Mehmet BULUT, H. Bayram TOSUN, SANCAR SERBEST, Yılmaz PALANCI, Erhan YILMAZ

Diz kıkırdak lezyonlarında mikrokırık tedavi yöntemi sonuçları ve sonuca etki eden faktörler

Amaç: Bu çalışmanın amacı diz ekleminde kıkırdak lezyonlarının tedavisinde mikrokırık yöntemi ile tedavi edilen olguların sonuçlarını ve sonuçlara etki eden faktörleri değerlendirmektir. Gereç ve yöntem: Femoral kondilde kıkırdak hasarı nedeniyle mikrokırık yöntemi ile tedavi edilen 26 hasta retrospektif olarak incelendi. Hastaların 15 tanesi erkek, 11 tanesi bayan ve yaş ortalaması 37.2 yıl (dağılım 23-56 yıl) idi. Şikayetlerin başlangıcı ile ameliyat arasında geçen süre ortalama 9.7 ay (dağılım 3-35 ay) ve ortalama defekt alanı 1,6 cm2 (dağılım 0.7-2.4cm2) idi. Ortalama takip süresi 24.3 ay (dağılım 10-44 ay) idi. Hastalar ameliyat öncesi ve sonrası subjektif hasta memnuniyeti ve Lysholm skalasına göre değerlendirildi. İstatistiksel analiz için Paired sample t-test ve Pearson-Spearman korelasyon testi kullanıldı. Bulgular: Ameliyat öncesi Lysholm skoru ortalama 56.9 (43-72) iken ameliyat sonrası Lysholm skoru ortalama 77.9 (62-100) olarak bulundu. Lysholm skoruna göre, 9 (34.6%) olguda mükemmel, 7 (27%) olguda iyi, 10 (38.4%) olguda orta sonuç elde edildi. Hastaların tümü diz fonksiyonlarından memnundular. Ameliyat sonrası 6. ayda çekilen MRG sonuçları subjektif hasta memnuniyeti ve Lysholm skorları ile doğru orantılı idi. Sonuç: İyi ve mükemmel sonuçlanan hastaların aktif, genç ve semptom sürelerinin daha kısa ve lezyon alanının daha küçük olduğu gözlemlendi. Kıkırdak lezyonlarının tedavisinde erken yapılan mikrokırık tedavi yönteminin, günlük aktivitelere geri dönüşü hızlandıran, maliyeti düşük, etkili ve başarılı bir tedavi seçeneği olduğu sonucuna varıldı.

Outcomes of the chondral lesions of knee treated by microfracture technique and effective factors on the results

Objectives: The aim of this study was to evaluate the results of the microfracture technique in the treatment of chondral lesions. Materials and methods: A retrospective study was performed in 26 patients who had treated by arthroscopic microfracture technique for chondral lesions in the femoral condils between January 2003 and 2007september in our department. There were 11 females and 15 males with mean age of 37.2 years (range from 23 to 56 years). The average time between beginning of complaints and operation were 9.7 months (range from 3 to 35 months). The average of chondral lesions size were 1,6 cm2 (range from 0.7 to 2.4 mm2). The average follow-up period was 24.3 months (ranged from 10 to 44 months). Patients assessed according to subjective patient satisfaction and Lisholm scale at preoperative and postoperative time. Results: The mean Lysholm score increased from a preoperative 56.9 (range from 43 to 72) to a postoperative 77.9 (range from 62 to 100) (p<0.05). The rating was excellent in 9 patients (34.6%), good in 7 (27%) and fair in 10 (38.4%) according to Lysholm scale. All patients were satisfied with their knee function. The results of MRI taken at postoperative sixth month were proportional with patient’s satisfaction and Lysholm scores. Conclusion: Patients with excellent or good results had short symptom period, small chondral lesion and young age. Applied early microfracture technique in treatment of chondral lesions was a low cost, effective and successful treatment modality.

