Menisküs Lezyonları
Özet
Menisküs yaralanmaları, özellikle hızlı yavaşlama ve ani yön değişikliği içeren spor aktiviteleri sırasında, dizin fleksiyon ve rotasyon hareketleriyle meydana gelen en sık yumuşak doku hasarlarındandır. Diz ekleminde femoral kondiller ile tibial platolar arasında yer alan medial ve lateral menisküsler; yük dağılımı, şok emilimi, eklem stabilizasyonu, yağlama ve propriyosepsiyon gibi kritik fonksiyonlara sahiptir. Gençlerde genellikle akut travmatik ve stabil olmayan (longitüdinal, kova sapı, radial) yırtıklar görülürken, 40 yaş üstü bireylerde minimal travmayla bile ortaya çıkabilen horizontal ve kompleks dejeneratif yırtıklar daha yaygındır. Klinik olarak ağrı, şişlik, takılma ve kilitlenme semptomlarıyla karakterize olan bu lezyonların tanısında Thessaly ve McMurray gibi provokatif muayene testleri ve MRG önemli rol oynar; artroskopi ise altın standarttır. Tedavi planlaması yırtığın tipi, lokalizasyonu ve kanlanma durumuna (kırmızı ve beyaz zonlar) göre yapılır. Beyaz bölgedeki avasküler yırtıkların iyileşme potansiyeli düşüktür. Güncel yaklaşımlar, cerrahinin erken osteoartrit riskini artırması ve dejeneratif yırtıklarda konservatif tedaviye üstünlüğünün kanıtlanamaması nedeniyle öncelikle istirahat, soğuk uygulama, breys kullanımı ve kuadriseps güçlendirme egzersizlerini içeren konservatif tedaviyi ilk basamak olarak önermektedir. Mekanik kilitlenme yapan ciddi semptomatik olgularda veya genç sporcuların vasküler bölgelerindeki yırtıklarda ise menisküsü korumayı amaçlayan cerrahi onarım tercih edilmelidir.
Meniscus injuries are among the most common soft tissue damages, typically occurring during sports activities involving rapid deceleration and sudden direction changes through knee flexion and rotation. Located between the femoral condyles and tibial plateaus, the medial and lateral menisci perform critical functions such as load distribution, shock absorption, joint stabilization, lubrication, and proprioception. While acute traumatic and unstable tears (longitudinal, bucket-handle, radial) are mostly observed in young individuals, horizontal and complex degenerative tears that can emerge even with minimal trauma are more common in adults over forty. Characterized clinically by pain, swelling, catching, and locking, these lesions are diagnosed via provocative physical examination tests like Thessaly and McMurray along with MRI, while arthroscopy remains the gold standard. Treatment planning depends on the type, location, and vascularity (red and white zones) of the tear; avascular tears in the white-white zone possess low healing potential. Current evidence suggests that surgery increases the risk of early osteoarthritis and demonstrates no superior benefit over conservative management for non-obstructive degenerative tears. Therefore, conservative treatment encompassing rest, ice, bracing, and progressive quadriceps strengthening exercises is strictly recommended as the primary approach. In severe symptomatic cases causing mechanical locking or acute traumatic tears in the vascularized peripheral zones of young athletes, surgical repair aimed at preserving the meniscus tissue should be meticulously preferred.
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