Evaluation of the association of ligamentum mucosum with anterior knee pain and the effect of ligamentum mucosum excision due to femoral attachment on arthroscopic surgery time
Öz
Aim: The main purpose of the study was to determine the duration of excisions made from the femoral attachment of the ligamentum mucosum during knee arthroscopy and the duration of excision from the portion attached to the retropatellar fat pad and evaluate which anatomic area excision shortens the surgical time. The second purpose of this study was to determine whether the excision of ligamentum mucosum has an effect on anterior knee pain with age.
Materials and methods: 64 patients were included in this retrospective study. Patients were assigned into two groups based on the ligamentum mucosum excision technique, and ligamentum mucosum excision times were calculated. Ligamentum mucosum excision was performed from the femoral attachment site in 34 and retropatellar fat pad attachment in 30 patients. Patients were divided into two groups younger or older than 40 years of age, regardless of the excision technique. All patients were evaluated with Kujala scores.
Results: Mean excision time of ligamentum mucosum was found to be 17.4 ±3.4 s in group excision from the femoral intercondylar node and the mean excision time was found to be 49 ±10.7 s from retropatellar fat pad attachment region. The mean Kujala score in the >40 year old group was 84.8 ±6.4, and in the <40 year old group was 94 ±5.5.
Conclusion: Excision made from the intercondylar node can shorten the surgical time relative to that of the excision made from the retropatellar fat pad. Clinical results of patients <40 years of age were better than those of patients aged >40 years of age.
Anahtar Kelimeler
Proje Numarası
-
Kaynakça
- Hardaker WT, Whipple TL, Bassett FH 3rd. (1980). Diagnosis and treatment of the plica syndrome of the knee. J Bone Joint Surg Am. 62 (2):221-5.
- Norris M, Corbo G, Banga K, Johnson M, Sandig M, Smallman T, Getgood A, Burkhart TA. (2018). The biomechanical and morphological characteristics of the ligamentum mucosum and its potential role in anterior knee pain. Knee. 25 (6):1134-41. https://doi.org/ 10.1016/j.knee.2018.08.017
- Boyd CR, Eakin C, Matheson GO. (2005) Infrapatellar plica as a cause of anterior knee pain. Clin J Sport Med. 15 (2):98-103. https://doi.org/ 10.1097/01.jsm.0000152706.43395.68
- Brooker B, Morris H, Brukner P, Mazen F, Bunn J. (2009) The macroscopic arthroscopic anatomy of the infrapatellar fat pad. Arthroscopy. 25 (8):839-45. https://doi.org/ 10.1016/j.arthro.2009.01.020.
- Smallman T, Shekitka K, Mann K, Race A. (2015) The infrapatellar plica A new non-isometric intra-articular ligament of the knee. FASEB J. 29:545.3 (suppl).
- Smallman TV, Portner OT, Race A, Shekitka K, Mann K. (2018) Arthroscopic Untethering of the Fat Pad of the Knee: Release or Resection of the Infrapatellar Plica (Ligamentum Mucosum) and Related Structures for Anterior Knee Pain. Arthrosc Tech. 7 (5):575-88. https://doi.org/ 10.1016/j.eats.2018.02.002.
- Krenn V, Hofmann S, Engel A. (1990) First description of mechanoreceptors in the corpus adiposum infrapatellare of man. Acta Anat (Basel). 137 (2) :187-8. https://doi.org/ 10.1159/000146883.
- Bohnsack M, Wilharm A, Hurschler C, Rühmann O, Stukenborg-Colsman C, Wirth CJ. (2004) Biomechanical and kinematic influences of a total infrapatellar fat pad resection on the knee. Am J Sports Med. 32(8):1873- 80. https://doi.org/ 10.1177/0363546504263946.
- Sonnery-Cottet B, Archbold P, Zayni R, Thaunat M, Bortolletto J, Fayard JM, Chambat P. (2011) High lateral portal for sparing the infrapatellar fat-pad during ACL reconstruction. Orthop Traumatol Surg Res. 97(8):870- 3. https://doi.org/ 10.1016/j.otsr.2011.08.007
- Kuru T, Dereli EE, Yaliman A. (2010) Validity of the Turkish version of the Kujala patellofemoral score in patellofemoral pain syndrome. Acta Orthop Traumatol Turc. 44(2):152-6. https://doi.org/ 10.3944/AOTT.2010.2252.
- Smallman TV, Race A, Ekroth S. (2012) Intra-operative visualization of deformation of the infrapatellar plica (IPP), and fat pad The link to anterior knee pain. J Bone Joint Surg Br 94:100 (suppl XXXVIII).
