Yalancı yokluk duyusu: Ön çapraz bağ kopmasına özgü bir belirti olabilir mi?

Amac: Ön çapraz bağları kopan hastalar, bağ kopması anında bacaklarının dizden itibaren koptuğu, dizlerinden itibaren alt tarafın olmadığı duyusuna kapıldıklarını belirttiler. Bu tarifin tanısal bir bulguya işaret edebileceğini düşünerek, diz travması geçirdikten sonra eklem içindeki patolojileri diz artroskopisi ile doğrulanan hastalarda bu duyunun varlığını araştırma amacıyla bir çalışma planladık. Çalışma planı: Tanımlanan duyuyu "yalancı yokluk duyusu" olarak adlandırdık. Travmaları komplike olmayan ya da beraberinde organ yaralanması bulunmayan diz travması geçiren 135 hasta çalışmaya alındı. Hastalar, ön çapraz bağ kopması olan 95 hasta (89 erkek, 6 kadın; ort. yaş 28; dagılım 15-50), diğer eklem içi patolojileri bulunan 40 hasta (34 erkek, 6 kadın; ort. yaş 35; dagılım 13-60) olarak iki gruba ayrıldı. Bu semptom her iki gruptaki hastalarda sorgulandı. Sonuçlar: Tanımlanan semptom, ön çapraz bağ kopukluğu olan hastalarda %87 oranında saptanırken, diğer eklem içi patolojisi olan hastalarda görülmedi (p

Anahtar Kelimeler:

Mekanoreseptörler, Tanı, Ön çapraz bağ, Diz eklemi, Tıbbi anamnez, Duyarlılık ve özgüllük, Testlerin kestirim değeri

The "false sense of absence" of the lower extremity below the knee: Is it a specific sign for anterior cruciate ligament ruptures?

Objectives: Patients whose anterior cruciate ligament (ACL) was completely ruptured described a feeling as if they had lost their lower extremity below the knee and gave an account that they had not sensed that part of their extremity at the time of ACL rupture. Thinking that this description might denote a diagnostic sign, an investigation was made to verify this feeling in patients whose ACL rupture was confirmed by knee arthroscopy. Methods: The described feeling was named as "false sense of absence." A total of 135 patients with knee trauma were included. Those whose injuries were complicated or who had multiorgan injuries were excluded. The patients were divided into two groups according to whether they had ACL rupture (95 patients; 89 males, 6 females; mean age 28 years; range 15 to 50 years) or other knee injuries (40 patients; 34 males, 6 females; mean age 35 years; range 13 to 60 years). The above-mentioned symptom was questioned in both groups. Results: The described symptom was found in 87% of patients with ACL rupture and in none of the patients with other knee pathologies (p<0.001). The specificity, sensitivity, positive and negative predictive values of this symptom in ACL ruptures were found as 100%, 98%, 100%, and 95%, respectively. Conclusion: The "false sense of absence" symptom, which has hitherto been undescribed in the literature, seems to occur in the majority of patients with ACL ruptures; it may be a specific and sensitive finding in determining ACL ruptures, and thus, may merit inclusion in the process of history taking.

Keywords:

Mechanoreceptors, Diagnosis, Anterior Cruciate Ligament, Knee Joint, Medical History Taking, Sensitivity and Specificity, Predictive Value of Tests,

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1.Marzo JN, Warren RF. Acute anterior cruciate and medial collateral ligament injuries. In: Insall JN, editor. Surgery of the knee. 2nd ed. New York: Churchill Livingstone; 1993. p. 403-25.
2. Swenson TM, Harner CD. Knee ligament and meniscal injuries. Current concepts. Orthop Clin North Am 1995;26:529-46.
3. Frank CB, Jackson DW. The science of reconstruction of the anterior cruciate ligament. J Bone Joint Surg [Am] 1997;79: 1556-76.
4. Denti M, Monteleone M, Berardi A, Panni AS. Anterior cruciate ligament mechanoreceptors. Histologic studies on lesions and reconstruction. Clin Orthop 1994;(308):29-32.
5. Dye SF, Vaupel GL. Functional anatomy of the knee. In: Lephart SM, Fu FH, editors. Proprioception and neuromuscular control in joint stability. Champaign, IL: Human Kinetics Publishers; 2000. p. 99-109.
6. Krauspe R, Schmidt M, Schaible HG. Sensory innervation of the anterior cruciate ligament. An electrophysiological study of the response properties of single identified mechanoreceptors in the cat. J Bone Joint Surg [Am] 1992;74:390-7.
7. Schutte MJ, Dabezies EJ, Zimny ML, Happel LT. Neural anatomy of the human anterior cruciate ligament. J Bone Joint Surg [Am] 1987;69:243-7.
8. Barrack RL, Skinner BB. The sensory function of knee ligaments. In: Daniel DM, Akeson WH, OÕConnor JJ. Knee ligaments: structure, function, injury, and repair. 1st ed. New York: Raven Press; 1990. p. 95-114.
9. Biedert RM, Stauffer E, Friederich NF. Occurrence of free nerve endings in the soft tissue of the knee joint. A histologic investigation. Am J Sports Med 1992;20:430-3.
10. Horner G, Dellon AL. Innervation of the human knee joint and implications for surgery. Clin Orthop 1994;(301):221-6.
11.Wojtys EM, Beaman DN, Glover RA, Janda D. Innervation of the human knee joint by substance-P fibers. Arthroscopy 1990;6:254-63.
12. Zimny ML. Mechanoreceptors in articular tissues. Am J Anat 1988;182:16-32.
13. Adams JA. Feedback theory of how joint receptors regulate the timing and positioning of a limb. Psychol Rev 1977;84: 504-23.