Reconstrução do ligamento cruzado anterior com uso do enxerto miotendinoso total: características clínicas e histológicas da manutenção do remanescente muscular dos tendões flexores
Data
2023-08-21
Autores
Funchal, Luis Fernando Zukanovich [UNIFESP]
Orientadores
Cohen, Moises [UNIFESP]
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: Características relacionadas ao enxerto utilizado na cirurgia de reconstrução do Ligamento Cruzado Anterior (LCA) são fatores importantes para o sucesso cirúrgico, nas questões mecânica e biológica. Objetivo: avaliar o diâmetro do enxerto, antes e após a retirada do remanescente muscular durante a reconstrução do ligamento cruzado anterior, assim como, as características histológicas do tecido muscular e tendinoso retirados, resultados clínicos funcionais e a qualidade da osteointegração. Método: Selecionados de março /20 a junho /21, 90 pacientes (média de 27 a) com lesão do LCA e cirurgia de reconstrução com flexores. Foram definidos dois grupos (G1) com a manutenção da musculatura aderia (enxerto miotendinoso total) com montagem, medida e anotação do diâmetro final e o (G2) com retirada da musculatura da forma habitual. Foram coletadas, 40 amostras dos tendões, para análise histológica. Realizamos imagem por RM seriada, aos 6, 12 e 24 meses, para avaliação da osteointegração. A análise clinica funcional segundo as escalas de Lysholm e Tegener. Resultados: No G1 conseguimos um aumento global de 11,87% no diâmetro comparativo. Foram encontrados importantes estruturas mecanorreceptoras nas amostras histológicas, além de diferentes tipos celulares relacionados à propriocepção e cicatrização. A RM magnética apresentou melhores resultados no G1 em 6 e 12 meses. O resultado funcional foi semelhante nos dois grupos. Conclusão: A técnica descrita é factível e apresenta vantagens mecânicas e biológicas, melhorando o diâmetro global dos enxertos e mantendo o potencial reparativo mais adequado, com melhores sinais na avaliação da RM e avaliação clínica semelhantes entre os dois grupos.
Introduction: The graft preparation technique used in ACL reconstruction surgery is an important factor for surgical success, both mechanically and biologically. Objective: To evaluate the diameter of the flexor tendon graft, before and after removal of the remaining muscle during reconstruction of the anterior cruciate ligament, as well as the histological characteristics of the muscle and tendon tissue removed, the functional clinical results and the quality of osseointegration. Method: March/20 to June/21, 90 healthy individuals (mean age 27 y) with ACL injury and surgical schedule for reconstruction with flexors were selected. We made the total myotendinous graft (G1) with assembly, measurement and note of the final diameter. Afterwards, we dismantled the system and performed a new confection, after the total removal of the musculature in the usual way (G2). During cleaning, 30 tendon samples (ST) and 10 (G) were collected for histological analysis. the patients underwent serial magnetic resonance imaging at 6, 12 and 24 months of follow-up to assess the osseointegration pattern. Functional clinical analysis was performed using the Lysholm and Tegener scales. Results: By maintaining the muscles over the tendon, we achieved an increase, on average, of 1.0 mm in the diameter of the femoral segment of the graft and 1.5 mm in the tibial part of the graft, in a global increase of 11.87% in the comparative diameter. Important biological stimulus factors were found in the histological samples, in addition to different cell types important for healing. Magnetic MRI showed better results in G1 at 6 and 12 months. The functional result was quite similar in both groups. Conclusion: This technique is adequate, feasible and presents possible advantages in its execution. It improves the global diameter of the grafts, maintains a more adequate biological potential, has better signs in the MRI evaluation, when using total myotendinous flexor tendons in ACL reconstruction.
Introduction: The graft preparation technique used in ACL reconstruction surgery is an important factor for surgical success, both mechanically and biologically. Objective: To evaluate the diameter of the flexor tendon graft, before and after removal of the remaining muscle during reconstruction of the anterior cruciate ligament, as well as the histological characteristics of the muscle and tendon tissue removed, the functional clinical results and the quality of osseointegration. Method: March/20 to June/21, 90 healthy individuals (mean age 27 y) with ACL injury and surgical schedule for reconstruction with flexors were selected. We made the total myotendinous graft (G1) with assembly, measurement and note of the final diameter. Afterwards, we dismantled the system and performed a new confection, after the total removal of the musculature in the usual way (G2). During cleaning, 30 tendon samples (ST) and 10 (G) were collected for histological analysis. the patients underwent serial magnetic resonance imaging at 6, 12 and 24 months of follow-up to assess the osseointegration pattern. Functional clinical analysis was performed using the Lysholm and Tegener scales. Results: By maintaining the muscles over the tendon, we achieved an increase, on average, of 1.0 mm in the diameter of the femoral segment of the graft and 1.5 mm in the tibial part of the graft, in a global increase of 11.87% in the comparative diameter. Important biological stimulus factors were found in the histological samples, in addition to different cell types important for healing. Magnetic MRI showed better results in G1 at 6 and 12 months. The functional result was quite similar in both groups. Conclusion: This technique is adequate, feasible and presents possible advantages in its execution. It improves the global diameter of the grafts, maintains a more adequate biological potential, has better signs in the MRI evaluation, when using total myotendinous flexor tendons in ACL reconstruction.