Drilling through lateral transmuscular portal lowers the risk of suprascapular nerve injury during arthroscopic SLAP repair.

PURPOSE: The aim of our study was to evaluate the risk of medial glenoid perforation and possible injury to suprascapular nerve during arthroscopic SLAP repair using lateral transmuscular portal. METHODS: Ten cadaveric shoulder girdles were isolated and drilled at superior glenoid rim from both anterior-superior portal (1 o'clock) and lateral transmuscular portal (12 o'clock) for SLAP repairs. Drill hole depth was determined by the manufacturer's drill stop (20 mm), and any subsequent drill perforations through the medial bony surface of the glenoid were directly confirmed by dissection. The bone tunnel depth and subsequent distance to the suprascapular nerve, scapular height and width, were compared for investigated locations. RESULTS: Four perforations out of ten (40 %) occurred through anterior-superior portal with one associated nerve injury. One perforation out of ten (10 %) occurred through lateral transmuscular portal without any nerve injury. The mean depth was calculated as 17.6 mm (SD 3) for anterior-superior portal and 26.5 mm (SD 3.6) for lateral transmuscular portal (P < 0.001). CONCLUSIONS: It is anatomically possible that suprascapular nerve could sustain iatrogenic injury during labral anchor placement during SLAP repair. However, lateral transmuscular portal at 12 o'clock drill entry location has lower risk of suprascapular nerve injury compared with anterior-superior portal at 1 o'clock drill entry location.

Arthroscopic synovectomy in the treatment of functional ankle instability: outcomes and gait analysis.

BACKGROUND: Natural consequence of repetitive ankle sprains is the chronic ankle instability. Objective of this study was to clarify the gait patterns of functional ankle instability (FAI) patients after arthroscopic synovectomy, but also assessment of postoperative recovery. PATIENTS AND METHODS: Arthroscopic synovectomy was performed to 14 FAI patients with history of unilateral repetitive ankle sprains, pain, and subjective sensation of instability. At a mean 54 months of follow-up (27-84), clinical assessment was conducted with respect to pain, number of ankle sprains, and American Orthopaedics Foot and Ankle Society (AOFAS) scores. Gait analysis was conducted to determine the temporospatial, kinetic and kinematic parameters at the last follow-up. RESULTS: Mean AOFAS scores increased from 68 (range 55-75) to 89 (range 77-100) points (P < 0.01). Mean ankle sprains was 13 in a period of 23 (range 14-48) months (0.58 per month) and decreased to three sprains in a mean time period of 54 months (0.053 per month) (P < 0.01). Mean preoperative and postoperative VAS scores were 8.0 and 2.9, respectively (P < 0.01). During gait analysis, no significant differences were found in ankle joint, including foot progression angles, ankle dorsi-plantar flexion degrees and ground reaction forces (P > 0.01). Among temporospatial parameters, only double support time showed a significant difference (P < 0.01). All patients were satisfied from the procedure and returned to their previous activity level. CONCLUSION: Improved long-term clinical results and scores were obtained in our patient group when compared with the preoperative scores. Also, three-dimensional gait analysis showed that the involved ankles demonstrate similar gait patterns to the uninvolved ankles in patients with FAI.

Comparison of two different measurement methods to determine glenoid bone defects: area or width?

BACKGROUND: This study compared two different techniques that have been used to measure the glenoids of patients with recurrent anterior shoulder dislocation. METHODS: We analyzed 36 patients who had received arthroscopic Bankart repair for anterior shoulder instability. Retrospectively, 3-dimensional computed tomography images of both shoulders were available for these patients. Two measurement methods were compared to determine the glenoid defects. One of these techniques is based on linear measurement, previously defined as the glenoid index. The other method is based on surface area measurement. Subsequently, 3 more diameters and the average values obtained from these diameters were compared with the surface measurement method. Pearson correlation coefficient (r) was assessed to determine the relationship. RESULTS: There was an almost perfect relationship between measurement methods when the defect area was less than 6% of the inferior glenoid circle (r, 0.915; P < .001). This relation decreased and the difference became more pronounced (r, 0.343; P = .657) when the bone loss exceeded 14% of the inferior glenoid circle. The highest correlations with the actual defects were the average values obtained from 4 different diameters (r, 0.964; P < .001) and the 4-o'clock position of the single diameter measurements (r, 0.860; P = .001). In addition, 11 patients had crescent-like defects, demonstrating a relatively low correlation between the measurement methods (r, 0.679; P = .021). CONCLUSION: Although the best correlation was achieved from average values obtained from different diameter positions, in practical use, we advise a linear measurement to estimate the glenoid bone loss at the 4-o'clock position to achieve a high correlation between the measurement techniques.

