Öz
Amaç: Patella
yükseklik ölçümünün özellikle diz çevresi patolojilerinin endikasyon ve cerrahi
çeşitliliğin artması sonucu önemi artmıştır. Literatürde tarif edilen metotlar
bulunmasına rağmen, günümüzde altın standart bir yöntem mevcut değildir.
Özellikle pediatrik yaş grubunda referans noktalarının tam belirlenememesi
nedeni ile ölçüm sonuçlarının güvenirliğinde sorunlar yaşanmaktadır. Jennifer
J. Beck ve arkadaşları Blumensaat-Epiphyseal Containment of the Knee Angle
(BECK) yöntemini tanımlamış ve pediatrik hasta grubunda kolay ve klinik alanda
uygulanabilen güvenilir bir yöntem olduğunu belirtmişlerdir. Biz çalışmamızda
bu yöntemin erişkinlerde kullanılabilirliğini araştırdık.
Gereç ve
Yöntemler:
Çalışmamıza dahil edilen çocuk hastaların lateral diz grafileri ölçümlerinden
elde edilen BECK açıları kullanılarak sağlıklı erişkin aile bireylerinde
patellar yükseklik ölçümü yapıldı. Aynı kişilerde bu ölçümleri Insall- Salvati
ve Blumensaat yöntemleri kullanarak tekrarlandı ve bu 3 yöntemin ölçüm
sonuçları karşılaştırıldı.
Bulgular: Çalışmaya
katılan çocuk hastanın %54,7’ si (n=29) erkek, %45,3’ü (n=24) kız ortalama yaşı
14,9±1,3 (13-18) idi. %28,3’ü (n=15) erkek %71,7’si (n=38) kadın ve ortalama
yaşları 49,3±7,7 (37-68) idi. Çocuk hastalardaki ortalama BECK açısı 46,58° (42,0°-
53,0°) ± 2,3°) idi. Ortalama değer ile erişkinlerde yapılan ölçümlerde en az
%50 patellar kapsama oranı %88,7 (n=47) idi. Bireysel açı değerleri ile yapılan
ölçümlerde bu oran %90,5 (n=48) olarak tespit edildi. Insall-Salvati yöntemi
ile normal değer ölçüm oranı %77,3 (41/53), anormal ölçüm %22,6 (12) olarak
saptandı. Blumensaat yöntemi ile %62,2 (33/53) oranında normal, %37,7 (20/53)
anormal aralıkta saptandı.
Sonuç: Erişkin
patellar yükseklik ölçümlerinin basit, anlaşılabilir, efektif bir yöntem ile
yapılabilmesi klinik uygulamalarda büyük kolaylık sağlar. BECK yöntemi bu
ölçümlerde uygulanabilecek alternatif bir yöntem olarak düşünülebilir.
Kaynakça
- 1. Aglietti P, Insall JN, Cerulli G. Patellar pain and incongruence. I: Measurements of incongruence. Clin Orthop Relat Res. 1983; (176): 217-24.
- 2. Ahlback S, Mattsson S. Patella alta and gonarthrosis. Acta Radiol Diagn (Stockh). 1978; 19(4): 578-84.
- 3. Simmons E Jr, Cameron JC. Patella alta and recurrent dislocation of the patella. Clin Orthop Relat Res. 1992; (274): 265-69.
- 4. Insall J, Salvati E. Patella position in the normal knee joint. Radiology. 1971; 101(1): 101-4.
- 5. Kesmezacar H, Erginer R, Ogut T, Seyahi A, Babacan M, Tenekecioglu Y. Evaluation of patellar height and measurement methods after valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2005; 13(7): 539-44.
- 6. Blumensaat C. Die Lageabweichungen und Verrenkungen der Kniescheibe. Ergeb Chir Orthop. 1938; 31(2): 149-223.
- 7. Seil R, Muller B, Georg T, Kohn D, Rupp S. Reliability and interobserver variability in radiological patellar height ratios. Knee Surg Sports Traumatol Arthrosc. 2000; 8(4): 231-6.
- 8. Beck JJ, Boguszewskia DV, Joshia NB, Cheunga EC, Bowen RE, Oppenheima WL. A novel method for determining sagittal pediatric patellar height with the blumensaat-epiphyseal containment of the knee angle. Journal of Pediatric Orthopaedics. 2018; 27(6): 510-5.
