Noninvasive Technique to Monitor the Pressure under a Cast: A Mobile Application-Friendly Bluetooth Pressure Sensor.

Aim: The purpose of this study was to design a sensor that could monitor the skin-cast contact surface pressure (SCCSP) of a limb under a cast and inform the user via a mobile application when the pressure increases. Methods: In this experimental study, an infant sphygmomanometer cuff was initially placed on the forearm of 10 volunteers. A pressure sensor with a Bluetooth chip was then placed on the volar aspect of the forearm. Short arm plaster was applied with synthetic cast material. The SCCSP under the plaster was measured by the sensor and the measured values were transmitted to a mobile application via a Bluetooth chip. The mobile application processed the data from the chip and converted it to mmHg. Results: Intracompartmental pressure (ICP) values were categorized as 0, 10, 20, 30, 40, 50, 60, and 75 mmHg. The highest SCCSP was 75 mmHg CP, while the lowest was 0 mmHg CP. The correlation coefficient of the mean pressure values was 0.993 (p ≤ 0.001) (SD 0.002, range 0.989-0.997), and there was a significant relationship between ICP and SCCSP values (p ≤ 0.05). Conclusion: We can monitor SCCSP, detect limb swelling, and notify the user via a mobile application by using Bluetooth pressure sensors.

Post-Operative Results of ACL Reconstruction Techniques on Single-Leg Hop Tests in Athletes: Hamstring Autograft vs. Hamstring Grafts Fixed Using Adjustable Cortical Suspension in Both the Femur and Tibia.

Background and Objectives: Anterior cruciate ligament (ACL) tears are common injuries in the athletic population, and accordingly, ACL reconstruction (ACLR) is among the most common orthopedic surgical procedures performed in sports medicine. This study aims to compare the semitendinosus/gracilis (ST/G) and ACL hamstring grafts fixed using adjustable cortical suspension in both the femur and tibia (MAI) ACLR techniques. We aimed to compare the results of single-leg hop tests (SLHT) applied in different directions and limb symmetry indices (LSI) in athletes with a 6-month post-operative ACLR history. Materials and Methods: A retrospective cohort of 39 athletes from various sports branches who underwent MAI (n = 16) and ST/G (n = 23) ACLR techniques by the same surgeon were evaluated. The knee strength of the participants on the operated and non-operated sides was evaluated with five different SLHTs. The SLHT included the single hop for distance (SH), triple hop for distance (TH), crossover triple hop for distance (CH), medial side triple hop for distance (MSTH), and medial rotation (90°) hop for distance (MRH). Results: There was a significant improvement in the mean Lysholm, Tegner, and IKDC scores in the post-operative leg for both techniques (p < 0.05) compared to the pre-operative levels. When there was a difference between the SH of the operative and the non-operative legs in the ST/G technique (p < 0.05), there was no significant difference in the other hop distance for both ST/G and MAI (p > 0.05). There was no difference between the techniques regarding the LSI scores. Conclusions: The fact that our research revealed similar LSI rates of the SLHTs applied in different directions in the ST/G and MAI techniques assumes that the MAI technique can be an ACLR technique which can be functionally used in athletes.

Synthesis and characterization of antibacterial drug loaded ß-tricalcium phosphate powders for bone engineering applications.

Powders of ß-tricalcium phosphate [ß-TCP, ß-Ca3(PO4)2] and composite powders of ß-TCP and polyvinyl alcohol (PVA) were synthesized by using wet precipitation methods. First, the conditions for the preparation of single phase ß-TCP have been delineated. In the co-precipitation procedure, calcium nitrate and diammonium hydrogen phosphate were used as calcium and phosphorous precursors, respectively. The pH of the system was varied in the range 7-11 by adding designed amounts of ammonia solution. The filtered cakes were desiccated at 80 °C and subsequently calcined at different temperatures in the range between 700-1100 °C. Later on, rifampicin form II was used to produce drug-loaded ß-TCP and PVA/ß-TCP powders. All the synthesized materials have been characterized from morphological (by scanning electron microscopy) and structural-chemical (by X-ray diffraction and Fourier transform infrared spectroscopy) point of view. The drug loading capacity of the selected pure ß-TCP powder has been assessed. The biological performance (cytocompatibility in fibroblast cell culture and antibacterial efficacy against Escherichia coli and Staphylococcus aureus) has been tested with promising results. Application perspectives of the designed drug-bioceramic-polymer blends are advanced and discussed.