Giant cell tumor of second and third metatarsals and a simplified surgical technique: report of two cases.

Giant cell tumor (GCT) is a rare benign tumor that often arises in tendon sheath as well as long bones of the lower extremity in adults, although localization in the metatarsus is rare. In this report, the authors describe the rare case of GCT localized to the third metatarsal GCT in a skeletally mature 17-year-old girl, and also describe the results of distal metatarsal resection with Kirschner wire stabilization for the treatment of this condition.

Arthroscopic capsular release for refractory shoulder stiffness: a critical analysis of effectiveness in specific etiologies.

HYPOTHESIS: The purpose of this study is to report and compare the outcome of arthroscopic capsular release in patients with shoulder stiffness with post-traumatic, postsurgical, and idiopathic etiologies. We hypothesize that patients with idiopathic or post-traumatic stiffness have better outcomes after arthroscopic capsular release than those with shoulder stiffness with a postsurgical etiology. MATERIALS AND METHODS: A retrospective review of 115 patients who underwent arthroscopic capsular release for refractory shoulder stiffness was performed. There were 60 men and 55 women with a mean age of 49 years (range, 27 to 81 years). The patients were divided into 3 groups according to the etiology of stiffness: post-traumatic (26 patients), postsurgical (48 patients), and idiopathic (41 patients). Arthroscopic capsular release was performed in all patients after a mean of 9 months of physical therapy (range, 6 to 13 months). RESULTS: At a mean follow-up of 46 months (range, 25 to 89 months), the overall subjective shoulder value in all groups improved from 29% to 73% and the age- and gender-adjusted Constant score improved from 35% to 86%. The mean pain score decreased from 7.5 to 1, and mean active forward flexion, external rotation, and internal rotation increased from 97 degrees , 14 degrees , and the L5 vertebral level, respectively, to 135 degrees , 38 degrees , and the T11 vertebral level, respectively (P < .0001). There was no significant difference between the outcomes of idiopathic and post-traumatic stiffness (P = .7). However, the Constant score and subjective shoulder value were significantly lower in the postsurgical group compared with the idiopathic and post-traumatic groups (P = .0001 and P = .006, respectively). CONCLUSIONS: Arthroscopic capsular release is an effective treatment for refractory shoulder stiffness. Patients with idiopathic and post-traumatic shoulder stiffness have better outcomes than patients with postsurgical stiffness.

Accuracy of anterior glenohumeral injections: a cadaver study.

PURPOSE: Intra-articular glenohumeral injections have an important role for therapeutic benefit and diagnostic information. Therefore, it is very important that the injected material should reach its desired target. This study assessed the accuracy of an anterior intra-articular injection in fresh cadavers. METHODS: A total of 50 shoulders of 25 fresh cadavers were included in the study. Anterior placement of a spinal needle using a location just 1 cm lateral to the coracoid, without radiographic assistance were performed. After the needle was placed and estimated to be intra-articular 1 cc of acrylic dye was injected into the joint to determine accuracy of position. RESULTS: Ninety-six percent of injections were accurately administered into the glenohumeral joint and 4% in the surrounding soft tissues and capsule. CONCLUSION: Based on our cadaveric study, an unassisted anterior injection to the glenohumeral joint could be accurately placed.

Acromioclavicular joint injuries: diagnosis and management.

Acromioclavicular joint injuries represent nearly half of all athletic shoulder injuries, often resulting from a fall onto the tip of the shoulder with the arm in adduction. Stability of this joint depends on the integrity of the acromioclavicular ligaments and capsule as well as the coracoclavicular ligaments and the trapezius and deltoid muscles. Along with clinical examination for tenderness and instability, radiographic examination is critical in the evaluation of acromioclavicular joint injuries. Nonsurgical treatment is indicated for type I and II injuries; surgery is almost always recommended for type IV, V, and VI injuries. Management of type III injuries remains controversial, with nonsurgical treatment favored in most instances and reconstruction of the acromioclavicular joint reserved for symptomatic instability. Recommended techniques for stabilization in cases of acute and late symptomatic instability include screw fixation of the coracoid process to the clavicle, coracoacromial ligament transfer, and coracoclavicular ligament reconstruction. Biomechanical studies have demonstrated that anatomic acromioclavicular joint reconstruction is the most effective treatment for persistent instability.

