Menisküs yırtıkları ile medial patellofemoral rüptür arasındaki ilişkinin tedavi yöntemi ve cinsiyete göre analizi

Yıl 2023, Cilt: 6 Sayı: 2, 206 - 212, 30.06.2023

Ayşe Gül Kabakcı , Volkan Tolga Tekbaş , Memduha Gülhal Bozkır

https://doi.org/10.53446/actamednicomedia.1192308

Öz

Amaç: Bu çalışmanın amacı, medial patellofemoral ligament rüptürü olan hastalarda patellar yükseklik, uyum açısı, lateral patellofemoral açı parametrelerinin tedavi yöntemine (cerrahi veya konvansiyonel), cinsiyete ve lateral ve medial menisküs yırtıkları olup olmamasına göre detaylı anatomik analizini yapmaktır.
Gereç ve Yöntem: Bu çalışma Ocak 2010 ile Ocak 2021 tarihleri arasında retrospektif olarak planlandı. Analiz için 61dize ait(61 kişi) manyetik rezonans görüntüleri (MRG) alındı. Bunlardan 38 diz sol ve 23 diz ise sağ tarafa aitti. Bir orthopedist ve iki anatomist, patellar morfolojiyi, patellar yüksekliği ve patellar hizalamayı bağımsız olarak ölçtü ve lateral, medial menisküs yırtıklarını değerlendirdi. Aksiyel T2 ağırlıklı turbo spin eko (TR:3600, TE:87 ms; kesit kalınlığı 5 mm; boşluk 1.5 mm) içeren diz MRG protokolü kullanıldı.
Bulgular: Konvansiyonel ve cerrahi tedavi grupları arasında yaş parametresi hariç (cerrahi tedavi yapılanlarda; 27,06±6,20 ve konvansiyonel tedavi yapılanlarda; 27,47±5,33), patellar yükseklik (cerrahi tedavi yapılanlarda; 1.21±0.27 ve konvansiyonel tedavi yapılanlarda; 0.99±0.16), uyum açısı (cerrahi tedavi yapılanlarda; -4.94±4.72 ve konvansiyonel tedavi yapılanlarda; 4.93±5.72), lateral patellofemoral açı (cerrahi tedavi yapılanlarda; -35.61 ve konvansiyonel tedavi yapılanlarda; 10,93±15,00) arasında anlamlı fark bulundu (p<0,05). Ayrıca medial patellofemoral yırtığı olan hastaların 29'unda lateral menisküs yırtığı, 11'inde medial menisküs yırtığı ve 8'inde hem lateral hem de medial menisküs yırtığı tespit ettik.
Sonuç: Menisküs yırtıkları ile medial patellofemoral rüptür arasındaki ilişkinin tedavi sürecini etkileyeceğini bulduk. Ayrıca bu çalışma, medial patellofemoral rüptürü olan hastalarda radyolojik ve klinik korelasyonların, patello-femoral pozisyonların değerlendirilmesine katkıda bulunacaktır.

Anahtar Kelimeler

anatomi, uyum açısı, lateral patellofemoral açı, diz, menisküs yırtıkları, patellar yükseklik

Analysis of the relationship between meniscal tears and medial patellofemoral rupture according to the treatment method and gender

Öz

Objective: The aim of this study was to make a detailed anatomical analysis of the parameters of patellar height, the congruence angle, the lateral patellofemoral angle in patients with medial patellofemoral rupture, according to the treatment method (surgical or conventional), gender and whether or not there is a lateral and medial meniscus tears.
Methods: This study was planned as retrospective study between January 2010 and January 2021. Magnetic resonance images (MRI) of 61 knees (61 individuals) were obtained for analysis. Of those, 38 knees were left, and 23 were right. One orthopaedic surgeons and two anatomist independently measured patellar morphology, patellar height and patellar alignment and evaluation lateral and medial meniscus tears. Knee MRI protocol including axial T2-weighted turbo spin echo (TR:3600, TE:87 ms; slice thickness 5 mm; gap 1.5 mm) was used.
Results: There was a significant difference patellar height (surgery; 1.21±0.27 and conventional; 0.99±0.16), the congruence angle (surgery; -4.94±4.72 and conventional; 4.93±5.72), the lateral patellofemoral angle (surgery; -35.61±16.62 and conventional; 10.93±15.00), except for age parameter (surgery; 27.06±6.20 and conventional; 27.47±5.33) between the conventional and surgical treatment groups (p<0.05). Moreover, we found that 29 patients of the patients with medial patellofemoral rupture had a lateral meniscus tear, 11 patients had a medial meniscus tear, and 8 patients had both lateral and medial meniscus tears.
Conclusion: We found that relationship between meniscal tears and medial patellofemoral rupture will affect the treatment course. Also, this study will contribute to evaluate the radiological and clinical correlations, patello-femoral positioning in patients who medial patellofemoral rupture.

