Yazar: Uzm. Dr. \u0130shak \u00d6zkay<\/p>\n\n\n\n
Edit\u00f6r: Dr. \u00d6\u011fr. \u00dcyesi \u00d6mer Yusuf Erdurmu\u015f<\/p>\n\n\n\n
Spor ili\u015fkili akut diz yaralanmalar\u0131nda geleneksel acil servis yakla\u015f\u0131m\u0131 b\u00fcy\u00fck \u00f6l\u00e7\u00fcde k\u0131r\u0131\u011f\u0131n d\u0131\u015flanmas\u0131na odaklan\u0131r. Ottawa Diz Kurallar\u0131 radyografi gereksinimini belirlemede de\u011ferli olmakla birlikte; ligament, menisk\u00fcs, osteokondral y\u00fczey ve ekstans\u00f6r mekanizma yaralanmalar\u0131n\u0131n riskini, immobilizasyon karar\u0131n\u0131 veya spora d\u00f6n\u00fc\u015f s\u00fcrecini belirlemek \u00fczere geli\u015ftirilmemi\u015ftir. Bu nedenle sporcularda k\u0131r\u0131k taramas\u0131na; mekanizma, eff\u00fczyon, fonksiyon, stabilite ve mekanik semptomlar\u0131 i\u00e7eren ikinci bir internal derangement (ba\u011f, menisk\u00fcs ve osteokondral yap\u0131lar gibi dizin internal yap\u0131lar\u0131n\u0131n klinik olarak \u00f6nemli yaralanmalar\u0131) de\u011ferlendirmesi eklenmesi \u00f6nerilebilir. Bu yaz\u0131m\u0131zda acil tehditlerin d\u0131\u015flanmas\u0131, hedefe y\u00f6nelik g\u00f6r\u00fcnt\u00fcleme, se\u00e7ici immobilizasyon, erken fonksiyonel yakla\u015f\u0131m ve kriter bazl\u0131 spora d\u00f6n\u00fc\u015f basamaklar\u0131ndan bahsedece\u011fiz.\u00a0<\/p>\n\n\n\n
Diz eklemi; kemik, k\u0131k\u0131rdak, menisk\u00fcs, kaps\u00fcl, ligamentler ve ekstans\u00f6r mekanizman\u0131n birlikte \u00e7al\u0131\u015ft\u0131\u011f\u0131 kompleks bir yap\u0131d\u0131r. Sporcularda akut travman\u0131n mekanizmas\u0131, hangi anatomik yap\u0131lar\u0131n \u00f6ncelikle risk alt\u0131nda oldu\u011funu \u00f6ng\u00f6rmede \u00f6nemli ipu\u00e7lar\u0131 sa\u011flar. Pivot veya ani y\u00f6n de\u011fi\u015ftirme gibi non-kontakt rotasyonel mekanizmalar \u00f6zellikle ACL ve menisk\u00fcs yaralanmalar\u0131yla; valgus ve varus stresleri kollateral ligament yaralanmalar\u0131yla; fleksiyondaki tibian\u0131n anterioruna do\u011frudan darbe PCL yaralanmas\u0131yla ili\u015fkilidir. H\u0131zl\u0131 geli\u015fen hemartroz ACL\/PCL yaralanmas\u0131, patellar dislokasyon, intraartik\u00fcler k\u0131r\u0131k veya osteokondral yaralanma olas\u0131l\u0131\u011f\u0131n\u0131 art\u0131r\u0131rken; aktif diz ekstansiyonunun ya da straight-leg raise’in kayb\u0131 quadriceps veya patellar tendon b\u00fct\u00fcnl\u00fc\u011f\u00fcn\u00fcn bozuldu\u011funu d\u00fc\u015f\u00fcnd\u00fcrmelidir. Bu nedenle acil serviste ama\u00e7 her anatomik lezyona kesin tan\u0131 koymak de\u011fil; yaralanma mekanizmas\u0131, eff\u00fczyonun zaman\u0131, fonksiyon kayb\u0131, fokal hassasiyet, instabilite ve mekanik semptomlar\u0131 birlikte de\u011ferlendirerek ciddi yaralanma paternini erken tan\u0131mak ve uygun g\u00f6r\u00fcnt\u00fcleme ile uzman y\u00f6nlendirmesini planlamakt\u0131r. [1\u20134]<\/p>\n\n\n\n
