Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Ön Çapraz Bağ Greft Rekonstrüksiyonu ve Tekrarlayan Potansiyel Rüptür Komplikasyonlarının Manyetik Rezonans Görüntüleme Bulguları: Tanımlayıcı Araştırma
Magnetic Resonance Imaging Findings in Anterior Cruciate Ligament Graft Reconstruction and Evaluation of Potential Recurrent Rupture Complication: Descriptive Study
Hakan BAHADIRa , Enise Yağmur ÖZKANb
aBetatom Emar, İstanbul, Türkiye
bİstanbul Üniversitesi-Cerrahpaşa Cerrahpaşa Tıp Fakültesi, Radyoloji ABD, İstanbul, Türkiye
Turkiye Klinikleri J Med Sci. 2024;44(1):27-34
doi: 10.5336/medsci.2023-100294
Article Language: TR
Full Text
ÖZET
 Amaç: Bu çalışmada, ön çapraz bağ (ÖÇB) rekonstrüksiyon cerrahisi geçirmiş bir grup vakada, normal greft rekonstrüksiyonlarının manyetik rezonans görüntüleme (MRG) bulgularını tanımlanması ve rekonstrüksiyon sonrası en sık karşılaşılan potansiyel komplikasyonların tanısında MRG'nin rolünün ortaya konulması amaçlanmıştır. Gereç ve Yöntemler: ÖÇB rekonstrüksiyon cerrahisi geçirmiş olan 16 olgu çalışmaya dâhil edildi. Retrospektif ve tek merkezli olan çalışma örneklemini tıbbi görüntüleme merkezimize başvuran ve ÖÇB rekonstrüktif cerrahisini takiben MRG ile tetkik edilmiş olgular oluşturmaktadır. Hastaların MRG bulguları, ÖÇB greft bütünlüğü ve eşlik eden diğer komplikasyonlar açısından retrospektif olarak değerlendirildi. Bulgular: On hastada sol (%62,5), 6 hastada ise sağ (%37,5) ÖÇB rüptürüne yönelik rekonstrüksiyon gerçekleştirilmiştir. ÖÇB rekonstrüksiyon cerrahisi geçirmiş 16 olgunun 6'sında ÖÇB konturu ayırt edilememiş, bu hastalardan 5'inde komplet ÖÇB greft yırtığı (rekürren yırtık), 1 tanesinde ise parsiyel ÖÇB greft yırtığı görülmüştür. Olguların 1 tanesinde avulsiyon fraktürü, 3 olguda meniskal dejenerasyon ve 7 olguda meniskal yırtık görülmüştür. Bir olguda mediyal menisküs posterior hornunda totale yakın rüptür, 1 olguda kova sapı yırtığı, 1 olguda intraligamentöz yırtık, 2 olguda greft impingement tespit edilmiştir. 16 olgunun 13'ünde ise eşlik eden minör patolojiler (9 intrakapsüler efüzyon, 4 intraartiküler sinoviyal efüzyon) saptanmıştır. Sonuç: Çalışmada ortaya konulan bulgular MRG'nin, ÖÇB greft rekonstrüksiyonunun, tünellerin ve fiksasyon materyallerinin pozisyonunu değerlendirmede, operasyon sonrası ağrı ve fonksiyon kaybının nedenini araştırmada kullanılabilen etkili bir görüntüleme yöntemi olduğunu desteklemektedir.

Anahtar Kelimeler: Ön çapraz bağ; ön çapraz bağ rekonstrüksiyonu; manyetik rezonans görüntüleme
ABSTRACT
 Objective: The aim of this study was to describe the magnetic resonance imaging (MRI) findings of normal graft reconstructions in a group of patients who underwent anterior cruciate ligament (ACL) reconstruction surgery and to demonstrate the role of MRI in the diagnosis of the most common potential complications after reconstruction. Material and Methods: Sixteen patients who underwent ACL reconstruction surgery were included in the study. The retrospective and single-center study sample consisted of patients who applied to our medical imaging center and were examined with MRI following ACL reconstructive surgery. The MRI findings of the patients were retrospectively evaluated for ACL graft integrity and other associated complications. Results: Ten patients underwent reconstruction for left (62.5%) and 6 patients for right (37.5%) ACL rupture. Discontinuity of the ligament or abnormal contour was detected in 6 of 16 patients who underwent ACL reconstruction surgery. Five of these patients had complete ACL graft tear (recurrent tear) and 1 patient had partial ACL graft tear. Avulsion fracture was seen in 1 case, meniscal degeneration in 3 cases and meniscal tear in 7 cases. In 1 case near total rupture of the posterior horn of the medial meniscus, in 1 case bucket handle tear, in 1 case intraligamantous tear and in 2 cases graft impingement were detected. In 13 of 16 cases, accompanying minor pathologies (9 intracapsular effusions, 4 intra-articular synovial effusions, 4 intra-articular) were observed. Conclusion: The findings of this study support that MRI is an important modality for assessing graft integrity, position of tunnels and fixation materials in ACL reconstruction. It is also an efficient imaging modality to investigate the cause of postoperative pain and loss of function.

