Traumatology and Orthopedics of RussiaTraumatology and Orthopedics of RussiaТравматология и ортопедия России2311-29052542-0933Vreden National Medical Research Center of Traumatology and Orthopedics1760610.17816/2311-2905-17606CLINICAL STUDIESКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯClinical studiesResearch ArticleСhanges in the donor site following bone-patellar tendon-bone graft harvesting with open or closed defectsИзменения в донорской зоне после забора трансплантата из связки надколенника с оставлением или закрытием дефектовhttps://orcid.org/0000-0002-4442-583158503543200TrachukPavel A.ТрачукПавел Александрович
Russian Federation
trachukpav@gmail.comhttps://orcid.org/0009-0005-5457-00036505851107TrachukAleksandr P.ТрачукАлександр Павлович
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук

trachukalex@mail.ruhttps://orcid.org/0000-0002-4883-054358502787000BogopolskiyOleg E.БогопольскийОлег Евгеньевич
Russian Federation
9202211@gmail.comVreden National Medical Research Center of Traumatology and OrthopedicsФГБУ «Национальный медицинский исследовательский центр травматологии и ортопедии им. Р.Р. Вредена» Минздрава России111120241812202430460710209202418102024Copyright ©; 2024, Eco-VectorCopyright ©; 2024, Эко-ВекторCopyright ©; 2024,2024Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://journal.rniito.org/jour/article/view/17606

Background. The patellar tendon is frequently used as a graft source for anterior cruciate ligament reconstruction. The search of the factors that enhance the healing process of the donor site may contribute to improved anatomical and functional outcomes.

The aim of the study — to determine the features of the harvesting techniques for better donor site healing by examining postoperative changes in the patellar tendon following two different graft harvesting methods.

Methods. This study examined the condition of the patellar tendon after two methods of graft harvesting under the same early mobilization protocols. Group 1 (retrospective) enrolled 30 patients who underwent follow-up MRI at different times after surgery, during which ligamentous and bony defects were not closed. Group 2 (prospective) included 30 patients who received full-layer suturing of the patellar tendon and patellar and tibial bone defects plasty. Postoperatively, all patients underwent radiography and the Insall-Salvati ratio of their patellar position was evaluated. In Group 2, MRI was performed preoperatively and 12 months post-surgery, while CT scans were taken 1 day and 6 months post-surgery. MRI was utilized to measure the size and qualitatively assess the condition of the tendon, whereas bone defects were evaluated on CT scans.

Results. The Insall-Salvati ratio of patellar position was within the physiological norm and did not differ between the groups (M1 = 1.11; SD1 = 0.13 and M2 = 1.12; SD2 = 0.15; p = 0.955). In Group 2, after 12 months, the length of the tendon was 3.1% shorter (M = -1.4 mm; SD = 2.4 mm; p = 0.003). The width of the tendon in the upper third and middle third was slightly increased (M = 0.3 mm; SD = 2.4 mm; p = 0.502 and M = 0.5 mm; SD = 2.1 mm; p = 0.205), while in the lower third it was 2.7% larger (M = 0.7 mm; SD = 1.7 mm; p = 0.034). The thickness of the tendon increased by 55% (M = 2.4 mm; SD = 1.6 mm; p = 0.001). All patients in Group 1 exhibited persistent bony and ligamentous defects. In Group 2, six months after surgery, cancellous bone filled the defects and integrated with the bone bed; 12 months later, the tendon was healed, and its shape and size approximated preoperative parameters.

Conclusion. Full-layer suturing of the patellar tendon, reconstruction of defects using cancellous bone autograft, and early mobilization promote the healing of bone defects and restore the integrity, shape, and size of the tendon.

Актуальность. Связку надколенника часто используют как источник трансплантата для пластики передней крестообразной связки. Поиск факторов, повышающих качество заживления донорского дефекта, может способствовать улучшению анатомо-функциональных результатов.

Цель — на основании изучения послеоперационных изменений в связке надколенника после двух вариантов забора трансплантата определить особенности техники, обеспечивающие более полноценное заживление донорской зоны.

Материал и методы. Проведено исследование состояния связки надколенника после двух вариантов забора трансплантата в одинаковых условиях ранней мобилизации. В первую (ретроспективную) группу вошли 30 пациентов, которым в различные сроки после операции выполняли МРТ, связочные и костные дефекты не устраняли. Вторую (проспективную) группу составили 30 пациентов, у которых выполняли полнослойный шов связки и костную аутопластику дефектов. У всех пациентов выполняли рентгенографию и изучали индекс положения надколенника Insall – Salvati после операции. Во второй группе выполняли МРТ до операции и через 12 мес., КТ — через 1 день и 6 мес. после операции. По МРТ измеряли размеры и качественно оценивали состояние связки, по КТ — состояние костных дефектов.

Результаты. Рентгенологический индекс положения надколенника соответствовал физиологической норме и не отличался между группами (M1 = 1,11; SD1 = 0,13 и M2 = 1,12; SD2 = 0,15; p = 0,955). У пациентов второй группы через 12 мес. длина связки была меньше на 3,1% (M = -1,4 мм; SD = 2,4 мм; p = 0,003); ширина связки в верхней трети и в середине незначительно увеличивалась (M = 0,3 мм; SD = 2,4 мм; p = 0,502 и M = 0,5 мм; SD = 2,1 мм; p = 0,205), а в нижней трети она была больше на 2,7% (M = 0,7 мм; SD = 1,7 мм; p = 0,034); толщина связки возрастала на 55% (M = 2,4 мм; SD = 1,6 мм; p = 0,001). У всех пациентов первой группы имелись стойкие костные и связочные дефекты. Во второй группе через 6 мес. после операции губчатая кость заполняла дефекты и прирастала к стенкам, через 12 мес. связка становилась целостной, ее форма и размеры приближались к дооперационным показателям.

Заключение. Полнослойное сшивание связки надколенника, пластика дефектов губчатой аутокостью и ранняя мобилизация обеспечивают заживление костных дефектов и восстановление целостности, формы и размеров связки.

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