Validity and Reliability of the Turkish Version of LHB Score.

INTRODUCTION: Long head of biceps (LHB) pathologies are an important cause of pain and dysfunction. As LHB pathologies have specific components from other underlying or related pathologies, the LHB score is designed for an accurate assessment. The aim of this study was to adapt the LHB score into Turkish and to assess its validity and reliability. MATERIALS AND METHODS: LHB score was translated and culturally adapted from English to Turkish, and then it was applied to 62 patients with biceps long head pathology. The reliability of the scale was checked through internal consistency and test-retest methods. Internal consistency was computed with Cronbach alpha value. Test-retest reliability was assessed using an intraclass correlation coefficient. American Shoulder and Elbow Surgeons Standard Shoulder Assessment Form and modified Constant-Murley score were used to analyze concurrent validity. RESULTS: The Cronbach alpha value of the scale was found as .640. When the subsections of LHB score were computed separately, Cronbach alpha levels of pain/cramps and cosmesis sections were found as .753 and .774, respectively. The intraclass correlation coefficient value of the scale was found to be excellent (.940; P < .001). The total LHB score was determined to have a good positive correlation with the American Shoulder and Elbow Surgeons Standard Shoulder Assessment Form (.527) and Constant-Murley score (.516). But an excellent correlation was revealed between the pain/cramps section of LHB score and other pain sections in American Shoulder and Elbow Surgeons Standard Shoulder Assessment Form (.811) and Constant-Murley score (.816) (P < .001). There was an excellent correlation (.916) between cosmesis section and Popeye sign (P < .001). There was a moderate correlation (.469) between elbow-flexion strength section of LHB score and the digital handheld dynamometer outcomes (P < .001). CONCLUSION: The Turkish version of the LHB is a valid and reliable tool, especially for biceps pathologies.

Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial.

PURPOSE: To compare the effectiveness of intraarticular (IA) multiple and single platelet-rich plasma (PRP) injections as well as hyaluronic acid (HA) injections in different stages of osteoarthritis (OA) of the knee. METHODS: A total of 162 patients with different stages of knee OA were randomly divided into four groups receiving 3 IA doses of PRP, one dose of PRP, one dose of HA or a saline injection (control). Then, each group was subdivided into two groups: early OA (Kellgren-Lawrence grade 0 with cartilage degeneration or grade I-III) and advanced OA (Kellgren-Lawrence grade IV). The patients were evaluated before the injection and at the 6-month follow-ups using the EuroQol visual analogue scale (EQ-VAS) and International Knee Documentation Committee (IKDC) subjective scores. Adverse events and patient satisfaction were recorded. RESULTS: There was a statistically significant improvement in the IKDC and EQ-VAS scores in all the treatment groups compared with the control group. The knee scores of patients treated with three PRP injections were significantly better than those patients of the other groups. There was no significant difference in the scores of patients injected with one dose of PRP or HA. In the early OA subgroups, significantly better clinical results were achieved in the patients treated with three PRP injections, but there was no significant difference in the clinical results of patients with advanced OA among the treatment groups. CONCLUSION: The clinical results of this study suggest IA PRP and HA treatment for all stages of knee OA. For patients with early OA, multiple (3) PRP injections are useful in achieving better clinical results. For patients with advanced OA, multiple injections do not significantly improve the results of patients in any group. LEVEL OF EVIDENCE: I.

Kyphoplasty for Intractable Pain Due to Glucocorticosteroid-induced Osteoporotic Vertebra Fracture of a 9-Year-Old Patient With Systemic Lupus Erythematosus: 8-Year Follow-up.

