Is Intraoperative Bleeding Control Useful After Tourniquet Release in Arthroscopic Anterior Cruciate Ligament Reconstruction?

Background Arthroscopic anterior cruciate ligament (ACL) reconstruction is a common orthopedic surgery, and rehabilitation is very important to achieve successful postoperative results. Postoperative hemarthrosis causes pain and limitation of movement, which prolongs the rehabilitation period. For these reasons, various strategies are used to reduce hemarthrosis in patients undergoing ACL reconstruction. This study aimed to evaluate the effect of bleeding control after releasing the tourniquet in ACL reconstruction surgery on the amount of hemarthrosis and pain in the postoperative period. Methodology A total of 60 patients who underwent arthroscopic single-bundle ACL reconstruction were enrolled in this prospective randomized control study. Bleeding control with the radiofrequency (RF) probe after releasing the tourniquet was done at the end of the arthroscopic ACL reconstruction in 30 patients (coagulation group) while bleeding control was not done for the other 30 patients (control group). Both groups were compared in terms of the degree of hemarthrosis using the Coupens and Yates classification in the early postoperative period and the degree of pain using the Visual Analog Scale (VAS) score and postoperative complications. Results In both groups, isolated ACL reconstruction was performed in 10 patients, additional partial meniscectomy in three patients, and additional arthroscopic meniscus repair in 17 patients. There was no statistically significant difference between the coagulation and control groups in terms of VAS (p > 0.05) and the degree of hemarthrosis (p > 0.05). Although the duration of tourniquet application was similar in both groups (p = 0.78), the duration of anesthesia was significantly longer in the coagulation group (p = 0.001). There was no significant difference between the groups in terms of postoperative complications. Conclusions Bleeding control with the RF probe after tourniquet release does not yield superior outcomes. More research with larger populations is needed to confirm these findings.

Traditional versus magnetically controlled growing rods in early onset scoliosis surgical treatment.

PURPOSE: Growing rod surgeries are common methods in the treatment of early onset scoliosis. Magnetic growing rod (MGR) surgery, in particular, has become more widespread in the last 10 years. The aim of this study was to compare the effects of traditional and magnetically controlled growing rod techniques on efficacy, safety, spinal growth, and lung development. METHODS: A retrospective analysis was made of 24 TGR and 17 MGR patients. Inclusion criteria were patients aged < 10 years, curvature > 40° or a progression of > 10° in the 4-6 month follow-up for curves between 25 and 40°. RESULTS: There were 9 males and 15 females in the TGR cohort and 7 males and 10 females in the MGR cohort. The mean age at first surgery was 6.1 years and 7.1 years, respectively. Major curve Cobb angles of TGR were preop. 51.5°, postop. 21.4° and 18.1° at the final follow-up. In the MGR cohort, these values were 60.4°, 41.8°, and 36.4°, respectively. The mean T1-S1 lengthening velocity was calculated as 1.12 cm/year (0.9318 mm/month) in the TGR group and 1.27 cm/year (1.0571 mm/month) in the MGR group. In the TGR cohort, a total of 99 procedures were performed as 24 initial surgeries and 75 additional procedures (5 lengthening during unplanned surgery due to complications; 4 revision, 1 debridement). In the MRG cohort, a total of 25 surgical procedures were performed as 17 initial surgeries and 7 additional procedures (3 debridements, 5 revisions). CONCLUSION: The results of this study showed that the TGR system provided better correction in the coronal plane and was superior in kyphosis restoration than the MGR system. Both methods were successful in lengthening, but complication rates were slightly higher in the MGR cohort. The most common complication was the pullout of the proximal anchors, and this was more common in the MGR. Both TGR and MGR were found to be effective treatments. Lengthening without surgery is a significant advantage of the MGR system, but it has a high revision rate, and Cobb angle correction was found to be less effective than with TGR.

Posterior Ankle Impingement Syndrome in a Nonathletic Population: Causes, Treatment Modalities, and the Results of Endoscopic Treatment.

BACKGROUND: A common cause of posterior ankle pain is posterior ankle impingement syndrome (PAIS). Many studies about PAIS have been conducted on special groups such as athletes and dancers; there has been no previous study of a nonathletic population. This study aimed to evaluate the causes and treatment methods of PAIS in the nonathletic population and compare it with the athletic population. METHODS: A retrospective review was performed and 28 of 46 patients (60.9%) recovered from two-staged conservative therapy. In the 18 patients (39.1%) who did not benefit from 3 months of conservative treatment, hindfoot endoscopy was applied. Patient data, including sex, age, occupation, and sports activity level, were recorded. Visual analog scale, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot, and Tegner scores were recorded. Patient satisfaction was assessed with a 4-point Likert scale. Complications were recorded. RESULTS: Mean follow-up was 27.4 months. At final follow-up, the AOFAS hindfoot score had significantly improved from 66.4 to 96.8 (P < .001). The Tegner score improved significantly from 4.6 to 8.8 (P < .001). The visual analog scale score was 6.4 and increased to 0.9 (P < .001). Using the 4-point Likert scale for patient satisfaction, 13 (72.2%) stated that the surgical procedure was excellent and five (27.8%) good. Mean time to return to work was 4.2 weeks. Sural nerve dysesthesia was seen in two patients (11.1%). CONCLUSIONS: This is the first study to evaluate PAIS in the nonathletic population. Conservative treatment showed good results as nearly two-thirds of the patients recovered. Hindfoot endoscopy in those not responding to conservative therapy is a successful treatment with low complication rates.

