Оценка исходов артроскопической пластики передней крестообразной связки коленного сустава аутотрансплантатом из сухожилия четырехглавой мышцы бедра

Abstract

Purpose of the study: to study the macro and microscopic state of tendon grafts at various times after arthroscopic implantation for damage to the anterior cruciate ligament of the knee joint.Methods. Primary arthroscopic ACL repair with a quadriceps tendon graft was performed in 678 patients. In 496 observations, a graft with a bone block from the upper pole of the patella was used, in 182 observations, a tendon graft without a bone block was used. In 206 cases graft fixation was carried out intratunnel with metal interference screws, in 340 cases - with biodegradable screws, in 132 cases - with metal and biodegradable screws.In 47 cases, arthroscopic removal of metal screws was performed within a period of 5 months to 2.5 years from the date of surgery, which made it possible to arthroscopically and histologically study the nature of graft remodeling. The anatomical and biomechanical features of such plastic material are considered, indications and contraindications for surgery are determined. The advantages and disadvantages of various methods of graft fixation are presented, and specific complications when using bioabsorbable screws are described.Results. Based on 47 revision operations, an arthroscopic classification of the functional states of grafts at various times after surgery was developed. 6 types of grafts are presented with a detailed description of each of them. The state and quality of graft remodeling was histologically studied up to 2.5 years after surgery.Conclusions. Analysis of the clinical material allowed the authors to conclude that the quadriceps tendon graft is an excellent plastic material for both primary and revision reconstruction of the anterior cruciate ligament.Keywords: knee joint, arthroscopy, anterior cruciate ligament, arthroscopic reconstruction of the anterior cruciate ligament, autograft.