İnsan Diz Ekleminin Morfometrisi: Manyetik Rezonans Görüntüleme Kullanımı

Abstract

Arka plan: Patella, tibia proksimal kısmı ve femur distal kısmının morfolojik ölçümleri hakkında bilgi eksikliği bulunmaktadır. Bu çalışma, Türk hastaların dizlerini ölçmeyi ve farklı popülasyonlarla karşılaştırmayı amaçlamaktadır. Yöntemler: Çalışmaya 56'sı kadın, 56'sı erkek olmak üzere toplam 112 hasta dahil edilmiştir. Ölçülen on yedi parametre arasında femurun distal kısmında altı, tibianın proksimal kısmında dört, patellada üç ve ön ve arka çapraz bağlarda iki parametre bulunmaktadır. Ölçümler, Selçuk Üniversitesi Tıp Fakültesi Radyoloji Anabilim Dalı'nda bir MRI cihazı kullanılarak gerçekleştirilmiştir. Sonuçlar: Cinsiyete göre toplanan veriler analiz edildiğinde, ön ve arka çapraz bağlar, patella, tibianın proksimal kısmı ve femurun distal kısmı arasında anlamlı farklılıklar (P<0,05) saptanmıştır. Erkeklerin genel olarak daha yüksek değerlere sahip olduğu bulunmuştur. Ancak, sağ, sol ve yaşa göre yapılan karşılaştırmalarda anlamlı bir fark saptanmamıştır (P> 0,05). Sonuç: Bu araştırmanın bulguları, üreticilerin total diz artroplastisinde kullanılacak bileşenlerin boyutlarını ve en boy oranlarını daha doğru bir şekilde belirlemelerini sağlayacaktır.

Keywords

• anatomi
• çapraz bağ
• diz
• MRI

Morphometry of the Human Knee Joint: Using Magnetic Resonance Imaging

Abstract

Background: There is a lack of information regarding the morphological measurements of the patella, proximal portion of the tibia, and distal portion of the femur. This study aims to measure the knees of Turkish patients and compare them with different populations. Methods: The study included 112 patients, 56 of whom were female and 56 of whom were male. Six parameters in the distal portion of the femur, four in the proximal portion of the tibia, three in the patella, and two in the anterior and posterior cruciate ligaments were among the seventeen parameters that were measured. Measurements were performed using an MRI device in the Department of Radiology at Selcuk University, Faculty of Medicine. Results: The anterior and posterior cruciate ligaments, the patella, the proximal portion of the tibia, and the distal portion of the femur all showed significant differences (P<0.05) when the data collected by gender were analyzed. Males were found to have higher values overall. However, no significant difference was identified in the comparisons by right, left and age (P> 0.05). Conclusion: The findings of this investigation will enable manufacturers to more accurately determine the dimensions and aspect ratios of components to be used in total knee arthroplasty.

Keywords

• anatomy
• cruciate ligament
• knee
• MRI

References

1. 1. Agel J, Rockwood T, Klossner D. Collegiate ACL injury rates across 15 sports: national collegiate athletic association injury surveillance system data update (2004–2005 through 2012–2013). Clin J Sport Med. 2016;26(6):518-23.
2. 2. Anderson AF, Dome DC, Gautam S, Awh MH, Rennirt GW. Correlation of anthropometric measurements, strength, anterior cruciate ligament size, and intercondylar notch characteristics to sex differences in anterior cruciate ligament tear rates. Am J Sports Med. 2001;29(1):58-66.
3. 3. Anderson AF, Snyder RB, Federspiel CF, Lipscomb AB. Instrumented evaluation of knee laxity: a comparison of five arthrometers. Am J Sports Med. 1992;20(2):135-40.
4. 4. Beynnon BD, Vacek PM, Newell MK, Tourville TW, Smith HC, Shultz SJ, et al. The effects of level of competition, sport, and sex on the incidence of first-time noncontact anterior cruciate ligament injury. Am J Sports Med. 2014;42(8):1806-12.
5. 5. Chandrashekar N, Slauterbeck J, Hashemi J. Sex-based differences in the anthropometric characteristics of the anterior cruciate ligament and its relation to intercondylar notch geometry: a cadaveric study. Am J Sports Med. 2005;33(10):1492-8.
6. 6. Dargel J, Feiser J, Gotter M, Pennig D, Koebke J. Side differences in the anatomy of human knee joints. Knee Surg Sports Traumatol Arthrosc. 2009;17:1368-76.
7. 7. Dargel J, Schmidt-Wiethoff R, Feiser J, Koebke J, Schlüter-Brust K, Eysel P, et al. Relationship between human femorotibial joint configuration and the morphometry of the anterior cruciate ligament. Arch Orthop Trauma Surg. 2011;131:1095-105.
8. 8. Eckstein F, Müller S, Faber SC, Englmeier KH, Reiser M, Putz R. Side differences of knee joint cartilage volume, thickness, and surface area, and correlation with lower limb dominance—an MRI-based study. Osteoarthritis Cartilage. 2002;10(12):914-21.