Clinical results of the Keck and Kelly Wedge Osteotomy approach in Haglund's deformity: Minimum 3-year follow-up.

BACKGROUND AND PURPOSE: The Haglund's deformity, which may be difficult to treat non-surgically, is caused by a prominent bone hump in the posterosuperior region of the calcaneus and may be associated with bursitis and foot pain. Many surgical treatments for resistant Haglund deformities have been described. Here, we evaluate the AOFAS scores, pain and other characteristics of patients undergoing removal of the dorsally based wedge from the posterior calcaneus with the Keck and Kelly procedure. MATERIALS AND METHODS: The study included 20 patients who had undergone the Keck and Kelly procedure at our center, from 2011 to 2019, and had attended follow-up for at least three years. Analyses were performed retrospectively. Preoperative (immediately before surgery) and postoperative (at last assessment) American Orthopedic Foot and Ankle Society (AOFAS) and visual analog pain scale scores (VAS) were determined, and calcaneal inclination angles were radiologically measured. Additionally, calcaneal pitch angle (CPA), Fowler and Philip angle (FPA), and Bohler angle were recorded. RESULTS: Fourteen patients were female, and six were male, mean age was 45.8 ± 8.1 years. AOFAS scores were significantly increased, whereas VAS scores were significantly decreased after surgery. Postoperative AOFAS scores were correlated with preoperative VAS, CPA, and FPA values. Preoperative VAS scores were correlated with CPA, FPA, and Bohler angle values. FPA and CPA values were correlated positively. CONCLUSIONS: It was found that ankle functions improved, and pain levels decreased after Keck and Kelly Wedge Osteotomy was applied for the treatment of Haglund's deformity. CPA and FPA were associated with both pain levels and ankle function. The Keck and Kelly Wedge Osteotomy procedure appears to be a preferable approach for the surgical treatment of Haglund's deformity.

Case report of concomitant avulsion fractures of the medial meniscus and posterior cruciate ligament.

RATIONALE: Posterior cruciate ligament (PCL) is the strongest ligament of the knee, and avulsion fractures of PCL are a very rare type of injury. These injuries occur as a result of high-energy traumas, and different accompanying pathologies may be seen. However, tibial avulsion fracture of the PCL associated with a medial meniscus (MM) avulsion fracture has never been reported before. We want to present this unique type of posteromedial knee injury as a case report. PATIENT CONCERN: A 42-year-old man presented with severe pain and swelling due to a ski injury. DIAGNOSIS: Concomitant avulsion fractures of PCL and MM were detected after imaging. INTERVENTIONS: Both avulsion fractures were treated with open reduction and fixation with lag screws using the posterior approach. OUTCOMES: No complications were encountered, and the painless full range of motion and weight-bearing was achieved at the third month after the operation. LESSONS: Anatomical reduction and stable fixation of these intra-articular fractures are essential for the stability of the knee. The posterior approach should be kept in mind to access these types of fractures safely. Care should be taken in terms of other injuries that may accompany the PCL avulsion fractures caused by high-energy traumas.

Modified arthroscopic Broström procedure using a soft anchor for chronic lateral ankle instability: Short-term follow-up results.

OBJECTIVES: This study aims to examine the clinical outcomes and complications of lateral ligament reconstruction performed using soft anchors according to the arthroscopic modified Broström technique (MBT) for the treatment of chronic ankle instability (CAI) and to evaluate the frequency of return to sports. PATIENTS AND METHODS: A total of 14 patients with CAI (9 males, 5 females; mean age: 30.1±4.6 years; range, 22 to 38 years) who underwent the MBT with soft anchors between January 2015 and December 2019 were retrospectively analyzed. Ankle function was evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale and Karlsson Ankle Function Score (Karlsson/Peterson, K/D score), while pain was evaluated using the Visual Analog Scale (VAS) after a minimum follow-up of 12 months. RESULTS: The mean follow-up was 23.6±7.7 months. The mean overall AOFAS score was 74.0±2.6 preoperatively, which improved to 96.2±1.9 in the postoperative period (p=0.001). The mean pre- and postoperative K/P scores were 72.4±3.1 (range, 68 to 78) and 95.3±2.2 (range, 92 to 98), respectively (p=0.001). The mean preoperative VAS score was 2.4±0.9 (range, 1 to 4) and showed a significant improvement to 0.6±0.5 (range, 0 to 1) in the postoperative period (p=0.001). Nine (64.3%) patients returned to sports activities after surgery at a mean period of 9±2.1 months. CONCLUSION: In the treatment of CAI, arthroscopic MBT performed with soft anchors provides successful outcomes in short-term follow-up. In addition to being a minimally invasive technique, MBT is a reliable and safe approach with low complication rates and significant functional improvement. However, the low ratio of return to sports should be considered as a failure of this technique.