- 9. Stijak L, Radonjic V, Nikolic V, Blagojevic Z, Aksic M, Filipovic B. Correlation between the morphometric parameters of the anterior cruciate ligament and the intercondylar width: gender and age differences. Knee Surg Sports Traumatol Arthrosc. 2009; 17(7): 812–7.
- 10. Berg EE, Mason SL, Lucas MJ. Patellar height ratios. Acomparison of four measurement methods. Am J Sports Med. 1996; 24(2): 218-21.
- 11. Picard F, Saragaglia D, Montbarbon E, Tourne Y, Charbel A. A morphometric study of the femoro-patellar joint from lateral xray view. [Article in French] Rev Chir Orthop Reparatrice Appar Mot. 1997; 83(2): 104-11.
- 12. Egund N, Lundin A, Wallengren NO. The vertical position of the patella. A new radiographic method for routine use. Acta Radiol. 1988; 29(5): 555-8.
- 13. Seyahi A, Atalar AC, Koyuncu LO, Cinar BM, Demirhan M. Blumensaat line and patellar height. Acta Orthop Scand Traumatol Turc. 2006; 40(3): 240-7.
- 14. Park MS, Chung CY, Lee KM, Lee SH, Choi IH. Which is the best method to determine the patellar height in children and adolescents? Clin Orthop Relat Res. 2010; 468(5): 1344-51.
- 15. Grelsamer RP, Proctor CS, Bazos AN. Evaluation of patellar shape in the sagittal plane: A clinical analysis. Am J Sports Med. 1994; 22(1): 61-6.
- 16. Burgess RC. A new method of determining patellar position. J Sports Med Phys Fitness. 1989; 29(4): 398-9.
- 17. Schlenzka D, Schwesinger G. The height of the patella: an anatomical study. Eur J Radiol. 1990; 11(1): 19-21.
- 18. Miller TT, Staron RB, Feldman F. Patellar height on sagittal MR imaging of the knee. AJR Am J Roentgenol. 1996; 167(2): 339-41.
- 19. Grelsamer RP, Meadows S. The modified Insall-Salvati ratio for assessment of patellar height. Clin Orthop. 1992; (282): 170-6.
- 20. Jozwiak M, Pietrzak S. Evaluation of patella position based on radiologic and ultrasonographic examination: comparison of the diagnostic value. J Pediatr Orthop. 1998; 18(5): 679-82.
Öz
Aim: The importance
of patellar height measurement has increased as a result of increased
indications and increased surgical technics of the knee joint pathologies.
Although there are methods described in the literature, there is currently no
gold standard method. Particularly in the paediatric age group, there are some
problems in the reliability of the measurement results because of the
difficulty in the determination of the reference points. Blumensaat-Epiphyseal
Containment of the Knee Angle (BECK) method was described by the Jennifer J.
Beck and et al. and it was reported that it is an easy and reliable method that
can be applied surgically and clinically without requiring complicated
calculations in the paediatric patient group. In our study, we investigated the
usability of this method in adults.
Material and Methods: Patellar height was measured in healthy adult family members using BECK
angles obtained from knee radiographs of pediatric patients enrolled in our
study. The same measurements were repeated using Insall-Salvati and Blumensaat
methods and the results of these three methods were compared.
Results: 54.7%
(n=29) of the paediatric patients who participated in the study were male and
45.3% (n=24) were female. The mean age of the patients was 14.9±1.3 (13-18)
years. 28.3% (n=15) of the adult patients were male, 71.7% (n=38) were female and the mean age was
49.3±7.7 (37-68) years. The mean BECK angle in paediatric patients was 46.58°
(42.0°- 53.0°) ± 2.3°. In the measurements of adults with mean value, the least 50% patellar
coverage rate was 88.7% (n=47). Measurements with individual angle values, this
ratio was 90.5% (n=48). Normal value measurement ratio was 77.4% (41/53) and
abnormal measurement was 22.6% (12/53) by Insall-Salvati method. 62.3% (33/53)
normal and 37.7% (20/53) abnormal ranges were determined by Blumensaat method.
