Sabriye ERCAN, Hilmi Mustafa DEMİR, Yurdagül BAYGÜL ATALAY, Ozan TURGAY, Tolga ATAY, Cem ÇETİN

ÖN ÇAPRAZ BAĞ REKONSTRÜKSİYONU SONRASI SPORA GÜVENLİ GERİ DÖNÜŞ KRİTERLERİNİN YETERLİLİĞİ

Ön çapraz bağ (ÖÇB) yaralanması, kas kuvvetinin azalmasına ve instabilite gelişmesine bağlı olarak uyluk kaslarının fonksiyonunu olumsuz yönde etkiler. Tedavide konservatif ve/veya cerrahi yöntemler tercih edilir. Literatürde spora geri dönüş için farklı kriterler önerilmiştir. Her ne kadar bu kriterler sağlanmış olsa da ÖÇB rekonstrüksiyon sonrası ilk iki yılda rerüptür riski yüksektir. Bu çalışmanın amacı; ÖÇB rekonstrüksiyonu sonrası normal diz fonksiyonlarına dönenlerin opere taraflarına ait fonksiyonel diz verilerinin incelenmesi, bu verilerin sağlam taraf ve sağlıklı kontrol grubu verileri ile karşılaştırılmasıdır. 14 sağlıklı erkek ile unilateral ÖÇB rekonstrüksiyonu geçiren 15 erkek hasta çalışmaya katıldı. Çalışmamızda Tegner aktivite seviyesini, Lysholm diz puanını ve aktif eklem hareket açıklığını ölçtük; tek bacak hoplama testini, flamingo denge testini, izokinetik kas kuvveti ve propriosepsiyon testini uyguladık. Gruplar arasında demografik veriler, aktivite düzeyi ve diz skorları açısından istatistiksel anlamlı farklılık yoktu (p>0,05). 30˚’deki pasif eklem pozisyon duyusu testinde opere ve sağlam diz arasında opere diz lehine istatistiksel anlamlı farklılık tespit edildi (p<0,05). ÖÇB yaralanması geçiren hastalar ve kontrol grubu arasında fonksiyonel testlerde, propriosepsiyon ölçümlerinde ve opere ekstremitenin hamstring kas kuvvetinde istatistiksel anlamlı farklılık saptandı (p<0,05). Unilateral ÖÇB rüptürü sonrası artrojenik kas inhibisyonu bilateral gelişir. Bu durum, ekstremite simetrisinin sağlandığı yönünde yanıltıcı yorumlara yol açabilir. Halbuki diz fonksiyonları sağlıklı kontrol grubu ile kıyaslandığında yetersiz olabilir. Bu sebeple, ÖÇB rehabilitasyon programında bilateral alt ekstremite fonksiyonlarını geliştirmeye önem vermeliyiz.

Anahtar Kelimeler:

Ön çapraz bağ, sportif rehabilitasyon, spora geri dönüş kriterleri

QUALIFICATION OF SAFE RETURN TO PLAY CRITERIA AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Anterior cruciate ligament (ACL) plays an important role in maintaining the function of the knee. In case of injury declining of the muscle strength and unstability of the knee occurs which affects the thigh muscle functions in a bad way. Conservative or/and surgical methods are used as a treatment method. In literature, different criterias can be found for return to play. Even though these criterias were fulfilled, in two years time after first ACL reconstruction, rerupture of the ACL risk is high.Purpose of this study is, compare ACL recontructed patients’ data, who have normal knee functions according to return to play guideline, to their health extremity and to non-injuered healthy subjects’ data.14 healthy male subject and 15 unilaterally ACL reconstructed patient enrolled into the study. Tegner activity scale, Lysholm Knee Score and active range of motions were evaluated. Single leg hop test, flamingo balance test, isokinetic test and proprioceptive evaluations were done too.There were no statistically significant differecences demographical datas, activity levels and knee scores between groups (p>0,05). Passive joint sense at 30˚ has statistically significant difference between operated and healthy knee (p<0,05, operated knee has better result). Between ACL group patients and healthy subjects, there were statictically significant differences between functional tests, proprioseptive measurements and operated extremity hasmtring muscle strength (p<0,05). Arthrogenic muscle inhibition occurs bilaterelly after an unilateral ACL rupture. This event causes a misguiding for gaining a functional symmetrical extremities. However knee functions can be insuffienct in contrast to healthy subjects. For this reason at ACL rehabilitation programme, improving lower extremity functions should be done bilaterally.

Keywords:

Anterior Cruciate Ligament, sportive rehabilitation, return to play guideline,

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