ROTATOR MANŞET YARALANMALARINA EŞLİK EDEN EKLEM İÇİ PATOLOJİLER

Öz

Giriş: Rotator manşet yaralanmaları özellikle yaşlı hastalarda sık görülen sorunlardandır. Bu durum tek başına görülebileceği gibi çeşitli eklem içi patolojilerle birlikte de bulunabilir. Çalışmamızda rotator manşet yırtığı nedeniyle artroskopik cerrahi tedavi uygulanan hastalardaki eklem içi patolojiler değerlendirildi. Materyal ve Metod: Rotator cuff yırtığı nedeniyle artroskopik tamir uygulanan 104 hasta (65 kadın, 39 erkek) çalışmaya dahil edildi. Hastaların ortalama yaşı 50.3 (dağılım 29-70) idi. Ameliyat öncesi grafi ve MRG görüntüleri ile ameliyat sırasındaki bulgular karşılaştırıldı. Bulgular: Ortalama takip süresi 23.9 (dağılım 12-40) ay idi. Ameliyat öncesi MRG sonuçlarına göre hastaların % 63.4’ünde, ameliyat sırasındaki video görüntüleri incelendiğinde ise hastaların % 73.8’inde rotator manşet yırtığına eşlik eden bir eklem içi patoloji saptandı. Artroskopik cerrahi sırasındaki kayıtlarda, MRG değerlendirmelerine göre SLAP lezyonlarının belirgin şekilde fazla olduğu saptandı (p<0.05). Sonuç: Rotator manşet yırtıkları eşlik eden eklem içi patolojilerle birlikte bulunabilir. Artroskopik cerrahi ile bunların büyük kısmına hem tanı konur, hem de tedavi edilir. SLAP lezyonları rotator manşet yırtıklarına eşlik eden en sık eklem içi patolojilerdendir ve MRG ile teşhisi zordur. Açık rotator manşet yırtığı tamiri yapılacaksa bile diagnostik artroskopi yapılması, SLAP lezyonlarının atlanmaması açısından önemlidir.

Anahtar Kelimeler

• Omuz artroskopisi
• rotator manşet yırtığı
• superolateralantero-posterior lezyon

THE INTRAARTICULAR PATHOLOGIES ASSOCIATED TO ROTATOR CUFF INJURIES

Öz

Introduction: Rotator cuff injuries were seen especially in elderly patients. It can be seen alone or accompanying with intraarticular problems. We evaluate the intraarticular problems associated to rotator cuff injuries in arthroscopic shoulder surgery. Materials and Methods: 104 patients (65 female, 39 male) who were operated arthroscopically because of rotator cuff injury were included in our study. The mean age of the patients was 50,3 (range 29-70). Intraarticular problems and cuff tears were evaluated from preoperative radiographies and MRI and the intraoperative video record and they were compared. Results: The mean follow up was 23,9 (range 12-40) months. 63.4% of the patients (66 patients) had an intraarticular pathology accompanying rotator cuff injury according to the radiological evaluation, whereas 73.8% of the patients (76 patients) had an intraarticular pathology in the arthroscopic records. SLAP lesions accompanying rotator cuff injuries were found valuably high in the arthroscopic records compared to preoperative MRI evaluation (p<0.05). Conclusion: SLAP lesions can accompany rotator cuff lesions and they were difficult to diagnose preoperatively. Arthroscopic surgery is useful to detect the SLAP lesions in rotator cuff repair. Diagnostic arthroscopy must be performed to avoid undiagnosed SLAP lesions even in open surgery.

Anahtar Kelimeler

• Shoulder arthroscopy
• rotator cuff tear
• superolatealanteroposterior lesion

Kaynakça

1. 1. Gartsman GM, Taverna E. The incidence of glenohumeral joint abnormalities associated with full-thickness, reparable rotator cuff tears. Arthroscopy 1997;13:450-455.
2. 2. Miller C, Savoie FH. Glenohumeral abnormalities associated with fullthickness tears of the rotator cuff. Orthop Rev 1994;23:159-162.
3. 3. Snyder SJ, Banas MP, Karzel RP. An analysis of 140 injuries to the superior glenoid labrum. J Shoulder Elbow Surg 1995;4:243-248.
4. 4. Andrews JR, Carson WG Jr, McLeod WD. Glenoid labrum tears related to the long head of the biceps. Am J Sports Med 1985;13:337-341.
5. 5. Alpantaki K, McLaughlin D, Kara-gogeos D, Hadjipavlou A, Kontakis G. Sympathetic and sensory neural elements in the tendon of the long head of the biceps. J Bone Joint Surg Am 2005;87:1580-3.
6. 6. Cooper DE, Arnoczky SP, O’Brien SJ, Warren RF, DiCarlo E, Allen AA. Anatomy, histology, and vascularity of the glenoid labrum. An anatomical study. J Bone Joint Surg Am 1992;74:46-52.
7. 7. Keener JD, Brophy RH. Superior labral tears of the shoulder: pathogenesis, evaluation, and treatment. J Am Acad Orthop Surg 2009;17:627-37.
8. 8. McFarland EG, Tanaka MJ, Gar-zon-Muvdi J, Jia X, Petersen SA. Clinical and imaging assessment for superior labrum anterior and posterior lesions. Curr Sports Med Rep 2009;8:234-9.

