Rekonstrukcija prednjeg ukrštenog ligamenta kolena primenom tetiva m.semitendinosus-a im.gracilis-a

Abstract

<p>The study has retrospective - prospective character. The first part of this study was experimental. Experimental investigations were carried out on porcine knee model. Fixation stench of different types of tendon grafts and fixations in bone tunel of tibia was determined. Investigatios were carried out on Department for Production Engineering (Laboratory of material investigations) ,Fa - culty of Technical Sciences, University of Novi Sad. Porcine knee model is used to predict chercteristics of graft/ fixation strench. On porcine knee model fixation strench was investigated: I.1 group -tendon graftprepared of porcine lower leg m.flexor digitorum tendon fixed by standard procedure in tibia. II.1 group -analo of KHK graft - prepared of porcine lower leg m.flexor digitorum tendon with fresh bone autotransplantate fixed to both ends of the graft, fixed by standard procedu - re in tibia bone tunel; III.1 grupa - analog of KHK graft - fixed by hybrid fixation procedure, with additional screw in tibia In III.1 group technical modification of hybrid graft fixation procedure in tibia is carried out. Technical modification of tendon graft hybrid fxation improved fixation strench of KHK graft in tibia ( fixation force increased of 700 N to 849 N). The second part of the study was the clinical trials of surgical patients. The examined group consisted of 90 patients of both sexes with an interruption anterior cruciate ligament of the left or right knee. The study included only those patients who gave signed informed consent to participate in the study, who met the criteria for inclusion and who had no exclusion criteria from the study. Each patient is thoroughly informed about the purpose of research, the manner of conducting examinations, procedures and measurements to be performed. Criteria for inclusion in the study included the following: that the patient was admitted to the Clinic for Orthopaedic Surgery and Traumatology, Clinical Center of Vojvodina in Novi Sad for the operative treatment interruption knee anterior cruciate ligament, that informed consent was signed by the switch to the age of 18 to 50 years. Criteria for exclusion of patients from the study were presence of associated injuries of lateral collateral ligament that requires surgical treatment, occurrence of severe general surgical complications, the patient wishes to be excluded from further investigation, without the obligation to explain its decision. Patients were divided in three groups (30 patients in group). Reconstruction of anterior cruciate ligament was carried out: I group - for reconstruction was used graft of m. semitendinosus and m. gracilis tendons (Hamstring tendons); II group- KHK- hamstrig tendon graft with fresh bone autotransplantate fixed to both ends of the graft, fixed by standard procedure in tibia; III-gro - up- KHK graft -fixed by hybrid fixation procedure, with additional screw in tibia. Evaluation of reconstruction clinical results was carried out by use of scor systems: KHK graft - fixed by hybrid fixation procedure, with additional screw in tibia .In the evaluation of re -construction results score system were used: Tegner score, Lysholm score, IKDC standard and Lachman test. Results show, that after reconstruction high level of activity and stability was obtained . Results of functional analysis show , the best results of reconstruction in III-group was obtained . Technical improvement of hybrid KHK-graft fixation in tibia, enabled the nearest reconstruction of ACL to the native ACL. In this case initial tension of graft is high and biological incorporation of graft in bo-ne tunel is fast, because bone autotransplantate fixed to both ends of the graft. Fixation strench is great because additional graft fixation in tibia.</p>