- Ozcan M, Copuroğlu C, Ciftdemir M, Turan FN, Calpur OU. (2011) Does an abnormal infrapatellar plica increase the risk of chondral damage in the knee. Knee Surg Sports Traumatol Arthrosc.19(2):218-21. https://doi.org/ 10.1007/s00167-010-1273-3.
- Goto K, Taketomi S, Shimizu N. (2020) Central patellar portal placement frequently provokes anterior knee compartment radiological abnormalities in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 28 (7) :2255-60. https://doi.org/10.1007/s00167-019-05817-4
- Asai K, Nakase J, Oshima T, Shimozaki K, Yoshimizu R, Tsuchiya H. (2020) Partial resection of the infrapatellar fat pad during anterior cruciate ligament reconstruction has no effect on clinical outcomes including anterior knee pain. Arch Orthop Trauma Surg. 140(11):1751-7. https://doi.org/10.1007/s00402-020- 03520-5.
- Stephen JM, Sopher R, Tullie S, Amis AA, Ball S, Williams A. (2018) The infrapatellar fat pad is a dynamic and mobile structure, which deforms during knee motion, and has proximal extensions which wrap around the patella. Knee Surg Sports Traumatol Arthrosc. 26(11):3515-3524. https://doi.org/ 10.1007/s00167-018-4943-1
- Bohnsack M, Hurschler C, Demirtas T, Rühmann O, Stukenborg-Colsman C, Wirth CJ. (2005) Infrapatellar fat pad pressure and volume changes of the anterior compartment during knee motion: possible clinical consequences to the anterior knee pain syndrome. Knee Surg Sports Traumatol Arthrosc.13(2):135-141. https://doi.org/10.1007/s00167-004-0561-1.
Ligamentum mukozumun diz önü ağrısı ile ilişkisi ve ligamentum mukozumun femoral tutunma yerinden eksizyonunun artroskopik cerrahi süresine etkisi
Öz
Amaç: Çalışmanın ilk amacı, diz artroskopisi sırasında ligamentum mukozasının femoral yapışma yerinden yapılan eksizyonların süresini ve retropatellar yağ yastıkçığına bağlı kısımdan yapılan eksizyon süresini belirlemek ve hangi anatomik alan eksizyonunun ameliyat süresini kısalttığını belirlemektir. Bu çalışmanın ikinci amacı, yaşla birlikte diz önü ağrısı üzerine ligamentum mukozum eksizyonunun etkisi olup olmadığını belirlemektir.
Gereç ve Yöntem: Bu retrospektif çalışmaya 64 hasta dahil edildi. Hastalar ligamentum mukozum eksizyon tekniğine göre iki gruba ayrıldı. Ligamentum mukozum eksizyon süreleri hesaplandı. Hastaların 34'ünde femoral yapışma bölgesinden ligamentum mukozom eksizyonu ve 30'unda retropatellar yağ yastıkçığı yapışma bölgesinden eksizyon yapıldı. Hastalar eksizyon tekniğinden bağımsız olarak 40 yaş altı veya 40 yaş üstü olmak üzere iki gruba ayrıldı. Tüm hastalar Kujala skorları ile değerlendirildi.
Bulgular: Femoral interkondiler alandan yapılan ligamentum mukozum eksizyonunun ortalama süresi 17,4 ±3,4 sn ve retropatellar bölgeden yapılan ortalama eksizyon süresi 49 ±10,7 sn olarak bulundu. >40 yaş grubunda ortalama Kujala skoru 84,8 ±6,4, <40 yaş grubunda ise 94 ±5,5 olarak tespit edildi.
Sonuç: İnterkondiler alandan yapılan eksizyon, retropatellar yağ yastıkçığından yapılan eksizyona göre cerrahi süreyi kısaltabilir. 40 yaş 40 yaş hastalara göre daha iyidir.
Anahtar Kelimeler
Etik Beyan
Çalışmamız Bahçeşehir Üniversitesi Tıp Fakültesi Etik kurulunun 2022-07/03 no lu onayı ile yapılmıştır.
Destekleyen Kurum
yok
Proje Numarası
-
Kaynakça
- Hardaker WT, Whipple TL, Bassett FH 3rd. (1980). Diagnosis and treatment of the plica syndrome of the knee. J Bone Joint Surg Am. 62 (2):221-5.