Are chondrocytes damaged when rheumatologic inflammation is suppressed?

AIM: The use of biological agents (BAs) for treating diseases such as rheumatoid arthritis (RA), spondyloarthropathy, and systemic lupus erythematosus to reduce inflammation has been fruitful. Especially as part of the increasing number of studies on the intra-articular application of BAs, the effects of BAs on cartilage have been widely investigated. In the present study, the effects of rituximab, abatacept, and adalimumab, all approved antirheumatic agents, on human primary chondrocytes were investigated comparatively and on the molecular level through viability, proliferation, and toxicity analyses. MATERIALS AND METHODS: Osteochondral tissues from the distal femur and proximal tibia were resected during total knee arthroplasty from patients (n = 3) with confirmed gonarthrosis in whom all medical or conservative treatments had failed. Standard human primary chondrocyte cell culturing was carried out. Immunophenotyping was performed on the cells that adhered to the flask, and their chondrotoxicity was observed using a flow cytometry device. Images of the cells showing chondrotoxicity were analyzed using invert and environmental scanning microscopes, and microimages were obtained. The MTT-enzyme linked immunosorbent assay was performed to observe the toxic effects of BAs on the proliferation of chondrocytes at 24 and 48 h. The results were analyzed using the number of cells and proliferation; statistical comparisons among the groups were carried out using one-way ANOVA. The alpha significance level was set at <0.01. RESULTS: These pharmaceutical agents were chondrotoxic, especially on viability and proliferation (p = 0.0000). CONCLUSION: BAs are generally used during active inflammation, and following the management of inflammation, their dosage should be determined taking into consideration their cellular-level toxic effects on chondrocytes.

Need for Bone Grafts in the Surgical Treatment of Displaced Intra-Articular Calcaneal Fractures.

Controversy is ongoing regarding the use of bone grafts to fill cavities that occur with collapse of the posterior facet in the joint and for repair of the calcaneal height with plating. The present study included 40 patients with 43 displaced intra-articular calcaneal fractures treated with open reduction and internal fixation from March 2009 to November 2013. In the present case-control study, the patients were separated into 2 groups: group A received an allograft (20 patients, 22 calcaneal fractures) and group B did not (20 patients, 21 calcaneal fractures). The calcaneal height and Böhler's angle were compared between the 2 groups. The final outcomes for all patients were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot scale score and compared between the 2 groups. No significant differences were observed between the groups with regard to the basic demographic variables (p > .05). Using Sanders classification, 8 (18%) were type 2, 19 (44%) were type 3, and 16 (37%) were type 4 fractures. The comparisons between the 2 groups showed a loss of Böhler's angle and loss of calcaneal height that was significantly greater in group B (p < .001). No significant differences were observed between the 2 groups in the AOFAS ankle hindfoot scale scores (p > .05). In conclusion, although no differences were found in the clinical results between the 2 groups, more satisfactory radiologic results were obtained in group A, in which bone grafts were used.

Comparison of quadriceps muscle volume after unilateral total knee arthroplasty with and without tourniquet use.

