İlhan ÖZKAN, EMRE ÇULLU, Öner ŞAVK, Semih AYDOĞDU, Bülent ALPARSLAN

Akut ve kronik ön çapraz bağ lezyonlarında sekonder manyetik rezonans görüntüleme bulguları

Amaç: Manyetik rezonans görüntüleme (MRG) incelemesinde ön çapraz bağ (ÖÇB) yırtığı saptanan olgularda sekonder bulguları ve bunların tanısal önemini değerlendirmek. Çalışma planı: Ön çapraz bağ yırtığı nedeniyle artroskopi uygulanan 46 olgunun (33 erkek, 13 kadın; yaş ort. 29.2) artroskopi öncesi çekilen MRG tetkikleri retrospektif olarak incelendi. Kontrol grubu olarak kabul edilen diğer 46 olguda (28 erkek, 18 kadın; yaş ort. 31.4) ise menüsküs lezyonu nedeniyle artroskopi uygulanmış ve ÖÇB yırtığı olmadığı görülmüştü. Tüm olguların MRG incelemelerinde ÖÇB yırtığına ait sekonder bulgular olarak kemik ödemi, arka çapraz bağ (AÇB) kavis değeri, tibianın öne yer değiştirmesi ve taşmış dış menüsküs bulguları değerlendirildi. İstatistiksel incelemelerde Student-t testi ve ki-kare testi kullanıldı. Sonuçlar: Çalışma grubunda 46 olgunun 13’ünde (%28.3) kemik ödemi gözlenirken kontrol grubunda bir olguda (%2.2) kemik ödemi gözlendi (p=0.000). Arka çapraz bağ kavis değeri ortalaması çalışma grubunda 0.49±0.12, kontrol grubunda 0.26±0.04 bulundu (p=0.000). Tibianın öne yer değiştirmesi çalışma grubunda ortalama 6.1±1.4 mm, kontrol grubunda 0.9±1.4 mm saptandı (p=0.000). Taşmış dış menüsküs bulgusu ise çalışma grubunda 26 olguda (%56.5) gözlenirken, kontrol grubunda hiçbir olguda gözlenmedi (p=0.000). Çıkarımlar: Şüpheli durumlarda ve özellikle çok uzun süreli kronik olgularda, ÖÇB yırtıklı hastaların MRG tetkiklerinde sekonder bulguların analizinin doğru tanıya yönlendirmede yardımcı olacağı fikrindeyiz.

Anahtar Kelimeler:

Artroskopi, Tanı, ayırıcı, Diz eklemi, Ligamentler, Manyetik rezonans görüntüleme, Menisküs, tibial, Tibia, Yaralar ve yaralanmalar, Ön çapraz bağ, Yırtık, Diz yaralanmaları, Ödem, Kronik hastalık, Akut hastalık, Diz

Secondary MRI findings in patients with acute and chronic anterior cruciate ligament ruptures

Objectives: To evaluate the diagnostic value and incidence of secondary magnetic resonance imaging (MRI) findings in patients with anterior cruciate ligament (ACL) rupture. Methods: Magnetic resonance imaging (MRI) findings obtained before arthroscopic surgery were retrospectively evaluated in 46 patients (33 males, 13 females; mean age 29.2 years) with ACL ruptures. A control group of 46 patients (28 males, 18 females; mean age 31.4 years) were also included, who underwent arthroscopy due to meniscus lesions and were not found to have any ACL ruptures. In all cases, secondary MRI findings of ACL rupture were assessed, including bone bruises, the value of the posterior cruciate ligament (PCL) curvature, anterior translation of the tibia, and uncovered lateral meniscus signs. Statistical analyses were made using Student's t-test and the chi-square test. Results: Bone bruises were observed in 13 patients (28.3%) in the study group compared to only one patient (2.2%) in the control group (p=0.000). Mean curvatures of the PCL were 0.49±0.12 and 0.26±0.04 in the study and control groups, respectively (p=0.000). The average anterior translation of the tibia was 6.1±1.4 mm in patients with ACL rupture and 0.9±1.4 mm in the control group (p=0.000). Uncovered lateral meniscus sign was observed in 26 patients (56.5%) in the study group and in none of the patients in the control group (p=0.000). Conclusion: The evaluation of secondary findings on MRI examination may enable to draw a correct diagnosis in patients with ACL ruptures, in whom primary MRI findings may be inadequate, particularly in chronic cases.

Keywords:

Arthroscopy, Diagnosis, Differential, Knee Joint, Ligaments, Magnetic Resonance Imaging, Menisci, Tibial, Tibia, Wounds and Injuries, Anterior Cruciate Ligament, Rupture, Knee Injuries, Edema, Chronic Disease, Acute Disease, Knee,

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