Tablo 1.<\/strong> Akut diz yaralanmalar\u0131nda yap\u0131, tipik yaralanma mekanizmas\u0131 ve kritik akut klinik ipu\u00e7lar\u0131<\/p>\n\n\n\n \u0130lk de\u011ferlendirme, ayr\u0131nt\u0131l\u0131 spor ortopedisi muayenesinden ziyade zaman kritik yaralanmalar\u0131 ve erken ileri de\u011ferlendirme gerektiren hastalar\u0131 ay\u0131rmaya odaklanmal\u0131d\u0131r. Bu a\u015famada belirgin deformite veya diz dislokasyonu, a\u00e7\u0131k yaralanma, distal nab\u0131z veya duyu-motor bozukluk gibi n\u00f6rovask\u00fcler bulgular ve ekstans\u00f6r mekanizma kayb\u0131 \u00f6ncelikle ara\u015ft\u0131r\u0131lmal\u0131d\u0131r. Ard\u0131ndan hastan\u0131n y\u00fck verebilme durumu, aktif ve pasif hareket a\u00e7\u0131kl\u0131\u011f\u0131, eff\u00fczyon, fokal kemik hassasiyeti ve gross instabilite de\u011ferlendirilerek k\u0131r\u0131k ve ciddi yumu\u015fak doku yaralanmas\u0131 riski belirlenmelidir. Akut a\u011fr\u0131 ve hemartroz baz\u0131 provokatif testlerin duyarl\u0131l\u0131\u011f\u0131n\u0131 azaltabilece\u011finden, ilk muayenenin s\u0131n\u0131rl\u0131 oldu\u011fu olgularda erken klinik yeniden de\u011ferlendirme \u00f6nem ta\u015f\u0131r. [1]<\/p>\n\n\n\n Ottawa Diz Kurallar\u0131 uygun hastalarda radyografi karar\u0131n\u0131 y\u00f6nlendirmeye devam etmelidir. Ancak Ottawa negatifli\u011fi yaln\u0131zca klinik olarak \u00f6nemli k\u0131r\u0131k olas\u0131l\u0131\u011f\u0131n\u0131n d\u00fc\u015f\u00fck oldu\u011funu g\u00f6sterir; ACL, menisk\u00fcs, osteokondral veya di\u011fer ligament\u00f6z yaralanmalar\u0131 d\u0131\u015flamaz. Bu nedenle sporcularda Ottawa sonras\u0131nda ikinci bir klinik filtre uygulanmas\u0131 yararl\u0131 olabilir. [5,6]<\/p>\n\n\n\n Acil serviste pratik bir sekonder de\u011ferlendirme, k\u0131r\u0131k olas\u0131l\u0131\u011f\u0131ndan ba\u011f\u0131ms\u0131z olarak klinik a\u00e7\u0131dan \u00f6nemli internal derangement riskini belirlemeyi ama\u00e7lamal\u0131d\u0131r. Bu de\u011ferlendirmede yaralanma mekanizmas\u0131, eff\u00fczyonun ortaya \u00e7\u0131k\u0131\u015f zaman\u0131 ve miktar\u0131, y\u00fck verme ve aktif hareket gibi fonksiyonel kapasite, subjektif veya objektif instabilite ve ger\u00e7ek kilitlenme gibi mekanik semptomlar birlikte ele al\u0131nmal\u0131d\u0131r. \u00d6zellikle pivot\/rotasyon mekanizmas\u0131, erken belirgin hemartroz, tam ekstansiyon kayb\u0131, bo\u015falma hissi veya objektif laksite ve mekanik blok varl\u0131\u011f\u0131 ligament, menisk\u00fcs ya da osteokondral yaralanma a\u00e7\u0131s\u0131ndan daha ileri de\u011ferlendirme gereksinimini art\u0131r\u0131r. Tek bir negatif \u00f6zel test, \u00f6zellikle akut a\u011fr\u0131 ve guarding varl\u0131\u011f\u0131nda, \u00f6nemli internal derangement’\u0131 g\u00fcvenle d\u0131\u015flamak i\u00e7in yeterli kabul edilmemelidir. [1,7]<\/p>\n\n\n\n Akut a\u011fr\u0131, hemartroz ve kas guarding’i \u00f6zel testlerin g\u00fcvenilirli\u011fini azaltabilir. Straight-leg raise\/aktif ekstansiyon, ROM, eff\u00fczyon, eklem hatt\u0131-kemik hassasiyeti, tolere ediliyorsa Lachman ve gerekti\u011finde valgus\/varus stres testleri acil serviste y\u00fcksek klinik de\u011fer ta\u015f\u0131r. Negatif akut menisk\u00fcs testleri tek ba\u015f\u0131na d\u0131\u015flay\u0131c\u0131 kabul edilmemelidir. [1,7]<\/p>\n\n\n\n Acil serviste g\u00f6r\u00fcnt\u00fclemenin amac\u0131 daha fazla tetkik de\u011fil, do\u011fru hastaya do\u011fru modaliteyi se\u00e7mektir. Direkt radyografi k\u0131r\u0131k de\u011ferlendirmesinin temelidir; BT kemik ayr\u0131nt\u0131s\u0131nda, MR internal derangement de\u011ferlendirmesinde \u00fcst\u00fcnd\u00fcr. POCUS ise MR’\u0131n yerine ge\u00e7en bir tarama y\u00f6ntemi de\u011fil, hedeflenmi\u015f klinik sorulara yatak ba\u015f\u0131nda yan\u0131t veren tamamlay\u0131c\u0131 bir ara\u00e7t\u0131r [6]<\/p>\n\n\n\n Tablo 2.