BACKGROUND CONTEXT: The incidence of glucocorticoid-induced osteoporosis is approximately 50% in patients treated for >6 months, and in the long-term usage fracture risk is approximately 34%. The awareness of pediatric vertebral fractures due to glucocorticoid-induced osteoporosis is increasing. Although most of these fractures are asymptomatic, a small number of children may have severe pain. PURPOSE: In this case report we are presenting long-term result of a 9-year-old patient with intractable pain due to glucocorticoid-induced osteoporotic vertebral fracture managed by kyphoplasty. STUDY DESIGN: Case report. PATIENT SAMPLE: Case report of a 9-year-old girl who had L3 vertebral fracture due to glucocorticoid-induced osteoporosis treated by kyphoplasty. METHODS: The patient was a 9-year-old girl with severe back pain, and lupus nephritis. Glucocorticoid-induced L3 vertebral fracture was detected and the case was resistant to conservative treatment. Seeing this, we have performed balloon kyphoplasty procedure to L3 vertebrae. RESULTS: No complication and pain was observed after the operation although L3 vertebral height could not restored. On the 8-year control, L3 vertebral height was almost totally restored with a compression index of 10% without any clinical problem. CONCLUSIONS: To the best of the authors' knowledge, the patient sample of this case report is the first and the youngest patient who was treated with kyphoplasty for vertebral compression fracture intractable pain due to glucocorticoid-induced osteoporosis, mentioned in literature. During the 8-year follow-up, no adverse effect was reported that was related to kyphoplasty procedure. This case report indicates that kyphoplasty can be an alternative method for selective pediatric intractable painful vertebral glucocorticoid-induced osteoporotic fractures, but it should be performed after careful consideration in pediatric group. We do not advise routine usage of kyphoplasty for pediatric vertebral fractures.

Does Preoperative Conservative Management Affect the Success of Arthroscopic Repair of Partial Rotator Cuff Tear?

BACKGROUND: The aim of this study is to examine the effect of preoperative conservative treatment on the success of high-grade bursal/articular-sided partial rotator cuff repair. METHODS: Patients who had undergone shoulder arthroscopy in institution for Ellman Stage 3 bursal-side or articular-side partial tears between January 2008 and April 2018 were investigated retrospectively. This study assessed 201 patients diagnosed with isolated partial rotator cuff tears with a history of failed conservative management and persistent shoulder pain who underwent arthroscopic surgery. The demographic data of patients and pre- and postoperative The American Shoulder and Elbow Surgeons Shoulder Scores (ASES) that were recorded in the archive were evaluated. RESULTS: While 55 of the patients with Ellman grade 3 bursal-sided partial tears received preoperative conservative management for at least 6 months (Group 1), 62 of them could not tolerate conservative management and early arthroscopic repair was performed (Group 2). On the other hand, 42 of the patients with Ellman grade 3 articular-sided tears received preoperative conservative management (Group 3), 42 of them could not tolerate preoperative conservative management (Group 4). The mean ASES score improvement was 52.33 ± 8.55 for Group 1, 54.68 ± 11.29 for Group 2, 48.4 ± 7.77 for Group 3 and 49.33 ± 10.05 for Group 4. A statistically significant difference was found between the groups with one-way ANOVA test (p = 0.05). With the Tukey test, this difference was seen to be caused by Group 2. CONCLUSION: Although there are many factors affecting its success, conservative management should be the first option in the treatment of partial rotator cuff tears. However, we think that it should not be insisted especially in patients with bursal-sided tears (> 50% of the tendon thickness) that cannot tolerate conservative management due to severe pain since the results of early arthroscopic repair of bursal-sided tears were found to be better. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.

The effect of pain catastrophizing and kinesiophobia on the result of shoulder arthroscopy.

OBJECTIVES: Emotional and cognitive factors have been shown to affect pain, and one of the main factors in the development of this effect is pain catastrophizing. The present study aims to determine the effect and frequency of the pain catastrophizing in shoulder lesions and to examine the association between pain catastrophizing and to assess the pre-operative and post-operative functional outcomes. METHODS: A total of 114 patients who underwent shoulder arthroscopy were included study. Pain catastrophizing scale, Tampa kinesiophobia scale, visual analog scale, and University of California at Los Angeles shoulder scale were used for evaluating patients' pre- and post-operative pain and functional situation. RESULTS: Pain catastrophizing was detected 42 of 114 patients (37%). Kinesiophobia was higher in patients who catastrophized shoulder pain (p<0.0001). If participant had a labrum (p=0.038), supraspinatus (p=0.043), or biceps pathology (p=0.032), catastrophization was determined more often. There was catastrophization in 50% of patients with post-operative University of California at Los Angeles score which was evaluated as fair/poor (p=0.039). CONCLUSION: Pre- and post-operative results of the current study strengthened the data about importance of catastrophization. Catastrophization (+) patient group had lower functional capacity outcomes than that of the catastrophization (-) patient group. Decreased levels of pain catastrophizing and kinesiophobia in surgically and conservatively treated patients will result in more satisfactory clinical outcomes.

