PURPOSE OF THE STUDY: The aim of the study is to present a comparison of short-term results of double- versus single-bundle anatomical reconstruction of the anterior cruciate ligament (ACL) using hamstring endons and their fixation with absorbable interference screws. MATERIAL AND METHODS: A total of 110 patients with an isolated ACL lesion and the healthy contralateral knee who met the indication criteria for ACL double bundle reconstruction (TISL, 14 mm; ICNW, 12 mm) were intra-operatively allocated at random to either double-bundle group (DB, n=55) or single-bundle group (SB, n=55). At 12 months after surgery, 97 patients (DB group, n=49; SB group, n=48), comprising 68 men and 29 women, were evaluated; the average age was 29.1 years and the injury-to-surgery interval was 15.9 weeks. Pre- and post-operative subjective criteria involved the IKDC and Lysholm score. Objectively, the occurrence of graft failure, range of motion deficit, return to pre-injury sports activity, side-to-side difference in anterior laxity of both knees in 20° flexion on a GNRB laximeter at an applied pressure of 124 N and 250 N, and pivot shift phenomenon were assessed. RESULTS: No statistically significant difference was found in pre-operative values between the two groups. Post-operatively, there were no significant differences in the occurrence of complete graft failure (p=0.0755; DB group, n=0; SB group, n=3), range-of-motion deficit (p=0.2277-0.9788) or return to pre-operative sports activity (p=0.2322). In the DB group, side-to-side anterior tibial shifts at a pressure of 124 N (medians=1.3 mm and 2.1 mm for DB and SB groups, respectively; p=0.0007) and at a pressure of 250 N (DB group =2.1 mm; SB group = 3.1 mm; p<0.0001) were significantly different from the corresponding values in the SB group. Positive results for the pivot shift test (PST) were significantly less frequent in the DB than the SB group (Chi-square test =0.0112). The SB group patients had a 2.9-times (odds ratio, 2.8704) higher risk of positive postoperative PST results than the DB group patients. In both groups, a comparison of pre- and post-operative criteria showed significant improvement in both the subjective and the objective results. DISCUSSION: The results of this study, in accordance with other authors' conclusions, suggest that the double-bundle technique provides better control over rotational and anterior knee laxity and therefore restores knee biomechanics better. However, other literature data do not confirm any significantly better outcomes of this method. Since only short-term results have been obtained so far, the study will continue because only the long-term results can provide conclusive evidence of an advantage of one technique over the other. CONCLUSIONS: Our study showed significantly better restoration of knee rotational and anterior laxity in the patients undergoing anatomical reconstruction of the ACL by the double-bundle technique. The other evaluated criteria did not differ in relation to the technique used.
- MeSH
- biomechanika MeSH
- dospělí MeSH
- kolenní kloub chirurgie MeSH
- lidé MeSH
- ligamentum cruciatum anterius MeSH
- nestabilita kloubu * diagnóza etiologie MeSH
- pooperační komplikace diagnóza MeSH
- poranění předního zkříženého vazu MeSH
- rekonstrukce předního zkříženého vazu * škodlivé účinky přístrojové vybavení metody MeSH
- rozsah kloubních pohybů MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
Cílem studie bylo zjistit, zda větší pevnosti vazby a klinické úspěšnosti ortodontických adhezivních systémů není dosaženo na úkor poškození skloviny po sejmutí zámku a delšího času potřebného k odstranění adheziva z povrchu skloviny. In vltro studie byla provedena na 62 extrahovaných premolárech. Byl srovnáván skloionoměrní cement GO Fuji Ortho a světlem tuhnoucí kompozitní pryskyřice Transbond XT ve spojení se zámky Discovery. Mikroskopicky byl hodnocen charakter povrchu skloviny na počátku experimentu a po sejmutí zámku a odstranení zbytku adheziva poté, co byl stanoven index ARI. Ve skupině Transbond XT zůstávalo více adheziva na povrchu skloviny (ANOVA, p < 0,0001), jeho odstranění trvalo déle než u GO Fuji Ortho (ANOVA, p < 0,0001). K vyhlazení perikymat docházelo častěji u Transbondu XT (chí-kvadrát test, p < 0,05), další významný rozdíl v poškození skloviny mezi oběma adhezivními systémy nebyl nalezen. Nárůst indexu prasklin koreloval pouze s dobou odstraňování adheziva z povrchu zubu (multiple regression, p < 0,0001). Mikroskopicky nebyl prokázán rozdíl ve výskytu vytržených prizmat skloviny ani v počtu zubů poškozených rotačním nástrojem.
The aim of the study was to find out whether better hardness and resistance of orthodontic bond systems, together with clinical success, is not paid for by damage to enamel after the bracket removal, and by longer time required to remove an adhesive material from the enamel surface. The study in vitro worked with 62 extracted premolars. The main task was to compare the glass ionomer cement GO Fuji Ortho with the light-cured composite resin Transbond XT applied together with Discovery brackets. Enamel surface was evaluated with a microscope, at the beginning of the experiment, and then after the bracket and residual adhesive were removed (after the API index was stated). In Transbond XT group there was greater amount of the adhesive left on the enamel surface (ANOVA, p < 0.0001), the removal of the adhesive took more time than in GO Fuji Ortho (ANOVA, p < 0.0001). Perikymata wearing was more frequent in Transbond XT (chi-quadrat test, p<0.05). Another significant difference in terms of enamel damage was not found. API index increase correlated only with the time required for the removal of the adhesive from a tooth surface (multiple regression, p < 0.0001). Microscopic examination did not prove a difference in the prevalence of damaged enamel prisms or in the number of teeth damaged due to the use of dental burs.
