Menisküs Yırtıklarında Tanı ve Tedavi
Özet
Menisküs yırtıkları, klinikte sıkça karşılaşılan ve hastaların genellikle ağrı ile takılma hissiyle başvurduğu diz yaralanmalarıdır. Diz fonksiyonlarının devamı, eklem stabilitesi, şok emilimi ve kıkırdak beslenmesi açısından menisküsün tamiri büyük önem taşır. Tanıda altın standart yöntem manyetik rezonans görüntüleme (MRG) olup, hassasiyeti %90, özgüllüğü ise %95 civarındadır. Ayrıca varus-valgus dizilimlerini değerlendirmede direkt grafi, tekrarlayan yırtıkların saptanmasında ise bilgisayarlı tomografi (BT) artrografi yardımcı yöntemler olarak kullanılmaktadır. Menisküsler normal morfolojide MRG'de homojen ve hipointens üçgenler şeklinde izlenirken, yırtıklar sinyal artışlarına göre Grade I, II ve III olarak evrelendirilir. Her menisküs yırtığı tamir endikasyonu taşımaz; iyileşme başarısı yırtığın boyutu (1 cm altı stabil, 4 cm üstü instabil), hastanın yaşı, aktivite düzeyi ve yırtık tipi (longitudinal/vertikal en uygun olanlardır) gibi birçok faktöre bağlıdır. Özellikle menisküs kök yırtıklarının korunması, osteoartrit gelişimini önlemek adına son yıllarda pull-out veya dikiş tamiri yöntemleriyle kabul görmektedir. Güncel cerrahide tedavi tamamen artroskopik hale gelmiş olup, yırtığın lokalizasyonuna göre dışarıdan içeri, içeriden dışarı veya hepsi içeride teknikleri benzer klinik başarılarla uygulanmaktadır. Cerrah, tamir kararını verirken hastanın yaşını, mesleğini, beklentilerini ve eşlik eden yaralanmaları kapsamlı şekilde değerlendirmelidir.
Meniscus tears are commonly encountered knee injuries in clinical practice, with patients usually presenting with pain and a catching sensation. Repairing the meniscus is of great importance for the continuation of knee functions, joint stability, shock absorption, and cartilage nutrition. Magnetic resonance imaging (MRI) is the gold standard method in diagnosis, with a sensitivity of approximately 90% and a specificity of 95%. Additionally, direct radiography is used to evaluate varus-valgus alignments, while computed tomography (CT) arthrography is employed as an auxiliary method to detect recurrent tears. While normal menisci appear as homogeneous and hypointense triangles on MRI, tears are graded as Grade I, II, and III based on signal increases. Not every meniscus tear indicates repair; healing success depends on many factors such as tear size (under 1 cm is stable, over 4 cm is unstable), patient age, activity level, and tear type, with longitudinal or vertical tears being the most suitable. Particularly, the preservation of meniscus root tears via pull-out or suture repair techniques has gained acceptance in recent years to prevent osteoarthritis development. In current surgery, treatment has become entirely arthroscopic, and outside-in, inside-out, or all-inside techniques are applied with similar clinical success depending on the location of the tear. The surgeon must comprehensively evaluate the patient's age, occupation, expectations, and concomitant injuries when making the repair decision.
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