Mehmet DEMİRKAYA, Hasan KARA, Yakup YILDIRIM, Zafer ORHAN, Mustafa ŞİRVANCI

Ön çapraz bağ tamiri sonrasında menüsküs iyileşmesinin histolojik ve radyolojik takibi: Deneysel çalışma

Amaç: Ön çapraz bağ (ÖÇB) rekonstrüskiyonu yapılan dizlerde menüsküs yırtıklarının iyileşmesi (tamir yapılan ve yapılmayan) histolojik ve radyolojik olarak incelendi. Çalışma planı: Sekiz koyun rastgele olarak dört gruba ayrılıp, ÖÇB hepsinde tamamen çıkartıldı ve medial menüsküs 1/3 periferal bölümde longitidunal yırtık oluşturuldu. Her iki dizde ÖÇB rekonstrüksiyonu yapılıp sağ dizlerde menüsküs yırtıkları sütüre edildi. Tamir sonrası 1, 2, 3 ve 6. haftalarda ikili gruplar halinde kesilen koyunların dizleri manyetik rezonans görüntüleme ile incelendi; ardından menüsküs iyileşmesi histolojik olarak değerlendirildi. Sonuçlar: Manyetik rezonans görüntülemede birinci ve ikinci haftalarda hem kontrol hem de çalışma grubundaki menüsküslerde yırtık bölgesine kontrast madde geçişi gözlenirken, üçüncü ve altıncı haftalarda her iki grupta da geçiş gözlenmedi. Histolojik incelemelerde Henning kriterlerine göre bazı menüsküslerde iyileşmeme (1, 2 ve 3. haftalarda %50’den fazla rezidüel yarık) ve parsiyel iyileşme (6. hafta %10-50 arası rezidüel yarık) görülürken tam iyileşme (%10’dan az rezidüel yarık) hiçbir örnekte görülmedi. Çıkarımlar: Rekonstrüksiyon yapılan dizlerde, tamir edilen ve edilmeyen gruplarda menüsküs iyileşmesinin normal seyrinde devam etmesi ve ÖÇB’nin oluşturduğu stabilite nedeniyle, menüsküslerde liflenmeye ve kompleks yırtıklara rastlanmamış olması, ÖÇB rekonstrüksiyonlu dizlerde menüsküs tamirinin gereksiz olduğunu göstermektedir.

Anahtar Kelimeler:

Koyun, Cerrahi işlemler, operatif, Ön çapraz bağ, Modeller, hayvan, Hayvan deneyleri, Artroskopi, Hastalık modelleri, hayvan, Menisküs, tibial, Diz yaralanmaları, Yara iyileşmesi

Histologic and radiologic evaluation of meniscal healing following reconstruction of the anterior cruciate ligament: An experimental study

Objectives: A histologic and radiologic evaluation was made of sutured and unsutured peripheral meniscal healing following reconstruction of the anterior cruciate ligament (ACL). Methods: Eight sheep (16 knees) were randomly assigned to four groups. The anterior cruciate ligament was totally excised and peripheral longitudinal tears were created in the medial menisci of all animals. Reconstruction of ACL and repair of menisci were performed with sutures in eight right knees, whereas left knees were left without any treatment. Each group (n=2) of animals were sacrificed in the 1st, 2nd, 3rd, and 6th weeks after operation. Meniscal healing was evaluated both by magnetic resonance imaging and histologically. Results: Radiologically, contrast material infusion into the incised part of menisci was demonstrated in both study and control groups in the 1st and 2nd weeks of healing. However, no contrast material infusion was observed on the 3rd and 6th weeks of operation. Histologically, according to Henning criteria, menisci exhibited no (during 1st, 2nd, and 3rd weeks with >50% residual incision) or partial healing (in the 6th week with %10-50 residual incision). Complete healing with <10% residual incision did not occur. Conclusion: The study suggests that meniscal healing shows no difference in ACL reconstructed knees with or without sutures. Since stability provided by the ACL reconstruction prevents additional complex ruptures and pathology, repair of the peripheral meniscus ruptures in ACL reconstructed knees seems to be of little value.

