Sporcularda Ön Çapraz Bağ Rekonstrüksiyonu Sonrası Proprioseptif Duyunun İncelenmesi

Yıl 2023, , 177 - 188, 26.08.2023

Nizamettin Güzel , Ahmet Serhat Genç

https://doi.org/10.17155/omuspd.1283441

Öz

Araştırmanın amacı, Semitendinosus/Gracilis (ST/G) (Hamstring Autograft) Ön Çapraz Bağ Rekonstrüksiyonu (ÖÇBR) uygulanan sporcularda ÖÇBR sonrası en az 6.ay proprioseptif duyuyu değerlendirmek ve sağlıklı diz ile karşılaştırmak, ÖÇBR’ye eşlik eden menisküs yaralanması geçiren ve herhangi bir menisküs deformasyonu geçirmeyen dizlerin karşılaştırmaktır. Araştırmanın çalışma grubu aynı cerrah tarafından geleneksel ÖÇBR ST/G tekniği uygulanan 22 erkek sporcudan oluşmaktadır. Bu değerlendirmede 22 erkek sporcudan 11’i ÖÇBR’ye eşlik eden menisküs deformasyonu geçiren ve 11’i herhangi bir menisküs deformasyonu geçirmeyen olarak tespit edilerek iki grupta değerlendirmeye alınmıştır. Hastaların opere ve nonopere taraflarından proprioseptif duyu ölçülmüştür. Hastaların bulguları yüzüstü ve sırtüstü 15, 30 ve 45 derece propriosepsiyon değerlendirmelerine bakıldığında ÖÇB opere ve nonopere taraflarda yalnızca yüzüstü 30° de istatistiksel açıdan anlamlı bir farklılık ortaya çıkmıştır (p<0,05). ÖÇB-menisküs opere ve nonopere taraflarda ise herhangi bir anlamlılığa rastlanmamıştır. Gruplar arası değerlendirmelerde ise yalnızca yüzüstü 30° de istatistiksel açıdan anlamlılık görülmüştür (p<0,05). Hastalarda ST/G ÖÇBR sonrası en az 6. ay proprioseptif duyu opere ve nonopere taraflar arasında ÖÇB ve ÖÇB-menisküs gruplarında genel olarak benzer bulgular ortaya çıkarması 6 aylık sürecin proprioseptif duyu açısından gruplar arasında belirgin bir farklılık göstermediğini ortaya koymuştur.

Anahtar Kelimeler

ÖÇB rekonstrüksiyonu, propriosepsiyon, menisküs, sporcu, artroskopi

Sporcularda Ön Çapraz Bağ Rekonstrüksiyonu Sonrası Proprioseptif Duyunun İncelenmesi

Öz

The purpose of the study was to evaluate and compare proprioceptive sensation at least 6 months after ACLR in athletes who underwent semitendinosus/gracilis (ST /G) (hamstring autograft) anterior cruciate ligament reconstruction (ACLR) with the healthy knee, and to compare knees with meniscal injury associated with ACLR with those without meniscal deformity. The study subject group consisted of 22 male athletes who underwent the traditional ACLR ST /G technique by the same surgeon. In this study, 11 of the 22 male athletes with meniscal deformity accompanying ACLR and 11 without meniscal deformity were studied in two groups. Proprioceptive sensation was measured on the operated and non-operated sides of the patients. When the patients' findings were analyzed in the assessment of proprioception in the prone and supine positions at 15, 30, and 45 degrees, a statistically significant difference was found between the ACL-operated and non-operated sides only at 30° in the prone position (p < 0.05). No significant difference was found between the ACL-operated and the non-operated side. In the analyzes between the groups, statistical significance was only found at 30° in prone position (p < 0.05). Proprioceptive sensation at least 6 months after ST /G ACLR showed generally similar results between the ACL-operated and non-operated sides in the ACL and ACL meniscus groups, suggesting that the 6-month period showed no significant difference between the groups in terms of proprioceptive sensation.

