience, patient age, activity status, comorbidities, presurgical status, and patient decision. Allograft ACL reconstruction is a good alternative to arthroscopic ACL reconstruction performed with hamstring tendon graft. Key words: anterior cruciate ligament, peroneus longus allograft, hamstring autograft, ACL reconstruction.
研究目的 比较采用腓骨长肌同种异体移植物与腘绳肌腱自体移植物进行前交叉韧带(ACL)重建患者的早期临床结果。材料与方法 本研究纳入40例行ACL重建的患者。患者根据其移植物偏好分组。对患者进行Lachman试验和轴移试验。采用KT-1000关节测量仪以15磅、20磅和30磅的力量测量膝关节松弛度。使用Cybex II等速测力计(HUMAC)记录非手术侧膝关节和手术侧膝关节的最大力量值并进行比较。比较两组患者的国际膝关节文献委员会(IKDC)表格、改良Lysholm评分和辛辛那提评估表格。结果 20例患者纳入腓骨长肌同种异体移植物组(第1组),20例患者纳入腘绳肌自体移植物组(第2组)。第1组和第2组患者的平均年龄分别为34.25±6.73岁和29.6±4.55岁。在改良Lysholm评分、辛辛那提评分和IKDC评分方面,两组之间无显著差异(p>0.01)。Lachman试验和轴移试验水平之间无统计学显著差异(p>0.01)。根据所采用的技术,两组在KT-1000仪器测量方面无显著差异(p>0.01)。患者的Cybex屈伸60°/秒测量值与屈伸240°/秒测量值之间无统计学显著差异(p>0.01)。讨论 同种异体移植物具有一些优点,如无供区并发症、手术时间短、移植物大、切口小、瘢痕小、美观、术后疼痛轻、活动受限少和关节纤维化少等,因此可作为首选。然而,也存在一些缺点,如疾病传播、生物相容性低、免疫反应、恢复时间长和成本高等。尽管由于研究中移植物处理、固定方法和手术技术的差异,难以比较同种异体移植物和自体移植物的稳定性和功能,但长期随访报告显示临床结果相似。结论 移植物的选择取决于手术经验、患者年龄、活动状态、合并症、术前状态和患者的决定。同种异体ACL重建是采用腘绳肌腱移植物进行关节镜下ACL重建的良好替代方法。关键词:前交叉韧带;腓骨长肌同种异体移植物;腘绳肌自体移植物;ACL重建