Öz
AMAÇ: Çalışmamız menisküs yırtığı mevcut olup artroskopik olarak menisküs tamiri uygulanan hastaların orta dönem takip sonuçlarının değerlendirilmesini amaçlamıştır.
YÖNTEMLER: Kliniğimizde ocak 2011– mart 2013 dönemi arasında hepsi içeride ve içeriden dışarıya dikiş tekniğiyle artroskopik menisküs tamiri ameliyatı uygulanan 46 hasta değerlendirildi. Bu hastalardan düzenli takibine devam eden 28 hastanın orta dönem sonuçları retrospektif olarak değerlendirildi. Çalışmamıza dahil edilen 13 hastanın (%46) menisküs yırtığı ile birlikte ön çapraz bağ yırtığı mevcut olup, bu hastalara aynı operasyonda artroskopik olarak ön çapraz bağ tamiri uygulanmıştır.Hastalarımız ameliyat öncesinde ve en az altı ay süre ile olmak üzere son yapılan kontrollerinde Lysholm Skorlaması sonuçları, Modifiye Cincinnati Skorlaması sonuçları, uyluk atrofisi sonuçları ve klinik muayene ile menisküs iyileşmeleri değerlendirilmiştir.
BULGULAR: Artroskopik menisküs tamiri uygulanan ve çalışmamıza dahil edilen hastaların 24'ü (%86) erkek, dörtü (%14) kadın idi. Bu hastaların 16 'sının (%57) sağ dizine, 12'sinin (%43) ise sol dizine menisküs tamiri uygulandı. Olgu serimizin ortalama yaşı 26 (17–33) idi. Hastalarımızın ortalama takip süresi 15 ay ( 6-32) idi. Klinik ve fonksiyonel olarak yapılan ameliyat öncesi ve son kontrollerindeki değerlendirmede; hastalarda Lysholm skoru ortalamasının 19.2 puan, Modifiye Cincinnati skoru ortalamasının 2.4 puan, uyluk atrofi ortalamasının bir cm azaldığı saptanmıştır. Bu değişikliklerin hepsi istatistiksel olarak anlamlı bulunmuştur (p<0.05). Son kontrolleri sırasında hastalara menisküs lezyonuna yönelik McMurray ve Apley testleri uygulanmış olup iki hasta harici diğer hastaların muayeneleri normal olarak kabul edilmiştir. Mevcut klinik şikayeti olan iki hastadan birinde yeni travmanın mevcut olduğu öğrenildi. Her iki hasta magnetik rezonans görüntüleme ile tekrardan değerlendirildi ve her iki hasta da menisküs yırtığının iyileşmediği ve yırtıkların deplase olduğu saptanması üzerine, kısmı menisektomi ameliyatı uygulanmıştır. İki hastamızda yeniden ameliyat gerekliği harici hastalarımızda major komplikasyona rastlanmamıştır.
SONUÇ: Artroskopik menisküs tamirinin özellikle genç erişkinlerde menisküsün periferik ve santral-periferik bölgelerinde ki yırtıklarında etkin bir tedavi seçeneğidir. Çalışmamızda menisküs tamirinde orta dönem klinik sonuçlarımızın başarılı olduğunu vurgulamakta olup, bu yöntemin kullanılmasının giderek artması gerektiğini düşünmekteyiz.
Anahtar Kelimeler
Kaynakça
- 1. Arnoczky SP, Bullough PG. Healing of menisci and knee ligaments. In: Insall J, editor. Surgery of the knee. London: Churchill-Livingstone;1993;2:21-42.
- 2. Cannon WD. Arthroscopic meniscal repair. In: McGinty JB, editor. Operative arthroscopy. New York: Lippincott- Raven;1991;1:237-51.
- 3. DeHaven KE, Arnoczky SP Meniscal repair. Part I: basic science, indications for repair and open repair. J Bone Joint Surg [Am] 1994;76:140-52
- 4. Buckwalter J.A. Amendola A.Clark C.R. Articular cartilage and meniscus: Biology, biomechanics and healing response. In: Scott W.N. editor. Surgery of the knee. Churchill Livingstone Elsevier; Philadelphia:2006;4:307–28.
- 5. Henning, C.E. Lynch. M.A. Clark, CR.: Vascularity for Healing of Meniscus Repairs. Arthroscopy. 1987;3(1):13-9.
- 6. Scott, G.A. , Jolly, B.L. Henning, C.E. Combined Posterior Incision and Arthroscopic Intra-Articular Repair of the Meniscus. J Bone Joint Surg. 68-A;1986:847-61.
- 7. Fairbank TJ. Knee joint changes after menisectomy. J Bone Joint Surg [Br] 1948;30:664-70.
- 8. Paxton E.S. Stock M.V. Brophy R.H. Meniscal repair versus partial meniscectomy: A systematic review comparing reoperation rates and clinical outcomes. Arthroscopy. 2011: 27;1275–88.
- 9. Andersson-Molina H. Karlsson H. Rockborn P. Arthroscopic partial and total meniscectomy: A long-term follow-up study with matched controls. Arthroscopy. 2002;18:183–9.
