genortГений ортопедииGenij Ortopedii1028-44272542-131XЦЕНТР ИЛИЗАРОВА10.18019/1028-4427-2021-27-1-48-54genort-2600Research ArticleОригинальные статьиOriginal articlesКлиническая эффективность анатомической пластики передней крестообразной связки коленного суставаClinical evaluation of anatomical reconstruction of the anterior cruciate ligamentЗаяцВ. В.ZayatsV. V.

Заяц Виталий Викторович, к. м. н.,

г. Санкт-Петербург

Vitaliy V. Zayats, M.D., Ph.D.,

Saint Petersburg

zaiatc.vitalii@gmail.comДулаевА. К.DulaevA. K.

Дулаев Александр Кайсинович, д. м. н., профессор,

г. Санкт-Петербург

Alexander K. Dulaev, M.D., Ph.D., Professor,

Saint Petersburg

akdulaev@gmail.comДыдыкинА. В.DydykinA. V.

Дыдыкин Андрей Валерьевич, д. м. н., профессор, 

г. Санкт-Петербург

Andrey V. Dydykin, M.D., Ph.D., Professor,

Saint Petersburg

dydykinav@mail.ruУльянченкоИ. Н.UlyanchenkoI. N.

Ульянченко Иван Николаевич,

г. Санкт-Петербург

Ivan N. Ulyanchenko,

Saint Petersburg

yluanchenko@gmail.comФедеральное государственное бюджетное образовательное учреждение высшего образования «Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова» Министерства здравоохранения Российской ФедерацииРоссияPavlov First St. Petersburg State Medical UniversityRussian Federation202128022021271№ 1 (2021)4854Copyright © Заяц В.В., Дулаев А.К., Дыдыкин А.В., Ульянченко И.Н., 20212021Заяц В.В., Дулаев А.К., Дыдыкин А.В., Ульянченко И.Н.Zayats V.V., Dulaev A.K., Dydykin A.V., Ulyanchenko I.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ilizarov-journal.com/jour/article/view/2600Цель

Цель. В сравнительном аспекте оценить клиническую эффективность анатомической рПКС, а также определить ее перспективы для практического здравоохранения.

Материалы и методы

Материалы и методы. Наблюдали 706 пациентов, которым с 2010 по 2018 год выполнили артроскопическую рПКС с фиксацией трансплантатов интерферентными винтами. В 1 группу включили 396 пациентов после анатомической рПКС через ПМД, во 2 группу – 310 человек после изометрической транстибиальной рПКС. Результаты лечения оценивали клинически, рентгенологически и по шкалам 2000 IKDC (International Knee Documentation Committee), KOOS (Knee Injury and Osteoarthritis Outcome Score) и Tegner Lysholm. Клинико-экономические показатели включали продолжительность операции, периода реабилитации и нетрудоспособности, сроки восстановления спортивной активности.

Результаты

Результаты. Стабильность коленного сустава при оценке «переднего выдвижного ящика» оказалась одинаково высокой и достоверно не различимой. Тест Лахмана и pivot shift тест были значимо выше у пациентов 1 группы (p меньше 0,001). Во 2 группе чаще наблюдали контрактуры, атрофию мышц бедра (p меньше 0,05), синовиты (p меньше 0,01), а также вертикальное положение костных каналов трансплантата, равно как и патологическое расширение костных каналов («эффект стеклоочистителя» – p меньше 0,001). По шкале 2000 IKDC восстановление нормальной функции КС произошло в 91,3 % случаев, а патологические изменения в суставе (С) и грубые нарушения функции (D) в 1 группе наблюдали в 2,5 и 5 раз реже, чем во 2 группе (p меньше 0,05). Показатели «боль» и «патологические симптомы», спортивная активность по шкале KOSS у пациентов 1 группы были значимо выше (p меньше 0,05). Вместе с тем, у пациентов 1 группы требовалось больше времени для оперативного лечения (p меньше 0,05), а общий период реабилитации оказался короче (p меньше 0,05).