- Norris M, Corbo G, Banga K, Johnson M, Sandig M, Smallman T, Getgood A, Burkhart TA. (2018). The biomechanical and morphological characteristics of the ligamentum mucosum and its potential role in anterior knee pain. Knee. 25 (6):1134-41. https://doi.org/ 10.1016/j.knee.2018.08.017
- Boyd CR, Eakin C, Matheson GO. (2005) Infrapatellar plica as a cause of anterior knee pain. Clin J Sport Med. 15 (2):98-103. https://doi.org/ 10.1097/01.jsm.0000152706.43395.68
- Brooker B, Morris H, Brukner P, Mazen F, Bunn J. (2009) The macroscopic arthroscopic anatomy of the infrapatellar fat pad. Arthroscopy. 25 (8):839-45. https://doi.org/ 10.1016/j.arthro.2009.01.020.
- Smallman T, Shekitka K, Mann K, Race A. (2015) The infrapatellar plica A new non-isometric intra-articular ligament of the knee. FASEB J. 29:545.3 (suppl).
- Smallman TV, Portner OT, Race A, Shekitka K, Mann K. (2018) Arthroscopic Untethering of the Fat Pad of the Knee: Release or Resection of the Infrapatellar Plica (Ligamentum Mucosum) and Related Structures for Anterior Knee Pain. Arthrosc Tech. 7 (5):575-88. https://doi.org/ 10.1016/j.eats.2018.02.002.
- Krenn V, Hofmann S, Engel A. (1990) First description of mechanoreceptors in the corpus adiposum infrapatellare of man. Acta Anat (Basel). 137 (2) :187-8. https://doi.org/ 10.1159/000146883.
- Bohnsack M, Wilharm A, Hurschler C, Rühmann O, Stukenborg-Colsman C, Wirth CJ. (2004) Biomechanical and kinematic influences of a total infrapatellar fat pad resection on the knee. Am J Sports Med. 32(8):1873- 80. https://doi.org/ 10.1177/0363546504263946.
- Sonnery-Cottet B, Archbold P, Zayni R, Thaunat M, Bortolletto J, Fayard JM, Chambat P. (2011) High lateral portal for sparing the infrapatellar fat-pad during ACL reconstruction. Orthop Traumatol Surg Res. 97(8):870- 3. https://doi.org/ 10.1016/j.otsr.2011.08.007
- Kuru T, Dereli EE, Yaliman A. (2010) Validity of the Turkish version of the Kujala patellofemoral score in patellofemoral pain syndrome. Acta Orthop Traumatol Turc. 44(2):152-6. https://doi.org/ 10.3944/AOTT.2010.2252.
- Smallman TV, Race A, Ekroth S. (2012) Intra-operative visualization of deformation of the infrapatellar plica (IPP), and fat pad The link to anterior knee pain. J Bone Joint Surg Br 94:100 (suppl XXXVIII).
- Ozcan M, Copuroğlu C, Ciftdemir M, Turan FN, Calpur OU. (2011) Does an abnormal infrapatellar plica increase the risk of chondral damage in the knee. Knee Surg Sports Traumatol Arthrosc.19(2):218-21. https://doi.org/ 10.1007/s00167-010-1273-3.
- Goto K, Taketomi S, Shimizu N. (2020) Central patellar portal placement frequently provokes anterior knee compartment radiological abnormalities in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 28 (7) :2255-60. https://doi.org/10.1007/s00167-019-05817-4
- Asai K, Nakase J, Oshima T, Shimozaki K, Yoshimizu R, Tsuchiya H. (2020) Partial resection of the infrapatellar fat pad during anterior cruciate ligament reconstruction has no effect on clinical outcomes including anterior knee pain. Arch Orthop Trauma Surg. 140(11):1751-7. https://doi.org/10.1007/s00402-020- 03520-5.
- Stephen JM, Sopher R, Tullie S, Amis AA, Ball S, Williams A. (2018) The infrapatellar fat pad is a dynamic and mobile structure, which deforms during knee motion, and has proximal extensions which wrap around the patella. Knee Surg Sports Traumatol Arthrosc. 26(11):3515-3524. https://doi.org/ 10.1007/s00167-018-4943-1
- Bohnsack M, Hurschler C, Demirtas T, Rühmann O, Stukenborg-Colsman C, Wirth CJ. (2005) Infrapatellar fat pad pressure and volume changes of the anterior compartment during knee motion: possible clinical consequences to the anterior knee pain syndrome. Knee Surg Sports Traumatol Arthrosc.13(2):135-141. https://doi.org/10.1007/s00167-004-0561-1.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Ortopedi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Proje Numarası | - |
| Yayımlanma Tarihi | 12 Mart 2025 |
| Gönderilme Tarihi | 30 Eylül 2024 |
| Kabul Tarihi | 12 Kasım 2024 |
| Yayımlandığı Sayı | Yıl 2025Cilt: 64 Sayı: 1 |
