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

Yıl 2022, Cilt: 9 Sayı: 2, 83 - 91, 19.07.2022

Özge Kasapoğlu , Rabia Tuğba Kılıç , Hayri Baran Yosmaoğlu

https://doi.org/10.15437/jetr.959252

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

• 1. Lian J, Diermeier T, Meghpara M, et al. Rotatory knee laxity exists on a continuum in anterior cruciate ligament injury. J Bone Joint Surg Am. 2020;102:213-220.
• 2. Frank JM, Moatshe G, Brady AW, et al. Lateral meniscus posterior root and meniscofemoral ligaments as stabilizing structures in the ACL-deficient knee: a biomechanical study. Orthop J Sports Med. 2017;5:2325967117695756.
• 3. Pinar H. Ön çapraz bağ rekonstrüksiyonlarının uzun süreli takip sonuçları. Acta Orthop Traumatol Turc. 1999;33:453-458.
• 4. Paschos N, Howell SM. Anterior cruciate ligament reconstruction: Principles of treatment. EFORT Open Rev. 2016:1(11):398-408.
• 5. Spang Iii RC, Nasr MC, Mohamadi A, et al. Rehabilitation following meniscal repair: a systematic review. BMJ Open Sport Exerc Med. 2018;4(1):e000212.
• 6. Knežević OM, Mirkov DM. Strength assessment in athletes following an anterior cruciate ligament injury. Kinesiology. 2013;45:3-15.
• 7. Kobayashi A, Higuchi H, Terauchi M, et al. Muscle performance after anterior cruciate ligament reconstruction. Int Orthop. 2004;28:48-51.
• 8. Li R, Maffulli N, Hsu YC, et al. Isokinetic strength of the M. Quadriceps femoris and hamstrings and functional ability of anterior cruciate deficient knees in recreational athletes. Br J Sports Med. 1996;30:161-164.
• 9. Cronström A, Ageberg E, Häger CK. Protocol: Does sensorimotor function predict graft rupture, contra-lateral injury or failure to return to sports after ACL reconstruction? A protocol for the STOP Graft Rupture study. BMJ Open. 2021;11:e042031.
• 10. Kim WK, Kim D-K, Seo KM, et al. Reliability and validity of isometric knee extensor strength test with hand-held dynamometer depending on its fixation: a pilot study. Ann Rehabil Med. 2014;38:84.
• 11. Kelln BM, McKeon PO, Gontkof LM, et al. Hand-held dynamometry: reliability of lower extremity muscle testing in healthy, physically active, young adults. J Sport Rehabil. 2008;17:160-170.
• 12. Sandal LF, Thorlund JB, Ulrich RS, et al. Exploring the effect of space and place on response to exercise therapy for knee and hip pain-a protocol for a double-blind randomised controlled clinical trial: the CONEX trial. BMJ Open. 2015;5:e007701.
• 13. Adams M, Dolan P, Marx C, et al. An electronic inclinometer technique for measuring lumbar curvature. Clin Biomech. 1986;1:130-134.
• 14. More RC, Karras BT, Neiman R, et al. Hamstrings—an anterior cruciate ligament protagonist: an in vitro study. Am J Sports Med. 1993;21:231-237.
• 15. Celik D, Coşkunsu D, Kılıçoğlu Ö. Translation and cultural adaptation of the Turkish Lysholm knee scale: ease of use, validity, and reliability. Clin Orthop Relat Res. 2013;471:2602-2610.
• 16. Heckmann TP, Barber-Westin SD, Noyes FR. Meniscal repair and transplantation: indications, techniques, rehabilitation, and clinical outcome. J Orthop Sports Phys Ther. 2006;36:795-814.
• 17. Yosmaoglu HB, Baltaci G, Kaya D, et al. Comparison of functional outcomes of two anterior cruciate ligament reconstruction methods with hamstring tendon graft. Acta Orthop Traumatol Turc. 2011;45:240-247.
• 18. Shaw T, Williams MT, Chipchase LS. Do early M. Quadriceps femoris exercises affect the outcome of ACL reconstruction? A randomised controlled trial. Aust J Physiother. 2005;51:9-17.
• 19. Nepple JJ, Dunn WR, Wright RW. Meniscal repair outcomes at greater than five years: a systematic literature review and meta-analysis. J Bone Joint Surg Am. 2012;94:2222-2227.
• 20. Cavanaugh JT, Powers M. ACL rehabilitation progression: where are we now? Curr Rev Musculoskelet Med. 2017;10:289-296.
• 21. Hart JM, Pietrosimone B, Hertel J, Ingersoll CD. M. Quadriceps femoris activation following knee injuries: a systematic review. J Athl Train. 2010;45:87-97.
• 22. de Jong SN, van Caspel DR, van Haeff MJ, et al. Functional assessment and muscle strength before and after reconstruction of chronic anterior cruciate ligament lesions. Arthroscopy. 2007;23:21-28.
• 23. Lautamies R, Harilainen A, Kettunen J, et al. Isokinetic M. Quadriceps femoris and hamstring muscle strength and knee function 5 years after anterior cruciate ligament reconstruction: comparison between bone-patellar tendon-bone and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc. 2008;16:1009-1016.
• 24. Morgan CD, Casscells SW. Arthroscopic meniscus repair: a safe approach to the posterior horns. Arthroscopy. 1986;2:3-12.
• 25. Gillquist J. Knee ligaments and proprioception: Taylor & Francis; 1996.
• 26. Buseck MS, Noyes FR. Arthroscopic evaluation of meniscal repairs after anterior cruciate ligament reconstruction and immediate motion. Am J Sports Med. 1991;19:489-494.
• 27. Pujji O, Keswani N, Collier N, et al. Evaluating the functional results and complications of autograft vs allograft use for reconstruction of the anterior cruciate ligament: a systematic review. Orthop Rev (Pavia). 2017;9:6833.
• 28. Uzun E, Misir A, Kizkapan TB, et al. Factors affecting the outcomes of arthroscopically repaired traumatic vertical longitudinal medial meniscal tears. Orthop J Sports Med. 2017;5:2325967117712448.