Open versus arthroscopic acromioclavicular joint resection: a retrospective comparison study.

PURPOSE: The purpose was to compare open and arthroscopic acromioclavicular joint (ACJ) resection. METHODS: We retrospectively reviewed 103 patients (105 shoulders) who underwent ACJ resection between 2000 and 2005. There were 56 women and 47 men with a mean age of 48 years. The mean duration of follow-up was 51 months (range, 15 to 91 months). Arthroscopic ACJ resection by use of a direct approach was performed in 81 shoulders (group A), and open ACJ resection was performed in 24 shoulders (group B). Results were graded according to pain relief both subjectively and objectively with cross-body adduction testing and direct palpation of the ACJ, subjective shoulder value, Constant score, and improved function. RESULTS: The Constant scores increased from 50 (range, 34 to 65) to 89 (range, 39 to 100) in group A (P < .0001) and from 46 (range, 22 to 63) to 87 (range, 43 to 100) in group B (P < .0001). There was no statistical difference in the postoperative normalized Constant score between group A and group B (P = .47). Pain with cross-body adduction testing and palpation of the ACJ improved in 76 shoulders (94%) in group A and 22 shoulders (92%) in group B. No patients had signs or symptoms of ACJ anteroposterior instability. Revision ACJ resection was performed in 5 patients (5 shoulders [6.2%]) in group A and 1 shoulder (4.2%) in group B (P = .37). The radiographs of the patients who underwent revision showed that 3 patients (3.7%) from group A had regrowth of the distal clavicle; in addition, 2 patients (2.5%) from group A and 1 patient (4.3%) from group B had incomplete distal clavicle excision. CONCLUSIONS: This study did not show a significant difference in the outcome between arthroscopic and open ACJ resection. Incomplete excision and regrowth of the distal clavicle are the most common causes of revision. Although only the arthroscopic group showed a small percentage of patients (3.7%) with regrowth of the distal clavicle, the number is too small to assume that this complication is the result of the arthroscopic technique only. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Results of arthroscopic capsulolabral repair: Bankart lesion versus anterior labroligamentous periosteal sleeve avulsion lesion.

PURPOSE: The purpose of this study was to evaluate the results of arthroscopic capsulolabral repair for traumatic anterior shoulder instability and to compare the outcome in patients who have Bankart lesions versus those with anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions. METHODS: This study included 99 patients (93 shoulders), 72 male and 17 female, with a mean age of 32 years, who underwent arthroscopic Bankart repair for traumatic, recurrent anterior shoulder instability, by use of suture anchors. In 67 shoulders (72%) a discrete Bankart lesion was repaired, and in 26 shoulders (28%) an ALPSA lesion was repaired. The 2 groups were analyzed with regard to the number of preoperative dislocations and number of postoperative recurrences. RESULTS: At a mean follow-up of 47 months (range, 24 to 98 months), recurrence of instability was documented in 10 shoulders (10.7%). Of the shoulders, 5 had Bankart lesions (7.4%) and 5 had ALPSA lesions (19.2%) (P = .0501). The mean number of dislocations or subluxations before the index surgery was significantly higher in the ALPSA group (mean, 12.3 [range, 2 to 57]) than in the Bankart group (mean, 4.9 [range, 2 to 24]) (P < .05). However, there were no significant differences in the number of anchors used, incidence of minor glenoid erosion, or incidence of bony Bankart lesions between the groups (P > .05 for all). CONCLUSIONS: Patients with ALPSA lesions present with a higher number of recurrent dislocations than those with discrete Bankart lesions. In addition, the failure rate after arthroscopic capsulolabral repair is higher in the ALPSA group than in the Bankart group. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

[Long-term results of conservative treatment for thoracolumbar compression fractures]. / Torakolomber omurga kompresyon kiriklarinda konservatif tedavinin uzun dönem sonuçlari.