Заключение

Заключение. Анатомическая рПКС, в сравнении с транстибиальной пластикой, более надежная технология при достижении комплексной стабильности коленного сустава, позволяющая чаще правильно формировать костные каналы. Это защищает трансплантат от повреждения в отдаленном периоде, снижает вероятность болевого синдрома, синовитов, контрактур, атрофии мышц, а также сокращает сроки реабилитации, общей нетрудоспособности и возвращения к спорту.

Purpose

Purpose. Evaluate clinical effectiveness of anatomical reconstruction of the anterior cruciate ligament (ACL) and determine the perspectives for practical health care.

Material and methods

Material and methods. The review included 706 patients who underwent arthroscopic reconstruction of the ACL and graft interference screw fixation between 2010 and 2018. ACL reconstruction was performed using either anteromedial portal (n = 396, Group I) or an isometric transtibial tunnel technique (n = 310, Group II). Outcomes were evaluated clinically and radiographically using the 2000 International Knee Documentation Committee (2000 IKDC) Subjective Knee Evaluation Form, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Tegner Lysholm scoring scale. Clinical and economic outcome measures included surgical time, rehabilitation and disability periods and period of recovery for sports performance.

Results

Results. The knee anterior drawer test was equally negative and showed no significant differences in the groups. The Lachman test and the pivot shift test showed better results in Group I (p less 0.001). Contractures, atrophic femoral muscles (p less 0.05), synovitis (p less 0.01), vertical position of the femoral graft channels and pathologically extended bone channels with wind-wiper effect (p less 0.001) were more common among patients of Group II. Although knee function returned to normal, as rated with the 2000 IKDC Subjective Knee Evaluation Form, in 91.3 % of cases pathological changes in the knee (C) and severely impaired function (D) were 2.5 and 5 times less common in group I than in Group II (p less 0.05). Pain, symptoms and sport scores were significantly higher on the KOSS scale for Group I (p less 0.05). Surgical time was longer in patients of Group I (p less 0.05) who had shorter rehabilitation period (p less 0.05).

Conclusion

Conclusion. Anatomical reconstruction of ACL using anteromedial portal was shown to be a more reliable technique as compared to transtibial approach to ensure overall knee stability arranging adequate bone channels. The technique is capable to protect the graft from injury, reduce the likelihood of pain, synovitis, contractures, muscle atrophy, providing shorter rehabilitation, disability period and recovery for sport performance.

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Acta Orthop. Traumatol. Turc., 2015, vol. 49, no. 5, pp. 483-491. DOI: 10.3944/AOTT.2015.15.0016Zbrojkiewicz D., Vertullo C., Grayson J.E. Increasing rates of anterior cruciate ligament reconstruction in young Australians, 2000-2015 // Med. J. Aust. 2018. Vol. 208, No 8. P. 354-358. DOI: 10.5694/mja17.00974Zbrojkiewicz D., Vertullo C., Grayson J.E. Increasing rates of anterior cruciate ligament reconstruction in young Australians, 2000- 2015. Med. J. Aust., 2018, vol. 208, no. 8, pp. 354-358. DOI: 10.5694/mja17.00974Revision Anterior Cruciate Ligament Reconstruction After Primary Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction: A Case Series of 40 Patients / S.Y. So, D.W. Suh, S.S. Lee, E.Y. Jung, D.H. Ye, D. Ryu, K.B. Kwon, J.H. Wang // Arthroscopy. 2020. Vol. 36, No 2. P. 546- 555. DOI: 10.1016/j.arthro.2019.08.038So S.Y., Suh D.W., Lee S.S., Jung E.Y., Ye D.H., Ryu D., Kwon K.B., Wang J.H. Revision Anterior Cruciate Ligament Reconstruction After Primary Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction: A Case Series of 40 Patients. Arthroscopy, 2020, vol. 36, no. 2, pp. 546-555. DOI: 10.1016/j.arthro.2019.08.038

The authors declare that there are no conflicts of interest present.