Popliteal artery injury following total knee arthroplasty due to a very rare variant of the popliteal artery: A case report of an unusual complication.

Variations of the popliteal artery are uncommon but often associated with popliteal artery injuries. Thus, in cases of popliteal artery injury, popliteal artery variations should be one of the primary differential diagnoses. Due to the poor prognosis that may result in amputation or mortality, such injuries are serious complications that can lead to medical malpractice cases. This report presents a case of a 77-year-old woman with bilateral knee osteoarthritis who sustained a popliteal artery injury during total knee arthroplasty due to the highly uncommon type II-C popliteal artery variation. In light of the current literature, the pathology, diagnosis, and treatment of this case of popliteal artery injury, as well as the necessary precautions, have been discussed. The terminal branching pattern of the popliteal artery is essential for surgical planning and the ability to treat accidental artery injuries. To reduce the risk of popliteal artery injury, it is important to discuss the need for preoperative arterial color Doppler ultrasonography and magnetic resonance imaging to reveal the branching pattern and structure (arteriosclerosis and obstruction) of the popliteal artery (arteriosclerosis and obstruction).

Evaluation of the degeneration of the multifidus and erector spinae muscles in patients with low back pain and healthy individuals.

BACKGROUND: Although several studies have been conducted to determine the cause of low back pain (LBP), a sufficient correlation has not been found between research findings and symptoms. Therefore there seems to be a need for studies to explain the relationship between pain and morphological changes in the paraspinal muscles of patients with LBP through comparisons with healthy control subjects. OBJECTIVE: The aim of this study was to examine degeneration in the lumbar musculus multifidus (LMF) and lumbar musculus erector spinae (LES) muscles in patients with chronic LBP with non-radiculopathy lumbar disc herniation (LDH), patients with mechanical LBP, and healthy individuals. METHODS: The study included 35 patients with mechanical LBP, 38 patients with non-radiculopathy LDH, and a control group of 36 healthy participants. In all patients and the control group, evaluations were made on axial magnetic resonance imaging slices at L3-S1 level of the LMF and LES cross-sectional areas (CSA), total CSA (TCSA = LMF+LES), fat infiltrations and asymmetries. RESULTS: The mean CSA values of the right and left LMF and LES showed significant differences between the groups (p< 0.001, p= 0.002, p= 0.002, p= 0.010, respectively). Fat infiltrations showed a difference between the right-left LMF and left LES groups (p= 0.007, p< 0.001, p= 0.026, respectively). Asymmetry was not observed between the CSA and TCSA of the right and left sides. CONCLUSION: A correlation was found between fat infiltration in the LMF and mechanical LBP and LDH. However, no significant correlation was determined between LBP and the CSA and TCSA of the LMF and LES. This was thought to be due to an incorrect result of CSA and TCSA in the evaluation of muscle mass. Therefore, for a more accurate evaluation of muscle mass, it can be considered necessary to measure muscle atrophy associated with fat infiltration or functional CSA.

The relationship between the degeneration and asymmetry of the lumbar multifidus and erector spinae muscles in patients with lumbar disc herniation with and without root compression.

