Posterior Tibial Eğim Ve Patellar Tendon Oryantasyon İlişkisinin Ön Çapraz Bağ Rüptürü Üzerine Etkisi
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Tarih
2023
Yazarlar
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Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
GİRİŞ: Ön çapraz bağ yaralanması sıklıkla karşımıza çıkan diz ve diz çevresi bağ yaralanmalarından biridir. Bu tür yaralanmalarda yaşa ve hastanın fiziksel durumuna göre cerrahi tedavi gerekebilmektedir. Birçok çalışmada ön çapraz bağ (ÖÇB) yaralanmasının etyolojisi ve mekanizması araştırılmaktadır. Artmış posterior tibial eğim (PTE) ve ön çapraz bağ yaralanması arasında ilişki olduğunu gösteren çalışmalar mevcuttur. Ancak hem PTE hem de patellar tendon oryantasyonu (PTO) ile ÖÇB rüptürü arasındaki ilişkiyi araştıran çalışma bildiğimiz kadarıyla literatürde incelenmemiştir. Bu çalışmanın amacı PTE ve PTO’nun ön çapraz bağ rüptürü ile ilişkisinin araştırılmasıdır.
YÖNTEMLER: 2015-2021 yılları arasında Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı kliniğinde ÖÇB rüptürü nedeniyle opere edilen hastalar retrospektif olarak analiz edildi. Çalışmanın dışlama kriterleri medial ve lateral menisküs yırtığı, geçirilmiş alt ekstremite cerrahisi, nöromuskuler ve hematolojik hastalıklar, alt ekstremite dizilim bozuklukları, (bacak boy uzunluk eşitsizliği, koronal ve sagittal plan deformiteleri patellar insitabilite), dejeneratif artrit (Kellgren Lawrance evre 2-3-4), radyolojik ölçümü için uygun diz yan grafisi olmayan hastalar, 18 yaş altı ve 50 yaş üstü hastalar idi. Radyolojik ölçümler için uygun, tibia şaftını içeren standart diz yan grafileri olan, diz MRG’leri bulunan ve izole ÖÇB rüptürü olan 80 hasta ve yaş, cinsiyet açısından benzer dağılımda MRG de normal diz görüntüsü olan 80 hasta kontrol grubu olmak üzere 2 grup halinde toplam 160 kişi çalışmaya dahil edildi. Çalışmamızda PTE ölçümleri tibia şaftını içeren, femur kondilleri birbiri üzerinde ekspoze olmuş tam yan radyografilerde; medial plato üzerinden geçen çizginin tanjantı ile tibia anatomik aksı arasındaki açı ölçülerek hesaplanmıştır. Aynı zamanda tam yan grafide
vi
patellar tendon uzunluğu (tuberositas tibia ile patella alt polu arası mesafe) ve patellanın diagonal uzunluğu ölçüldü. Patellar tendon uzunluğu, patella uzunluğuna oranlanarak Insall-Salvati oranı hesaplandı. Ayrıca patellar tendon trasesinden (tuberositas tibia-patella inferior polü) geçen doğru ile tibia platolarına teğet geçen doğru arasındaki tibial eğim-patellar tendon açısı (TEPTA) hesaplandı.