Keywords: Anterior cruciate ligament; anterior cruciate ligament reconstruction; magnetic resonance imaging
REFERENCES:
  1. Kiapour AM, Murray MM. Basic science of anterior cruciate ligament injury and repair. Bone Joint Res. 2014;3(2):20-31. [Crossref]  [PubMed]  [PMC] 
  2. Herrington L, Wrapson C, Matthews M, Matthews H. Anterior cruciate ligament reconstruction, hamstring versus bone-patella tendon-bone grafts: a systematic literature review of outcome from surgery. Knee. 2005;12(1):41-50. [Crossref]  [PubMed] 
  3. Duthon VB, Barea C, Abrassart S, Fasel JH, Fritschy D, Ménétrey J. Anatomy of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 2006;14(3):204-13. [Crossref]  [PubMed] 
  4. Gregory C. Fanelli. The Multiple Ligament Injured Knee: A Practical Guide to Management. 2nd ed. New York: Springer; 2012. [Crossref] 
  5. Hassebrock JD, Gulbrandsen MT, Asprey WL, Makovicka JL, Chhabra A. Knee ligament anatomy and biomechanics. Sports Med Arthrosc Rev. 2020;28(3):80-6. [Crossref]  [PubMed] 
  6. Kim S, Bosque J, Meehan JP, Jamali A, Marder R. Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am. 2011;93(11):994-1000. [Crossref]  [PubMed] 
  7. Ellman MB, Sherman SL, Forsythe B, LaPrade RF, Cole BJ, Bach BR Jr. Return to play following anterior cruciate ligament reconstruction. J Am Acad Orthop Surg. 2015;23(5):283-96. [Crossref]  [PubMed] 
  8. Csintalan RP, Inacio MC, Funahashi TT. Incidence rate of anterior cruciate ligament reconstructions. Perm J. 2008;12(3):17-21. [Crossref]  [PubMed]  [PMC] 
  9. White LM, Kramer J, Recht MP. MR imaging evaluation of the postoperative knee: ligaments, menisci, and articular cartilage. Skeletal Radiol. 2005;34(8):431-52. [Crossref]  [PubMed] 
  10. Bencardino JT, Beltran J, Feldman MI, Rose DJ. MR imaging of complications of anterior cruciate ligament graft reconstruction. Radiographics. 2009;29(7):2115-26. [Crossref]  [PubMed] 
  11. Petersen W, Taheri P, Forkel P, Zantop T. Return to play following ACL reconstruction: a systematic review about strength deficits. Arch Orthop Trauma Surg. 2014;134(10):1417-28. [Crossref]  [PubMed] 
  12. Siegel L, Vandenakker-Albanese C, Siegel D. Anterior cruciate ligament injuries: anatomy, physiology, biomechanics, and management. Clin J Sport Med. 2012;22(4):349-55. [Crossref]  [PubMed] 
  13. Beynnon BD, Uh BS, Johnson RJ, Abate JA, Nichols CE, Fleming BC, et al. Rehabilitation after anterior cruciate ligament reconstruction: a prospective, randomized, double-blind comparison of programs administered over 2 different time intervals. Am J Sports Med. 2005;33(3):347-59. [Crossref]  [PubMed] 
  14. Recht MP, Kramer J. MR imaging of the postoperative knee: a pictorial essay. Radiographics. 2002;22(4):765-74. [Crossref]  [PubMed] 
  15. De Smet AA, Tuite MJ, Norris MA, Swan JS. MR diagnosis of meniscal tears: analysis of causes of errors. AJR Am J Roentgenol. 1994;163(6):1419-23. [Crossref]  [PubMed] 
  16. Chiu SS. The anterior tibial translocation sign. Radiology. 2006;239(3):914-5. [Crossref]  [PubMed] 
  17. Brandser EA, Riley MA, Berbaum KS, el-Khoury GY, Bennett DL. MR imaging of anterior cruciate ligament injury: independent value of primary and secondary signs. AJR Am J Roentgenol. 1996;167(1):121-6. [Crossref]  [PubMed] 
