Comparision of The Four Years MRI and Arthroscopy Results of Anterior Cruciate Ligament and Meniscus Assesments

Öz

Aim: In the meniscal and ligamentous injuries physical examination and MR imaging is frequently, knee arthroscopy sometimes used in the diagnosis. Our aim is to compare the result of the knee arthroscopy and MR imaging findings retrospectively. And we think MR imaging after physical examination could reduce the rates of diagnostic arthroscopy. In addition we believe that arthroscopy only should made efor treatment. 
Marerial and Method: Preoperative clinical and physical examination findings and MR imaging results of the patients undergoing knee arthroscopy in our hospital were evaluated statistically by reference of arthroscopy retrospectively. 
Results: The mean age of the patients in the study is 32,8 (17-59) and 22 of the patients were female, 73 of them were male. Arthroscopic surgery was performed for 51 left knee and 44 right knee. According to the arthroscopy results; 43 patients have medial meniscus tear, 3 patient have degeneration in medial meniscus, 14 patients have lateral meniscus tear, 4 patient have degeneration in lateral meniscus, 42 patients have complet anterior cruciate ligament injury. MR imaging evaluation of the medial meniscus, lateral meniscus and anterior cruciate ligament revealed sensitivity 97.8%, 38.9%, 100%, specificity 40.8%, 87%, 100% respectively. 
Conclusion: MR imaging after clinical and physical examination is efficient diagnostic method for meniscus and ligamentous injury. Arthroscopy which is a invasive procedure, is only have to used for treatment.

Anahtar Kelimeler

• Magnetic resonance imaging,arthroscopy,knee

Ön Çapraz Bağ ve Menisküslerin Değerlendirilmesinde Dört Yıllık MRG ve Artroskopi Sonuçlarımızın Karşılaştırılması

Öz

Amaç: Menisküs ve ligamentöz lezyonların tanısında fizik muayene ve manyetik rezonans(MR) görüntüleme sıklıkla, diz artroskopisi ise bazen kullanılmaktadır. Bu çalışmada MR görüntüleme ve diz artroskopi sonuçlarını retrospektif olarak karşılaştırılması amaçlandı. Fizik muayene sonrası yapılan MR incelemenin tanısal artroskopi oranını azaltacağı, artroskopinin sadece tedavi amaçlı yapılması gerektiği kanısındayız. 
Materyal ve Metot: Hastanemizde diz artroskopisi yapılan hastaların ameliyat öncesi klinik-fizik muayene bulguları ve MR inceleme sonuçları, referans artroskopi alınarak retrospektif olarak değerlendirildi. 
Bulgular: Çalışmaya katılan hastaların yaş ortalaması 32,8 (17-59) olarak belirlendi. Çalışmadaki hastaların 22 si kadın, 73 ü erkek olup, 44 sağ diz, 51 sol dize artroskopi yapıldı. Artroskopi sonuçlarına göre 43 hastada medial menisküs yırtığı, 3 hastada dejenerasyonu, 14 hastada lateral menisküs yırtığı, 4 hastada dejenerasyonu, 42 hastada ön çapraz bağda tam kat rüptür saptanmıştır. Yapılan değerlendirmede MR görüntülemede medial menisküs için sensitivite %97.8, spesifite %40,8 lateral menisküs için sensitivite %38.9 spesifite %87 ön çapraz bağ için sensitivite ve spesifite %100 olarak tesbit edilmiştir. 
Sonuç: Klinik bulgular ve fizik muayene bulgularına dayanılarak yapılan MR inceleme dizde menisküs ve bağ lezyonlarının tanısında etkin bir tanı yöntemi olup, invaziv bir işlem olan artroskopi sadece tedavi amaçlı yapılmalıdır.