<\/strong> Akut diz travmas\u0131nda g\u00f6r\u00fcnt\u00fcleme modalitelerinin acil servis kullan\u0131m\u0131na g\u00f6re konumland\u0131r\u0131lmas\u0131<\/p>\n\n\n\n Konvansiyonel radyografi, BT ve MR akut diz travmas\u0131n\u0131n temel g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemleri olmaya devam etmektedir. Bununla birlikte sporcu yaralanmalar\u0131nda g\u00f6r\u00fcnt\u00fcleme, yaln\u0131z anatomik lezyonu g\u00f6stermenin \u00f6tesinde dinamik instabilite, doku mekanik \u00f6zellikleri, erken biyokimyasal de\u011fi\u015fiklikler ve iyile\u015fmenin nicel de\u011ferlendirilmesine do\u011fru geni\u015flemektedir. Bu tekniklerin \u00e7o\u011fu rutin acil servis uygulamas\u0131n\u0131n par\u00e7as\u0131 de\u011fildir; se\u00e7ilmi\u015f sporcularda ileri tan\u0131, cerrahi planlama, rehabilitasyon takibi ve spora d\u00f6n\u00fc\u015f de\u011ferlendirmesinde tamamlay\u0131c\u0131 rol oynayabilir.<\/p>\n\n\n\n Ultrasonografinin temel avantaj\u0131 yap\u0131lar\u0131n ger\u00e7ek zamanl\u0131 ve kontroll\u00fc stres alt\u0131nda de\u011ferlendirilebilmesidir. \u00d6zellikle kollateral ligamentler, quadriceps ve patellar tendonlar ile eklem eff\u00fczyonu de\u011ferlendirilebilir; stres alt\u0131nda eklem aral\u0131\u011f\u0131 de\u011fi\u015fiklikleri fonksiyonel laksitenin nesnelle\u015ftirilmesine katk\u0131 sa\u011flayabilir. Shear-wave elastografi ise tendonlar\u0131n mekanik sertli\u011fi hakk\u0131nda nicel bilgi \u00fcretir ve \u00f6zellikle tendon patolojisi ile longitudinal rehabilitasyon ara\u015ft\u0131rmalar\u0131nda umut vericidir. Bununla birlikte operat\u00f6r ba\u011f\u0131ml\u0131l\u0131\u011f\u0131 ve standardizasyon sorunlar\u0131 nedeniyle akut diz travmas\u0131nda kapsaml\u0131 rutin ED taramas\u0131 olarak \u00f6nerilmemelidir. [8]<\/p>\n\n\n\n DECT, iki farkl\u0131 enerji spektrumundan elde edilen verilerle materyal ayr\u0131\u015ft\u0131rmas\u0131 yapar. Virtual non-calcium g\u00f6r\u00fcnt\u00fcler, trabek\u00fcler kemikte kalsiyum sinyalini bask\u0131layarak travmatik kemik ili\u011fi \u00f6demi benzeri de\u011fi\u015fikliklerin ve baz\u0131 occult osse\u00f6z yaralanmalar\u0131n g\u00f6r\u00fcn\u00fcrl\u00fc\u011f\u00fcn\u00fc art\u0131rabilir. \u00d6zellikle radyografi negatif veya belirsiz olmas\u0131na ra\u011fmen kemik yaralanmas\u0131 \u015f\u00fcphesi s\u00fcren ve MR eri\u015fimi s\u0131n\u0131rl\u0131 se\u00e7ilmi\u015f olgularda tamamlay\u0131c\u0131 de\u011fer ta\u015f\u0131yabilir. Bununla birlikte MR, kemik ili\u011fi ve e\u015flik eden yumu\u015fak doku yaralanmalar\u0131n\u0131 birlikte de\u011ferlendirmede daha kapsaml\u0131d\u0131r; DECT rutin olarak MR’\u0131n yerine ge\u00e7memelidir. [9,10]<\/p>\n\n\n\n Konvansiyonel BT \u00e7o\u011funlukla y\u00fck ta\u015f\u0131mayan supin pozisyonda yap\u0131l\u0131rken WBCT, eklemi fizyolojik y\u00fcke daha yak\u0131n ko\u015fullarda \u00fc\u00e7 boyutlu de\u011ferlendirme olana\u011f\u0131 sa\u011flar. Alt ekstremite hizalanmas\u0131, tibiofemoral ili\u015fki ve \u00f6zellikle patellofemoral alignment\/tracking gibi parametrelerde ek bilgi sa\u011flayabilir. Akut sporcu