  18. Lee K, Siegel MJ, Lau DM, Hildebolt CF, Matava MJ. Anterior cruciate ligament tears: MR imaging-based diagnosis in a pediatric population. Radiology. 1999;213(3):697-704. [Crossref]  [PubMed] 
  19. Volokhina YV, Syed HM, Pham PH, Blackburn AK. Two Helpful MRI signs for evaluation of posterolateral bundle tears of the anterior cruciate ligament: a pilot study. Orthop J Sports Med. 2015;3(8):2325967115597641. [Crossref]  [PubMed]  [PMC] 
  20. Mitchell BC, Siow MY, Bastrom T, Bomar JD, Pennock AT, Parvaresh K, et al. Coronal lateral collateral ligament sign: a novel magnetic resonance imaging sign for identifying anterior cruciate ligament-deficient knees in adolescents and summarizing the extent of anterior tibial translation and femorotibial internal rotation. Am J Sports Med. 2021;49(4):928-34. [Crossref]  [PubMed] 
  21. Parkinson B, Robb C, Thomas M, Thompson P, Spalding T. Factors that predict failure in anatomic single-bundle anterior cruciate ligament reconstruction. Am J Sports Med. 2017;45(7):1529-36. [Crossref]  [PubMed] 
  22. Meyers AB, Haims AH, Menn K, Moukaddam H. Imaging of anterior cruciate ligament repair and its complications. AJR Am J Roentgenol. 2010;194(2):476-84. [Crossref]  [PubMed] 
  23. Schilaty ND, Bates NA, Sanders TL, Krych AJ, Stuart MJ, Hewett TE. Incidence of Second Anterior Cruciate Ligament Tears (1990-2000) and Associated Factors in a Specific Geographic Locale. Am J Sports Med. 2017;45(7):1567-73. [Crossref]  [PubMed]  [PMC] 
  24. Liechti DJ, Chahla J, Dean CS, Mitchell JJ, Slette E, Menge TJ, et al. Outcomes and Risk Factors of Rerevision Anterior Cruciate Ligament Reconstruction: A Systematic Review. Arthroscopy. 2016;32(10):2151-59. [Crossref]  [PubMed] 
  25. Gentili A, Seeger LL, Yao L, Do HM. Anterior cruciate ligament tear: indirect signs at MR imaging. Radiology. 1994;193(3):835-40. [Crossref]  [PubMed] 
  26. Streich NA, Friedrich K, Gotterbarm T, Schmitt H. Reconstruction of the ACL with a semitendinosus tendon graft: a prospective randomized single blinded comparison of double-bundle versus single-bundle technique in male athletes. Knee Surg Sports Traumatol Arthrosc. 2008;16(3):232-8. [Crossref]  [PubMed] 
  27. Howell SM. Principles for placing the tibial tunnel and avoiding roof impingement during reconstruction of a torn anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 1998;6 Suppl 1:S49-55. [Crossref]  [PubMed] 
  28. Steiner ME, Hecker AT, Brown CH Jr, Hayes WC. Anterior cruciate ligament graft fixation. Comparison of hamstring and patellar tendon grafts. Am J Sports Med. 1994;22(2):240-6; discussion 246-7. [Crossref]  [PubMed] 
  29. Saupe N, White LM, Chiavaras MM, Essue J, Weller I, Kunz M, et al. Anterior cruciate ligament reconstruction grafts: MR imaging features at long-term follow-up--correlation with functional and clinical evaluation. Radiology. 2008;249(2):581-90. [Crossref]  [PubMed] 
  30. Collins MS, Unruh KP, Bond JR, Mandrekar JN. Magnetic resonance imaging of surgically confirmed anterior cruciate ligament graft disruption. Skeletal Radiol. 2008;37(3):233-43. [Crossref]  [PubMed] 
  31. Horton LK, Jacobson JA, Lin J, Hayes CW. MR imaging of anterior cruciate ligament reconstruction graft. AJR Am J Roentgenol. 2000;175(4):1091-7. [Crossref]  [PubMed] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com