PURPOSE: Determination of the effect of tourniquet use in total knee arthroplasty (TKA) on thigh and quadriceps muscle volume using magnetic resonance imaging (MRI). METHODS: A total of 148 knees of 74 patients (mean age 66.5 ± 4.8 years; female/male, 62/12) with bilateral primary varus gonarthrosis underwent unilateral TKA with a tourniquet (Group A, n = 35) or without a tourniquet (Group B, n = 39). The total thigh volume and connective, bone, and muscle tissue volumes were stereologically measured on preoperative and postoperative MRI. The Knee Society Score (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were calculated to evaluate functional outcomes. RESULTS: After TKA, the knees of patients in Group A exhibited a significant decrease in all tissue measurements, except bone tissue volume; however, the knees of patients in Group B exhibited no significant difference in tissue measurements. Although no difference was found between the operated and contralateral non-operated thighs (4076.9 and 4073.4 cm(3), respectively) in Group B postoperatively at 1 month (p > 0.05), the operated thighs had lost 20 % of its volume in Group A postoperatively at 1 month (p < 0.001). A significant difference was found in all tissue measurements, except the connective and bone tissue volumes of the thigh between the operated and contralateral non-operated knees in Group A. No significant difference was identified between the operated and contralateral non-operated knees in Group B. The total WOMAC score was significantly higher, and the total KSS was significantly lower in Group A than in Group B during the postoperative follow-up period of 1-6 months (p < 0.001 for all) but not 12 months (n.s.). CONCLUSION: Tourniquet use in TKA decreases the thigh and quadriceps muscle volumes and postoperatively delays the recovery of knee function. Therefore, caution should be exercised for tourniquet use during TKA in daily clinical practice and using alternative methods for tourniquet application in preventing intraoperative blood loss. LEVEL OF EVIDENCE: III.

The effect of glenoid cavity depth on rotator cuff tendinitis.

INTRODUCTION: Some of the most important causes of shoulder pain are inflammation and degenerative changes in the rotator cuff (RC). Magnetic resonance imaging (MRI) is a noninvasive and safe imaging modality. MRI can be used for the evaluation of cuff tendinopathy. In this study, we evaluated the relationship between glenoid cavity depth and cuff tendinopathy and we investigated glenoid cavity depth on the pathogenesis of cuff tendinopathy. MATERIALS AND METHODS: We retrospectively evaluated 215 patients who underwent MRI. Of these, 60 patients showed cuff tendinopathy (group A) and 54 patients showed no pathology (group B). Glenoid cavity depth was calculated in the coronal and transverse planes. RESULTS: The mean axial depth was 1.7 ± 0.9 and the mean coronal depth 3.8 ± 0.9, for group A. The mean axial depth was 3.5 ± 0.7 and the mean coronal depth 1.5 ± 0.8, for group B. There were significant differences in the axial and coronal depths between the two groups. CONCLUSION: High coronal and low axial depth of the glenoid cavity can be used to diagnose RC tendinitis.

Graft position in arthroscopic anterior cruciate ligament reconstruction: anteromedial versus transtibial technique.

INTRODUCTION: When treating anterior cruciate ligament (ACL) injuries, the position of the ACL graft plays a key role in regaining postoperative knee function and physiologic kinematics. In this study, we aimed to compare graft angle, graft position in tibial tunnel, and tibial and femoral tunnel positions in patients operated with anteromedial (AM) and transtibial (TT) methods to those of contralateral healthy knees. MATERIALS AND METHODS: Forty-eight patients who underwent arthroscopic ACL reconstruction with ipsilateral hamstring tendon autograft were included. Of these, 23 and 25 were treated by AM and TT techniques, respectively. MRI was performed at 18.4 and 19.7 months postoperatively in AM and TT groups. Graft angles, graft positions in the tibial tunnel and alignment of tibial and femoral tunnels were noted and compared in these two groups. The sagittal graft insertion tibia midpoint distance (SGON) has been used for evaluation of graft position in tunnel. RESULTS: Sagittal ACL graft angles in operated and healthy knees of AM patients were 57.78° and 46.80° (p < 0.01). With respect to TT patients, ACL graft angle was 58.87° and 70.04° on sagittal and frontal planes in operated knees versus 47.38° and 61.82° in healthy knees (p < 0.001). ACL graft angle was significantly different between the groups on both sagittal and frontal planes (p < 0.001). Sagittal graft insertion tibia midpoint distance ratio was 0.51 and 0.48 % in the operated and healthy knees of AM group (p < 0.001) and 0.51 and 0.48 % in TT group (p < 0.001). Sagittal tibial tunnel midpoint distance ratio did not differ from sagittal graft insertion tibia midpoint distance of healthy knees in either group. Femoral tunnel clock position was better in AM [right knee 10:19 o'clock-face position (310° ± 4°); left knee 1:40 (50° ± 3°)] compared with TT group [right knee 10:48 (324° ± 5°); left knee 1:04 (32° ± 4°)]. With respect to the sagittal plane, the anterior-posterior position of femoral tunnel was better in AM patients. Lysholm scores and range of motion of operated knees in the AM and TT groups showed no significant difference (p > 0.05). CONCLUSIONS: Precise reconstruction on sagittal plane cannot be obtained with either AM or TT technique. However, AM technique is superior to TT technique in terms of anatomical graft positioning. Posterior-placed grafts in tibial tunnel prevent ACL reconstruction, although tibial tunnel is drilled on sagittal plane.