travmas\u0131nda rutin ED endikasyonu bulunmamakta; kullan\u0131m alan\u0131 daha \u00e7ok se\u00e7ilmi\u015f patellofemoral, deformite ve cerrahi planlama problemlerinde geli\u015fmektedir. [11]<\/p>\n\n\n\n Ultrashort echo time (UTE) ve zero echo time (ZTE) teknikleri, tendon, ligament ve menisk\u00fcs gibi k\u0131sa-T2 dokulardan standart sekanslara g\u00f6re daha fazla sinyal elde etmeyi ama\u00e7lar ve doku mikrostr\u00fckt\u00fcr\u00fcn\u00fcn nicel de\u011ferlendirilmesine y\u00f6nelik ara\u015ft\u0131rmalarda kullan\u0131lmaktad\u0131r. T2 ve T1\u03c1 mapping gibi kantitatif MR teknikleri ise k\u0131k\u0131rdak matriksindeki su, kollajen organizasyonu ve proteoglikanla ili\u015fkili erken de\u011fi\u015fiklikleri morfolojik hasar belirginle\u015fmeden \u00f6nce de\u011ferlendirme potansiyeline sahiptir. Bu y\u00f6ntemler akut ED y\u00f6netimini \u00e7o\u011funlukla de\u011fi\u015ftirmez; daha \u00e7ok ileri merkezlerde ara\u015ft\u0131rma, longitudinal takip ve posttravmatik dejenerasyonun de\u011ferlendirilmesinde \u00f6nem ta\u015f\u0131r. [12,13]<\/p>\n\n\n\n Y\u00fcksek \u00e7\u00f6z\u00fcn\u00fcrl\u00fckl\u00fc isotropik 3D MR verileri farkl\u0131 d\u00fczlemlerde rekonstr\u00fcksiyona ve k\u0131k\u0131rdak, menisk\u00fcs, kemik ve kas yap\u0131lar\u0131n\u0131n nicel segmentasyonuna olanak sa\u011flayabilir. Yapay zek\u00e2 tabanl\u0131 algoritmalar ACL ve menisk\u00fcs lezyonlar\u0131n\u0131n saptanmas\u0131, otomatik segmentasyon ve g\u00f6r\u00fcnt\u00fcleme verilerinden nicel biyobelirte\u00e7 \u00fcretiminde umut vericidir. Sistematik derlemeler tan\u0131sal performans\u0131n umut verici oldu\u011funu, ancak \u00e7al\u0131\u015fmalar aras\u0131nda veri seti, d\u0131\u015f do\u011frulama ve metodolojik kalite a\u00e7\u0131s\u0131ndan heterojenlik bulundu\u011funu g\u00f6stermektedir. Bu nedenle AI g\u00fcn\u00fcm\u00fczde ba\u011f\u0131ms\u0131z karar verici de\u011fil, potansiyel bir karar-destek arac\u0131d\u0131r. [14]<\/p>\n\n\n\n Statik g\u00f6r\u00fcnt\u00fcleme eklemi tek bir pozisyonda de\u011ferlendirirken dynamic\/cine MRI ve baz\u0131 biplanar g\u00f6r\u00fcnt\u00fcleme teknikleri patellar tracking, tibiofemoral translasyon ve rotasyon gibi hareket s\u0131ras\u0131nda ortaya \u00e7\u0131kan kinematik de\u011fi\u015fiklikleri incelemeyi ama\u00e7lar. \u00d6zellikle patellofemoral instabilite ve spor biyomekani\u011fi ara\u015ft\u0131rmalar\u0131nda fonksiyonel bilgi sa\u011flayabilir. \u00d6zel ekipman, protokol ve standardizasyon gereksinimi nedeniyle rutin akut ED g\u00f6r\u00fcnt\u00fclemesinin par\u00e7as\u0131 de\u011fildir. [15]<\/p>\n\n\n\n D\u00fc\u015f\u00fck alanl\u0131 ve ta\u015f\u0131nabilir MR teknolojileri, daha d\u00fc\u015f\u00fck altyap\u0131 gereksinimi ve g\u00f6r\u00fcnt\u00fclemeyi bak\u0131m noktas\u0131na yakla\u015ft\u0131rma potansiyeli nedeniyle geli\u015fmektedir. Kas-iskelet g\u00f6r\u00fcnt\u00fclemesi olas\u0131 kullan\u0131m alanlar\u0131ndan biridir; ancak d\u00fc\u015f\u00fck sinyal-g\u00fcr\u00fclt\u00fc oran\u0131, g\u00f6r\u00fcnt\u00fc kalitesi ve k\u00fc\u00e7\u00fck yap\u0131sal lezyonlar\u0131n tan\u0131sal performans\u0131 cihaz ve protokole g\u00f6re de\u011fi\u015fmektedir. Bu nedenle g\u00fcn\u00fcm\u00fczde standart y\u00fcksek alanl\u0131 diz