Ön çapraz bağ rekonstrüksiyonu ile birlikte uygulanan artroskopik menisküs onarımının cerrahi sonrası rehabilitasyona etkileri

Öz

Amaç: Bu çalışmanın amacı, ön çapraz bağ rekonstrüksiyonu (ÖÇB-R) ile yapılan menisküs tamirinin postoperatif dönemde diz eklemindeki fonksiyonel etkilerini incelemekti.
Yöntem: Sadece ÖÇB-R uygulanan (ÖÇB-R grubu) 15 hastanın (yaş: 34±8 yıl) ameliyat sonrası rehabilitasyon sonuçları ile aynı cerrahi işlemde hem ÖÇB-R hem de menisküs tamiri uygulanmış (ÖÇB+M grubu) 15 hastanın (yaş: 27±8 yıl) ameliyat sonrası rehabilitasyon sonuçları karşılaştırıldı. Her iki grupta da rehabilitasyon programı postoperatif ilk gün başlatıldı 6 hafta devam ettirildi. Farklı olarak ÖÇB+M grubu, 15 gün opere bacağa yük vermedi ve diz fleksiyonu 90 derece ile sınırlandı. Bu 15 gün süren iki kısıtlama hariç iki grup aynı rehabilitasyon programına alındı. Bireylerin M. Quadriceps femoris ve hamstring kas kuvveti el dinamometresi ile diz eklem hareket açıklığı inklinometre ile ölçüldü. Fonksiyonel yetersizliği değerlendirmek için Lysholm Diz Ölçeği kullanıldı.
Bulgular: Değerlendirmeler sonucunda 1. (p=0,011) 4. (p=0,048) ve 6. (p=0,001) haftalarda ÖÇB-R grubunda M. Quadriceps femoris kas kuvveti ÖÇB+M grubuna göre daha fazla bulunurken, 2. haftadan itibaren kas kuvveti ortalamaları bakımından gruplar arasında istatistiksel fark bulunmadı (p=0,229). Gruplar arasında diz eklemi fleksiyon açısı ve Lysholm diz ölçeği sonuçları bakımından tüm haftalarda anlamlı bir fark olmamasına karşın (p>0,05) ekstansiyon limitasyonu 1. (p=0,006) ve 2. (p=0,012) haftalarda ÖÇB+M grubunda daha fazla bulundu.
Sonuç: ÖÇB-M grubuna postoperatif dönemde uygulanan kısıtlayıcı rehabilitasyonun M. Quadriceps femoris kas kuvveti ve tam ekstansiyon derecesi üzerine erken dönemde olumsuz etkileri olabilir.

Anahtar Kelimeler

• diz yaralanmaları
• egzersiz tedavisi
• ön çapraz bağ rekonstrüksiyonu

Effects of arthroscopic meniscal repair performed with anterior cruciate ligament reconstruction on post operative rehabilitation after surgery

Öz

Purpose: The aim of this study was to evaluate the functional effects of meniscal repair performed with anterior cruciate ligament reconstruction on knee joint during post-operative stage.
Methods: Postoperative rehabilitation results of 15 patients (age: 27±8 years) who had both anterior cruciate ligament reconstruction with meniscus repair (ACL+M), and 15 patients (age: 34±8 years) who had isolated anterior cruciate ligament reconstruction (ACL-R) were compared in terms of functional outcomes.
In both groups, the rehabilitation program was started on the first postoperative day and continued for 6 weeks. Differently, the ACL+M group did not load the operated leg for 15 days and knee flexion was limited to 90 degrees. Except for these two 15-day restrictions, the two groups were included in the same rehabilitation program. M. Quadriceps femoris and hamstring muscle strength of the subjects were measured with a handheld dynamometer, and knee range of motion was measured with an inclinometer. Lysholm Knee Scale was used to assess functional disability.
Results: As a result of the evaluations, M. Quadriceps femoris muscle strength was found to be higher in the ACL-R group than in the ACL+M group at the 1st (p=0.011), 4th (p=0.048) and 6th (p=0.001) weeks. However, there was no statistical difference between the groups in terms of muscle strength averages at 2 weeks (p=0.229). Although there was no significant difference between the groups in terms of knee joint flexion angle and Lysholm Knee Scale results at all weeks (p>0.05), extension limitation was found to be higher in the ACL+M group at the 1st (p=0.006) and 2nd (p=0.012) weeks.
Conclusion: Restrictive rehabilitation applied to the ACL-M group in the postoperative period may have negative effects on the M. Quadriceps femoris muscle strength and the degree of full extension in the early period.

Anahtar Kelimeler

• Knee injuries
• Exercise therapy
• Anterior cruciate ligament reconstruction

Kaynakça

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