Anahtar Kelimeler

• Manyetik rezonans görüntüleme,artroskopi,diz

Kaynakça

1. 1-Remer EM, Fitzgerald SW, Friedman H, Rogers LF, Hendrix RW, Schafer MF.Anterior cruciate ligament injury: MR imaging diagnosis and patterns of injury. Radiograph 1992;12(5):901-11.
2. 2- Barber-Westin SD, Noyes FR. Objective criteria for return to athletics after anterior cruciate ligament reconstruction and subsequent reinjury rates: a systematic review. Phys Sports Med 2011;39(3):100-10
3. 3- Claus Muhle, Joong Mo Ahn and Constanze Dieke. Diagnosis of ACL and meniscal injuries: MR imaging of knee flexion versus extension compared to arthroscopy. Springer Plus 2013;2:213.
4. 4- O’Shea KJ, Murphy KP, Heekin RD, Herzwurm PJ. The diagnostic accuracy of history, physical examination, and radiographs in the evaluation of traumatic knee disorders. Am J Sports Med 1996;24:164–7.
5. 5- Weinstabl R, Muellner T, Vecsei V, Kainberger F, Kramer M. Economic considerations for the diagnosis and therapy of meniscal lesions: Can magnetic resonance imaging help reduce the expense? World J Surg 1997;21:363–8.
6. 6- Stoller DW, Martin C, Crues JV, Kaplan L, Mink JH. Meniscal tears: Pathologic correlation with MR imaging. Radiol 1987;163:731-8).
7. 7- Stoller DW, Cannon WD, Lesley JR. Magnetic resonance imaging in orthopedics and sport medicine. The knee in: Stoller D (edi). Philadelphia: JB Lipponcott; 1997:204-5.)
8. 8- McMohan PJ, Dettling LA, Glousman RE. The cyclops lesion: a cause of diminished knee extension after rupture of the anterior crıciate ligament. Arthroscopy 1999; 15(7):757-61).

9. 9- Ireland J, Trickey EL, Stoker DJ. Arthroscopy and arthrography of the knee: a critical review. J Bone Joint Surg Br 1980;62- B(1):3–6.
10. 10 -Dandy DJ, Jackson RW. The diagnosis of problems after meniscectomy. J Bone Joint Surg Br 1975;57(3):349–52.
11. 11- Jackson RW, Abe I. The role of arthroscopy in the management of disorders of the knee. An analysis of 200 consecutive examinations. J Bone Joint Surg Br 1972;54(2):310-22.
12. 12- Boeve BF, Davidson RA, Staab EV Jr. Magnetic resonance imaging in the evaluation of knee injuries. South Med J 1991;84(9):1123–7.
13. 13- Remer EM, Fitzgerald SW, Friedman H, Rogers LF, Hendrix RW, Schafer MF. Anterior cruciate ligament injury: MR imaging diagnosis and patterns of injury. Radiographics 1992;12(5):901-15
14. 14- Coward DB. Arthroscopic knee surgery. In: Chapman M, cd. Operative orthopaedics 3rd ed. Philadelphia: Lippincott Williams& Wilkins; 2001,2279.
15. 15- Bari V, Murad M. Accuracy of magnetic resonance imaging in the knee. J Coll Physicians Surg Pak 2003;13(7):408-11
16. 16- Bui-Mansfield LT, Youngberg RA, Warme W, Pitcher JD, Nguyen PL. Potential cost saving of MR imaging obtained before arthroscopy of the knee. Evaluation of 50 consecutive cases. AJR 1997;168:913-18
17. 17- Shahriaree, Heshmat (Editör): O’Connor’s Text book of arthroscopic surgery. Philadelphia: J.B Lippincot;1984.
18. 18- Ozturan KE, Yucel I, Cakıcı H, Guven M, Gurel K. Menisküs Ve Bağ Yaralanmalarının Manyetik Rezonans Görüntüleme Ve Artroskopik Cerrahi Bulgularının Karşılaştırılması. Düzce Tıp Derg 2012;14(2):1-4
19. 19- Malkoç M, Korkmaz Ö, Sever C. Diz manyetik rezonans görüntüleme bulguları ve fizik muayene bulgularının artroskopik bulgular ile karşılaştırılması. Ş.E.E.A.H.Tıp Bül 2013;47(3):104-108
20. 20- 3.Ireland J, Trickey EL, Stoker DJ. Arthroscopy and arthrography of the knee: a critical review. J Bone Joint Surg Br 1980;62 B(1):3–6.
21. 21- Dandy DJ, Jackson RW. The diagnosis of problems after meniscectomy. J Bone Joint Surg Br 1975;57(3):349–52.
22. 22- Jackson RW, Abe I. The role of arthroscopy in the management of disorders of the knee. An analysis of 200 consecutive examinations. J Bone Joint Surg Br 1972;54(2):310-22.
23. 23- Boeve BF, Davidson RA, Staab EV Jr. Magnetic resonance imaging in the evaluation of knee injuries. South Med J 1991;84(9):1123–7.