- 10. Jakob RP, Staubli HU, Zuber K, Esser M. The arthroscopic meniscal repair. Techniques and clinical experience. Am J Sports Med 1988;16:137-42.
- 11. Barber FA, Stone RG. Meniscal repair. An arthroscopic technique. J Bone Joint Surg [Br] 1985;67:39-41.
- 12. De Haven KE. Long-term results of meniscus repair. Sports Med Arthroscopy Rev 1999;7:48-50.
- 13. Pınar H. Menisküs tamiri: Bir literatür derlemesi. Acta Orthop Traumatol Turc.1990;24:47-52.
- 14. Rosenberg TD. Indications for repair. In: Arthroscopy Association of North America 17th Annual Meeting-Specialty Day; April 23-26, 1997; San Diego, California. 160-4.
- 15. Veltri DM, Wickiewicz TL. Rationale and indications for meniscal repair. Sports Med Arthrosc Rev 1993;1:108-13.
- 16. DeHaven KE, Arnoczky SP. Meniscus repair: basic science, indications for repair, and open repair. Instructional Course Lectures, The American Academy of Orthopaedic Surgeons, Rosemont, Illinois, March 1994;43:65-76.
- 17. Verdonk R. Alternative treatments for meniscal injuries. European Instructional Course Lectures 1997;3:34-41.
- 18. DeHaven K.E. : Peripheral Meniscus Repair. Ch. 21 In "Arthroscopy: Diagnostic and Surgical Practice", Ed. Casscells, S,w. 1. ed. 175-180. Lea Febiger. Phifadelphia. 1984.
- 19. Miller, D.B.: Arthroscopic Meniscus Repair. Am. J. Sports Med. 1988;16:315-20.
- 20. Barber F.A. Herbert M.A. Bava E.D.Drew O.R. Biomechanical testing of suture-based meniscal repair devices containing ultrahigh-molecular-weight polyethylene suture: Update 2011. Arthroscopy. 2012;28:827–34.
- 21. Grant J.A.Wilde J. Miller B.S.Bedi A. Comparison of inside-out and all-inside techniques for the repair of isolated meniscal tears: A systematic review. Am J Sports Med. 2012;40:459–68.
- 22. Turman K.A. Diduch D.R. Miller M.D. All-inside meniscal repair. Sports Health. 2009;1:438–44.
- 23. Cohen S.B. Boyd L. Miller M.D. Vascular risk associated with meniscal repair using Rapidloc versus FasT-Fix: Comparison of two all-inside meniscal devices. J Knee Surg. 2007;20:235–40.
- 24. Miller M.D. Kline A.J. Gonzales J. Beach W.R. Pitfalls associated with FasT-Fix meniscal repair. Arthroscopy.2002;18:939–43.
- 25. Lee GP, Diduch DR. Deteriorating outcomes after meniscal repair using the Meniscus Arrow in knees undergoing concurrent anterior cruciate ligament reconstruction: increased failure rate with long-term follow-up. Am J Sports Med. 2005 Aug;33(8):1138-41 Epub 2005 Jul 6.
- 26. Nepple J.J. Dunn W.R. Wright R.W. Meniscal repair outcomes at greater than five years: A systematic literature review and meta-analysis. J Bone Joint Surg Am. 2012;94:2222–7.
Öz
OBJECTIVE: The purpose of this study is to evaluate mid-term functional results of the patients who had been treated by arthroscopic meniscal tear repair.
METHODS: We evaluated the functional results of 28 patients retrospectively who was treated by arthroscopic meniscal repair with all-inside and inside-out suture technique between january 2011 and march 2013. Twenty-four patients were male (%86) and four patients were female (%14). Meniscus repairs were performed for 16 right knees (%57) and 12 left knees (%43). The mean age of the patients was 26 (17-33). We performed anterior cruciate ligament reconstruction at the same operation for 13 patients (%46). Functional results were evaluated by Lysholm Knee Scoring Scale, Modified Cincinnati Score. Measurement of thigh circumference and physical examination was also performed.
RESULTS: Average follow-up time was 15 months (6-32). At the time of last examination; Lysholm scores raised meanly 19.2 points and Modified Cincinnati Scores raised meanly 2.4 points in contrast to preoperative evaluation. Thigh atrophy was lessened meanly one centimeter. All of these differences were statistically significant (p<0.05). McMurray and Apley tests were positive for two patients (% 7.1) at the time of last physical examination. Knee magnetic resonance imaging was performed for these two patients and it was seen that meniscal tears had not been healed and also it was seen that teared meniscus was displaced. After that arthroscopic partial meniscectomy was performed. We didn’t see any other complications at the follow-up of remaining patients.
CONCLUSION: Arthroscopic meniscus repair is an effective treatment method especially for young patients who have meniscus tears in red-red and red-white zone. We suggest that, arthroscopic meniscus repair procedures has to be performed widely, after reporting the successfull results of mid-term functional results of our patients.
Anahtar Kelimeler
Kaynakça
- 1. Arnoczky SP, Bullough PG. Healing of menisci and knee ligaments. In: Insall J, editor. Surgery of the knee. London: Churchill-Livingstone;1993;2:21-42.