MR’\u0131n\u0131n yerine rutin olarak \u00f6nerilemez. [16,17]<\/p>\n\n\n\n Diz yaralanmas\u0131na modern yakla\u015f\u0131mda ‘normal grafi = immobilizer’ \u015feklindeki rutin uygulamadan ka\u00e7\u0131n\u0131lmal\u0131d\u0131r. \u0130mmobilizasyon karar\u0131 g\u00f6r\u00fcnt\u00fcleme sonucundan \u00e7ok mekanik stabiliteye ve yaralanan dokunun korunma ihtiyac\u0131na g\u00f6re verilmelidir. [1,4] Ayn\u0131 g\u00fcn ortopedi de\u011ferlendirmesi; diz dislokasyonu\/n\u00f6rovask\u00fcler bozukluk, a\u00e7\u0131k yaralanma, ciddi instabil frakt\u00fcr veya ekstans\u00f6r mekanizma kayb\u0131nda gereklidir. B\u00fcy\u00fck akut hemartroz, belirgin instabilite, ger\u00e7ek kilitlenme, g\u00fc\u00e7l\u00fc ACL\/\u00e7oklu ba\u011f veya osteokondral yaralanma \u015f\u00fcphesinde ise acil cerrahi gerekmese bile erken (genellikle birka\u00e7 g\u00fcn\u20131 hafta i\u00e7inde) spor hekimli\u011fi\/ortopedi de\u011ferlendirmesi planlanmal\u0131d\u0131r.<\/p>\n\n\n\n Tablo 3. <\/strong>Akut diz travmas\u0131nda immobilizasyon ve erken fonksiyonel yakla\u015f\u0131m i\u00e7in klinik se\u00e7im<\/p>\n\n\n\n Erken mobilizasyon, erken spora d\u00f6n\u00fc\u015f anlam\u0131na gelmez. Spora d\u00f6n\u00fc\u015f yaln\u0131zca ge\u00e7en zamana g\u00f6re de\u011fil; a\u011fr\u0131 ve eff\u00fczyonun kontrol\u00fc, hareket a\u00e7\u0131kl\u0131\u011f\u0131, kas g\u00fcc\u00fc, stabilite, n\u00f6romusk\u00fcler kontrol, spora \u00f6zg\u00fc fonksiyon ve psikolojik haz\u0131r olu\u015f birlikte de\u011ferlendirilerek kademeli bi\u00e7imde planlanmal\u0131d\u0131r. \u00d6zellikle ACL ve menisk\u00fcs yaralanmalar\u0131nda g\u00fcncel yakla\u015f\u0131m kriter bazl\u0131 ilerlemeyi desteklemektedir. [2,7]<\/p>\n\n\n\n \u015eekil 1.<\/strong> Sporcularda akut diz travmas\u0131 i\u00e7in \u00f6nerilen acil serviste y\u00f6netim basamaklar\u0131<\/p>\n\n\n\n Sporcularda akut diz yaralanmas\u0131nda acil servis y\u00f6netimi, k\u0131r\u0131k d\u0131\u015flama paradigmas\u0131n\u0131n \u00f6tesine ge\u00e7erek \u00f6nemli internal derangement riskini erken tan\u0131may\u0131 ve fonksiyonu korumay\u0131 hedeflemelidir. \u00d6nerilen modelde \u00fc\u00e7 karar birbirinden ayr\u0131l\u0131r. K\u0131r\u0131k riski g\u00f6r\u00fcnt\u00fcleme karar\u0131n\u0131; mekanik stabilite ve doku koruma ihtiyac\u0131 immobilizasyon karar\u0131n\u0131; internal derangement riski ise erken uzman de\u011ferlendirmesi ve MR gereksinimini belirler. Bu yakla\u015f\u0131m Ottawa Diz Kurallar\u0131n\u0131n yerine ge\u00e7mez; Ottawa’y\u0131 k\u0131r\u0131k g\u00f6r\u00fcnt\u00fcleme mod\u00fcl\u00fc olarak korur ve \u00fczerine sporcuya \u00f6zg\u00fc ikinci bir risk katman\u0131 ekler. B\u00f6ylece gereksiz ileri g\u00f6r\u00fcnt\u00fcleme ve uzun immobilizasyon azalt\u0131l\u0131rken, gecikmi\u015f tan\u0131dan zarar g\u00f6rebilecek sporcular daha erken tan\u0131nabilir.<\/p>\n\n\n\n 1. Jadidi S, et al. Non-operative Management of Acute Knee Injuries. Curr Rev Musculoskelet Med. 2023.<\/p>\n\n\n\n 2. American Academy of Orthopaedic Surgeons. Management of Anterior Cruciate Ligament Injuries: Evidence-Based Clinical Practice Guideline. 2022.<\/p>\n\n\n\n 3. Bl\u00f8nd L, Balcarek P, et al. Management of first-time patellar dislocation: ESSKA 2024 Formal Consensus, Parts I-II. Knee Surg Sports Traumatol Arthrosc. 