OBJECTIVES: We evaluated the radiologic and clinical outcomes of conservative treatment for thoracolumbar compression fractures. METHODS: Forty-three patients (28 males, 15 females; mean age 39 years; range 24 to 54 years) were treated conservatively for 47 thoracolumbar compression fractures. All the patients were assessed by plain radiograms and computed tomography. According to the Denis classification, there were eight type A, 20 type B, 12 type C, and seven type D fractures. Involvement was at L1 in 30, L2 in five, and T12 in 12 fractures. There were no neurological deficits. Treatment involved use of a body cast for two months, followed by a thoracolumbosacral orthosis for four months. Radiographically, local kyphosis angle and sagittal index were measured before treatment, after casting, and at the final follow-ups. Pain and functional scales proposed by Denis et al. were also utilized. The mean follow-up was 7.5 years (range 6 to 11 years). RESULTS: The mean local kyphosis angle and sagittal index were measured as 12.6 and 13.7 degrees before treatment, and 5.9 and 7.0 degrees after casting, respectively (p<0.05). However, both did not differ significantly from the baseline at the final measurements (12.7 and 13.9, respectively; p>0.05). The mean pain and functional scores were 1.4 and 1.6, respectively. Four patients had moderate to severe back pain despite mean kyphosis angles of 12 (baseline), 13.5 (after casting), and 14.8 (final). Two patients required substitution of the body cast for orthosis due to excessive sweating, and three patients received local treatment for skin problems secondary to the use of orthosis. CONCLUSION: If the kyphosis angle is less than 30 degrees, compression fractures are supposed to be stable to be treated conservatively with satisfactory clinical results. Functional results seem to be unaffected from the fact that casting does not improve radiographic parameters in the long-term.

[The effect of debridement performed before capsular plication on biomechanical properties of the knee joint capsule: an experimental study in rabbits]. / Plikasyondan önce debridman uygulamasinin diz kapsülünün biyomekanik özelliklerine etkisi: tavsanda deneysel çalisma.

OBJECTIVES: The purpose of this study was to evaluate early postoperative biomechanical changes in plicated joint capsules and to determine the effect of debridement to create a bleeding inner capsular surface on the healing process. METHODS: Fifty-four mature New Zealand white rabbits were used. Plication was performed in unilateral medial knee joint capsules of 48 rabbits either alone (n=24) or following debridement (n=24) to create a bleeding inner capsular surface. Six rabbits remained untreated for the control group. The operated knee joints were immobilized in flexion postoperatively. The rabbits from the two study groups were sacrificed in groups of six immediately after operation, in the first, second, and third weeks, of which five were evaluated in tensile tests and one was evaluated histologically. RESULTS: Compared to the controls, tensile strengths were significantly higher in both study groups until the third week (p<0.01), after which the difference became insignificant (p>0.05). The strength of the plicated capsules was significantly higher in the first week in both study groups than those measured in subsequent weeks (p<0.01), whereas similar tensile strengths were recorded in the second and third weeks (p>0.05). Compared to its absence, the use of debridement was associated with a significantly lower strength in the first week (p<0.01), but this difference was not observed afterwards (p>0.05). Histological findings were similar in the two study groups and were characterized by healing with increased fibrosis starting from the first week. CONCLUSION: A plicated capsule would not be weaker than an intact one. Our findings do not favor debridement for a more rapid and better healing process. Rather, it might have adverse effects on the biomechanical properties of the capsule.

The use of anchors in shoulder surgery: a shift from metallic to bioabsorbable anchors.

With major advances in arthroscopy, suture anchors became the primary devices used to assist in fixing soft tissues to bone. Metallic anchors were first produced and used in soft tissue fixation around the shoulder. However, their use resulted in some reported complications, including articular surface damage from migrating implants and distortion and artifact production in postoperative magnetic resonance imaging. Bioabsorbable anchors were developed to avoid these problems. Their newer versions were proven to have pulling-out strength equal to that of metallic anchors, with a reported lower complication rate. This had led to a major shift away from metallic anchors toward bioabsorbable anchors.

[Arthroscopic treatment of anterior-inferior shoulder instability]. / One-asagi omuz instabilitelerinin artroskopik tedavisi.