Diagnostic Value of Elastography in the Diagnosis of Intermetatarsal Neuroma.

The objective of the present study was to characterize the ultrasound and elastographic properties of intermetatarsal neuroma (interdigital neuroma) and their contribution to diagnosis. Eighteen patients with metatarsalgia, who had presented to an orthopedic clinic from April 2013 to February 2015, were diagnosed with 25 intermetatarsal neuromas (11 unilateral [61.11%], 7 bilateral [38.89%]). These patients underwent evaluation with ultrasonography and simultaneous ultrasound strain elastography to assess the elastographic properties of the tissues in the intermetatarsal space. The intermetatarsal neuroma diagnosis was confirmed by histopathologic inspection. The lesion contours, localization, dimensions, and vascularization were evaluated before surgical excision. The elasticity and strain ratio values were compared between the neuroma and adjacent healthy intermetatarsal space. Of the 25 intermetatarsal neuromas, 1 (4%) was not detected by ultrasonography (incidence of detection of 96%). The mean neuroma width was 6.35 (range 3.7 to 13) mm in the coronal plane, and the mean elasticity and strain ratio values were 3.44 (range 1.1 to 5.1) and 9.47 (range 2.3 to 19.3), respectively. The elasticity and strain ratio values were significantly greater in the presence of an interdigital neuroma than in the adjacent healthy intermetatarsal spaces (Z = -3.964, p = .0001 and Z = -3.927, p = .0001, respectively). The diagnostic cutoff values were calculated as 2.52 for elasticity and 6.1 for the strain ratio. Four neuromas (16%) were not demarcated, and the elasticity and strain ratio values for these were lower than those for neuromas with demarcated contours but were greater than those for healthy intermetatarsal spaces (p < .006 and p < .005, respectively). Patients with clinically suspected intermetatarsal neuromas that do not show demarcation and with smaller lesions might benefit from the use of ultrasound elastography for diagnosis.

Safety of bioabsorbable implants in vitro.

BACKGROUND: The aim of the present study was to investigate the safety of bioabsorbable plates and screws in humans. METHODS: For this purpose, an implant system based on [poly(lactic-co-glycolic acids)(85:15)] was designed. The system was tested for pH, temperature, and swelling and then its surface morphology was analyzed for surface porosity using environmental electron microscopy. Then, the effects of this bioabsorbable system on the viability and profileration of osteocytes were examined on a molecular level via in vitro experiments. A [poly(lactic-co-glycolic acids)(90:10)] bioabsorbable implant, which is commercially available and used in orthopedic surgery, was used as control group. For the statistical evaluation of the data obtained in the present study, the groups were compared by Tukey HSD test following ANOVA. The significance level was set as p < 0.05. RESULTS: It was observed that the osteocytes cultivated on the PLGA system designed in the present study included more live cells and allowed more proliferation compared to the control. CONCLUSION: One of the criteria in the selection of implants for orthopedic surgery is that a good implant should not need removal and thus a second surgery. In the present study, a bioabsorbable implant was designed considering this criterion. The present study is the first step to prove the safety of this new design by in vitro toxicity and viability experiments.