BACKGROUND: The determination of muscle pathologies in lumbar disc herniation (LDH) and other conditions with low back pain is important for understanding low back problems and determining appropriate treatment methods. In patients with lumbar disc herniation with radiculopathy, elucidating the effect of root compression on the severity of muscle degeneration may predict the importance of alleviating root compression. For this purpose, magnetic resonance imaging (MRI) was used to compare the degeneration and asymmetries of the lumbar musculus multifidus (MF) and lumbar musculus erector spinae (ES) muscles in patients with lumbar discopathy without root compression (radiculopathy) and in patients with lumbar discopathy with root compression (radiculopathy). METHODS: The patients were examined in two groups: 56 patients with lumbar discopathy and no radiculopathy (Non-rad group) and 51 patients with lumbar discopathy and radiculopathy (Rad group). On axial MRI sections passing through the centre of the disc at the L3-S1 level, the asymmetry, cross-sectional area (CSA), fat infiltration, and total CSA (TCSA = MF + ES) of the MF and ES muscles were measured and compared. RESULTS: No difference was seen between the groups with respect to the CSA values of the right and left MF and left ES, but a significant difference was found in the right ES CSA (p = 0.021). The CSA and TCSA of the MF and ES showed no asymmetry according to group. Severe fat infiltration of > 50% in the right and left MF and left ES was found in the Rad group at a higher rate than in the Non-rad group. Fat infiltration was significantly positively correlated with age, body mass index, and the duration of pain (p < 0.001, p < 0.001, p = 0.004, respectively). CONCLUSIONS: The study results showed a correlation between LDH and paraspinal muscle degeneration, while no correlation was found with asymmetry. Severe (> 50%) fat infiltration is associated with root compression, and the severity of fat filtration increases in the presence of root compression. The development of more severe degeneration due to denervation associated with root compression plays a role in the emergence of this situation. Therefore, in patients with lumbar disc herniation with radiculopathy, it can be foreseen that to stop and correct severe fat infiltration and muscle degeneration, first, nerve root compression should be corrected with appropriate medical treatment methods, and in patients in whom there is no response, the pressure should be alleviated with appropriate surgical methods.

Investigation of the relationship between the clinical evaluation results of lumbar region muscles with cross-sectional area and fat infiltration.

BACKGROUND: The relationship between the endurance of the lumbar paraspinal muscles and morphological changes needs to be clarified. In this context, the importance can be revealed of increasing the endurance level of the paraspinal muscles in the prevention and treatment of low back diseases. OBJECTIVE: The aim of this study was to examine the relationship between the clinical evaluation results of the cross-sectional area (CSA) and fat infiltration of the lumbar deep paraspinal muscles. METHODS: The study included 37 patients with mechanical low back pain (mechanical), 41 patients with lumbar hernia without root compression (discopathy) and 36 healthy individuals as a control group. The functional status of the lumbar deep paraspinal muscles was evaluated clinically with muscle endurance tests. The fat infiltration and CSA of the muscles were evaluated on axial MRI sections at the L3-S1 level. RESULTS: The mean values of the prone bridge, Biering-Sorenson, and trunk flexion tests were seen to be highest in the control group and lowest in the discopathy group (p< 0.001). In all tests, the longest test period was obtained at < 10% fat infiltration and the shortest at > 50% fat infiltration. It was observed that as the amount of fat infiltration of the muscles increased, the test times were shortened. There was no significant relationship between the endurance level and the CSA of the groups. CONCLUSION: The study results demonstrated that the endurance of the paraspinal muscles is associated with the fat infiltration of the muscles. In patients with chronic low back pain, information about muscle morphology and degeneration can be obtained with simple endurance tests without the need for further measurements. On clinical examination, a weak endurance level of the paraspinal muscles indicates the presence of a low back problem and an increase in the amount of fat infiltration.

An evaluation of the efficacy of a four-grade fat infiltration classification method, presented for the first time in literature.

BACKGROUND: The deficiency of the commonly used 3-grade fat infiltration system is discussed by comparing it with the 4-grade fat infiltration system, newly presented to the literature. The aim of this study was to evaluate the efficacy of a semi-quantitative simplified 4-grade fat infiltration measurement system, described for the first time in literature, through comparison with the existing simplified 3-grade fat infiltration system in the prediction of lumbar disc herniation. METHODS: The study included 51 patients diagnosed with lumbar disc hernia and 50 healthy individuals as the control group. The patients were evaluated in respect of fat infiltration of the right and left lumbar multifidus and erector spina muscles on axial magnetic resonance imaging slices passing through the centre of the disc at L3-S1 level using the 3 and 4-grade fat infiltration measurement systems. RESULTS: The 3-grade fat infiltration system was found to be insufficient in the prediction of lumbar disc herniation (p > 0.05) and the 4-grade fat infiltration system was determined to be effective in the prediction of lumbar disc herniation (p < 0.001). CONCLUSION: The 4-grade fat infiltration system was seen to be more effective than the 3-grade fat infiltration system in the determination of the level of fat infiltration in the paraspinal muscles and the prediction of lumbar disc herniation. The 4-grade fat infiltration system is a more effective semi-quantitative grading system which can be used instead of the simplified 3-grade system.