2025.<\/p>\n\n\n\n 4. Svantesson J, et al. Rehabilitation of medial collateral ligament injuries – a systematic review. BMJ Open Sport Exerc Med. 2024.<\/p>\n\n\n\n 5. Stiell IG, et al. Derivation and validation of the Ottawa Knee Rule for the use of radiography in acute knee injuries. JAMA. 1995; Ann Emerg Med validation studies.<\/p>\n\n\n\n 6. American College of Radiology. ACR Appropriateness Criteria\u00ae: Acute Trauma to the Knee. G\u00fcncel AC Search s\u00fcr\u00fcm\u00fc, 2026.<\/p>\n\n\n\n 7. Prill R, Pujol N, et al. The Formal EU-US Meniscus Rehabilitation 2024 Consensus. Knee Surg Sports Traumatol Arthrosc. 2025.<\/p>\n\n\n\n 8. Albano D, et al. Shear-wave elastography for the evaluation of tendinopathies: a systematic review and meta-analysis. European Radiology. 2024. PMID: 37907673.<\/p>\n\n\n\n 9. Albano D, et al. Dual-energy CT in musculoskeletal imaging. La Radiologia Medica. 2024.<\/p>\n\n\n\n 10. Wang Y, et al. Diagnostic performance of dual-energy CT in detecting bone marrow edema in patients with lower limb joint injuries: a systematic review and meta-analysis. Clinical Imaging. 2024. PMID: 39232467.<\/p>\n\n\n\n 11. da Silva AGM, et al. Weight-bearing computed tomography in knee pathologies: current applications and clinical perspectives. Frontiers in Surgery. 2026.<\/p>\n\n\n\n 12. Malhi BS, et al. Tendon evaluation with ultrashort echo time (UTE) MRI: a systematic review. Frontiers in Musculoskeletal Disorders. 2024.<\/p>\n\n\n\n 13. Casula V, et al. Quantitative MRI methods for the assessment of structure and composition of articular cartilage: current applications and emerging techniques. 2024.<\/p>\n\n\n\n 14. Santomartino SM, et al. Systematic review of artificial intelligence development and evaluation for MRI diagnosis of knee ligament or meniscus tears. 2024. PMID: 37584757.<\/p>\n\n\n\n 15. Rosa SB, et al. Dynamic evaluation of patellofemoral instability: a clinical reality or just a research field? 2019. PMCID: PMC6904628.<\/p>\n\n\n\n 16. Kravchenko D, et al. Low-field and portable MRI technology: advancements and innovations. European Radiology Experimental. 2025.<\/p>\n\n\n\n 17. Inaoka T, et al. Enhancement of image quality in low-field knee MR imaging using advanced image-processing approaches. 2024. PMCID: PMC11550924.<\/p>\n","protected":false},"excerpt":{"rendered":" Yazar: Uzm. Dr. \u0130shak \u00d6zkay Edit\u00f6r: Dr. \u00d6\u011fr. \u00dcyesi \u00d6mer Yusuf Erdurmu\u015f Giri\u015f Spor ili\u015fkili akut diz yaralanmalar\u0131nda geleneksel acil servis yakla\u015f\u0131m\u0131 b\u00fcy\u00fck \u00f6l\u00e7\u00fcde k\u0131r\u0131\u011f\u0131n d\u0131\u015flanmas\u0131na odaklan\u0131r. Ottawa Diz Kurallar\u0131…<\/p>\n","protected":false},"featured_media":440,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","_tatd_show_on_main_site":"","footnotes":""},"categories":[1,10014,10015],"tags":[10018,10037,10038,10021,10020,10031,10036],"class_list":["post-439","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-akademik-blog-yazisi","category-sosyal-blog-yazisi","tag-acil-tip","tag-diz-yaralanmasi","tag-emergency-medicine","tag-spor-acilleri","tag-sporcu","tag-sporcu-sagligi","tag-sports-medicine"