What is the fate of clubfoot patients treated by posteromedial release?

INTRODUCTION: Management and long-term results of operatively treated clubfoot deformity still remains controversial. The aim of this study was to evaluate the radiological and clinical results of adult clubfoot patients treated with posteromedial release. MATERIALS AND METHODS: Between 2005 and 2012, we evaluated patients with congenital foot deformities regarding clubfoot who were operatively treated with complete posteromedial release. Out of 320 patients evaluated, 29 patients (40 feet) were included the study. We also included foot radiographies of 40 healthy adults. Talocalcaneal angle on the dorsoplantar projection (TC-DP) and lateral projection (TC-L) and talus-first metatarsal angle on the dorsoplantar projection (TFM-DP) were measured for both clubfeet and control groups. Laaveg-Ponseti functional rating system was used for clinical evaluation and measurement of lower leg circumference was used for detection of atrophy. RESULTS: The average age was 21.5 years (range 19-34). The mean TC-DP angle was 16.97 in the clubfeet group and 21.03 in the control group. The mean TC-L angle was 23.34 in the clubfeet group and 33.98 in the control group. The mean TFM-DP angle was 9.02 in the clubfeet group and 7.9 in control group. There were statistically significant difference between clubfoot and control groups regarding the TC-DP angle and the TC-L angle. The average Laaveg-Ponseti score was 74 points (range 42-96). While no significant correlations could be detected between the TC-DP angle, the TC-L angle, the TFM-DP angle and the functional score, a significant correlation was detected between circumferential measurement of lower leg and functional score (p = 0.04). CONCLUSION: Functional outcome may be affected by lower leg muscular atrophy instead of foot alignment disturbance. Lastly we believe that results for treatment of clubfoot-a three-dimensional deformity-need to be evaluated with three-dimensional imaging techniques.

Nail Braces as an Alternative Treatment for Ingrown Toenails: Results From a Comparison With the Winograd Technique.

Ingrown toenails are one of the most frequent nail disorders and can be treated with conservative or surgical approaches. Although discovered a long time ago, the available data are still very limited on the potential effectiveness of nail braces for ingrown toenail treatment. In the present retrospective study, we compared nail braces with surgical wedge excision using the Winograd technique with respect to the time to return to work, recurrence, interval to recurrence, and patient satisfaction. A total of 159 patients were divided into the nail brace (n = 74; mean age 29.51 ± 8.48 years) and Winograd technique (n = 85; mean age 26.95 ± 8.06 years) groups. In the nail brace group, the mean time to return to work (4.15 ± 1.07 days) was significantly shorter than that in the Winograd technique group (13.8 ± 2.26 days; p < .001). Patient satisfaction was significantly greater in the nail brace group (94.6%) compared with the Winograd technique group (82.4%; p = .018). Of the 159 patients, 6 (8.1%) in the nail brace group and 8 (9.4%) in the Winograd technique group developed recurrence; however, this difference was not statistically significant (p > .05). A statistically significant difference was observed in the mean interval to recurrence (12.46 ± 1.60 versus 13.24 ± 2.48 months, respectively; p = .031). The progression-free follow-up periods for the nail brace and Winograd technique groups were 15.45 ± 0.22 months (95% confidence interval 15.02 to 15.88) and 17.18 ± 0.29 months (95% confidence interval 16.61 to 17.84), respectively. We have concluded that the use of nail braces is an appropriate alternative treatment of ingrown toenails with high patient satisfaction, fast recovery times, and a low recurrence rate.

Evaluation of results of conservative therapy in patients with transient osteoporosis of hip.

