KẾT QUẢ PHẪU THUẬT NỘI SOI ĐIỀU TRỊ ĐỨT DÂY CHẰNG CHÉO TRƯỚC CÓ SỬ DỤNG VẬT LIỆU HỖ TRỢ BÊN TRONG

Mục tiêu của nghiên cứu nhằm đánh giá kết quả phẫu thuật nội soi điều trị đứt dây chằng chéo trước có sử dụng vật liệu hỗ trợbên trong. Thiết kế nghiên cứu can thiệp lâm sàng không đối chứng trên 31 bệnh nhân được chẩn đoán đứt dây chằng chéo trước và được phẫu thuật nội soi điều trị bằng nẹp hỗ trợ bên trong (internal brace)tại Bệnh viện Đại học Y Hà Nội và Bệnh viện Đa khoa Saint Paul, từ tháng 01/2019 đến tháng 12/2020. Kết quả cho thấy tuổi trung bình là 29,87 ± 7,9; tỷ số nam/nữ = 4,2; Thời gian phẫu thuật trung bình là là 102,3 ± 15,5 phút, thời gian nằm viện trung bình là 6,0 ± 1,0 ngày.Thang điểm Lysholm trước phẫu thuật trung bình là 60,2 ± 3,7.Sau phẫu thuật 6 tháng, giá trị trung bình của điểm Lysholm được cải thiện tốt (91,2±11,7);tỷ lệ đạt kết quả tốt và rất tốt (87,1%). Điểm mức độ hoạt động Tegner trung bình trước chấn thương là6,3±0,6 (dao động từ 5-7); trước phẫu thuật là 3,3±1,1 (dao động từ 1-5). Tại thời điểm sáu tháng sau phẫu thuật, giá trị trung bình của điểm này là 5,0±1,2 (dao động từ 2-7). Phẫu thuật nội soi điều trị đứt dây chằng chéo trước có sử dụng vật liệu hỗ trợ bên trong cho kết quả rất khả quan.

Repair of Acute Patellar Tendon Rupture Using an Internal Brace Technique

Acute patellar tendon rupture is a serious injury, resulting in the disruption of the knee extensor mechanism. Many authors recommend augmented repairs of patellar tendon ruptures to allow early active rehabilitation. An internal brace technique, which is a ligament augmentation using high-strength suture tape and knotless anchors, has been used as augmentation for the primary tendon or ligament injury. A case of acute patellar tendon rupture in a Judo player, who was successfully treated with primary repair and augmentation using an internal brace technique, is presented. In this case, the patient regained full function of the knee and returned to full sports activities postoperatively. An internal brace technique provides biomechanical stability of the repaired tendon without donor site morbidity and could be an effective procedure for the treatment of acute patellar tendon rupture.

Manual Lachman Test Underestimates Tibial Translation Compared to Standardized Generated Force: A Biomechanical Study of Cadaveric Anterior Cruciate Ligament Repair Using Internal Brace (205)

Objectives: With an increasing incidence over time, anterior cruciate ligament (ACL) rupture can produce functionally limiting knee instability that requires operative treatment to address the instability as well as prevent the development of osteoarthritis. Anteroposterior instability forms the basis of the most sensitive physical exam maneuver to examine the ACL for rupture, the Lachman test. This investigation has two goals: to assess the precision and accuracy of the manual Lachman test by comparing anterior tibial translation generated to that of a standardized applied force Lachman test, and to compare the anteroposterior stability of cadaver specimens with simulated ACL ruptures which were repaired with and without internal suture tape augmentation. Methods: The tibial plateau in ten cadaveric knees was divided into medial, middle and lateral reference points, which were monitored digitally during testing using Optotrak. Intact knees were subjected to both manual Lachman tests at 30 degrees of flexion and standardized 150N force Lachman tests utilizing a hook and pulley system with force transducer. The ACL’s of all specimens were then transected, and the ACL deficient knees were subjected to both the manual and standardized Lachman tests. The specimens were then randomly divided into two groups to be repaired with or without internal suture tape augmentation, and subsequently underwent 100, 250, and 500 cycles from 90 degrees of flexion through full extension with a frequency of .1Hz, after which the same standardized Lachman test was performed on all repaired specimens. Comparison of variances were made using a two-sample F-Test for variances. Comparison of means were made using a two sample t-test assuming unequal variances and one-way ANOVA. Significance was set at p </= 0.05. Results: Comparing ACL intact to ACL deficient states, the standardized Lachman test detected a significant difference in tibial translation at the medial (14.1mm versus 20.3mm, p=.031), middle (17.5mm versus 24.6mm, p=.011), and lateral (14.8mm versus 21.5mm, p=.050) reference points while the manual Lachman test only detected a significant difference at the middle (12.6mm versus 19.8mm, p=.026) reference point. In ACL deficient knees, there was a statistically significant underestimation in tibial translation when using the manual method as compared to the standardized method (17.4mm versus 22.3mm, p=0.046). When comparing the precision of the testing methods, F-Tests for variance did not yield significant differences between variances in measured tibial translation for the manual and standardized Lachman tests in either intact or ACL deficient knees. There were no statistically significant differences in measured tibial translation between specimens with intact ACL, ACL repair, and ACL repair with internal brace at the medial (14.1mm versus 13.7mm versus 16.45mm, p=0.462), middle (17.5mm versus 16.6mm versus 18.3mm, p=0.767), lateral (14.8mm versus 15.9mm versus 15.9mm, p=0.934), or call (15.5mm versus 15.2mm versus 16.9mm, p=0.748) reference points. Conclusions: Tibial translation generated by Lachman tests performed manually may be underestimated when compared to Lachman tests performed with a standard force, lending to difficulty detecting the ACL deficient state. ACL repair both with and without internal brace augmentation allowed for a return to pre-rupture levels of anteroposterior stability.