PDF

___

1. Ürgüden M, Özdemir H, Özenci AM, Akyıldız FF, Altınel E. Femorotibial eklemdeki kıkırdak lezyonlarının abrazyon ve dirileme ile Tedavisi “Orta Dönem Sonuçlar”. Joint Dis Rel Surg 2003;14(1):7-12.
2. Davis JT, Jones DG. Treatment of knee articular cartilage injuries. Curr Opin Orthop 2004;15:92-9.
3. Alparslan B, Özkan İ, Acar U, Çullu E, Şavk ŞÖ. Diz ekleminde tam kat kıkırdak lezyonlarının tedavisinde mikrokırık yöntemi. Acta Orthop Traumatol Turc 2007;41 Suppl 2:62-6.
4. Detterline AJ, Steven Goldberg S, Bach BR Jr, Cole BJ. Treatment options for articular cartilage defects of the knee. Orthop Nurs 2005;24(5):361-8.
5. Steadman JR, Miller BS, Karas SG, Schlegel TF, Briggs KK, Hawkins RJ. The microfracture technique in the treatment of full-thickness chondral lesions of the knee in National Football League players. J Knee Surg 2003;16(2):83-6.
6. Magnussen RA, Dunn WR, Carey JL, Spindler KP. Treatment of focal articular cartilage defects in the knee: a systematic review. Clin Orthop Relat Res 2008;466(4):952-7.
7. Steadman JR, Rodkey WG, Rodrigo JJ. Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res 2001;(391 Suppl):362-9.
8. Gill TJ, Asnis PD, Berkson EM. The treatment of articular cartilage defects using the microfracture technique. J Orthop Sports Phys Ther 2006;36(10):728-33.
9. Güneş T, Sen C, Erdem M, Köseoğlu RD, Filiz NO. Tam kalınlıkta kıkırdak defektlerinin tedavisinde mikrokırık ve periost transplantasyon tekniklerinin birlikte kullanımı. Acta Orthop Traumatol Turc 2006;40(4):315-23.
10. Gobbi A, Nunag P, Malinowski K. Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surg Sports Traumatol Arthrosc 2005;13(3):213-21.
11. Yen YM, Cascio B, O’Brien L, Stalzer S, Millett PJ, Steadman JR. Treatment of osteoarthritis of the knee with microfracture and rehabilitation. Med Sci Sports Exerc 2008;40(2):200-5.
12. Smith GD, Knutsen G, Richardson JB. A clinical review of cartilage repair techniques. J Bone Joint Surg [Br] 2005;87(4):445-9.
13. Aşık M, Şen C, Çiftçi F, Polat G. Diz ekleminde tam kat kıkırdak lezyonlarının mikrokırık yöntemiyle tedavisi. Turkiye Klinikleri J Orthop & Traumatol-Special Topics 2011;4(1):39-44.
14. Matsunaga D, Akizuki S, Takizawa T, Yamazaki I, Kuraishi J. Repair of articular cartilage and clinical outcome after osteotomy with microfracture or abrasion arthroplasty for medial gonarthrosis. Knee 2007;14(6):465-71.
15. Mithoefer K, Williams RJ, Warren RF, et al. The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg [Am] 2005;87(9):1911-20.
16. Irrgang JJ, Snyder-Mackler L, Wainner RS, Fu FH, Harner CD. Development of a patient-reported measure of function of the knee. J Bone Joint Surg [Am] 1998;80(8):1132-45.
17. Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985;(198):43-9.
18. Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg [Br] 1961;43(5):752-7.
19. Mithoefer K, Williams RJ, Warren RF, et al. Chondral resurfacing of articular cartilage defects in the knee with the microfracture technique. Surgical technique. J Bone Joint Surg [Am] 2006;88:294-204.
20. Mithoefer K, Steadman JR. The microfracture technique. techniques in knee surgery. 2006;5(3):140-8.
21. Doral MN, Bozkurt M, Atay OA, Tetik O. Diz eklemi kıkırdak lezyonlarında artroskopik cerrahi ile diğer uygulamalar. Acta Orthop Traumatol Turc 2007;41 Suppl 2:93-7
22. Taşer Ö, Çetinkaya S, Kocabey Y. İnstabil dizlerde eklem kıkırdak lezyonları. Acta Orthop Traumatol Turc 2007;41:138-6.
23. Mithoefer K, Williams RJ, Warren RF, Wickiewicz TL, Marx RG. High-impact athletics after knee articular cartilage repair: a prospective evaluation of the microfracture technique. Am J Sports Med 2006;34(9):1413-8.
24. Kreuz PC, Steinwachs MR, Erggelet C, et al. Results after microfracture of full-thickness chondral defects in different compartments in the knee. Osteoarthritis Cartilage 2006;14(11):1119-25.
25. Knutsen G, Drogset JO, Engebretsen L, et al. A randomized trial comparing autologous chondrocyte implantation with microfracture. Findings at five years. J Bone Joint Surg [Am] 2007;89(10):2105-12.
26. Knutsen G, Engebretsen L, Ludvigsen TC, et al. Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg [Am] 2004;86(3):455-64.
27. Kon E, Gobbi A, Filardo G, Delcogliano M, Zaffagnini S, Marcacci M. Arthroscopic second-generation autologous chondrocyte implantation compared with microfracture for chondral lesions of the knee: prospective nonrandomized study at 5 years. Am J Sports Med 2009;37(1):33-41.