Traditional Dual Growing Rod Technique in the Management of Early Onset Scoliosis and Its Effects on Spinal Growth and Lung Development: The Mid-Term Prospective Results.

OBJECTIVE: The purpose of this study was to investigate the safety and effectiveness of the traditional dual growing rod (TDGR) technique, using only pedicle screws for fixation with more frequent lengthening while evaluating scoliosis correction in the growing spine, spinal growth rates, and the differences in lung volumes. PATIENTS AND METHODS: In this single-centre prospective study, 27 patients with a follow-up of over three years were included in the study. Only pedicle screws were used as foundations for fixation. Routine lengthening procedures were performed every six months. Data were recorded including the age of initial surgery, gender, number of lengthenings, follow-up, and complications. The Cobb angle of the major curve, kyphosis angle, T1- S1 length, space available for lung (SAL) ratio, coronal and sagittal balance, and the height of all patients were measured and recorded preoperatively, immediately postoperatively, and finally before and after every lengthening. RESULTS: The average follow-up time was 46.3 months (36-64 months). The correction rate was 69.5% for Cobb angle and 43.2% for kyphosis between preoperative and final follow-up period. The time between two lengthenings was 6.9 months, and the mean T1-S1 length increase was 1.78 cm per year. The SAL ratio increased from 0.885 preinitially to 0.985 at the last follow-up. The complication rate was determined as 9.6% in 187 procedures. Acceptable improvements were determined in the specified parameters with low complication rates with the use of this technique. CONCLUSION: The TDGR technique with proximal and distal pedicle screws as anchors is a safe and effective treatment for deformity control in selected patients with early onset scoliosis (EOS). Repetitive surgical interventions are the negative side of this technique.

The efficacy of in situ local autograft in adolescent idiopathic scoliosis surgery: a comparison of three different grafting methods

Background/aim: This study was performed to show the efficacy of in situ local autograft with a comparison of in situ local autograft, local autograft with allograft, and local autograft with posterior iliac crest autograft.Materials and methods: In this prospective randomized study, a total of 65 adolescent idiopathic scoliosis (AIS) patients were separated into 3 groups: Group 1 using local autograft and allograft, Group 2 using local autograft only, and Group 3 using local autograft and posterior iliac crest autograft. Posterior segmental instrumentation was also applied to all patients. The mean follow-up period was 28.5 months (range, 15-40 months). Pseudarthrosis was investigated with the multiplanar and three-dimensional images obtained using multislice computed tomography, thoracolumbar bone single-photon emission computed tomography, and three-phase regional and whole body bone scintigraphy. Results: Pseudarthrosis was not observed in any patient. Fusion was obtained in all patients at the end of the follow-up periods.Conclusion: Similar results were obtained in respect of fusion in all 3 groups. Without the use of additional grafts, sufficient fusion can be achieved with the use of local autograft alone for posterior spinal fusion in patients with AIS.

Minimally invasive Achilles tendon repair: a modification of the Achillon technique.

BACKGROUND: The purpose of the study was to present the results of a new minimally invasive operative method for Achilles tendon (AT) ruptures that could reduce nerve injuries and add no extra cost. METHODS: Thirteen patients with acute AT ruptures who were treated with minimally invasive surgery and followed for a minimum of 12 months were included. At the latest follow-up, American Orthopaedic Foot & Ankle Society (AOFAS) score, calf diameters, ability to walk on tiptoe, and ultrasound examination were evaluated. The average age was 42.8 years (range, 31-62 years). Average follow up was 24.5 months (range, 12-34 months). RESULTS: AOFAS score was 92.5 (range, 85-100). Average calf diameters on the operated and nonoperated extremities were 38.9 cm (range, 36-44 cm) and 38.9 cm (range, 36-41 cm), respectively. On ultrasound examination, the site of the rupture was found to be 46.2 mm proximal from the calcaneal insertion, and the operated side was found to be significantly thicker than the nonoperated side (P = .008). There was 1 deep vein thrombosis, which recovered without sequelae. There were no wound problems, reruptures, or nerve injuries. CONCLUSIONS: This new minimally invasive operative method was successful, showing good functional results and low complication rates. In our experience, the use of 3 continuous polyester sutures was less irritable with 3 knots. LEVEL OF EVIDENCE: Level IV, retrospective case series.