Patient-Reported Outcomes Following Multi-Ligament Knee Injuries With or Without Internal Brace Augmentation and the Role of Patient Access to Rehabilitation (174)

Objectives: (1) To compare the postoperative outcomes in patient who underwent multifilament knee reconstruction (MLKR) with or without internal brace augmentation and (2) To examine potential differences in outcomes of patients with different access to postoperative rehabilitation following MLKR. Methods: Adult patients sustaining a multifilament knee injury (MLKI) from 2007 to 2020 who were surgically treated by a single surgeon were retrospectively identified and invited to participate. Patients with incomplete follow up data were excluded. Data recorded included patient demographics, intraoperative procedure performed (with versus without use of internal brace), patient access to rehabilitation after surgery (limited versus full access) and postoperative patient reported outcomes. The last included the Multiligament Quality of Life Questionnaire (MLQOL), PROMIS Computer Adaptive Testing (CAT) for Physical Function, Mobility, and Pain Interference, and the Lysholm Knee Questionnaire. Descriptive statistics were conducted using STATA. Comparison of the postoperative outcomes was performed between patients who received or did not receive internal brace during MLKR and those who had limited versus full access to postoperative rehabilitation, using descriptive statistics (STATA). The level of statistical significance was set at <0.05. Results: A total of 85 (15 females,70 males) patients met the inclusion criteria. Of those, 62 patients (13 females, 49 males underwent MLKR without internal brace augmentation (NIB group) and 23 patients (2 females, 11 males) underwent MLKR with internal brace augmentation (IB group). Patient age and BMI were similar between the IB and NIB groups (Table 1). The mean follow-up time was 5.2+/-0.6 years on the NIB group and 1.5+/-0.1 years in the IB group (p<0.0001). The comparison of baseline characteristics and postoperative outcomes in MLKR patients in the NIB and IB groups is shown in Table 1. There was no difference in any of the postoperative outcome scores between patients in the NIB and IB groups who underwent MLKR. Access to rehabilitation data were available for 83 patients. Of those, 69 patients (12 females, 57 males) had full access to rehabilitation and 17 patients (3 females, 14 males) had limited access to postoperative rehabilitation. The mean follow- up time was similar between patients with versus limited access to rehabilitation (mean time was 2.6 years and 2.2 years respectively, p=0.96). The baseline patient characteristics were similar between the last two subgroups. However, patients with limited access to postoperative rehabilitation had significantly lower PROMIS Pain (p=0.018) and PROMIS Physical Function (p=0.025) scores compared to patients with full access to rehabilitation. The comparison of baseline characteristics and postoperative outcomes in MLKR patients with limited versus full access to postoperative rehabilitation is presented in Table 2. Conclusions: Internal bracing augmentation did not result in significant improvement of postoperative outcomes in patients undergoing MLKR, compared to the traditional technique without the use of internal brace, at short-term follow up. Postoperative rehabilitation is critical in patients who undergo MLKR, as patients with limited access to may experience worse outcomes at short term follow up in comparison to those who have full access to rehabilitation services. The socioeconomic status of the MLKR candidates should be examined preoperatively, and efforts should be made to grant these patients access to postoperative rehabilitation in order to optimize their clinical outcomes.