OBJECTIVES: We evaluated patients who underwent arthroscopic repair for posttraumatic, recurrent anterior-inferior glenohumeral instability with capsular laxity. METHODS: Seventeen patients (4 females, 13 males; mean age 27 years; range 18 to 40 years) were treated with arthroscopic Bankart repair and posterior capsular plication for posttraumatic, recurrent anterior-inferior glenohumeral instability with capsular laxity. Involvement was on the right side in 11 patients, and on the left in six patients. The mean duration from the first dislocation to surgery was 5.2 years (range 1 to 11 years). All the patients received conservative treatment before surgery. Range of motion was measured with a goniometer and muscle strength was measured manually. Apprehension test, Jobe apprehension-relocation test, and posterior apprehension test were used to assess instability. Preoperatively, all the patients were examined by anteroposterior and axillary radiographs and magnetic resonance imaging. Shoulder functions were assessed with the Rowe rating scale for Bankart repairs. The mean follow-up was 35.6 months (range 24 to 50 months). RESULTS: Instability recurred in three patients (17.7%). The Rowe score increased from a mean of 41 (range 15-45) to 78 (range 43-100) postoperatively. Functional results were excellent-good in 13 patients (76.5%), fair in one patient (5.9%), and poor in three patients (17.7%). One patient underwent arthroscopic revision following redislocation. Pre- and postoperative values for active forward flexion, external rotation, and internal rotation did not differ significantly (p>0.05). CONCLUSION: The results of arthroscopic Bankart repair and posterior capsular plication are satisfactory in the treatment of anterior glenohumeral instability with capsular laxity. However, the use of capsular plication with arthroscopic Bankart repair should be considered in selected cases.

[Familial tumoral calcinosis in three patients in the same family]. / Ayni aileden üç olguda ailesel tümöral kalsinozis.

Tumoral calcinosis is a rare condition characterized by large calcific soft tissue deposits occurring predominantly in a periarticular location. Familial tumoral calcinosis was detected in three members of a family, namely, the father and two offsprings. The father underwent many operations since age 10 for occurrences or recurrences of mass lesions in the right posterior elbow, both hips, left gluteal region, and perineal region. His 16-year-old son underwent his first operation at the age of 10 for a lesion in the posterior elbow, which recurred at the same site and required another operation two years later. He underwent subsequent surgeries for lesions that appeared in the right elbow and right dorsal foot. Finally, the 12-year-old daughter was treated with surgery for a lesion in the right dorsal foot. In all the patients, pathologic diagnoses of all surgical specimens were reported as tumoral calcinosis. All had normocalcemia, hyperphosphatemia, and D hypervitaminosis.

[Arthroscopic rotator cuff repair: evaluation of outcomes and analysis of prognostic factors]. / Artroskopik rotator manset onarimi: Sonuçlar ve belirleyici faktörlerin analizi.

OBJECTIVES: The purpose of this study was to evaluate the results of arthroscopic rotator cuff repair of full-thickness tears and to determine prognostic factors. METHODS: Forty-one shoulders of 40 patients (16 males, 24 females; mean age 56 years; range 39 to 72 years) unresponsive to conservative treatment were evaluated. The mean symptom duration was 15 months (range 2 to 24 months). Involvement was on the right in 34 shoulders, on the left in seven shoulders, 80% being on the dominant side. The range of motion was measured with a goniometer, muscle strength was measured manually. Clinical and functional evaluations were based on physical and radiological examinations, and the UCLA scale. The mean follow-up was 37 months (range 12 to 61 months). Prognostic factors included age, symptom duration, range of motion, muscle strength, tear size, retraction and quality of tendon, and fatty degenerative changes. RESULTS: According to the UCLA scale, the results were satisfactory in 29 shoulders (70.7%), moderate in five (12.2%), and poor in seven (17.1%). Six shoulders (14.6%) required revision surgery. Postoperative improvements in forward flexion and muscle strength were significant (p<0.05), whereas change in external rotation was insignificant (p>0.05). Age, tear size, retraction and quality of tendon, and fatty degenerative changes were found to significantly affect unsatisfactory results (p<0.05). Preoperative symptom duration, range of motion, and muscle strength were not effective on the results (p>0.05). CONCLUSION: Our results are not as successful as those obtained from open procedures. The results may be more satisfactory through improving arthroscopic skills and taking prognostic factors into consideration in patient selection.