Conclusion: Measurement of the adult patellar height with a simple, understandable,
effective method, provides great convenience in clinical applications. The BECK
method can be considered as an alternative method for these measurements.
Kaynakça
- 1. Aglietti P, Insall JN, Cerulli G. Patellar pain and incongruence. I: Measurements of incongruence. Clin Orthop Relat Res. 1983; (176): 217-24.
- 2. Ahlback S, Mattsson S. Patella alta and gonarthrosis. Acta Radiol Diagn (Stockh). 1978; 19(4): 578-84.
- 3. Simmons E Jr, Cameron JC. Patella alta and recurrent dislocation of the patella. Clin Orthop Relat Res. 1992; (274): 265-69.
- 4. Insall J, Salvati E. Patella position in the normal knee joint. Radiology. 1971; 101(1): 101-4.
- 5. Kesmezacar H, Erginer R, Ogut T, Seyahi A, Babacan M, Tenekecioglu Y. Evaluation of patellar height and measurement methods after valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2005; 13(7): 539-44.
- 6. Blumensaat C. Die Lageabweichungen und Verrenkungen der Kniescheibe. Ergeb Chir Orthop. 1938; 31(2): 149-223.
- 7. Seil R, Muller B, Georg T, Kohn D, Rupp S. Reliability and interobserver variability in radiological patellar height ratios. Knee Surg Sports Traumatol Arthrosc. 2000; 8(4): 231-6.
- 8. Beck JJ, Boguszewskia DV, Joshia NB, Cheunga EC, Bowen RE, Oppenheima WL. A novel method for determining sagittal pediatric patellar height with the blumensaat-epiphyseal containment of the knee angle. Journal of Pediatric Orthopaedics. 2018; 27(6): 510-5.
- 9. Stijak L, Radonjic V, Nikolic V, Blagojevic Z, Aksic M, Filipovic B. Correlation between the morphometric parameters of the anterior cruciate ligament and the intercondylar width: gender and age differences. Knee Surg Sports Traumatol Arthrosc. 2009; 17(7): 812–7.
- 10. Berg EE, Mason SL, Lucas MJ. Patellar height ratios. Acomparison of four measurement methods. Am J Sports Med. 1996; 24(2): 218-21.
- 11. Picard F, Saragaglia D, Montbarbon E, Tourne Y, Charbel A. A morphometric study of the femoro-patellar joint from lateral xray view. [Article in French] Rev Chir Orthop Reparatrice Appar Mot. 1997; 83(2): 104-11.
- 12. Egund N, Lundin A, Wallengren NO. The vertical position of the patella. A new radiographic method for routine use. Acta Radiol. 1988; 29(5): 555-8.
- 13. Seyahi A, Atalar AC, Koyuncu LO, Cinar BM, Demirhan M. Blumensaat line and patellar height. Acta Orthop Scand Traumatol Turc. 2006; 40(3): 240-7.
- 14. Park MS, Chung CY, Lee KM, Lee SH, Choi IH. Which is the best method to determine the patellar height in children and adolescents? Clin Orthop Relat Res. 2010; 468(5): 1344-51.
- 15. Grelsamer RP, Proctor CS, Bazos AN. Evaluation of patellar shape in the sagittal plane: A clinical analysis. Am J Sports Med. 1994; 22(1): 61-6.
- 16. Burgess RC. A new method of determining patellar position. J Sports Med Phys Fitness. 1989; 29(4): 398-9.
- 17. Schlenzka D, Schwesinger G. The height of the patella: an anatomical study. Eur J Radiol. 1990; 11(1): 19-21.
- 18. Miller TT, Staron RB, Feldman F. Patellar height on sagittal MR imaging of the knee. AJR Am J Roentgenol. 1996; 167(2): 339-41.
- 19. Grelsamer RP, Meadows S. The modified Insall-Salvati ratio for assessment of patellar height. Clin Orthop. 1992; (282): 170-6.
- 20. Jozwiak M, Pietrzak S. Evaluation of patella position based on radiologic and ultrasonographic examination: comparison of the diagnostic value. J Pediatr Orthop. 1998; 18(5): 679-82.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Eylül 2019 |
| Gönderilme Tarihi | 4 Eylül 2019 |
| Yayımlandığı Sayı | Yıl 2019 Cilt: 9 Sayı: 3 |
