Med Bull Sisli Etfal Hosp. 2020; 54(4): 475-482 | DOI: 10.14744/SEMB.2020.07752

Is Cyclic Exercise Performed before Tibial Fixation Effective on Grafts during Anterior Cruciate Ligament Reconstruction?

Burak Gunaydin¹, Yasar Mahsut Dincel¹, Abdulkadir Sari¹, Mehmet Umit Cetin¹, Cem Sever², Cagatay Tekin³, Melih Guney¹, Yavuz Kabukcuoðlu^1
1Department of Orthopaedics and Traumatology, Tekirdag Namik Kemal University Faculty of Medicine, Tekirdag, Turkey
²Department of Orthopaedics and Traumatology, Istanbul Sisli Kolan International Hospital, Istanbul, Turkey
³Department of Orthopaedics and Traumatology, Cizre State Hospital, Sirnak, Turkey

Objectives: The necessity of cyclic exercise to pre-stretch the autograft before tibial fixation during ACL reconstruction is unknown. In this study, we evaluated whether there was a statistically significant difference between the results of patients who underwent cyclic exercise by way of physical examinations, knee joint stability tests, and functional evaluation tests, compared with the patients who underwent ACL reconstructions with or without cyclic exercise.
Methods: Between March 2016 and May 2018, 59 patients with at least eight months’ follow-up of an ACL reconstruction were identified. Thirty patients (Group 1) who underwent cyclic exercise before tibial fixation and 29 patients (Group 2) who did not undergo cyclic exercise were evaluated and compared.
Results: The mean age of the patients in Group 1 and Group 2 was 25.9 (range, 18-36) years and 25.2 (range, 18-35) years, respectively. The mean follow-up period in Group 1 was 14.6 (range, 8-22) months and 13.5 months in Group 2 (range, 8-21 months).
The mean Lysholm scores of Group 1 and 2 were 95.1 (range, 83-100) and 87.1 (range, 78-100), respectively. The modified Cincinnati scores of Groups 1 and 2 were 28.7 (range, 24-30) and 26.2 (range, 21-30). The mean IKDC subjective knee evaluation scores in Groups 1 and 2 were 91.9 (range, 83-100) and 86.7 (range, 75-100). The mean thigh atrophy was 1.5 cm in Group 1 and 2.5 cm in Group 2. In Group 1, 23 patients jumped 85% of the distance compared with the intact side in the single-legged hop test, and 12 patients in Group 2 were able to hop this distance successfully.
Group 1 had statistically significantly better results in Lysholm activity scores, modified Cincinnati scores, IKDC subjective knee assessment scores, two-time IKDC activity scale results, comparison of thigh diameters, and single-legged hop tests (p<0.05). No significant difference was found in other examinations and tests.
Conclusion: Cyclic exercise during the operation had a positive effect on functional scores. We believe that cyclic exercise should be added to the operative procedure.

Keywords: Anterior cruciate ligament, arthroscopic reconstruction; cyclic exercise; functional knee scoring.

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Ön çapraz bað rekonstrüksiyonu sýrasýnda greftin tibial tesbit öncesi uygulanan siklik egzersizin etkinliði var mýdýr?

Burak Gunaydin¹, Yasar Mahsut Dincel¹, Abdulkadir Sari¹, Mehmet Umit Cetin¹, Cem Sever², Cagatay Tekin³, Melih Guney¹, Yavuz Kabukcuoðlu^1
1Tekirdað Namýk Kemal Üniversitesi Týp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalý, Tekirdað
²Ýstanbul Þiþli Kolan International Hospital Ortopedi ve Travmatoloji Kliniði, Ýstanbul
³Cizre Devlet Hastanesi Ortopedi ve Travmatoloji Kliniði, Þýrnak

Giriþ: ÖÇB rekonstruksiyonunda tibial fiksasyon öncesi gerilmemiþ otogreftin siklik egzersiz yaptýrýlarak gerdirilmesi gerekliliði bilinmemektedir. Çalýþmanýn amacý; ön çapraz bað yýrtýðý sonrasýnda tek band yöntemi ile bað rekonstruksiyonu yapýlan hastalarý retrospektif olarak deðerlendirilerek, siklik egzersiz uygulanan hastalar ile uygulanmayan hastalarda anlamlý bir fark olup olmadýðýný karþýlaþtýrmaktýr.
Gerec ve Yöntem: 2016–2018 yýllarý arasýnda ön çapraz bað tamiri uygulanan en az 8 ay takibi olan 59 hasta saptandý. Bu hastalardan ameliyatý sýrasýnda tibial tespit öncesi siklik egzersiz uygulanan 30 hasta (Grup 1) ile siklik egzersiz uygulanmayan 29 hasta (Grup 2) deðerlendirildi
Sonuçlar: Grup 1’in Lysholm skoru ortalamasý 95.1 (daðýlým 83–100), Grup 2’nin 87.1 (daðýlým 78–100) saptandý. Grup 1‘in Modifiye Cincinnati skoru ortalamasý 28.7 (24–30), iken Grup 2’nin 26.2 (21-30) saptandý. IKDC subjektif diz deðerlendirme formu skoru ortalamasý Grup 1’de 91,9 (daðýlým 83–100) iken Grup 2’de 86.7 (daðýlým 75–100) saptandý. Grup 1’ de ortalama uyluk atrofi deðeri 1.5 cm, Grup 2’de 2.68 cm saptandý. Grup 1‘de tek ayaðý üzerinde ileri atlama testinde saðlam tarafa göre %85 mesafenin üzerine 23 hasta atlarken, Grup 2 ‘de 11 hastanýn baþarýyla bu mesafeyi atlayabildiði saptandý.
Bu sonuçlara göre ÖÇB rekonstruksiyonu esnasýnda siklik egzersiz yapýlan hastalarýn klinik sonucu yapýlmayanlara göre anlamlý derece de farklýdýr
Çýkarýmlar: Ameliyat sýrasýnda greftin tibial tesbiti öncesi siklik egzersiz uygulanmasýnýn fonksiyel sonuçlar üzerine olumlu etkisi olduðu saptandý. Bu nedenle siklik egzersiz uygulamasýnýn ÖÇB tamiri yapýlan hastalarda ameliyat prosedürüne eklenmesi gerektiði kanýsýndayýz. (SETB-2020-02-019)

Anahtar Kelimeler: Ön çapraz bað, Siklik egzersiz, Artroskopik tamir, Dizin fonksiyonel skorlamasý

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