[The results of curettage and bone cementing for enchondromas of the distal femur]. / Femur alt uç enkondromlarinin küretaj ve kemik çimentosu ile tedavi sonuçlari.

OBJECTIVES: We evaluated patients who were treated with curettage and cementing for enchondromas localized in the distal femur. METHODS: The study included 13 patients (7 females, 6 males; mean age 54 years; range 43 to 65 years) who underwent surgery for enchondromatosis in the distal femur. Enchondromas were detected incidentally in 10 patients; of these, complaints of pain appeared afterwards in seven patients. Surgery involved curettage and cement filling of the defects. Preoperative biopsies were obtained in seven patients. Clinical evaluations were made with a visual analog scale. The mean follow-up period was four years (range 1 to 5 years). RESULTS: Radiographically, the size of the lesions ranged from 3 cm to 6 cm (mean 4.5 cm). Computed tomography showed cortical extension in five patients and erosion leading to narrowing in the posterior cortex in one patient. The mean pain score decreased from 3.63 (range 0 to 7) to 0.54 (range 0 to 3) postoperatively (p<0.05). Histopathological diagnoses of surgical specimens were enchondroma in 12 patients and grade 1 chondrosarcoma in one patient. Postoperatively, only one patient who had erosion and narrowing in the posterior cortex required cast immobilization for three weeks. None of the patients had recurrence, sarcomatous changes, or infection. No functional loss developed after surgical treatment. CONCLUSION: Treatment of femoral enchondromas with curettage and cementing yields successful functional and radiologic results.

[Arthroscopic treatment of type 2 superior labrum anterior posterior lesions]. / Tip 2 superior labrum anterior posterior lezyonlarinin artroskopik tedavisi.

OBJECTIVES: We retrospectively evaluated patients who underwent arthroscopic repair for isolated type 2 superior labrum anterior posterior (SLAP) lesions. METHODS: Isolated type 2 SLAP lesions were treated with arthroscopic repair with suture anchors in eight patients (5 males, 3 females; mean age 48.5 years; range 27 to 60 years) with shoulder pain unresponsive to conservative treatment. The mean duration of symptoms was 18.6 months (range 2 to 48 months). Initial diagnoses were based on patients' complaints and findings of physical examination and radiologic imaging, and were confirmed at diagnostic arthroscopy. Two suture anchors were used in six patients. Patients were evaluated with physical examination, radiographs, and the UCLA (University of California at Los Angeles) score. The mean follow-up was 30.8 months (range 14 to 48 months). RESULTS: The mean preoperative and postoperative UCLA scores were 13.3 (range 10 to 18) and 30.8 (range 24 to 33), respectively (p<0.05). The results were good in seven patients (87.5%), and fair in one patient (12.5%). The mean preoperative active forward elevation was 136.3 degrees (range 90 degrees to 170 degrees), adduction-external rotation was 42.5 degrees (range 40 degrees to 60 degrees), and adduction-internal rotation was at T7 in three patients, and at L1 in five patients. At final follow-ups, the mean active forward flexion increased to 164.3 degrees (range 150 degrees to 170 degrees), adduction-external rotation was 40 degrees (range 30 degrees to 60 degrees), and adduction-internal rotation was at T7 in four patients, and at T12 in four patients. CONCLUSION: The results of arthroscopic fixation of type 2 SLAP lesions with suture anchors are successful in the majority of patients, provided that an appropriate arthroscopic technique is performed to re-establish the stability of the biceps anchor.

[Arthroscopic treatment of symptomatic loose bodies in osteoarthritic elbows]. / Osteoartritli dirsekte eklem içi serbest cisimlerin artroskopik tedavisi.