The present study aimed to review the general characteristics of 18 cases diagnosed with transient osteoporosis of the hip (TOH) in our hospital within a 3-year period and to present their follow-up results after conservative treatment. A retrospective evaluation was made of the treatment and results of follow-up of TOH cases using physical examination and laboratory findings, hip radiographs and magnetic resonance imaging (MRI) and Harris Hip Scores (HHS). The mean duration of complaints of 6 females (mean age, 34.3±4.3 years) and 12 males (mean age, 40.7±10.5 years) was 6.1±2.7 weeks before the treatment. Three female patients had a history of giving birth by cesarean delivery. None of the patients had any history of trauma. MRI revealed increased intensity in T2 sequences and decreased intensity in T1 sequences in the proximal aspect of the femur. None of the patients had subchondral collapse or intra-articular effusion. For 3 female patients who were breastfeeding, no medical therapy was given, but only hyperbaric oxygen (HBO) therapy and forearm crutches. As standard management, the other patients were prevented from weight-bearing with the use of forearm crutches and medical therapy of diclofenac sodium, acetylsalicylic acid, and risedronate sodium was administered and additional HBO therapy. Clinical and radiological improvements were observed in all patients. None of the patients had avascular necrosis (AVN) of the femoral head. There was no record of therapy-related complications. While HHS was 55.6±7.8 before the treatment, it increased to 88.8±5.8 in the 3rd month and to 96.0±1.8 in the 6th month after the treatment. This change in score over time was found to be significant.

A comparative analysis of 3D bioprinted gelatin-hyaluronic acid-alginate scaffold and microfracture for the management of osteochondral defects in the rabbit knee joint.

OBJECTIVES: This study aims to compare the radiological, biomechanical, and histopathological results of microfracture treatment and osteochondral damage repair treatment with a new scaffold product produced by the three-dimensional (3D) bioprinting method containing gelatin-hyaluronic acid-alginate in rabbits with osteochondral damage. MATERIALS AND METHODS: A new 3D bioprinted scaffold consisting of gelatin, hyaluronic acid, and alginate designed by us was implanted into the osteochondral defect created in the femoral trochlea of 10 rabbits. By randomization, it was determined which side of 10 rabbits would be repaired with a 3D bioprinted scaffold, and microfracture treatment was applied to the other knees of the rabbits. After six months of follow-up, the rabbits were sacrificed. The results of both treatment groups were compared radiologically, biomechanically, and histopathologically. RESULTS: None of the rabbits experienced any complications. The magnetic resonance imaging evaluation showed that all osteochondral defect areas were integrated with healthy cartilage in both groups. There was no significant difference between the groups in the biomechanical load test (p=0.579). No statistically significant difference was detected in the histological examination using the modified Wakitani scores (p=0.731). CONCLUSION: Our study results showed that 3D bioprinted scaffolds exhibited comparable radiological, biomechanical, and histological properties to the conventional microfracture technique for osteochondral defect treatment.

Tibial Press-Fit Fixation Technique in Anterior Cruciate Ligament Reconstruction Surgery.

Implant-free press-fit tibial fixation technique has recently gained popularity in anterior cruciate ligament reconstruction because it does not cause tunnel widening, does not cause complications associated with additional fixation materials, allows bone-to-bone healing, and does not cause defects in revision surgery. Bone-patellar tendon autograft offers the advantage of direct bone-to-bone integration of the graft, and anterior knee pain is less expected than bone-patellar tendon-bone autograft. This technical report includes details of arthroscopic ACL reconstruction of patellar tendon-tibial tubercle bone autograft distal press-fit fixation technique. We call this the Kocabey distal press-fit technique.

Can isokinetic test be a supportive tool for unilateral knee arthroplasty decision?

