Artroskop Açılarının RAMP Lezyonu Tanısındaki Etkisi: 30° mu Yoksa 70° Artroskop mu?

Abstract

Amaç: Bu çalışma, ön çapraz bağ (ÖÇB) rekonstrüksiyonu sırasında medial menisküsün tam ve kısmi ramp lezyonlarının saptanmasında, standart anterior portallerden kullanılan 30° ve 70° artroskopların tanısal doğruluğunu karşılaştırmıştır. Materyal ve Metot: Bu prospektif tanısal doğruluk çalışmasına, Ağustos 2018 ile Ağustos 2024 arasında primer ÖÇB rekonstrüksiyonu uygulanan ve tümünde MRG bulguları ramp lezyonunu düşündüren 114 hasta dahil edildi. İki kıdemli cerrah (>20 yıl deneyim) ve iki kıdemsiz cerrah (<5 yıl deneyim), posteromedial bölmeyi anterolateral portalden her iki artroskopu da rastgele sırayla kullanarak bağımsız olarak değerlendirdi. Bir kıdemli cerrah tarafından posteromedial portalden yapılan prob ile muayene referans standart olarak kabul edildi. Lezyonlar intraoperatif olarak tam veya kısmi şeklinde sınıflandırıldı. Tanısal doğruluk, duyarlılık ve gözlemciler arası uyum hesaplandı; artroskop açısı, cerrah deneyimi ve lezyon alt tipinin etkileri karma etkili lojistik regresyon ile analiz edildi. Bulgular: 114 hastada (ortalama yaş 26,8 yıl) 107 ramp lezyonu (79 tam, 28 kısmi) doğrulandı. Kıdemli cerrahlarda duyarlılık 30° ile %72,9 ve %69,2; 70° ile %96,3 ve %92,5 idi (p<0,001). Kıdemsiz cerrahlar 30° ile %57,9 ve %53,3; 70° ile %73,8 ve %69,2 değerlerine ulaştı (p<0,001). Karma etkili analizde açının (OR=4,9, p<0,001) ve deneyimin (OR=2,3, p=0,01) bağımsız etkileri saptandı; anlamlı bir Açı × Tip etkileşimi mevcuttu (p=0,04). Sonuç: Artroskopi ramp lezyonlarının tanısında altın standart olmaya devam etse de, anterolateral portalden yalnızca 30° artroskop kullanılması, özellikle kısmi yırtıklarda tanının atlanmasına yol açabilir. 70° artroskobun eklenmesi, cerrah deneyiminden bağımsız olarak görüntülemeyi ve tanısal doğruluğu artırır.

Keywords

• Artroskopi
• Diz yaralanmaları
• Duyarlılık ve özgüllük
• Ön çapraz bağ yaralanmaları
• Tibial menisküs yaralanmaları

Ethical Statement

Bu çalışma, Helsinki Beyanı ilkeleri doğrultusunda yürütülmüştür. Çalışma için İstanbul Medeniyet Üniversitesi Göztepe Eğitim ve Araştırma Hastanesi Kurumsal Etik Kurulu tarafından etik onay verilmiştir (Tarih: 15.08.2018, Onay No: 2018/0427).

Impact of Arthroscopes in the Diagnosis of the RAMP Lesion: 30° or 70° Arthroscope?

Abstract

Aim: This study compared the diagnostic accuracy of 30° and 70° arthroscopes used through standard anterior portals for detecting complete and partial ramp lesions of the medial meniscus during anterior cruciate ligament (ACL) reconstruction. Materials and Methods: This prospective diagnostic accuracy study included 114 patients undergoing primary ACL reconstruction between August 2018 and August 2024, all with MRI findings suggestive of a ramp lesion. Two senior surgeons (>20 years’ experience) and two junior surgeons (<5 years’ experience) independently evaluated the posteromedial compartment through the anterolateral portal using both arthroscopes in randomized order. Posteromedial portal inspection with probing served as the reference standard. Lesions were classified intraoperatively as complete or partial. Diagnostic accuracy, sensitivity, and interobserver agreement were calculated, and the effects of arthroscope angle, surgeon experience, and lesion subtype were analyzed using mixed-effects logistic regression. Results: Among 114 patients (mean age 26.8 years), 107 ramp lesions (79 complete, 28 partial) were confirmed. For senior surgeons, sensitivities were 72.9% and 69.2% with 30°, and 96.3% and 92.5% with 70° (p < 0.001). Junior surgeons achieved 57.9% and 53.3% with 30°, and 73.8% and 69.2% with 70° (p < 0.001). Mixed-effects analysis showed independent effects of angle (OR = 4.9, p < 0.001) and experience (OR = 2.3, p = 0.01), with a significant Angle × Type interaction (p = 0.04). Conclusion: Although arthroscopy remains the gold standard for diagnosing ramp lesions, using only a 30° arthroscope through the anterolateral portal may cause underdiagnosis, particularly of partial tears. Incorporating a 70° arthroscope enhances visualization and diagnostic accuracy regardless of surgeon experience.

Keywords

• Anterior Cruciate Ligament Injuries
• Arthroscopy
• Knee Injuries
• Sensitivity and Specificity
• Tibial Meniscus Injuries

Ethical Statement

This study was performed in line with the principles of the Declaration of Helsinki. Ethical approval was granted by the Istanbul Medeniyet University Göztepe Training and Research Hospital Institutional Ethics Committee (Date: 15.08.2018, Approval No: 2018/0427).

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