Anahtar Kelimeler

anatomy, congruence angle, lateral patellofemoral angle, knee, meniscus tears, patellar height

Kaynakça

• Wolfe S, Varacallo M, Thomas JD, Carroll JJ, Kahwaji CI. Patellar Instability. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan.
• Sanchis-Alfonso V, Ginovart G, Alastruey-López D, et al. Evaluation of patellar contact pressure changes after static versus dynamic medial patellofemoral ligament reconstructions using a finite element model. J Clin Med. 2019;8(12):2093. doi:10.3390/jcm8122093.
• Wilkens OE, Hannink G, Van de Groes SAW. Recurrent patellofemoral instability rates after MPFL reconstruction techniques are in the range of instability rates after other soft tissue realignment techniques. Knee Surg Sports Traumatol Arthrosc. 2020;28(6):1919-1931. doi: 10.1007/s00167-019-05656-3.
• Özcafer R, Çetinkaya E, Bomba H. Menisküs yırtıklarının konservatif tedavisi. TOTBİD Dergisi. 2019;17:123–127.
• Dutton RA, Khadavi MJ, Fredericson M. Patellofemoral pain. Phys Med Rehabil Clin N Am. 2016;27:31–52.
• Dorfmann H, Juan LH, Bonvarlet JP, Boyer T. Arthroscopy of degenerative lesions of the internal meniscus classification and treatment. Rev Rhum Mal Osteoartic. 1987;54(4):303–10.
• Tucker A, McMahon S, McArdle B, Rutherford B, Acton D. Synthetic versus autologous reconstruction (Syn-VAR) of the medial patellofemoral ligament: a study protocol for a randomised controlled trial. Trials. 2018;19(1):268. doi: 10.1186/s13063-018-2622-7. PMID: 29724252; PMCID: PMC5934878.
• Hautamaa PV, Fithian DC, Kaufman KR, Daniel DM, Pohlmeyer AM. Medial soft tissue restraints in lateral patellar instability and repair. Clin Orthop Relat Res. 1998;(349):174–182.
• Sanchis-Alfonso V. Guidelines for medial patellofemoral ligament reconstruction in chronic lateral patellar instability. J Am Acad Orthop Surg. 2014;22:175–182.
• Manske RC, Prohaska D. Rehabilitation following medial patellofemoral ligament reconstruction for patellar instability. Int J Sports Phys Ther. 2017;12(3):494-511.
• Maenpaa H Lehto MU. Patellar dislocation. The long-term results of nonoperative management in 100 patients. Am J Sports Med. 1997;25:213-217.
• Aframian A, Smith TO, Tennent TD, Cobb JP, Hing CB. Origin and insertion of the medial patellofemoral ligament: a systematic review of anatomy. Knee Surg Sports Traumatol Arthrosc. 2017;25(12):3755-3772. doi: 10.1007/s00167-016-4272-1.
• Matsushita T, Kuroda R,Oka S, Matsumoto T, Takayama K, Kurosaka M. Clinical outcomes of medial patellofemoral ligament reconstruction in patients with an increased tibial tuberosity-trochlear groove distance. Knee Surg Sports Traumatol Arthrosc. 2014;22(10):2438-44.
• Kopf S, Beaufils P, Hirschmann MT, Rotigliano N, Ollivier M, Pereira H, Verdonk R, Darabos N, Ntagiopoulos P, Dejour D, Seil R, Becker R. Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc. 2020;28(4):1177-1194. doi: 10.1007/s00167-020-05847-3.
• Stocco E, Porzionato A, De Rose E, Barbon S, De Caro R, Macchi V. Meniscus regeneration by 3D printing technologies: Current advances and future perspectives. J Tissue Eng. 2022;13:20417314211065860. doi: 10.1177/20417314211065860.
• Akgün I, Kuru İ, Arık M. Patellofemoral instabilite ve tedavisi. Türk Ortopedi ve Travmatoloji Birliği Derneği Dergisi. 2012;11(4):325-334. doi: 10.5606/totbid.dergisi.2012.45.