9. 9. Giaconi JC, Link TM, Vail TP, Fisher Z, Hong R, Singh R, et al.Morbidity of direct MR arthrography. AJR Am J Roentgenol 2011;196:868-74.
10. 10. Saupe N, Zanetti M, Pfirrmann CW, Wels T, Schwenke C, Hodler J.Pain and other side effects after MR arthrography: prospective evaluation in 1085 patients. Radiology 2009;250:830-8.
11. 11. Dinauer PA, Flemming DJ, Murphy KP, Doukas WC. Diagnosis of superior labral lesions: comparison of noncontrast MRI with indirect MR arthrography in unexercised shoulders. Skeletal Radiol 2007;36:195-202.
12. 12. Major NM, Browne J, Domzalski T, Cothran RL, Helms CA. Evaluatio-nof the glenoid labrum with 3-T MRI: is intraarticular contrastnecessary? AJR Am J Roentgenol 2011;196:1139-44.
13. 13. Murray PJ, Shaffer BS. Clinical update: MR imaging of the shoulder. Sports Med Arthrosc 2009;17:40-8.
14. 14. Walton JR, Murrell GA. A two-year clinical outcomes study of 400 patients, comparing open surgery and arthroscopy for rotator cuff repair. Bone Joint Res 2012;1:210-7.
15. 15. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre-and postoperative evaluation by CT scan. Clin Orthop Relat Res 1994;304:78-83.
16. 16. Zhang Z, Gu B, Zhu W, Zhu L, Li Q. Arthroscopic versus mini-open rotator cuff repair: a prospective, randomized study with 24-month follow-up. Eur J Orthop Surg Trau-matol 2013 Jun 28 (DOI: 10.1007/s00590-013-1263-5).
17. 17. Adla DN, Rowsell M, Pandey R. Cost-effectiveness of open versus arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2010;19:258-61.
18. 18. Franceschi F, Longo UG, Ruzzini L, Rizzello G, Maffulli N, Denaro V. No advantages in repairing a type II superior labrum anterior and posterior (SLAP) lesion when associated with rotator cuff repair in patients over age 50: a randomized controlled trial. Am J Sports Med 2008;36:247-253.
19. 19. Voos JE, Pearle AD, Mattern CJ, Cordasco FA, Allen AA, Warren RF. Outcomes of combined arthroscopic rotator cuff and labral repair. Am J Sports Med 2007;35:1174-1179.
20. 20. Savoie FH, Field LD, Atchinson S. Anterior superior instability with rotator cuff tearing: SLAC lesion. Ort-hop Clin North Am 2001;32:457-461.
21. 21 .Abbot AE, Li X, Busconi BD. Arthroscopic treatment of concomitant superior labral anterior posterior (SLAP) lesions and rotator cuff tears in patients over the age of 45 years. Am J Sports Med. 2009;37:1358-62
22. 22 .Conway JE. Arthroscopic repair of partial-thickness rotator cuff tears and SLAP lesions in professional baseball players. Orthop Clin North Am 2001;32:443-456.
23. 23 .Mileski RA, Snyder SJ. Superior labral lesions in the shoulder: pat-hoanatomy and surgical management. J Am Acad Orthop Surg. 1998; 6:121-131.
24. 24 .Prodromos CC, Ferry JA, Schiller AL, Zarins B. Histological studies of the glenoid labrum from fetal life to old age. J Bone Joint Surg Am. 1992;72:1344-1348.
25. 25 .Abrams GD, Safran MR. Diagnosis and management ofsuperior labrum anterior posterior lesions in overhead athletes. Br J Sports Med 2010;44:311-8
26. 26 .Phillips JC, Cook C, Beaty S, Kis-senberth MJ, Siffri P, Hawkins RJ. Validity of noncontrast magnetic resonance imaging in diagnosing superior labrum anterior-posterior tears. J Shoulder Elbow Surg 2013 ;22:3-8.
27. 27 .Oh JH, Yoon JP, Kim JY, Kim SH. Effect of expectations and concerns in rotator cuff disorders and correlations with preoperative patient characteristics. J Shoulder Elbow Surg 2012;21:715-21.
28. 28 .Forsythe B, Martin SD. Concomitant arthroscopic SLAP and rotator cuff repair: surgical technique. J Bone Joint Surg Am 2011;93:1-9.