Could superior capsule findings be used as a predictor for partial bursal-sided rotator cuff tears?

PURPOSE: The purpose of this study was to investigate the relationship between the superior capsule tear patterns and synovitis with subacromial pathologies, such as bursal-sided rotator cuff tear and subacromial impingement syndrome. METHODS: Fifty patients who underwent arthroscopic treatment for isolated bursal-sided tear were included in the study. Fifty more patients who underwent arthroscopic treatment for isolated Superior Labrum Anterior Posterior (SLAP) 2 lesion without pathology in the rotator cuff were included in the control group. Firstly, superior capsule tear and common synovitis on the rotator cable were assessed during glenohumeral joint examination. Coracoacromial Ligament (CAL) degeneration grading was performed according to the Royal Berkshire Hospital classification. Bursal-sided partial tear grading was done using Ellman classification. Whether or not there was a relationship between synovitis, classic capsule tear, plus reverse flap capsule tear, and partial bursal-sided tear existence. RESULTS: There were 21 patients with reverse flap capsule tear in the study group and 3 patients in the control group. In addition, there were 13 patients with synovitis in the study group and 4 in the control group. Compared to the control group, there was also a significant positive correlation in the presence of both synovitis and reverse flap capsule tear with the presence of bursal-sided tear in the study group (p = 0.000). There was, however, no significant difference between the presence of classical capsule tear and the presence of bursal-sided tear (p = 0.485). CONCLUSION: This study shows that the presence of reverse flap capsule tear and synovitis was associated with partial bursal-sided tears. Therefore, if the reverse flap capsule tear or synovitis is detected in the superior capsule, the rotator cuff should be evaluated in more detail during subacromial bursoscopy in order not to miss a bursal-sided partial cuff tear.

Is routine coracoplasty necessary in isolated subscapularis tears?

OBJECTIVES: This study aims to investigate the effect of simultaneous coracoplasty on postoperative clinical outcomes of patients undergoing shoulder arthroscopy due to the tear of the isolated subscapularis. PATIENTS AND METHODS: The study included 53 patients (16 males, 37 females; mean age 55.8 years; range, 44 to 70 years) who underwent arthroscopic repair for isolated subscapularis tear (type 2 and type 3) with anterior shoulder pain and tenderness. All patients had a coracohumeral distance of less than 7 mm on the preoperative magnetic resonance images and a minimum follow-up period of two years. Patients were divided into two groups as group 1 including patients who underwent coracoplasty and group 2 including those who did not undergo coracoplasty. Patients were evaluated pre- and postoperatively by the University of California Los Angeles (UCLA) shoulder score and the simple shoulder test (SST) score. RESULTS: There were no significant differences between the groups in terms of age, gender and follow-up time (p>0.05). The preoperative mean UCLA score was 19.65 for group 1 and 20.45 for group 2. The postoperative mean UCLA scores were 27.92 and 29.00, respectively. The preoperative mean SST score was 4.9 for group 1 and 5.1 for group 2. The postoperative mean SST scores were 10.0 and 9.5, respectively. Functional scores increased significantly in both groups postoperatively when compared to the preoperative values (p<0.01). However, there was no statistically significant difference in terms of the increase in UCLA and SST scores between the two groups (p>0.05). CONCLUSION: We believe that concomitant coracoplasty during arthroscopic repair may not be a necessary routine in the treatment of isolated subscapularis tears.

Atypical femoral fracture following zoledronic acid treatment.