- 2. Cannon WD. Arthroscopic meniscal repair. In: McGinty JB, editor. Operative arthroscopy. New York: Lippincott- Raven;1991;1:237-51.
- 3. DeHaven KE, Arnoczky SP Meniscal repair. Part I: basic science, indications for repair and open repair. J Bone Joint Surg [Am] 1994;76:140-52
- 4. Buckwalter J.A. Amendola A.Clark C.R. Articular cartilage and meniscus: Biology, biomechanics and healing response. In: Scott W.N. editor. Surgery of the knee. Churchill Livingstone Elsevier; Philadelphia:2006;4:307–28.
- 5. Henning, C.E. Lynch. M.A. Clark, CR.: Vascularity for Healing of Meniscus Repairs. Arthroscopy. 1987;3(1):13-9.
- 6. Scott, G.A. , Jolly, B.L. Henning, C.E. Combined Posterior Incision and Arthroscopic Intra-Articular Repair of the Meniscus. J Bone Joint Surg. 68-A;1986:847-61.
- 7. Fairbank TJ. Knee joint changes after menisectomy. J Bone Joint Surg [Br] 1948;30:664-70.
- 8. Paxton E.S. Stock M.V. Brophy R.H. Meniscal repair versus partial meniscectomy: A systematic review comparing reoperation rates and clinical outcomes. Arthroscopy. 2011: 27;1275–88.
- 9. Andersson-Molina H. Karlsson H. Rockborn P. Arthroscopic partial and total meniscectomy: A long-term follow-up study with matched controls. Arthroscopy. 2002;18:183–9.
- 10. Jakob RP, Staubli HU, Zuber K, Esser M. The arthroscopic meniscal repair. Techniques and clinical experience. Am J Sports Med 1988;16:137-42.
- 11. Barber FA, Stone RG. Meniscal repair. An arthroscopic technique. J Bone Joint Surg [Br] 1985;67:39-41.
- 12. De Haven KE. Long-term results of meniscus repair. Sports Med Arthroscopy Rev 1999;7:48-50.
- 13. Pınar H. Menisküs tamiri: Bir literatür derlemesi. Acta Orthop Traumatol Turc.1990;24:47-52.
- 14. Rosenberg TD. Indications for repair. In: Arthroscopy Association of North America 17th Annual Meeting-Specialty Day; April 23-26, 1997; San Diego, California. 160-4.
- 15. Veltri DM, Wickiewicz TL. Rationale and indications for meniscal repair. Sports Med Arthrosc Rev 1993;1:108-13.
- 16. DeHaven KE, Arnoczky SP. Meniscus repair: basic science, indications for repair, and open repair. Instructional Course Lectures, The American Academy of Orthopaedic Surgeons, Rosemont, Illinois, March 1994;43:65-76.
- 17. Verdonk R. Alternative treatments for meniscal injuries. European Instructional Course Lectures 1997;3:34-41.
- 18. DeHaven K.E. : Peripheral Meniscus Repair. Ch. 21 In "Arthroscopy: Diagnostic and Surgical Practice", Ed. Casscells, S,w. 1. ed. 175-180. Lea Febiger. Phifadelphia. 1984.
- 19. Miller, D.B.: Arthroscopic Meniscus Repair. Am. J. Sports Med. 1988;16:315-20.
- 20. Barber F.A. Herbert M.A. Bava E.D.Drew O.R. Biomechanical testing of suture-based meniscal repair devices containing ultrahigh-molecular-weight polyethylene suture: Update 2011. Arthroscopy. 2012;28:827–34.
- 21. Grant J.A.Wilde J. Miller B.S.Bedi A. Comparison of inside-out and all-inside techniques for the repair of isolated meniscal tears: A systematic review. Am J Sports Med. 2012;40:459–68.
- 22. Turman K.A. Diduch D.R. Miller M.D. All-inside meniscal repair. Sports Health. 2009;1:438–44.
- 23. Cohen S.B. Boyd L. Miller M.D. Vascular risk associated with meniscal repair using Rapidloc versus FasT-Fix: Comparison of two all-inside meniscal devices. J Knee Surg. 2007;20:235–40.
- 24. Miller M.D. Kline A.J. Gonzales J. Beach W.R. Pitfalls associated with FasT-Fix meniscal repair. Arthroscopy.2002;18:939–43.
- 25. Lee GP, Diduch DR. Deteriorating outcomes after meniscal repair using the Meniscus Arrow in knees undergoing concurrent anterior cruciate ligament reconstruction: increased failure rate with long-term follow-up. Am J Sports Med. 2005 Aug;33(8):1138-41 Epub 2005 Jul 6.
- 26. Nepple J.J. Dunn W.R. Wright R.W. Meniscal repair outcomes at greater than five years: A systematic literature review and meta-analysis. J Bone Joint Surg Am. 2012;94:2222–7.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 31 Ağustos 2014 |
| Gönderilme Tarihi | 30 Aralık 2013 |
| Yayımlandığı Sayı | Yıl 2014 Cilt: 3 Sayı: 2 |
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