• Indelli PF, Marcucci M, Cariello D, Poli P, Innocenti M. Contemporary femoral designs in total knee arthroplasty: effects on the patello-femoral congruence. International orthopaedics. 2012;36(6):1167–1173. https://doi.org/10.1007/s00264-011-1454-9.
• Kan JH, Heemskerk AM, Ding Z, Gregory A, Mencio G, Spindler K, Damon BM. DTI-based muscle fiber tracking of the quadriceps mechanism in lateral patellar dislocation. Journal of magnetic resonance imaging. 2009;29(3):663–670. https://doi.org/10.1002/jmri.21687.
• Aksu N, Atansay V, Karalök I, Aksu T, Kara AN, Hamzaoglu A (2021) Relationship of patellofemoral angles and tibiofemoral rotational angles with jumper's knee in professional dancers: an mri analysis. Orthopaedic journal of sports medicine. 2021;9(3):2325967120985229. https://doi.org/10.1177/2325967120985229.
• Yang GM, Wang YY, Zuo LX, Li FQ, Dai YK, Wang F. Good outcomes of combined femoral derotation osteotomy and medial retinaculum plasty in patients with recurrent patellar dislocation. Orthopaedic surgery. 2019;11(4):578–585. https://doi.org/10.1111/os.12500.
• Grimm NL, Wooster BM, Tainter DM, Kildow BJ, Kim J, Taylor DC. Anatomic Magnetic Resonance Imaging Measurements in First-Time Patellar Dislocators by Sex and Age. Journal of athletic training. 2019; 54(8):901–905. https://doi.org/10.4085/1062-6050-280-18.
• Lullini G, Belvedere C, Busacca M, Moio A, Leardini A, Caravelli S, Maccaferri B, Durante S, Zaffagnini S, Marcheggiani Muccioli GM. Weight bearing versus conventional CT for the measurement of patellar alignment and stability in patients after surgical treatment for patellar recurrent dislocation. La Radiologia medica. 2021;126(6):869–877. https://doi.org/10.1007/s11547-021-01339-7.
• Xu JC, Zhang BX, Jia YF, Wang XF, Shen K, Ren WB, Sun R. Medial Patellofemoral Ligament Reconstruction Using Suture Tape for Patellofemoral Joint Instability. Orthopaedic surgery. 2021;13(3):847–854. https://doi.org/10.1111/os.12945.
• Huddleston HP, Bodendorfer BM, Yanke AB. Surgical Technique for Obligate Flexion Patellar Dislocation: Medial Patellofemoral Ligament Reconstruction, Distal Femoral Osteotomy, Quadricepsplasty, and Lateral Retinacular Reconstruction with Dermal Allograft. Arthroscopy techniques. 2021;10(7):e1845–e1852. https://doi.org/10.1016/j.eats.2021.04.004.
• Moon HS, Choi CH, Jung M, Park SH, Lee DY, Shin JK, Kim SH. The effect of medial open wedge high tibial osteotomy on the patellofemoral joint: comparative analysis according to the preexisting cartilage status. BMC musculoskeletal disorders. 2019;20(1):607. https://doi.org/10.1186/s12891-019-2989-y.
• Ergun T. Asemptomatik bireylerde yas ve cinsiyete bağlı patellofemoral morfolojideki farklılıkların analizi: manyetik rezonans görüntüleme çalışması. FU Sag Bil Tıp Derg. 2019;33(1):31-37.
• Arun KC, Ram GG. Measurement of Insall Salvati ratio and modified Insall Salvati ratio to assess the position of the patella in South Indian population. Int J Res Orthop. 2017;3(1):23-25.
• Leung YF, Wai YL, Leung YC. Patella alta in southern China. A new method of measurement. Int Orthop. 1996;20:305-10.
• Zhang YQ, Zhang Z, Wu M, Zhou YD, Tao SL, Yang YL, Li Y, Liu JL, Li P, Teng YS, Guo YM. Medial patellofemoral ligament reconstruction: A review. Medicine. 2022;101(1):e28511. https://doi.org/10.1097/MD.0000000000028511.