Anahtar Kelimeler

ACL reconstruction, proprioception, meniscus, athletes, arthroscopy

Kaynakça

• Adıgüzel, Ö. (2007). Genç basketbolcularda proprioseptif eğitimin ayak bileği yaralanmalarından korunmada etkisinin incelenmesi. Yüksek Lisans Tezi. Ankara Üniversitesi Sağlık Bilimleri Enstitüsü, Ankara.
• Angoules, A. G., Mavrogenis, A. F., Dimitriou, R., Karzis, K., Drakoulakis, E., Michos, J., & Papagelopoulos, P. J. (2011). Knee proprioception following ACL reconstruction; a prospective trial comparing hamstrings with bone–patellar tendon–bone autograft. The Knee, 18(2), 76–82. DOI: 10.1016/j.knee.2010.01.009
• Assimakopoulos, A. P., Katonis, P. G., Agapitos, M. V, & Exarchou, E. I. (1992). The innervation of the human meniscus. Clinical Orthopaedics and Related Research, 275, 232–236.
• Barenius, B., Ponzer, S., Shalabi, A., Bujak, R., Norlén, L., & Eriksson, K. (2014). Increased Risk of Osteoarthritis After Anterior Cruciate Ligament Reconstruction. The American Journal of Sports Medicine, 42(5), 1049–1057. DOI: 10.1177/0363546514526139
• Barrack, R. L., Skinner, H. B., & Buckley, S. L. (1989). Proprioception in the anterior cruciate deficient knee. The American Journal of Sports Medicine, 17(1), 1–6. DOI: 10.1177/036354658901700101
• Barrett, D. (1991). Proprioception and function after anterior cruciate reconstruction. The Journal of Bone and Joint Surgery. British Volume, 73-B(5), 833–837. DOI: 10.1302/0301-620X.73B5.1894677
• Bingöl, O., Özdemir, G., Kulakoğlu, B., Keskin, Ö. H., Kılıç, E., & Korkmaz, İ. (2021). Should Meniscus Tears be Repaired During Arthroscopic Anterior Cruciate Ligament Reconstruction? Journal of Ankara University Faculty of Medicine, 71(1), 72–76. DOI: 10.4274/atfm.galenos.2021.88709
• Boden, B. P., Griffin, L. Y., & Garrett, W. E. (2000). Etiology and Prevention of Noncontact ACL Injury. The Physician and Sportsmedicine, 28(4), 53–60. DOI: 10.3810/psm.2000.04.841
• Church, S., & Keating, J. F. (2005). Reconstruction of the anterior cruciate ligament. The Journal of Bone and Joint Surgery. British Volume, 87-B(12), 1639–1642. DOI: 10.1302/0301-620X.87B12.16916
• Co, F. H., Skinner, H. B., & Cannon, W. D. (1993). Effect of reconstruction of the anterior cruciate ligament on proprioception of the knee and the heel strike transient. Journal of Orthopaedic Research, 11(5), 696–704. DOI: 10.1002/jor.1100110512
• Corrigan, J., Cashman, W., & Brady, M. (1992). Proprioception in the cruciate deficient knee. The Journal of Bone and Joint Surgery. British Volume, 74-B(2), 247–250. DOI: 10.1302/0301-620X.74B2.1544962
• Ergen, E., & Ulkar, B. (2007). Proprioception and Coordination. In Clinical Sports Medicine (pp. 237–255). Elsevier. DOI: 10.1016/B978-141602443-9.50021-0
• Fetzer, G., Spindler, K., Amendola, A., Andrish, J., Bergfeld, J., Dunn, W., Flanigan, D., Jones, M., Kaeding, C., Marx, R., Matava, M., McCarty, E., Parker, R., Wolcott, M., Vidal, A., Wolf, B., & Wright, R. (2009). Potential Market for New Meniscus Repair Strategies – Evaluation of the MOON Cohort. Journal of Knee Surgery, 22(03), 180–186. DOI: /10.1055/s-0030-1247746
• Foster, A., Butcher, C., & Turner, P. G. (2005). Changes in arthroscopic findings in the anterior cruciate ligament deficient knee prior to reconstructive surgery. The Knee, 12(1), 33–35. DOI: 10.1016/j.knee.2003.10.007