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/sportibbi\/wp-json\/wp\/v2\/posts\/439","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/sportibbi\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/sportibbi\/wp-json\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/sportibbi\/wp-json\/wp\/v2\/comments?post=439"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/sportibbi\/wp-json\/wp\/v2\/posts\/439\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/sportibbi\/wp-json\/wp\/v2\/media\/440"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/sportibbi\/wp-json\/wp\/v2\/media?parent=439"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/sportibbi\/wp-json\/wp\/v2\/categories?post=439"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/sportibbi\/wp-json\/wp\/v2\/tags?post=439"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}Yap\u0131<\/strong><\/td> Tipik mekanizma<\/strong><\/td> Kritik akut ipucu<\/strong><\/td><\/tr> ACL<\/td> Pivot, ani y\u00f6n de\u011fi\u015ftirme\/deselerasyon, valgus-rotasyon<\/td> Pop hissi, h\u0131zl\u0131 hemartroz, bo\u015falma hissi<\/td><\/tr> PCL<\/td> Fleksiyondaki tibian\u0131n anterioruna darbe, hiperekstansiyon<\/td> Posterior instabilite<\/td><\/tr> MCL \/ LCL-PLC<\/td> Valgus \/ varus-rotasyon<\/td> Medial\/lateral hassasiyet ve laksite<\/td><\/tr> Menisk\u00fcs<\/td> Y\u00fck alt\u0131nda fleksiyon + rotasyon<\/td> Eklem hatt\u0131 a\u011fr\u0131s\u0131, ger\u00e7ek kilitlenme<\/td><\/tr> Patella \/ MPFL<\/td> Valgus-rotasyon, lateral patellar translasyon<\/td> Dislokasyon \u00f6yk\u00fcs\u00fc, hemartroz<\/td><\/tr> Ekstans\u00f6r mekanizma<\/td> Ani g\u00fc\u00e7l\u00fc eksantrik kontraksiyon<\/td> Aktif ekstansiyon veya straight-leg raise kayb\u0131<\/td><\/tr> Kemik \/ osteokondral yap\u0131<\/td> Aksiyel y\u00fck, direkt travma, impaksiyon<\/td> Y\u00fck verememe, fokal hassasiyet, hemartroz<\/td><\/tr> \u00c7oklu ligament \/ diz dislokasyonu<\/td> Y\u00fcksek enerjili veya a\u011f\u0131r rotasyonel travma<\/td> Gross instabilite ve n\u00f6rovask\u00fcler risk<\/td><\/tr><\/tbody><\/table><\/div><\/figure>\n\n\n\n Primer De\u011ferlendirme<\/h2>\n\n\n\n
\n
Sekonder De\u011ferlendirme<\/h2>\n\n\n\n
\n
G\u00f6r\u00fcnt\u00fcleme Y\u00f6ntemleri<\/h2>\n\n\n\n
Modalite<\/strong><\/td> Acilde yap\u0131lmal\u0131<\/strong><\/td> Se\u00e7ilmi\u015f hastada<\/strong><\/td> Rutin gerekli de\u011fil \/ \u00f6nerilmez<\/strong><\/td><\/tr> Direkt grafi<\/td> Ottawa pozitifli\u011fi veya kemik\/osteokondral yaralanma \u015f\u00fcphesi<\/td> Klinik \u015f\u00fcpheye g\u00f6re ek projeksiyonlar<\/td> Ottawa negatif ve d\u00fc\u015f\u00fck k\u0131r\u0131k riskli hastada rutin kullan\u0131m<\/td><\/tr> BT<\/td> Acil kemik anatomisi y\u00f6netimi de\u011fi\u015ftirecekse<\/td> Occult tibial plato, kompleks intraartik\u00fcler veya osteokondral kemik fragman\u0131 \u015f\u00fcphesi<\/td> \u0130zole ligament\/menisk\u00fcs taramas\u0131 amac\u0131yla kullan\u0131l\u0131r<\/td><\/tr> POCUS<\/td> Ekstans\u00f6r mekanizma ve belirgin eff\u00fczyon i\u00e7in eri\u015fim\/deneyim varsa<\/td> Y\u00fczeyel ligament veya hedeflenmi\u015f dinamik de\u011ferlendirme<\/td> ACL\/menisk\u00fcs\u00fc d\u0131\u015flamak veya t\u00fcm internal derangement’\u0131 tarama amac\u0131yla