9. 9. Edwards A, Bull AMJ, Amis AA. The attachments of the fiber bundles of the posterior cruciate ligament: an anatomic study. Arthroscopy. 2007;23(3):284-90.
10. 10. Fridén T, Jonsson A, Erlandsson T, Jonsson K, Lindstrand A. Effect of femoral condyle configuration on disability after an anterior cruciate ligament rupture: 100 patients followed for 5 years. Acta Orthop Scand. 1993;64(5):571-4.
11. 11. Galbusera F, Freutel M, Dürselen L, D’Aiuto M, Croce D, Villa T, et al. Material models and properties in the finite element analysis of knee ligaments: a literature review. Front Bioeng Biotechnol. 2014;2:54.
12. 12. Gali JC, de Sousa Oliveira HC, Lisboa BCB, Dias BD, de Godoy Casimiro F, Caetano EB. Tibial insertions of the posterior cruciate ligament: topographic anatomy and morphometric study. Rev Bras Ortop. 2013;48(3):263-7.
13. 13. Giffin JR, Vogrin TM, Zantop T, Woo SLY, Harner CD. Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med. 2004;32(2):376-82.
14. 14. Gokeler A, Schmalz T, Knopf E, Freiwald J, Blumentritt S. The relationship between isokinetic quadriceps strength and laxity on gait analysis parameters in anterior cruciate ligament reconstructed knees. Knee Surg Sports Traumatol Arthrosc. 2003;11:372-8.
15. 15. Hashemi J, Chandrashekar N, Mansouri H, Gill B, Slauterbeck JR, Schutt RC Jr, et al. Shallow medial tibial plateau and steep medial and lateral tibial slopes: new risk factors for anterior cruciate ligament injuries. Am J Sports Med. 2010;38(1):54-62.
16. 16. Heckman JD. Campbell’s operative orthopaedics. Philadelphia: Lippincott Williams & Wilkins; 2003.
17. 17. Hitt K, Shurman JR, Greene K, McCarthy J, Moskal J, Hoeman T, et al. Anthropometric measurements of the human knee: correlation to the sizing of current knee arthroplasty systems. J Bone Joint Surg Am. 2003;85 Suppl 4:115-22.
18. 18. Incavo SJ, Ronchetti PJ, Howe JG, Tranowski JP. Tibial plateau coverage in total knee arthroplasty. Clin Orthop Relat Res. 1994;(299):81-5.
19. 19. Jonsson H, Kärrholm J, Elmqvist LG. Laxity after cruciate ligament injury in 94 knees: the KT-1000 arthrometer versus roentgen stereophotogrammetry. Acta Orthop Scand. 1993;64(5):567-70.
20. 20. Liu W, Maitland ME. Influence of anthropometric and mechanical variations on functional instability in the ACL-deficient knee. Ann Biomed Eng. 2003;31:1153-61.
21. 21. Mensch JS, Amstutz HC. Knee morphology as a guide to knee replacement. Clin Orthop Relat Res. 1975;(112):231-41.
22. 22. Prodromos CC, Han Y, Rogowski J, Joyce B, Shi K. A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury–reduction regimen. Arthroscopy. 2007;23(12):1320-5.
23. 23. Surendran S, Pengatteeri YH, Park SE, Choi KN, Gopinathan P, Han SH, et al. Morphometry of the proximal tibia to design the tibial component of total knee arthroplasty for the Korean population. Knee. 2007;14(4):295-300.
24. 24. Tajima G, Nozaki M, Iriuchishima T, Ingham SJM, Shen W, Smolinski P, et al. Morphology of the tibial insertion of the posterior cruciate ligament. J Bone Joint Surg Am. 2009;91(4):859-66.
25. 25. Todd MS, Lalliss S, Garcia E, DeBerardino TM, Cameron KL. The relationship between posterior tibial slope and anterior cruciate ligament injuries. Am J Sports Med. 2010;38(1):63-7.
26. 26. Uehara K, Kadoya Y, Kobayashi A, Ohashi H, Yamano Y. Anthropometry of the proximal tibia to design a total knee prosthesis for the Japanese population. J Arthroplasty. 2002;17(8):1028-32.
27. 27. Wang HM, Shultz SJ, Ross SE, Henson RA, Perrin DH, Kraft RA, et al. Sex comparisons of in vivo anterior cruciate ligament morphometry. J Athl Train. 2019;54(5):513-8.
28. 28. Westrich GH, Haas SB, Insall JN, Frachie A. Resection specimen analysis of proximal tibial anatomy based on 100 total knee arthroplasty specimens. J Arthroplasty. 1995;10(1):47-51.
29. 29. Westrich GH, Laskin RS, Haas SB, Sculco TP. Resection specimen analysis of tibial coverage in total knee arthroplasty. Clin Orthop Relat Res. 1994;(309):163-75.
30. 30. Whitney DC, Sturnick DR, Vacek PM, DeSarno MJ, Gardner-Morse M, Tourville TW, et al. Relationship between the risk of suffering a first-time noncontact ACL injury and geometry of the femoral notch and ACL: a prospective cohort study with a nested case-control analysis. Am J Sports Med. 2014;42(8):1796-805.