Objectives: This study analyzed whether the isokinetic muscle strength of bilateral knee osteoarthritis patients undergoing unilateral total knee arthroplasty (TKA) is a predictor for prior surgery side. Patients and methods: In the prospective study conducted between April 2021 and December 2021, 58 knees of 29 unilateral TKA candidates (6 males, 23 females; mean age: 66.7±7.4 years; range, 53 to 81 years) were enrolled. The patients were divided into surgical (n=29)and nonsurgical (n=29) groups. The knees of patients with bilateral knee osteoarthritis (Stage III or IV) according to the Kellgren-Lawrence (KL) scale were scheduled for unilateral TKA. An isokinetic testing system was used to assess knee flexor and extensor muscle strength (peak torque) at angular velocities of 60°/sec and 180°/sec (five cycles per velocity). The radiological (X-ray-based KL scale and magnetic resonance imaging-based quadriceps angle) and clinical findings (isokinetic test and Visual Analog Scale pain scores) in both groups were compared. Results: The mean symptom duration was 10±5.4 years. The KL score and quadriceps angle showed no significant differences (p=0.056 and p=0.663, respectively). Isokinetic test results were in accordance with the clinical results of the surgery group. In the isokinetic evaluation, both the 60°/sec concentric extension (35.00 vs. 46.00, p=0.002) and flexion peak torque (18.00 vs. 26.00, p=0.001) values were significantly lower in the surgical group than in the nonsurgical group. Conclusion: Isokinetic testing can be a supportive tool for assessing the prior side of TKA in patients with bilateral knee osteoarthritis. Further studies are required to support these findings.

Morphological Changes in the Tibial Tunnel After ACL Reconstruction With the Outside-In Technique and Adjustable Suspensory Fixation.

Background: Anterior cruciate ligament reconstruction (ACLR) using the complete tibial tunnel technique and adjustable-loop cortical suspensory fixation is known to leave a "dead space" that holds the loop device in the tibial tunnel. The consequence of the dead space and its effect on graft healing are still uncertain. Purpose: To investigate morphological changes in the tibial tunnel and their effect on graft healing, and to identify factors affecting bone healing in the tibial loop tunnel after ACLR with a quadrupled semitendinosus tendon autograft using adjustable suspensory fixation. Study Design: Case series; Level of evidence, 4. Methods: Included were 48 patients (34 male, 14 female; mean age, 25.2 ± 5.6 years) who underwent ACLR with a quadrupled semitendinosus tendon autograft using adjustable suspensory fixation. To evaluate tibial tunnel morphology, computed tomography was performed at 1 day and 6 months postoperatively. At 1 year postoperatively, graft healing was assessed on magnetic resonance imaging using the graft signal-to-noise quotient (SNQ). Multivariate regression and correlation analyses were performed to determine any associations between volumetric changes in bone healing and operative variables. Results: At 6 months after ACLR, a mean of 63.2% of the tibial loop tunnel was filled by bone. Multivariate regression analysis showed that remnant preservation was significantly associated with the loop tunnel filling rate (P < .001). At 1 year after ACLR, the tibial loop tunnel was almost completely closed (98.5%). There were no correlations between loop tunnel volume and graft integration or graft SNQ. A significant but weak correlation was found between graft tunnel volume and intratunnel graft SNQ (P = .10) as well as integration grade in the tibial tunnel (P = .30). Conclusion: Excellent bone filling in the tibial loop tunnel was seen at 1 year after ACLR. Remnant preservation was significantly associated with the loop tunnel filling rate. A weak correlation was found between graft tunnel volume and intratunnel graft SNQ as well as integration grade in the tibial tunnel.

Comparative Results of Anterior Cruciate Ligament Reconstruction with Full Tibial Tunnel: Quadrupled Semitendinosus Suspensory Femoral and Tibial Fixation versus Quadrupled Semitendinosus and Gracilis Suspensory Femoral and Tibial Screw and Staple Fixation.

