20 GODINA NAKON REKONSTRUKCIJE STRAŽNJE UKRIŽENE SVEZE UMJETNIM LIGAMENTOM GORE-TEX: PRIKAZ SLUČAJA

Prije dvadesetak godina u Klinici za ortopediju ugrađivali smo umjetne ligamente, i to tip proteze ligamenta Gore-Tex (razgranati polytetrafluoroethylen) kao postupak spašavanja nestabilnih koljena. U 13 bolesnika koristili smo protezu ligamenta Gore-Tex za rekonstrukciju stražnje ukrižene sveze (engl. posterior cruciate ligament PCL). U pacijenta F. K. imali smo priliku nakon 20 godina od izvršene rekonstrukcije PCL-a izvršiti kliničku, artroskopsku, magnetskorezonantsku (MRI) i patohistološku evaluaciju. Zbog artrotskih promjena u koljenu u bolesnika je bilo potrebno izvršiti artroskopsku toaletu koljena. Tom prilikom se izvršila i artroskopska evaluacija ugradene proteze ligamenta Gore-Tex te se napravila biopsija za patohistološku analizu (PHD). Prethodno je napravljen MRI koji je pokazivao uredan kontinuitet i volumen PCLa uz uznapredovale artrotske promjene koljena. Nalaz MRI bio je sukladan kliničkom nalazu koji je pokazivao dobru stabilnost koljena. Tijekom artroskopije uz standardne ulaze koristio se i posteromedijalni ulaz radi boljeg prikazivanja PCL-a. Artroskopija je pokazala da je proteza ligamenta Gore-Tex u cijelosti obložena zadebljanom sinovijalnom membranom odnosno fibrozom, a kada se na jednom mjestu odstranila sinovijalna membrana vidjele su se karakteristične polytetrafluoroethylenske niti u kontinuitetu. Probatornom sondom dokazao se kontinuitet PCL-a, a potom se uzelo nekoliko komadića ovojnice umjetnog ligamenta za PHD. Isto tako uzelo se i nekoliko komadića sinovijalne membrane iz drugih dijelova koljena. Patohistološki nalaz je pokazao da nema upalne reakcije u sinovijalnoj membrani koljena, a u ovojnici proteze ligamenta Gore-Tex našlo se zrelo vezivno tkivo s prisustvom multinuklearnih orijaških stanica uz fragmente stranog polarizirajuceg materijala. Ovaj prikaz slučaja pokazuje dobru biokompaktibilnost te dobru stabilnost koljena nakon 20 godina od ugradnje proteze ligamenta Gore-Tex u bolesnika s izrazito nestabilnim koljenom. Zanimlj
Twenty years ago the Gore-Tex expanded polytetrafluoroethylene (PTFE) prosthetic ligament was used as feasible salvage procedure in patients with failed, multiply operated knees, or knees with gross instability. At the Department of Orthopaedic Surgery we operated 13 patients and replaced the posterior cruciate ligament (PCL) with the Gore-Tex prosthetic ligament. Recently we had opportunity to evaluate clinical, arthroscopic, magnetic resonance imagining (MRI) and patohystologic (PH) findings in patient F. K. twenty years after the reconstruction. Due to osteoarthritic changes arthroscopic toilette of the knee was performed. On that occasion arthroscopic evaluation and biopsies for microscopic examination were carried out. MRI performed prior to arthroscopy revealed tidy continuity and volume of PCL with advanced arthritic changes of knee. MRI findings were consistent to clinical findings of good knee stability. Arthroscopy revealed the Gore-Tex prosthetic ligament completely coated with thicken synovial membrane i.e. fibrosis. Partial removal of the synovial membrane showed continuity of characteristic PTFE strands. The continuity of PCL was established by the probe. After that, few pieces of synovial membrane from sheath of PCL and from other parts of synovial membrane of the knee were taken. One PTFP strand of artificial PCL was collected as well. Patohystological findings clearly excluded inflammatory reaction in synovial membrane of the knee. Furthermore, synovial membrane of Gore-Tex prosthetic ligament sheath was found to contain mature fibrotic tissue with multinuclear giant cells and fragments of foreign polarizing material. This case report demonstrated good biocompatibility and good knee stability twenty years after replacement of the PCL with the Gore-Tex prosthetic ligament in patient with gross instability. It is interesting to mention that there was no deterioration of PTFE strands.