A 68-year-old female patient admitted to our clinic with right anterior thigh pain ongoing for six months and which increased in last two months. The patient had no trauma history. The patient had been followed-up for 15 years because of osteoporosis and administrated alendronate and ibandronate treatment for 10 years. Patient had three shots of zoledronate once a year during the last three years. Her pain was increasing when she was walking. Physical examination revealed pain in her right thigh. Radiogram showed thickened lateral cortex of the subtrochanteric area. Magnetic resonance imaging also showed thickening and edema of the same area. These images were correlated with atypical fracture in right femoral subthrochanteric zone. Dual energy X-ray absorptiometry revealed that T score was -3.3 in lumbar region and -2.5 in femoral neck. Zoledronate treatment was ended. Prophylactic surgical fixation was performed with titanium elastic nails.

Glucosamine-chondroitin sulphate accelerates tendon-to-bone healing in rabbits.

OBJECTIVES: This study aims to investigate the contribution of glucosamine-chondroitin sulphate (GlcN-CS) to the healing of tendons within the bone tunnel. MATERIALS AND METHODS: Tendon-to-bone healing was investigated in 28 New Zealand rabbits by re-attaching the extensor digitorum longus tendon into bone tunnel which was created in the proximal tibia. Rabbits were separated into two groups as treatment and control groups. Treatment group (n=14) received 210-250 mg/kg/day glucosamine sulphate and 170-200 mg/kg/day chondroitin sulphate, whereas control group (n=14) received equivalent dose of vehicle. Treatment and control groups were compared at sixth and 12th week after the procedure according to histological and biomechanical analysis. Yamakado scoring system was used to evaluate the histological changes. RESULTS: According to histological analysis, scores were significantly higher at both sixth and 12th week evaluations in the treatment group (p=0.029). Although not statistically significant, the ultimate pullout strength was higher in the treatment group at the 12th week evaluation (35.3 N/mm2 vs. 24.3 N/mm2) (p>0.05). However, stripping occurred at the muscle-tendon junction in the treatment group whereas tendons stripped from the bone tunnels in the control group. While no tendons in the treatment group stripped from the bone tunnels, we observed at sixth and 12th week evaluations that tendons in the control group stripped from the tunnels. CONCLUSION: Glucosamine-chondroitin sulphate treatment enhances tendon-to-bone healing by increasing hyaline cartilage formation and decreasing formation of capillary vessels.

An incidental diagnosis of obturator hernia during total hip arthroplasty.

Obturator hernia is a rarely seen disease that frequently affects females and the elderly population. It is clinically characterized with pain generally involving the hip region, and unless suspected, its diagnosis is difficult. Another reason for pain in the hip region and orthopedic surgery is coxarthrosis. The patient should be evaluated in detail radiographically and clinically before surgery. Although preoperative clinical examinations and radiographic findings support the indication for orthopedic surgery performed due to coxarthrosis, the probability of the presence of other pathologies accompanying the present disease should not be forgotten. In this article, we report an obturator hernia incidentally diagnosed in a 65-year-old female patient who was performed total hip arthroplasty due to coxarthrosis.

An unusual presentation of charcot arthropathy caused by syringomyelia mimicking a soft tissue tumor.

Charcot arthropathy is a chronic, degenerative condition and is associated with decreased sensorial innervation. Numerous causes of this arthropathy have been described. Here we report a case of neuropathic arthropathy secondary to syringomyelia which was misdiagnosed as a soft tissue tumor and treated surgically and additionally with radiotherapy at another institution. The patient had clinical and radiological signs of syringomyelia, associated with a limited range of motion, swelling, and pain in the affected joint. Neuropathic arthropathy, although less common, should be considered in cases of unexplained joint swelling, pain, and limited range of motion of the affected joint.

Comparison of the results of ultrasonographic evaluation and arthroscopy in patients scheduled for surgery of the supraspinatus tendon rupture.