This study compared the clinical outcomes of patients treated with described "modified all-inside" anterior cruciate ligament reconstruction (ACLR) technique with those of patients treated with suspensory femoral fixation and a bioabsorbable tibial interference screw with the ACLR technique. From 2017 to 2019, 98 patients who underwent ACLR surgery by two surgeons using either of the techniques were included in this study. Patients in group 1 were treated with the "modified all-inside" ACLR technique. In this technique, only the semitendinosus tendon was harvested as a four-strand graft and fixed to the tibia and femur with suspensory buttons. Patients in group 2 were treated with suspensory femoral fixation and a bioabsorbable tibial interference screw ACL reconstruction technique. Patients' functional outcomes were evaluated by the Lysholm score, Tegner activity scale, and International Knee Documentation Committee (IKDC) subjective score. Postoperative knee stability of the patients was evaluated using the Lachman test and the pivot-shift test. The mean ages of the patients were 31.1 (16-55) and 28.7 (18-48) years in groups 1 and 2, respectively. The average follow-up durations were 26 (20-30) and 25.9 (22-30) months for both groups. There was no significant difference between the preoperative and postoperative Lysholm's score, Tegner's activity score, and IKDC subjective score in groups 1 and 2. There were no major complications or reruptures in either group. ACLR incorporating the "modified all-inside" ACLR technique obtained significant clinical outcomes compared to ACLR with a suspensory femoral fixation and a bioabsorbable tibial interference screw.

Evaluation of Isokinetic Knee Strengths after ACL Reconstruction with Quadrupled Semitendinosus Suspensory Femoral and Tibial Fixation versus Four-Strand Semitendinosus and Gracilis Suspensory Femoral and Tibial Screw Fixation.

INTRODUCTION: The purpose of this study was to demonstrate that patients undergoing ACL reconstruction with quadrupled semitendinosus suspensory femoral and tibial fixation have comparable results in muscle strength and knee function to those undergoing ACL reconstruction with four-strand semitendinosus-gracilis suspensory femoral fixation and a bioabsorbable tibial interference screw fixation. MATERIALS AND METHODS: Between 2017 and 2019, 64 patients who were operated on by the same surgeon were included. Patients underwent ACL reconstruction technique with quadrupled semitendinosus suspensory femoral and tibial button fixation in Group 1, and patients underwent ACL reconstruction with coupled four-strand semitendinosus-gracilis suspensory femoral fixation and a bioabsorbable tibial interference screw in Group 2. Evaluation of patients was performed with the Lysholm and Tegner activity scale preoperatively and at the 1st and 6th months postoperatively. At the 6-month visit, isokinetic testing of the operated and non-operated limbs was performed in both groups. RESULTS: There was no significant difference in the age, weight, and BMI values of the patients in Groups 1 and 2 (p < 0.05). According to the strength values of the operated sides of the patients in Group 1 and Group 2, there was no significant difference in the angular velocities of 60° s-1, 180° s-1, and 240° s-1 in both extension and flexion phases between the operated sides of Groups 1 and 2 (p < 0.05). CONCLUSIONS: Patients who have ACL reconstruction with quadrupled semitendinosus suspensory femoral and tibial fixation have comparable muscle strength and knee function to those who undergo ACL reconstruction with four-strand semitendinosus-gracilis suspensory femoral fixation and a bioabsorbable tibial interference screw.

Evaluation of the patient satisfaction of using a 3D printed medical casting in fracture treatment.

OBJECTIVES: This study aims to assess, through a questionnaire, the functionality, and efficacy of using three-dimensional (3D) printed medical casts. PATIENTS AND METHODS: Between February 2017 and March 2019, a total of 24 patients (14 males, 10 females; mean age: 33.1±9.4 years, range, 12 to 62 years) with upper extremity fracture who were applied 3D printed medical cast were included. Patient satisfaction was evaluated using the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 (QUEST 2.0). Each item is scored on a five-point scale. RESULTS: The mean follow-up was 14 (range, 6 to 18) months. All fractures healed within four to six weeks without any complications. In all cases, there was no loss of reduction. The total mean QUEST 2.0 satisfaction score for the participants was 4.7. The ratings on each scale ranged from 4.5 to 4.9. CONCLUSION: Almost all patients with upper extremity fractures were satisfied with the 3D printed medical cast. The patients found the 3D printed medical cast to be comfortable, safe, easy-to-apply, lightweight, and effective.