Traumatology and Orthopedics of RussiaTraumatology and Orthopedics of RussiaТравматология и ортопедия России2311-29052542-0933Vreden National Medical Research Center of Traumatology and Orthopedics1741510.17816/2311-2905-17415CLINICAL STUDIESКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯClinical studiesResearch ArticleMid-term Results of a Single-Stage Revision Anterior Cruciate Ligament Reconstruction: A Retrospective Analysis of 36 CasesСреднесрочные результаты одноэтапной ревизионной реконструкции передней крестообразной связки: ретроспективный анализ 36 случаевhttps://orcid.org/0009-0000-3886-163XGoferAnton S.ГоферАнтон Серегеевич
Russian Federation
a.hofer.ortho@gmail.comhttps://orcid.org/0000-0003-3264-8146AlekperovAleksandr A.АлекперовАлександр Александрович
Russian Federation
alecperov@mail.ruhttps://orcid.org/0000-0002-6398-9413GurazhevMikhail B.ГуражевМихаил Борисович
Russian Federation
tashtagol@inbox.ruhttps://orcid.org/0009-0008-9147-5808AvdeevArtem K.АвдеевАртем Константинович
Russian Federation
avdeev.artiom@mail.ruhttps://orcid.org/0000-0002-3411-508XLukinovVitaliy L.ЛукиновВиталий Леонидович
Russian Federation

Cand. Sci. (Phys.-Mat.)

канд. физ.-мат. наук

vitaliy.lukinov@gmail.comhttps://orcid.org/0009-0007-1490-9783RubtsovDmitriy V.РубцовДмитрий Вячеславович
Russian Federation
rubic.dv@yandex.ruhttps://orcid.org/0000-0002-8997-7330PavlovVitalii V.ПавловВиталий Викторович
Russian Federation

Dr. Sci. (Med.)

д-р мед. наук

pavlovdoc@mail.ruTsivyan Novosibirsk Research Institute of Traumatology and OrthopaedicsФГБУ «Новосибирский научно-исследовательский институт травматологии и ортопедии им. Я.Л. Цивьяна» Минздрава России120320243103202430176882011202315012024Copyright ©; 2024, Eco-VectorCopyright ©; 2024, Эко-ВекторCopyright ©; 2024,2024Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://journal.rniito.org/jour/article/view/17415

Background. Revision anterior cruciate ligament reconstruction is becoming more and more common in the knee surgery due to the annual increase in the number of primary anterior cruciate ligament reconstructions. Choosing the most suitable graft and determining the staging of the surgical treatment by preoperative assessment of the possibility of performing the most anatomical revision canals and their interposition with the primary canals are the main factors that influence treatment results.

Aim of the study — comparative assessment of the results of using hamstring tendon and peroneus longus tendon autografts in a one-stage revision reconstruction of the anterior cruciate ligament.

Methods. A retrospective analysis of the medical records of 36 patients who underwent revision anterior cruciate ligament reconstruction was performed. The patients were divided into two groups: in the patients of the study group (n = 19) a peroneus longus tendon (PLT) autograft was used, in the comparison group (n = 17) a hamstring tendon autograft (HT) was applied. Subjective and objective evaluation using the KOOS, IKDC, and Lysholm scales was performed, and position of the central entry points of the primary and revision canals was determined.

There were no statistically significant differences in the objective assessment of the knee joint stability. Significantly better results of subjective assessment of the knee function according to the Lysholm and KOOS scales were obtained in the PLT group (p = 0.042 and p<0.001, respectively). Position of revision canals corresponded to the standard values, but position of the femoral canal had a slight cranial and anterior displacement. It was also found that the PLT graft diameter was statistically significantly larger than the HT graft diameter (p<0.001).

Results. There were no statistically significant differences in the objective assessment of the knee joint stability. Significantly better results of subjective assessment of the knee function according to the Lysholm and KOOS scales were obtained in the PLT group (p = 0.042 and p<0.001, respectively). Position of revision canals corresponded to the standard values, but position of the femoral canal had a slight cranial and anterior displacement. It was also found that the PLT graft diameter was statistically significantly larger than the HT graft diameter (p<0.001).

Conclusion. One-stage revision anterior cruciate ligament reconstruction is a safe and effective surgical procedure providing satisfactory objective and subjective clinical results. Use of peroneus longus tendon autograft allows to obtain better results in comparison with the hamstring tendon autograft.

Актуальность. Ревизионная реконструкция передней крестообразной связки становится все более распространенным оперативным вмешательством на коленном суставе ввиду ежегодного увеличения количества выполненных ее первичных реконструкций. Выбор оптимального трансплантата и определение этапности хирургического лечения с помощью предоперационной оценки возможности проведения максимально анатомичных ревизионных каналов и их взаиморасположения с первичными каналами являются основными факторами, которые влияют на результаты лечения.

Цель исследования — сравнительная оценка результатов применения аутотрансплантатов из сухожилий подколенных сгибателей голени и длинной малоберцовой мышцы при одноэтапной ревизионной реконструкции передней крестообразной связки.

Материал и методы. Проведен ретроспективный анализ медицинской документации 36 пациентов, которым была выполнена ревизионная реконструкция передней крестообразной связки. Пациенты были разделены на две группы: у пациентов группы исследования (n = 19) использовался аутотрансплантат из сухожилия длинной малоберцовой мышцы (PLT), в группе сравнения (n = 17) — трансплантат из сухожилий подколенных сгибателей голени (HT). Проводилась субъективная и объективная оценка по шкалам KOOS, IKDC и Lysholm, а также определялось положение центральных точек входа в первичные и ревизионные каналы.

Результаты. Статистически значимых различий при объективной оценке стабильности коленного сустава не выявлено. Лучшие результаты субъективной оценки функции КС по шкалам Lysholm и KOOS получены в группе PLT (p = 0,042 и p<0,001 соответственно). Положение ревизионных каналов соответствовало нормативным значениям, однако положение бедренного канала имело незначительное смещение краниально и кпереди. Также выявлено, что диаметр трансплантата PLT оказался статистически значимо больше значений диаметра трансплантата HT (p<0,001).

Заключение. Одноэтапная ревизионная реконструкция передней крестообразной связки является безопасным и эффективным оперативным вмешательством, обеспечивающим удовлетворительные объективные и субъективные клинические результаты. Применение аутотрансплантата из сухожилия длинной малоберцовой мышцы позволяет получить лучшие результаты по сравнению с трансплантатом из сухожилий подколенных сгибателей голени.

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