• Fox, A. J. S., Wanivenhaus, F., Burge, A. J., Warren, R. F., & Rodeo, S. A. (2015). The human meniscus: A review of anatomy, function, injury, and advances in treatment. Clinical Anatomy, 28(2), 269–287. DOI: 10.1002/ca.22456
• Fremerey, R. W., Lobenhoffer, P., Zeichen, J., Skutek, M., Bosch, U., & Tscherne, H. (2000). Proprioception after rehabilitation and reconstruction in knees with deficiency of the anterior cruciate ligament. The Journal of Bone and Joint Surgery, 82(6), 801–806. DOI: /10.1302/0301-620X.82B6.10306
• Fulton, J., Wright, K., Kelly, M., Zebrosky, B., Zanis, M., Drvol, C., & Butler, R. (2014). Injury risk is altered by previous injury: a systematic review of the literature and presentation of causative neuromuscular factors. International Journal of Sports Physical Therapy, 9(5), 583–595.
• Good, L., Roos, H., Gottlieb, D. J., Renström, P. A., & Beynnon, B. D. (1999). Joint position sense is not changed after acute disruption of the anterior cruciate ligament. Acta Orthopaedica Scandinavica, 70(2), 194–198. DOI: 10.3109/17453679909011261
• Iwasa, J., Ochi, M., Adachi, N., Tobita, M., Katsube, K., & Uchio, Y. (2000). Proprioceptive Improvement in Knees With Anterior Cruciate Ligament Reconstruction. Clinical Orthopaedics and Related Research, 381, 168–176. DOI: 10.1097/00003086-200012000-00020
• Jerosch, J., Prymka, M., & Castro, W. H. (1996). Proprioception of knee joints with a lesion of the medial meniscus. Acta Orthopaedica Belgica, 62(1), 41–45.
• Krafft, F. C., Stetter, B. J., Stein, T., Ellermann, A., Flechtenmacher, J., Eberle, C., Sell, S., & Potthast, W. (2017). How does functionality proceed in ACL reconstructed subjects? Proceeding of functional performance from pre- to six months post-ACL reconstruction. PLOS ONE, 12(5), e0178430. DOI: 10.1371/journal.pone.0178430
• Lee, B.-I., Kwon, S.-W., Kim, J.-B., Choi, H.-S., & Min, K.-D. (2008). Comparison of Clinical Results According to Amount of Preserved Remnant in Arthroscopic Anterior Cruciate Ligament Reconstruction Using Quadrupled Hamstring Graft. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 24(5), 560–568. DOI: 10.1016/j.arthro.2007.11.011
• Lee, D.-H., Lee, J.-H., Ahn, S.-E., & Park, M.-J. (2015). Effect of Time after Anterior Cruciate Ligament Tears on Proprioception and Postural Stability. PLOS ONE, 10(9), e0139038. DOI: 10.1371/journal.pone.0139038
• Lephart, S. M., Pincivero, D. M., Giraido, J. L., & Fu, F. H. (1997). The Role of Proprioception in the Management and Rehabilitation of Athletic Injuries. The American Journal of Sports Medicine, 25(1), 130–137. DOI: 10.1177/036354659702500126
• Makris, E. A., Hadidi, P., & Athanasiou, K. A. (2011). The knee meniscus: Structure–function, pathophysiology, current repair techniques, and prospects for regeneration. Biomaterials, 32(30), 7411–7431. DOI: 10.1016/j.biomaterials.2011.06.037
• Muaidi, Q. I., Nicholson, L. L., Refshauge, K. M., Adams, R. D., & Roe, J. P. (2009). Effect of Anterior Cruciate Ligament Injury and Reconstruction on Proprioceptive Acuity of Knee Rotation in the Transverse Plane. The American Journal of Sports Medicine, 37(8), 1618–1626. DOI: 10.1177/0363546509332429