BULGULAR: ÖÇB rüptürü olan hastaların 47’si(%58,7) erkek 33’ü(%41,3) kadın, kontrol grubu hastaların 44’ü(%55) erkek 36’sı(%45) kadındı. ÖÇB rüptürü olan hastaların PTE ortalama değeri: 10.65º±1.91º, kontrol grubu hastaların PTE ortalama değeri: 9.52º±1.50º bulundu. ÖÇB rüptürü olan hastaların PTE değerleri kontrol grubuna göre anlamlı düeyde yüksek bulundu.(p=0.005) ÖÇB rüptürü olan hasta grubunun insall-salvati oranı kontrol grubuna göre anlamlı düzeyde düşük bulundu.(p꞊0.043) Hastaların rekonstrüksiyon öncesi ve sonrası yapılan tibial eğim patellar tendon açısı(TEPTA) ölçümleri kıyaslandığında rekonstruksiyon sonrası TEPTA değeri rekonstruksiyon öncesi yapılan TEPTA ölçümlerine göre anlamlı düzeyde yüksek bulundu.(p<0.001) Rekonstrüksiyon yapılan hastaların TEPTA değerleri ile kontrol grubu TEPTA değerleri karşılaştırıldığında rekonstrüksiyon yapılan hastaların TEPTA değerleri anlamlı düzeyde yüksek bulundu.(p<0.001)
TARTIŞMA VE SONUÇ: Bu çalışmanın en önemli bulgusu patellar tendon oryantasyonunun ÖÇB rüptürü ve Insall-Salvati oranı ile ilişkili olabileceğini göstermesidir. TEPTA ile ÖÇB rüptürü arasındaki ilişkiyi incelediğimizde ÖÇB rekonstrüksiyonu yapılan hastaların TEPTA’sı ÖÇB rüptürü olan grup ve kontrol grubuna göre anlamlı düzeyde yüksekti. Bu yönüyle çalışmamız patellar tendon oryantasyonunun ÖÇB rüptürü ile ilişkili olabileceğini göstermiştir.
INTRODUCTION: Anterior cruciate ligament injury is one of the most common knee and knee ligament injuries. In such injuries, surgical treatment may be required depending on the age and physical condition of the patient. Many studies investigate the etiology and mechanism of anterior cruciate ligament ( ACL) injury. There are studies showing an association between increased posterior tibial slope (PTE) and anterior cruciate ligament injury. However, the study investigating the relationship between both PTE and patellar tendon orientation (PTO) and ACL rupture has not been reviewed in the literature to the best of our knowledge. The aim of this study is to investigate the relationship of PTE and PTO with anterior cruciate ligament rupture. METHODS: Patients who were operated for ACL rupture in Necmettin Erbakan University Meram Medical Faculty Department of Orthopedics and Traumatology between 2015-2021 were analyzed retrospectively. Exclusion criteria of the study were medial and lateral meniscal tear, previous lower extremity surgery, neuromuscular and hematological diseases, lower extremity malalignment, (leg length inequality, coronal and sagittal plane deformities, patellar instability), degenerative arthritis (Kellgren Lawrance stage 2-3-4 ), patients without knee radiography suitable for radiological measurement were patients under the age of 18 and over the age of 50. A total of 160 patients were divided into 2 groups, consisting of 80 patients with standard knee lateral radiographs including the tibial shaft, suitable for radiological measurements, with knee MRIs, and isolated ACL rupture, and 80 patients with a similar distribution in terms of age and gender, with a normal knee image on MRI, as the control group. Person was included in the study. In our study, PTE measurements were made on full lateral radiographs containing the tibial shaft, with the femoral condyles exposed on each other; The angle between the tangent of the line passing over the medial plateau and the tibia anatomical viii axis was calculated by measuring. At the same time, patellar tendon length (the distance between tuberositas tibia and lower pole of the patella) and diagonal length of the patella were measured in the full lateral radiograph. The Insall-Salvati ratio was calculated by proportioning the patellar tendon length to the patella length. In addition, the tibial tilt-patellar tendon angle (TEPTA) between the line passing through the patellar tendon trace (tuberositas tibia-patella inferior pole) and the line tangent to the tibial plateaus was calculated. RESULTS: 47 (58.7%) of the patients with ACL rupture were male, 33 (41.3%) were female, and 44 (55%) of the control group patients were males and 36 (45%) were females. The mean PTE value of the patients with ACL rupture was 10.65º±1.91º, the mean PTE value of the control group patients: 9.52º±1.50º. The PTE values of the patients with ACL rupture were found to be significantly higher than the control group.(p=0.005) The insall-salvati ratio of the patient group with ACL rupture was found to be significantly lower than the control group.(p꞊0.043) The tibial slope patellar When the tendon angle (TEPTA) measurements were compared, the TEPTA value after the reconstruction was found to be significantly higher than the TEPTA measurements performed before the reconstruction. <0.001) DISCUSSION AND CONCLUSION: The most important finding of this study is that patellar tendon orientation may be associated wıth ACL rüptüre and Insall-Salvati ratio. When we examined the relationship between TEPTA and ACL rupture, the TEPTA of the patients who underwent ACL reconstruction was significantly higher than the group with ACL rupture and the control group. In this respect, our study showed that patellar tendon orientation may be associated with ACL rupture.
