İzole Menisküs Yırtıklarında Alt Ekstremite Q Açısının ve Rotasyonel Dizilimlerin Karşılaştırılması

Yıl 2016, Cilt: 13 Sayı: 1, 54 - 60, 28.04.2016

Uğur Erdem Işıkan Cemil Ertürk Ali Levent İbrahim Avşin Öztürk Ömer Karakaş Mehmet Akif Altay

Öz

Amaç: Bu çalışmanın amacı alt ekstremitenin rotasyonel diziliminin ve kuadriseps (Q) açısının izole
menisküs yırtıklarıyla ilişkisini değerlendirmektir.
Hastalar ve yöntem: Bu çalışma tek taraflı izole menisküs yırtıklı 30 hastanın 60 dizi (hepsi erkek; ortalama yaşı 35.3; dağılım:17-47 yaş) ile kontrol grubu olarak, 30 sağlıklı gönüllünün 60 dizini (hepsi erkek;
ortalama yaşı 33.6; dağılım:24-46 yaş) içeriyordu. Hastaların tanıları manyetik rezonans görüntüleme
(MRG) ve ardından yapılan artroskopik cerrahi ile konuldu. 30 dizden oluşan dört grup oluşturuldu. Grup 1
izole menisküs yırtıklı hastalar ve Grup 2 hastaların sağlam dizlerini kapsamaktayken; Grup 3 sağlıklı
gönüllülerin hasta dizine karşılık gelen tarafı, Grup 4 ise sağlam taraf dizlerinden oluşturuldu. Tüm grupların
alt ekstremiteleri bilgisayarlı tomoğrafi (BT) eşliğinde femoral anteversiyon ve tibial torsiyon dereceleri ile
Q açıları ölçüldü.
Bulgular: Dört grubun alt ekstremiteleri arasında rotasyonel dizilim farkı saptanmadı. Ayrıca, hastaların
menisküs yırtık taraflı ve sağlam dizi arasında Q açısı yönünden bir fark görülmedi. Bu çalışmada hasta
grubundaki Q açısını kontrol grubundan önemli derecede daha yüksek gözlemledik.
Sonuç: Çalışmamızda izole menisküs yırtığı ile alt ekstremitenin rotasyonel dizilimi bakımından herhangi
bir ilişki gösteremedik. Bu bulgu izole menisküs yırtığında, alt ekstremitenin rotasyonel deformitelerinin
başlıca etken olamayacağını düşündürmektedir. Ancak, artmış Q açısı menisküs yırtıklarına eğilimi artırıcı
bir etken olabilir.

Anahtar Kelimeler

kemik anteversiyonu, tibial torsiyon, menisküsler

A comparison of rotational alignment and Q angle of the lower limb in isolated meniscal tears

Öz

Objectives: The aim of this study was to evaluate the isolated meniscal tears and its relation with the
rotational alignments and quadriceps angles (Q angles) of the lower limb.
Patients and methods: This study included 60 knees of 30 patients with unilateral isolated meniscal tears
(mean age 35.3; range 17 to 47 years) and 60 knees of 30 healthy men were examined (mean age, 33.6; range
24 to 46 years) as controls. We divided into four groups of 30 limbs each as follows. Group 1 included the
patients with isolated meniscal tears, and Group 2 included the patients with the contralateral intact limb.
However, Group 3 included the healthy controls with ipsilateral limb, and Group 4 included the healthy
controls with contralateral limb. The lower extremity of all groups were imaged by computed tomography
and femoral anteversion, tibial torsion, and Q angles were measured.
Results: There was no statistical difference in the rotational alignments with the lower limb between the four
groups. Additionally, there was no statistical difference in the Q angles between the isolated meniscal tears
group and the contralateral knees. In this study, we observed significantly higher Q angle in the patient
groups than controls.
Conclusion: We were not able to show any association between the isolated meniscal tears and rotational
alignments with the lower limb. This result suggest that the lower extremity torsional deformities cannot be
regarded as primary etiological factor for the isolated meniscal tears. However, increased Q angles may be
played a role as predisposing factors for meniscal tears.

