Mehmet AŞIK, Ata Can ATALAR, Mürsel DEBRE, Cengiz ŞEN

Yeni meniskus tamir materyallerinin geç çözünmelerine bağlı sorunlar

Menisküs tamirinde giderek daha yoğun olarak kullanılan eriyebilir implantlar, hızlı ve kolay uygulanırlıkları ve nörovasküler komplikasyon riskini azaltmaları nedeniyle tercih edilirler. Bu yazıda, eriyebilir Biostinger tamir implantı ile menisküs tamirinden sonra devam eden menisküs yırtığı benzeri şikayetleri nedeniyle ikinci artroskopileri yapılan üç olgu sunuldu. Olguların her üçünde de menisküslerin iyileştiği, ancak tamir materyallerinin bir kısmının çözünmediği ve eklem içinde irritasyona yol açtığı görüldü. Çözünmemiş implantların çıkarılmasıyla semptomlar tamamen kayboldu. Eriyebilir menisküs implantları kullanılırken bu materyallerin uzun dönem etkileri gözönünde bulundurulmalı ve bu konuda yeni tasarım ve araştırmalar yapılmalıdır.

Anahtar Kelimeler:

Artroskopi, Diz eklemi, Menisküs, tibial, Ön çapraz bağ, Emilebilir implantlar, Kıkırdak, eklem, Sinovit

Problems associated with late resorption of bioabsorbable meniscus repair devices

The use of bioabsorbable meniscus repair devices is becoming more frequent because of their easy and quick application and reduced risk of neurovascular complications. We present three patients who had symptoms mimicking meniscus tears following meniscal repair with the use of the Biostinger bioabsorbable device. Second-look arthroscopies of all cases showed that some of the repair devices were not resorbed despite meniscal healing. Early recovery of symptoms was achieved after the removal of unabsorbed remnants. Prolonged resorption of bioabsorbable meniscus materials may cause intraarticular problems like synovitis and chondral lesions, which should be taken into consideration by meniscal implant designers and researchers.

Keywords:

Arthroscopy, Knee Joint, Menisci, Tibial, Anterior Cruciate Ligament, Absorbable Implants, Cartilage, Articular, Synovitis,

PDF

___

1. DeHaven KE. Meniscus repair-open vs. arthroscopic. Arthroscopy 1985;1:173-4.
2. Gillquist J. Long term results of partial meniscectomy. Sports Med Arthrosc Rev 1999;7:1-7.
3. Aşık M, Şener N, Dikici F, Şen C. Menisküs dikiş teknikleriyle tamir materyallerinin primer dayanımlarının karşılaştı- rılması. Acta Orthop Traumatol Turc 2000;34:512-6.
4. Becker R, Schroder M, Starke C, Urbach D, Nebelung W. Biomechanical investigations of different meniscal repair implants in comparison with horizontal sutures on human meniscus. Arthroscopy 2001;17:439-44.
5. Sims WF, Simonian PT. Delayed degradation of bioabsorbable meniscal fixators. Arthroscopy 2001;17:E11.
6. Song EK, Lee KB, Yoon TR. Aseptic synovitis after meniscal repair using the biodegradable meniscus arrow. Arthroscopy 2001;17:77-80.
7. Seil R, Rupp S, Dienst M, Mueller B, Bonkhoff H, Kohn DM. Chondral lesions after arthroscopic meniscus repair using meniscus arrows. Arthroscopy 2000;16:E17.
8. Ross G, Grabill J, McDevitt E. Chondral injury after meniscal repair with bioabsorbable arrows. Arthroscopy 2000; 16:754-6.
9. Lombardi JA. Second-look arthroscopy with removal of bioabsorbable tacks. Am J Orthop 2000;29:125-7.
10. Hechtman KS, Uribe JW. Cystic hematoma formation following use of a biodegradable arrow for meniscal repair. Arthroscopy 1999;15:207-10.
11. Calder SJ, Myers PT. Broken arrow: a complication of meniscal repair. Arthroscopy 1999;15:651-2.
12. DeHaven KE, Arnoczky SP. Meniscal repair. J Bone Joint Surg [Am] 1994;76:140-52.
13. Morgan CD. The "all-inside" meniscus repair. Arthroscopy 1991;7:120-5.
14. Athanasiou KA, Agrawal CM, Barber FA, Burkhart SS. Orthopaedic applications for PLA-PGA biodegradable polymers. Arthroscopy 1998;14:726-37.
15. Barber FA. Meniscus repair aftercare. Sports Med Arthrosc Rev 1999;7:43-7.
16.Kawai Y, Fukubayashi T, Nishino J. Meniscal suture. An experimental study in the dog. Clin Orthop 1989;(243):286-93.
17. Arnoczky SP, Lavagnino M. Tensile fixation strengths of absorbable meniscal repair devices as a function of hydrolysis time. An in vitro experimental study. Am J Sports Med 2001;29:118-23.
18.Barber FA, Herbert MA. Meniscal repair devices. Arthroscopy 2000;16:613-8.
19. Cannon WD. Other all inside repair techniques. Sports Med Arthrosc Rev 1999;7:34-42.