Keywords:

Sheep, Surgical Procedures, Operative, Anterior Cruciate Ligament, Models, Animal, Animal Experimentation, Arthroscopy, Disease Models, Animal, Menisci, Tibial, Knee Injuries, Wound Healing,

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1. Cerabona F, Sherman MF, Bonamo JR, Sklar J. Patterns of meniscal injury with acute anterior cruciate ligament tears. Am J Sports Med 1988;16:603-9.
2. Levy IM, Torzilli PA, Warren RF. The effect of medial meniscectomy on anterior-posterior motion of the knee. J Bone Joint Surg [Am] 1982;64:883-8.
3. Henning CE, Lynch MA, Yearout KM, Vequist SW, Stallbaumer RJ,Decker KA. Arthroscopic meniscal repair using an exogenous fibrin clot. Clin Orthop 1990;(252):64-72
4. Gudde P, Wagenknecht R. Untersuchungsergebnisse bei 50 patienten 10-12 Jahre nach der Innenmeniskusoperation bei gleichzeitig vorliegender Ruptur des vorderen Kreuzbandes. Z Orthop Ihre Grenzgeb 1973;111:369-72.
5. Johnson RJ, Kettelkamp DB, Clark W, Leaverton P. Factors effecting late results after meniscectomy. J Bone Joint Surg [Am] 1974;56:719-29.
6. Lynch MA, Henning CE, Glick KR Jr. Knee joint surface changes. Long-term follow-up meniscus tear treatment in stable anterior cruciate ligament reconstructions. Clin Orthop 1983;(172):148-53.
7. Cannon WD Jr, Vittori JM. The incidence of healing in arthroscopic meniscal repairs in anterior cruciate ligamentreconstructed knees versus stable knees. Am J Sports Med 1992;20:176-81.
8. Morgan CD, Wojtys EM, Casscells CD, Casscells SW. Arthroscopic meniscal repair evaluated by second-look arthroscopy. Am J Sports Med 1991;19:632-8.
9. Rosenberg TD, Scott SM, Coward DB, Dunbar WH, Ewing JW, Johnson CL, et al. Arthroscopic meniscal repair evaluated with repeat arthroscopy. Arthroscopy 1986;2:14-20.
10. Aglietti P, Zaccherotti G, De Biase P, Taddei I. A comparison between medial meniscus repair, partial meniscectomy, and normal meniscus in anterior cruciate ligament reconstructed knees. Clin Orthop 1994;(307):165-73.
11. Shirakura K, Kato K, Udagawa E. Characteristics of the isokinetic performance of patients with injured cruciate ligaments. Am J Sports Med 1992;20:754-60.
12. Barber FA. Meniscus repair: results of an arthroscopic technique. Arthroscopy 1987;3:25-30.
13. Kimura M, Shirakura K, Hasegawa A, Kobuna Y, Niijima M. Second look arthroscopy after meniscal repair. Factors affecting the healing rate. Clin Orthop 1995;(314):185-91.
14. Stone RG, Frewin PR, Gonzales S. Long-term assessment of arthroscopic meniscus repair: a two- to six-year follow-up study. Arthroscopy 1990;6:73-8.
15. Miller MD, Ritchie JR, Gomez BA, Royster RM, DeLee JC. Meniscal repair. An experimental study in the goat. Am J Sports Med 1995;23:124-8.
16. Huang TL, Lin GT, O'Connor S, Chen DY, Barmada R. Healing potential of experimental meniscal tears in the rabbit. Preliminary results. Clin Orthop 1991;(267):299-305.
17. Takeuchi N, Suzuki Y, Sagehashi Y, Yamaguchi T, Itoh H, Iwata H. Histologic examination of meniscal repair in rabbits. Clin Orthop 1997;(338):253-61.
18.Veth RP, den Heeten GJ, Jansen HW, Nielsen HK. Repair of the meniscus. An experimental investigation in rabbits. Clin Orthop 1983;(175):258-62.