BACKGROUND AND OBJECTIVES: This study aims to compare the findings of the shoulder ultrasonography (US) of patients with a supraspinatus (SS) tendon rupture with those of the shoulder arthroscopy, to determine the reliability and diagnostic performance of the shoulder US in the algorithm of the SS tendon pathologic lesions and their secondary ultrasonographic findings. DESIGN AND SETTINGS: A prospective study conducted with patients scheduled for arthroscopy of the shoulder due to an SS tendon rupture in Yildirm Beyazit Education and Research Center and Gazi University, Ankara, Turkey. MATERIALS AND METHODS: Fifty patients scheduled for an arthroscopy of the shoulder due to an SS tendon rupture were evaluated by shoulder US 1 week before the surgery. SS tendon pathologic lesions (tendinosis, partial tears, and full-thickness tears) and humeral degeneration were recorded, and the results of shoulder US were compared with those of arthroscopy. RESULTS: With reference to the arthroscopic data, the sensitivity of the ultrasonographic evaluation for the diagnosis of a full-thickness SS tendon rupture was 91%, with a specificity of 88%; the sensitivity for the diagnosis of a partial-thickness rupture was 86%, with a specificity of 82%; and the sensitivity for the diagnosis of a tendinosis was 98%, with a specificity of 71%. With reference to the arthroscopic data, the sensitivity of US for the diagnosis of humeral degeneration was 93%, with a specificity of 91%. CONCLUSION: The high sensitivity and specificity rates of US in detecting SS tendon rupture and its secondary imaging findings make it an efficient and reliable diagnostic modality, which should be preferred to other more expensive and more invasive methods in the algorithm.

[Eight-year follow-up of uncemented hydroxyapatite coated hip prosthesis for hip osteoarthritis secondary to developmental hip dysplasia]. / Gelisimsel kalça displazisi zemininde gelisen osteoartritli kalçalarda kullanilan çimentosuz hidroksiapatit kapli kalça protezlerinde sekiz yillik izlem.

OBJECTIVES: This study aims to investigate the mid-term clinical and radiological results of cementless hydroxyapatite coated total hip arthroplasty (THA) for hip osteoarthritis due to developmental dysplasia of the hip (DDH). PATIENTS AND METHODS: Between January 2004 and December 2010, 34 hips (12 Crowe type I, 12 Crowe type II, 4 Crowe type III, 6 Crowe type IV) of 30 patients (22 females, 8 males; mean age 53.4 years; range 30 to 75 years) with degenerative arthritis due to DDH were analyzed in terms of cementless hydroxyapatite coated acetabular component (EPF Plus(®)) over Zweymüller femoral component (Zweymüller SL-PLUS(®)) and porous coating. Clinical assessment was performed using Harris hip scores (HHS) preoperatively and at the last clinic visit, while radiological assessment was done according to the Callaghan and Engh's criteria. RESULTS: The mean follow-up was 48 months (range, 25-91 months). The mean HHS was 44.97 (28-55) preoperatively and 92.25 (69-100) at the last visit. All femoral components were graded as stable according to Callaghan and Engh's criteria. Radiolucency was mostly observed in Gruen zones 1 and zone 7 of the femur [zone 1; 20 hips zone 7; 19 hips zone 2; one hip, zone 3; one hip and zone 6 one hip]. Around acetabular component, radiolucency was detected in zone 2 in 12 hips, zone 3 in 10 hips and zone 1 in six hips. Heterotopic ossification developed in two hips, while neuropraxy was detected in two hips postoperatively. Femoral fissure in one hip, nonunion in the femoral osteotomy line in one hip, and femoral head autograft nonunion in one hip developed. CONCLUSION: Mid-term results of uncemented Zweymüller femoral stem and hydroxyapatite coated press-fit using acetabular components for THA femoral stem are excellent.

Osteochondritis dissecans with subchondral bone cyst of the femoral condyle: a novel surgical technique of treatment.

Osteochondritis dissecans (OCD) with a large subchondral bone cyst (SBC) is not common. The treatment of this lesion may be unsuccessful with conventional techniques. A novel surgical technique is described for the treatment of OCD with SBC of the femoral condyle. Modified osteochondral multiple autograft transfer following extraarticular curettage and bone grafting of SBC is a promising technique.