kullan\u0131l\u0131r<\/td><\/tr> MR<\/td> Acil y\u00f6netimi de\u011fi\u015ftiren \u00f6zel durumlar d\u0131\u015f\u0131nda \u00e7o\u011funlukla \u015fart de\u011fildir<\/td> H\u0131zl\u0131 hemartroz, belirgin instabilite, kilitlenme, osteokondral yaralanma veya persistan fonksiyon kayb\u0131nda erken ayaktan planlama<\/td> Her akut sporcu diz travmas\u0131nda acil rutin MR \u00f6nerilmez<\/td><\/tr><\/tbody><\/table><\/div><\/figure>\n\n\n\n Yeni ve Geli\u015fmekte Olan G\u00f6r\u00fcnt\u00fcleme Y\u00f6ntemleri<\/h2>\n\n\n\n
Dinamik\/stres ultrasonografisi ve elastografi<\/h3>\n\n\n\n
Dual-energy CT (DECT)<\/h3>\n\n\n\n
Weight-bearing CT (WBCT) ve cone-beam CT<\/h3>\n\n\n\n
UTE\/ZTE ve kantitatif k\u0131k\u0131rdak g\u00f6r\u00fcnt\u00fcleme<\/h3>\n\n\n\n
3D MR, otomatik segmentasyon ve yapay zek\u00e2<\/h3>\n\n\n\n
Dinamik MRI ve hareket s\u0131ras\u0131nda g\u00f6r\u00fcnt\u00fcleme<\/h3>\n\n\n\n
Ta\u015f\u0131nabilir ve d\u00fc\u015f\u00fck alanl\u0131 MR<\/h3>\n\n\n\n
Tedavi<\/h2>\n\n\n\n
Daha g\u00fc\u00e7l\u00fc koruma \/ immobilizasyon<\/strong><\/td> Rutin uzun rijid immobilizasyondan ka\u00e7\u0131n<\/strong><\/td><\/tr> Ekstans\u00f6r mekanizma r\u00fcpt\u00fcr\u00fc; instabil frakt\u00fcr; dislokasyon sonras\u0131; belirgin \u00e7oklu ba\u011f instabilitesi; g\u00fcvenli mobilizasyonun m\u00fcmk\u00fcn olmad\u0131\u011f\u0131 se\u00e7ilmi\u015f olgular<\/td> Stabil d\u00fc\u015f\u00fck dereceli sprain; bir\u00e7ok izole d\u00fc\u015f\u00fck dereceli MCL yaralanmas\u0131; stabil ve k\u0131r\u0131k d\u0131\u015flanm\u0131\u015f yumu\u015fak doku yaralanmalar\u0131<\/td><\/tr> Ama\u00e7: yaralanm\u0131\u015f dokuyu korumak ve sekonder hasar\u0131 \u00f6nlemek<\/td> Ama\u00e7: erken kontroll\u00fc ROM, uygun y\u00fcklenme ve quadriceps fonksiyonunu korumak<\/td><\/tr><\/tbody><\/table><\/div><\/figure>\n\n\n\n Spora D\u00f6n\u00fc\u015f<\/h2>\n\n\n\n
SPORCU + AKUT D\u0130Z TRAVMASI<\/strong><\/td><\/tr> 1. ZAMAN KR\u0130T\u0130K YARALANMAYI DI\u015eLA
Dislokasyon \u2022 N\u00f6rovask\u00fcler bozukluk \u2022 A\u00e7\u0131k yaralanma \u2022 Ekstans\u00f6r mekanizma kayb\u0131
Pozitif \u2192 Acil spesifik y\u00f6netim + ortopedi\/vask\u00fcler de\u011ferlendirme<\/strong><\/td><\/tr>\u2193<\/td><\/tr> 2. KIRIK R\u0130SK\u0130
Ottawa Diz Kurallar\u0131 + klinik de\u011ferlendirme
Endikasyon varsa direkt grafi; occult\/kompleks kemik yaralanmas\u0131 \u015f\u00fcphesinde se\u00e7ilmi\u015f hastada BT<\/strong><\/td><\/tr>\u2193<\/td><\/tr> 3. INTERNAL DERANGEMENT SCREEN
Mekanizma + Eff\u00fczyon + Fonksiyon + Stabilite + Mekanik semptom<\/strong><\/td><\/tr>\u2193<\/td><\/tr> 4. R\u0130SK SINIFLAMASI
D\u00fc\u015f\u00fck: <\/strong>Erken fonksiyonel yakla\u015f\u0131m
Orta: hedeflenmi\u015f <\/strong>G\u00f6r\u00fcnt\u00fcleme\/koruma + yak\u0131n kontrol
Y\u00fcksek: <\/strong>Erken uzman + uygun MR<\/td><\/tr>\u2193<\/td><\/tr> 5. FONKS\u0130YONEL \u0130Y\u0130LE\u015eME VE SPORA D\u00d6N\u00dc\u015e
A\u011fr\u0131\/eff\u00fczyon \u2192 ROM \u2192 g\u00fc\u00e7 \u2192 stabilite \u2192 n\u00f6romusk\u00fcler kontrol \u2192 spora \u00f6zg\u00fc fonksiyon \u2192 kriter bazl\u0131 kademeli d\u00f6n\u00fc\u015f<\/strong><\/td><\/tr><\/tbody><\/table><\/div><\/figure>\n\n\n\nSonu\u00e7<\/h2>\n\n\n\n
Referanslar<\/h2>\n\n\n\n