INTRODUCTION: Anterior cruciate ligament injury is one of the most common knee and knee ligament injuries. In such injuries, surgical treatment may be required depending on the age and physical condition of the patient. Many studies investigate the etiology and mechanism of anterior cruciate ligament ( ACL) injury. There are studies showing an association between increased posterior tibial slope (PTE) and anterior cruciate ligament injury. However, the study investigating the relationship between both PTE and patellar tendon orientation (PTO) and ACL rupture has not been reviewed in the literature to the best of our knowledge. The aim of this study is to investigate the relationship of PTE and PTO with anterior cruciate ligament rupture. METHODS: Patients who were operated for ACL rupture in Necmettin Erbakan University Meram Medical Faculty Department of Orthopedics and Traumatology between 2015-2021 were analyzed retrospectively. Exclusion criteria of the study were medial and lateral meniscal tear, previous lower extremity surgery, neuromuscular and hematological diseases, lower extremity malalignment, (leg length inequality, coronal and sagittal plane deformities, patellar instability), degenerative arthritis (Kellgren Lawrance stage 2-3-4 ), patients without knee radiography suitable for radiological measurement were patients under the age of 18 and over the age of 50. A total of 160 patients were divided into 2 groups, consisting of 80 patients with standard knee lateral radiographs including the tibial shaft, suitable for radiological measurements, with knee MRIs, and isolated ACL rupture, and 80 patients with a similar distribution in terms of age and gender, with a normal knee image on MRI, as the control group. Person was included in the study. In our study, PTE measurements were made on full lateral radiographs containing the tibial shaft, with the femoral condyles exposed on each other; The angle between the tangent of the line passing over the medial plateau and the tibia anatomical viii axis was calculated by measuring. At the same time, patellar tendon length (the distance between tuberositas tibia and lower pole of the patella) and diagonal length of the patella were measured in the full lateral radiograph. The Insall-Salvati ratio was calculated by proportioning the patellar tendon length to the patella length. In addition, the tibial tilt-patellar tendon angle (TEPTA) between the line passing through the patellar tendon trace (tuberositas tibia-patella inferior pole) and the line tangent to the tibial plateaus was calculated. RESULTS: 47 (58.7%) of the patients with ACL rupture were male, 33 (41.3%) were female, and 44 (55%) of the control group patients were males and 36 (45%) were females. The mean PTE value of the patients with ACL rupture was 10.65º±1.91º, the mean PTE value of the control group patients: 9.52º±1.50º. The PTE values of the patients with ACL rupture were found to be significantly higher than the control group.(p=0.005) The insall-salvati ratio of the patient group with ACL rupture was found to be significantly lower than the control group.(p꞊0.043) The tibial slope patellar When the tendon angle (TEPTA) measurements were compared, the TEPTA value after the reconstruction was found to be significantly higher than the TEPTA measurements performed before the reconstruction. <0.001) DISCUSSION AND CONCLUSION: The most important finding of this study is that patellar tendon orientation may be associated wıth ACL rüptüre and Insall-Salvati ratio. When we examined the relationship between TEPTA and ACL rupture, the TEPTA of the patients who underwent ACL reconstruction was significantly higher than the group with ACL rupture and the control group. In this respect, our study showed that patellar tendon orientation may be associated with ACL rupture.
Açıklama
Anahtar Kelimeler
Posterior tibial eğim, Insall-Salvati oranı, Ön çapraz bağ rüptürü, Patellar tendon, Posterior tibial tilt, Insall-salvati ratio, Anterior cruciate ligament rupture, Patellar tendon
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Demiryürek. M. (2023). Posterior Tibial Eğim Ve Patellar Tendon Oryantasyon İlişkisinin Ön Çapraz Bağ Rüptürü Üzerine Etkisi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Ortopedi ve Travmatoloji Anabilim Dalı, Konya.