• Muneta, T., Koga, H., Ju, Y.-J., Horie, M., Nakamura, T., & Sekiya, I. (2013). Remnant volume of anterior cruciate ligament correlates preoperative patients’ status and postoperative outcome. Knee Surgery, Sports Traumatology, Arthroscopy, 21(4), 906–913. DOI: 10.1007/s00167-012-2023-5
• Nordenvall, R., Bahmanyar, S., Adami, J., Mattila, V. M., & Felländer-Tsai, L. (2014). Cruciate Ligament Reconstruction and Risk of Knee Osteoarthritis: The Association between Cruciate Ligament Injury and Post-Traumatic Osteoarthritis. A Population Based Nationwide Study in Sweden, 1987–2009. PLoS ONE, 9(8), e104681. DOI: 10.1371/journal.pone.0104681
• Ordu, S., Bayram, E., Çetinus, E., Kaya, İ., & Yılmaz, M. (2014). Elli Yaş Altındaki Hastalarda Menisküs Yırtık Tiplerinin Ön Çapraz Bağ ve Osteokondral Lezyonlarla İlişkis. Haseki Tıp Bülteni, 52(3), 177–180. DOI: 10.4274/haseki.1619
• Paterno, M. V., Huang, B., Thomas, S., Hewett, T. E., & Schmitt, L. C. (2017). Clinical Factors That Predict a Second ACL Injury After ACL Reconstruction and Return to Sport: Preliminary Development of a Clinical Decision Algorithm. Orthopaedic Journal of Sports Medicine, 5(12), 232596711774527. DOI: 10.1177/2325967117745279
• Reed-Jones, R. J., & Vallis, L. A. (2007). Proprioceptive deficits of the lower limb following anterior cruciate ligament deficiency affect whole body steering control. Experimental Brain Research, 182(2), 249–260. DOI: 10.1007/s00221-007-1037-6
• Reider, B., Arcand, M. A., Diehl, L. H., Mroczek, K., Abulencia, A., Stroud, C. C., Palm, M., Gilbertson, J., & Staszak, P. (2003). Proprioception of the knee before and after anterior cruciate ligament reconstruction. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 19(1), 2–12. DOI: 10.1053/jars.2003.50006
• Safran, M. R., Allen, A. A., Lephart, S. M., Borsa, P. A., Fu, F. H., & Harner, C. D. (1999). Proprioception in the posterior cruciate ligament deficient knee. Knee Surgery, Sports Traumatology, Arthroscopy, 7(5), 310–317. DOI: 10.1007/s001670050169
• Sanders, T. L., Maradit Kremers, H., Bryan, A. J., Larson, D. R., Dahm, D. L., Levy, B. A., Stuart, M. J., & Krych, A. J. (2016). Incidence of Anterior Cruciate Ligament Tears and Reconstruction. The American Journal of Sports Medicine, 44(6), 1502–1507. DOI: 10.1177/0363546516629944
• Shidahara, H., Deie, M., Niimoto, T., Shimada, N., Toriyama, M., Adachi, N., Hirata, K., Urabe, Y., & Ochi, M. (2011). Prospective Study of Kinesthesia After ACL Reconstruction. International Journal of Sports Medicine, 32(05), 386–392. DOI: 10.1055/s-0031-1271675
• Solomon, L., Warwick, D. J., & Nayagam, S. (2005). Apley’s Concise System of Orthopaedics and Fractures (3rd ed.). Hodder Education Publishers.
• Viggiano, D., Corona, K., Cerciello, S., Vasso, M., & Schiavone-Panni, A. (2014). The Kinematic Control During the Backward Gait and Knee Proprioception: Insights from Lesions of the Anterior Cruciate Ligament. Journal of Human Kinetics, 41(1), 51–57. DOI: 10.2478/hukin-2014-0032
• Walter, R. P., Dhadwal, A. S., Schranz, P., & Mandalia, V. (2014). The outcome of all-inside meniscal repair with relation to previous anterior cruciate ligament reconstruction. The Knee, 21(6), 1156–1159. DOI: 10.1016/j.knee.2014.08.014
• Zhou, M., Gu, L., Chen, Y., Yu, C., Ao, Y., Huang, H., & Yang, Y. (2008). Factors affecting proprioceptive recovery after anterior cruciate ligament reconstruction. Chinese Medical Journal, 121(22), 2224–2228.