Gecikmiş ön çapraz bağ rekonstrüksiyonu uygulanan hastalardaki meniskal ve osteokondral lezyonların insidansı

Amaç: Ön çapraz bağ (ÖÇB) yırtığı rekonstrükte edilmezse, tekrarlayan boşalma hissine ve rotasyonel-translasyonel instabilitelere neden olmaktadır. Çalışmamızın amacı ÖÇB yırtığı olan hastaların cerrahi tedavileri geciktirilirse ve özellikle bu kişilerin Tegner aktivite düzeyleri yüksekse, bu kişilerde daha ciddi ve komplike meniskal ve osteokondral yaralanmaların gelişebileceği ve tedavi sonucuna olumsuz yönde etki edebileceği hipotezimizi test etmekti. Çalışma planı: Çalışma 2001-2009 yılları arasında artroskopik ÖÇB rekonstrüksiyonu uygulanan 385 hasta üzerinde gerçekleştirildi. Hastaların ameliyat anındaki artroskopik video kayıtları, MRG görüntüleri ve hastane kayıtları incelendi. Tedavi sonucunu olumsuz etkileyebilecek ciddi meniskal ve osteokondral yaralanmaları saptayarak bunları tedavi sonucunu etkileyen meniskal yaralanmalar (TSEMY) ve tedavi sonucunu etkileyen osteokondral yaralanmalar (TSEOY) olarak adlandırdık. TSEMY, TSEOY ile yaralanmadan sonra geçen süre ve hastaların Tegner aktivite düzeyleri arasındaki ilişki istatistiksel olarak analiz edildi. Bulgular: TSEMY ve TSEOY görülme sıklığının yaralanmadan sonra geçen sürenin artması ile birlikte istatistiksel olarak arttığını saptadık (p=0.001, p

Incidence of meniscal and osteochondral lesions in patients undergoing delayed anterior cruciate ligament reconstruction

Objective: Unreconstructed anterior cruciate ligament (ACL) tears cause repeated incidences of giving-way and rotational-translational instability. The aim of this study was to test our hypothesis that delayed surgical treatment of patients with ACL tears, especially those with high Tegner activity levels, results in more severe and complicated meniscal and osteochondral lesions with potential affect on the outcome. Methods: This study included 385 patients who underwent arthroscopic ACL reconstruction between 2001 and 2009. Patients’ arthroscopic video records or MRI scans and patient files at the time of surgery were analyzed. We defined severe meniscal and osteochondral lesions which could negatively affect the outcome and labeled them meniscal lesions affecting outcome (MLAO) and osteochondral lesions affecting outcome (OLAO). The relation between MLAO, OLAO, time since injury and Tegner activity levels were statistically analyzed. Results: The incidences of MLAO and OLAO grew statistically higher as time elapsed between the injury and surgery increased (p=0.001, p

___

1. Church S, Keating JF. Reconstruction of the anterior cruciate ligament: timing of surgery and the incidence of meniscal tears and degenerative change. J Bone Joint Surg Br 2005;87:1639-42.
2. Foster A, Butcher C, Turner PG. Changes in arthroscopic findings in the anterior cruciate ligament deficient knee prior to reconstructive surgery. Knee 2005;12:33-5.
3. Indelicato PA, Bittar ES. A perspective of lesions associated with ACL insufficiency of the knee. A review of 100 cases. Clin Orthop 1985;(198):77-80.
4. Karlsson J, Kartus J, Magnusson L, Larsson J, Brandsson S, Eriksson BI. Subacute versus delayed reconstruction of the anterior cruciate ligament in the competitive athlete. Knee Surg Sports Traumatol Arthrosc 1999;7:146-51.
5. Woods GW, Chapman DR. Repairable posterior meniscocapsular disruption in anterior cruciate ligament injuries. Am J Sports Med 1984;12:381-5.
6. Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985;(198): 43-9.
7. Gomoll AH, Farr J, Gillogly SD, Kercher J, Minas T. Surgical management of articular cartilage defects of the knee. J Bone Joint Surg Am 2010;92:2470-90.
8. Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br 1961;43:752.
9. Nishikawa H, Imanaka Y, Sekimoto M, Hayashida K, Ikai H. Influence of verification bias on the assessment of MRI in the diagnosis of meniscal tear. Am J Roentgenol 2009; 193:1596-602.
10. Drongowski RA, Coran AG, Wojtys EM. Predictive value of meniscal and chondral injuries in conservatively treated anterior cruciate ligament injuries. Arthroscopy 1994;10: 97-102.
11. Laxdal G, Kartus J, Ejerhed L, Sernert N, Magnusson L, Faxén E, et al. Outcome and risk factors after anterior cruciate ligament reconstruction: a follow-up study of 948 patients. Arthroscopy 2005; 21:958-64.
12. Bellabarba C, Bush-Joseph C, Bach BR. Patterns of meniscal injury in the anterior cruciate-deficient knee: a review of the literature. Am J Orthop 1997;26:18-23.
13. Cipolla M, Scala A, Gianni E, Puddu G. Different patterns of meniscal tears in acute anterior cruciate ligament (ACL) ruptures and in chronic ACL-deficient knees: classification, staging and timing of treatment. Knee Surg Sports Traumatol Arthrosc 1995;3:130-4.
14. Gillquist J, Messner K. Anterior cruciate ligament reconstruction and the long-term incidence of gonarthrosis. Sports Med 1999;27:143-56.
15. Smith JP 3rd, Barrett GR. Medial and lateral meniscal tear patterns in anterior cruciate ligament-deficient knees. A prospective analysis of 575 tears. Am J Sports Med 2001; 29:415-9.
16. Tando¤an RN, Tafler Ö, Kayaalp A, Taflk›ran E, P›nar H, Alparslan B, et al. Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time from injury, and level of sport. Knee Surg Sports Traumatol Arthrosc 2004;12:262-70.
17. Murrell GA, Maddali S, Horovitz L, Oakley SP, et al. The effects of time course after anterior cruciate ligament injury in correlation with meniscal and cartilage loss. Am J Sports Med 2001;29:9-14.
18. Papastergiou SG, Koukoulias NE, Mikalef P, Ziogas E, et al. Meniscal tears in the ACL-deficient knee: correlation between meniscal tears and the timing of ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2007;15:1438-44.
19. Yoo JC, Ahn JH, Lee SH, Yoon YC. Increasing incidence of medial meniscal tears in nonoperatively treated anterior cruciate ligament insufficiency patient documented by serial magnetic resonance imaging studies. Am J Sports Med 2009;37:1478-83.
20. Naranje S, Mittal R, Nag H, Sharma R. Arthroscopic and magnetic resonance imaging evaluation of meniscus lesions in the chronic anterior cruciate ligament-deficient knee. Arthroscopy 2008;24:1045-51.
21. De Roeck NJ, Lang-Stevenson A. Meniscal tears sustained awaiting anterior cruciate ligament reconstruction. Injury 2003;34:343-5.
22. Tayton E, Verma R, Higgins B, Gosal H. A correlation of time with meniscal tears in anterior cruciate ligament deficiency: stratifying the risk of surgical delay. Knee Surg Sports Traumatol Arthrosc 2009;17:30-4.
23. Roeck NJ, Lang-Stevenson A. Meniscal tears sustained awaiting anterior cruciate ligament reconstruction. Injury, Int. J Care Injured 2003;34:343-5.
24. Sekiya JK. Failed ACL repair. Orthopedics 2010; 33:677.