OBJECTIVES: We evaluated functional and clinical results of patients who underwent arthroscopic surgery for symptomatic loose bodies in osteoarthritic elbow joint. METHODS: Arthroscopic surgery was performed in 10 patients (6 males, 4 females; mean age 47 years; range 30 to 59 years) for symptomatic loose bodies in osteoarthritic elbow joint. Eight patients had a history of trauma. Involvement was on the right in seven patients, and on the left in three patients. Preoperatively, six patients had limited joint movements and locking, and five patients had pain. The presence and the number of loose bodies were investigated by standard radiographs and computed tomography preoperatively, and by radiographs and magnetic resonance imaging postoperatively. The range of motion was measured with a goniometer. Functional assessment was made with the use of the Broberg and Morrey's scoring system, and pain was assessed with a visual analog scale. The mean follow-up was 31 months (range 7-59 months). RESULTS: The mean range of motion of the elbows increased from 100 degrees (range 55 degrees to 160 degrees) preoperatively to 115 degrees (range 70 degrees to 160 degrees) at the end of the follow-up (p=0.05). None of the patients developed valgus or varus instability. The mean preoperative and postoperative Broberg and Morrey's scores were 59 (range 45 to 80) and 86 (range 59 to 100), respectively (p<0.01). The results were excellent in five patients, good in three patients, and poor in two patients. The mean visual analog score decreased from 7 (range 5 to 10) preoperatively to 1 (range 0-4) postoperatively (p<0.01). Eight patients were satisfied with surgery and returned to normal activities after a mean of 16 days (range 1 to 60 days). CONCLUSION: Arthroscopic surgery is effective in reducing pain in selected patients with symptomatic loose bodies in osteoarthritic elbows, with the advantages of low morbidity and rapid functional recovery.

[Results of the surgical treatment for symptomatic mesoacromion]. / Semptomatik mezo-akromiyon cerrahi tedavisinin sonuçlari.

OBJECTIVES: Functional results of patients who were operated on for symptomatic meso os acromiale were retrospectively evaluated. METHODS: The study included six patients (5 females, 1 male; mean age 58.5 years; range 51 to 64 years) who underwent surgical treatment for symptomatic os acromiale following unsuccessful conservative treatment. Internal fixation and bone grafting were performed in all the patients. Evaluations were based on physical assessment, radiographic examination, and the UCLA (University of California at Los Angeles) score. All the patients had symptoms of subacromial impingement accompanied by various degrees of rotator cuff tears. Symptomatic os acromiale was diagnosed by imaging studies and tenderness over the acromion during palpation. In case of suspected stability of the acromion, arthroscopy was performed. Fixation was performed with cannulated screws (n=4) or K-wires (n=2) and a cerclage wire or nonabsorbable sutures. Bone graft was harvested locally. The mean follow-up period was 29 months (range 18 to 35 months). RESULTS: The mean UCLA score increased from a preoperative 11.8 to postoperative 28.2. Union was achieved in four patients in whom cannulated screws were used. Two patients who were fixed with K-wires remained ununited. CONCLUSION: It is possible to obtain satisfactory results with cannulated screws which probably enable a more rigid fixation in symptomatic os acromiale. Arthroscopic evaluation may be helpful in deciding whether or not os acromiale is symptomatic.

[Arthroscopic repair of combined superior labrum anterior posterior and Bankart lesions]. / Superior labrum anterior posterior ve Bankart kombine lezyonlarinin artroskopik tamiri.

OBJECTIVES: We retrospectively evaluated patients who underwent arthroscopic treatment for superior labrum anterior posterior (SLAP) lesions combined with antero-inferior labral detachment (Bankart lesion, Maffet type 5). METHODS: The study included eight male patients (mean age 31.8 years; range 23 to 50 years) who were treated with suture anchors for type 5 SLAP lesions. In all the patients the symptoms started after trauma, and all presented with shoulder instability findings. The range of motion was measured in the sitting position by a goniometer, and muscle force was assessed manually. In addition, Speed and O'Brien tests and Jobe relocation test were performed. All the patients were examined by standard shoulder magnetic resonance scans. Functional results were evaluated according to the UCLA (University of California at Los Angeles) shoulder score, and the Rowe rating scale for Bankart repairs. The mean follow-up was 37.8 months (range 24 to 52 months). RESULTS: Functional results were excellent-good in five patients, fair in two patients, and poor in one patient. The mean UCLA score increased from a preoperative 15 (range 14-17) to a postoperative 30 (range 20-35), with a corresponding increase in the mean Rowe score from 25 (range 15-45) to 81 (range 50-95) (p<0.05). CONCLUSION: Arthroscopic repair of combined Bankart and SLAP lesions may present technical difficulties. Nevertheless, it is possible to get good results in selected patients in whom intraarticular pathologies are diagnosed and treated appropriately.