Anahtar Kelimeler

Bone Anteversion, Tibial torsion, Menisci

Kaynakça

• 1.Flandry F, Hommel G. Normal anatomy and biomechanics of the knee. Sports Med Arthrosc. 2011;19:82-92.
• 2.Makris EA, Hadidi P, Athanasiou KA. The knee meniscus: structure-function, pathophysiology, current repair techniques, and prospects for regeneration. Biomaterials. 2011;32:7411-31.
• 3.Jarit GJ, Bosco JA 3rd. Meniscal repair and reconstruction. Bull NYU Hosp Jt Dis. 2010;68:84-90.
• 4.Yeh PC, Starkey C, Lombardo S, Vitti G, Kharrazi FD. Epidemiology of Isolated Meniscal Injury and Its Effect on Performance in Athletes From the National Basketball Association. Am J Sports Med. 2012;40:589- 94.
• 5.Habata T, Ishimura M, Ohgushi H, Tamai S, Fujisawa Y. Axial alignment of the lower limb in patients with isolated meniscal tear. J Orthop Sci. 1998;3:85-9.
• 6.Radler C, Kranzl A, Manner HM, Höglinger M, Ganger R, Grill F. Torsional profile versus gait analysis: consistency between the anatomic torsion and the resulting gait pattern in patients with rotational malalignment of the lower extremity. Gait Posture. 2010;32:405-10.
• 7.Seber S, Hazer B, Köse N, Göktürk E, Günal I, Turgut A. Rotational profile of the lower extremity and foot progression angle: computerized tomographic examination of 50 male adults. Arch Orthop Trauma Surg. 2000;120:255-8.
• 8.Powers CM, Chen PY, Reischl SF, Perry J. Comparison of foot pronation and lower extremity rotation in persons with and without patellofemoral pain. Foot Ankle Int. 2002;23:634-40.
• 9.Nguyen AD, Shultz SJ. Identifying relationships among lower extremity alignment characteristics. J Athl Train. 2009;44:511-8.
• 10.Eckhoff DG, Brown AW, Kilcoyne RF, Stamm ER. Knee version associated with anterior knee pain. Clin Orthop Relat Res. 1997;339:152-5.
• 11.Lee TQ, Morris G, Csintalan RP. The influence of tibial and femoral rotation on patellofemoral contact area and pressure. J Orthop Sports Phys Ther. 2003;33:686- 93.
• 12.Bruce WD, Stevens PM. Surgical correction of miserable malalignment syndrome. J Pediatr Orthop. 2004;24:392-6.
• 13.Dickschas J, Harrer J, Pfefferkorn R, Strecker W. Operative treatment of patellofemoral maltracking with torsional osteotomy. Arch Orthop Trauma Surg. 2012;132:289-98.
• 14.Moussa M. Rotational malalignment and femoral torsion in osteoarthritic knees with patellofemoral joint involvement. A CT scan study. Clin Orthop Relat Res. 1994;304:176-83.
• 15.Krackow KA, Mandeville DS, Rachala SR, BayersThering M, Osternig LR. Torsion deformity and joint loading for medial knee osteoarthritis. Gait Posture. 2011;33:625-9.
• 16.Akalın Y, Ozçelik A, Köse N, Seber S. [Rotational alignment of the lower extremity in adults: no relationship with osteoarthritis of the knee was proved]. Eklem Hastalik Cerrahisi. 2011;22:75-80.
• 17.Nguyen AD, Boling MC, Levine B, Shultz SJ. Relationships between lower extremity alignment and the quadriceps angle. Clin J Sport Med. 2009;19:201-6.
• 18.Turner MS. The association between tibial torsion and knee joint pathology. Clin Orthop Relat Res. 1994;302:47- 51.
• 19.Yercan HS, Taşkıran E. [The relationship between lower extremity torsion deformities and patellofemoral disorders]. Eklem Hastalik Cerrahisi. 2004;15:71-5.
• 20.Alentorn-Geli E, Myer GD, Silvers HJ, Samitier G, Romero D, Lázaro-Haro C, Cugat R. Prevention of noncontact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors. Knee Surg Sports Traumatol Arthrosc. 2009;17:705-29.
• 21.Rauh MJ, Koepsell TD, Rivara FP, Rice SG, Margherita AJ. Quadriceps angle and risk of injury among high school cross-country runners. J Orthop Sports Phys Ther. 2007;37:725-33.
• 22.Tsakoniti AE, Mandalidis DG, Athanasopoulos SI, Stoupis CA. Effect of Q-angle on patellar positioning and thickness of knee articular cartilages. Surg Radiol Anat. 2011;33:97-104.
• 23.Haim A, Yaniv M, Dekel S, Amir H. Patellofemoral pain syndrome: validity of clinical and radiological features. Clin Orthop Relat Res. 2006;451:223-8.
• 24.Park SK, Stefanyshyn DJ. Greater Q angle may not be a risk factor of patellofemoral pain syndrome. Clin Biomech (Bristol, Avon). 2011;26:392-6.