Reconstruction of the anterior cruciate ligament against the backdrop of gonarthrosis
Keywords:knee joint, osteoarthritis, plastic of the anterior cruciate ligament, corrective osteotomy
Objective: To develop techniques for differential selection of indications for surgical treatment of anterior knee instability on the backdrop of osteoarthritis (OA). Methods: long-term outcomes were analyzed in 149 patients (86 men, 63 women) aged 36–63 years with knee OA which operated from 2 to 12 years ago. We assessed a stage of OA, medial tibial angle, tibial slope, area and extent of the cartilage damage, and a degree of joint space narrowing. Results: tactic of choice for surgical treatment in patients with injuries of the anterior crucial ligament (ACL) on the backdrop of gonarthrosis I–II stages was defined. Generally indications enunciated in patients up to 55 years. Plastic of the ACL on the backdrop of gonarthrosis in patients with a body mass index over 30 remains a subject of debate. The tendency for better results was observed in men. In patients aged up to 60 years without varus deformity in case of presence of an articular cartilage damage one may perform plastic of the ACL with predictable good outcomes. In case of damage of the articular cartilage III–IV stages up to 4 cm2 one may perform chondroplasty or substitution of the defect. Varus deformity or large cartilage defects more than 4 cm2 is an indication for the simultaneous reconstruction of the ACL and valgization osteotomy. If in patients with varus deformity and damage of the ACL there is big tibial slope (11º or more) it is necessary to make a correction of varus deformity and to reduce a tibial slop. Conclusions: Chronic anterior instability leads to deterioration of cartilage in the medial part. Restoration of stability of the knee joint due to plastic of the ACL and change of geometry in the frontal and sagittal planes through valgization and reducing of a tibial slope facilitate reducing of mechanical loading on the graft cartilage and slower abrasion of the cartilage. Issues arising in cases of reconstruction of the ACL against the backdrop of gonarthrosis remain unsolved and proposed criteria are controversial.
Grigorovski V. V. Hystipathology and correlations of morphological indexes of the of autological tendon grafts of anterior cruciate ligaments for patients with recurrence knee instability / V. V. Grigorovski, S. S. Strafun, S. V. Bogdan// Orthopedics, Traumatology and Prosthetics. — 2013. — № 2. —P. 34–34.
Electromyograpy in diagnostic and treatment of recurrences of anteromedial knee instability /S. S. Strafun, R. O. Sergiyenko, O. S. Strafun et al. //Trauma . — 2012. — Vol. 13, № 3. — P. 64–68.
To the question of predicting the results of high corrective tibial osteotomy / N. A. Korzh, M. L. Golovakha,V. A. Filippenko et al. // Orthopedics, Traumatology and Prosthetics. — 2009. — № 4. —P. 5–9. doi: http://dx.doi.org/10.15674/0030-5987200945-9
Predicting of the knee cartilage treatment / N. A. Korzh, M.L. Golovakha, E. Agaev, W. Orljanski // Orthopedics, Traumatology and Prosthetics.— 2010. — № 4. —P.24–31. doi: http://dx.doi.org/10.15674/0030-59872010424-31
Results of conservative treatment knee ligaments injuries /V. G. Klimovitskiy, A. A. Tyazhelov, L. D. Goncharova, R. A. Shchikota // Trauma. — 2012. — Vol. 13, № 1. — P. 79–82.
Simulation of results of the knee ligaments injuries/ M. Yu. Karpinski, E. D. Karpinska, R. A. Shchikota et al.//Trauma — 2012. — Vol. 13, № 3. — P. , 1645–1171.
Comparative analysis of long term results of high tibial osteotomy and monocondillar knee replacement in medial knee osteoarthritis /M. L. Golovakha, I. V. Shyshka, O. V. Banit et al. // Orthopedics, Traumatology and Prosthetics. — 2013. — №1. —P. 20–24.
Strafun S. S. Treatment results predicting in patients with anterolateral knee instability / S. S. Strafun, R. O. Sergiyenko, O. S. Strafun, S. V. Bogdan // Orthopedics, Traumatology and Prosthetics. — 2012. — № 2. —P. 64–67.
A comparison between a retrograde interference screw, suture button, and combine fixation on the tibial side in all-inside an¬terior cruciate ligament reconstruction: a biomechanical study in a porcine model / M. P. Walsh, C. A. Wijdicks, J. B. Parker [et al.] // Am. J. Sport Med. — 2009. — Vol. 37. — P. 160–167. doi: 10.1177/0363546508323747.
Atlas of individual radiographic feature sin osteoarthritis / R. D. Itman, M. Hochberg, W. A. Murphy Jr. [et al.] // Osteo¬arthritis Cartilage. — 1995. — Vol. 3, Suppl A. — Р. 3–70.
Baer G. S. Clinical outcomes of allograft versus autograft in anterior cruciate ligament reconstruction / G. S. Baer, C. D. Harner // Clin. Sports Med. — 2007. — Vol. 26. — P. 661–681.
Heijne A. A 2-years follow-up of rehabilitation after ACL re¬construction using patellar tendon or hamstring tendon grafts: a prospective randomized study / A. Heijne, S. Werner // Knee Surg. Sports. Traumatol. Arthrosc. — 2010. — Vol. 18. — P. 805–813. doi: 10.1007/s00167-009-0961-3.
Long-term follw-up of ACL reconstruction with hamstring autograft / J. R. S. Leiter, R. Gourlay, S. McRae [et al.] // Knee Surg. Sports. Traumatol. Arthrosc. — 2014. — Vol. 22. — P. 1061–1069. doi: 10.1007/s00167-013-2466-3.
Papalia R. The anterior cruciate ligament remnant: to leave it or not? / R. Papalia, N. Maffulli, V. Denaro // Arthroscopy. — 2013. — Vol. 29, № 11. — P. 1736–1737. doi: 10.1016/j.arthro.2013.08.019.
Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults / N. G. Mohtadi, D. S. Chan, K. N. Dainty [at al.] // Cochrane Database Syst Rew. — 2011. — Vol. 9. doi:10.1002/14651858.CD005960.
Return to sports after arthroscopic anterior stabilization in pa¬tients aged younger than 25 years / B. Y. Ozturk, T. G. Maak, P. Fabricant [et al.] // Arthroscopy. — 2013. — Vol. 29 (12). — P. 1922–1931. doi: 10.1016/j.arthro.2013.09.008.
Schindler O. S. Surgery of anterior cruciate ligament defi¬ciency: a historical perspective / O. S. Schindler // Knee Surg. Sports. Traumatol. Arthrosc. — 2012. — Vol. 20. — P. 5–47. doi: 10.1007/s00167-011-1756-x.
The concept of individualized anatomic anterior cruciate ligament (ACL) reconstruction / M. Hofbauer, B. Muller, C. D. Murawski [et al.] // Knee Surg. Sports. Traumatol. Arthrosc. — 2014. — Vol. 22. — P. 979–986. doi: 10.1007/s00167-013-2562-4.
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