A comparison of percutaneous and mini-open techniques of Achilles tenotomy: an experimental study in rats.

PURPOSE: To investigate the effect of Achilles tenotomy performed percutaneously and by mini-open methods on tendon healing and final strength. MATERIALS AND METHODS: In two groups, each consisting of 14 rats, percutaneous and mini-open techniques in Achilles tenotomy were compared in terms of biomechanical, histological and gross properties. RESULTS: In the gross evaluation, it was observed that an obvious thickening and adhesion to the subcutaneous tissue of the healing tendon were observed in nearly all rats in which the mini-open technique was performed. In the biomechanical analysis, there was no significant difference between percutaneous and mini-open groups and between operated and intact Achilles tendons in both groups, in terms of tendon strength (P > 0.05). In the histological evaluation, irregularity in the parallel pattern of the collagen fibres, emergence of a non-specific collagenous tissue formation and infiltration of mild mononuclear inflammatory cells were reported. These changes were more marked in the rats in which the percutaneous technique was performed. CONCLUSION: Mini-open technique for Achilles tenotomy may be considered as an alternative method of treatment to apply the tenotomy technique in a secure way. CLINICAL RELEVANCE: There are two basic advantages of Achilles tenotomy performed by the mini-incision open technique: (1) a complete tenotomy is guaranteed, as it has to be in the original Ponseti technique, (2) iatrogenic neuro-vascular injury risk is nearly completely avoided due to the subparatenon exploration of the tendon and direct visual observation during the transection. The mini-open technique may only be used in cases in which a vascular compromise is clinically suspected or confirmed by Doppler ultrasonography and/or arteriography. On the other hand, the technique may be performed in all cases routinely by the choice of the surgeon.

Clinical importance of femoral and tibial tunnel localizations in arthroscopic anterior cruciate ligament reconstruction.

OBJECTIVES: The aim of this study is to evaluate the effect of femoral and tibial tunnel localizations on knee functions after arthroscopic single bundle anterior cruciate ligament (ACL) reconstruction and to contribute to the definition of the ideal tunnel localizations for the best results. PATIENTS AND METHODS: Thirty knees of 30 patients (29 males, 1 female; mean age 28.4 years; range 20 to 43 years) who underwent hamstring autograft reconstruction with the transfemoral fixation technique due to isolated complete rupture of the ACL were retrospectively evaluated. All of the operations were performed by the same surgeons and in the same institution. Tunnel localizations were defined according to the Harner Quadrant method in the post operative period. Mean follow-up period was 19.6 months and postoperative Lysholm knee scores and joint range of motion values were noted. The correlation between tunnel parameters and the scores were statistically evaluated. RESULTS: When all parameters were considered it was found out that the tunnel localizations in the sagittal tibial plane solely and independently had a significant effect on knee functions. CONCLUSION: It was concluded that especially the tibial tunnel located sagittally in the anterior second half of the plateau improves the knee functional scores after ACL reconstruction.

[Congenital pseudarthrosis of the clavicle in two siblings]. / Iki kardeste dogustan klavikula psödoartrozu.

Congenital pseudarthrosis of the clavicle is a rare disorder of unknown etiology. Among nearly 200 cases hitherto reported, only a few cases have familial coexistence, and none are first-degree relatives. A nine-year old girl had complaints of weakness in the right arm and swelling in the right shoulder. On physical examination, a mass-like lesion in the right clavicle, abnormal clavicular movement, and asymmetric shoulders were noted. The range of motion of the shoulder was in normal range on both sides. A plain radiogram showed a defect in the diaphysis of the right clavicle and computed tomography showed discontinuity of the right clavicle. Similar clinical and radiologic findings were also detected in her younger sister who was three years old. None had a history of trauma, difficult delivery, or natal complication, any abnormal findings related to the musculoskeletal system, any abnormality in routine laboratory test results and genetic analysis. The diagnosis was made as congenital pseudarthrosis of the clavicle in both siblings. Since they had normal range of joint movements without pain, they were scheduled for clinical follow-up. To our knowledge, these two siblings are the first to be reported in the literature for having congenital pseudarthrosis of the clavicle.

[The results of calcaneal lengthening osteotomy for the treatment of flexible pes planovalgus and evaluation of alignment of the foot]. / Fleksibl pes planovalgusta kalkaneal uzatma osteotomisinin sonuçlari ve ayak diziliminin degerlendirilmesi.

OBJECTIVES: We evaluated the results of calcaneal lengthening using the modified Evans osteotomy technique in patients with flexible pes planovalgus and the effectiveness of this technique in restoring the alignment of the foot. METHODS: Calcaneal lengthening osteotomy was performed using the modified Evans technique in 22 feet of 11 patients (6 males, 5 females; mean age at the end of follow-up, 10 years 10 months; range 5 years 6 months to 14 years 8 months) with flexible pes planovalgus deformity. Etiologies were cerebral palsy (n=5), sequela of myelomeningocele (n=1), and sensorimotor polyneuropathy (n=1); four patients were evaluated as idiopathic. All the patients received long-term conservative therapy preoperatively, and, except for one patient, none had undergone surgery for the deformity. All patients but one were operated on bilaterally at a single session. Clinical assessment was based on 10 parameters, and radiographic assessment was based on seven parameters on standard anteroposterior and lateral radiographs. The mean follow-up was 18 months (range 13 to 75 months). RESULTS: Radiographically, union was achieved in all the patients after a mean of seven weeks (range 6 to 8 weeks). Clinical results were perfect in 17 feet (77.3%), good in three feet (13.6%), fair in one foot (4.6%), and poor in one foot. Radiographically, five feet (22.7%), 13 feet (59.1%), and four feet (18.2%) were assessed as perfect, good, and fair, respectively. An average of 7.3 mm (range 4 to 9 mm) of calcaneal lengthening was obtained (p<0.05). Malpositioning of the graft or overcorrection did not occur. Before surgery, five patients could walk on the heel with (n=3) or without (n=2) support; postoperatively, all the patients but one could perform this without support. CONCLUSION: Calcaneal lengthening osteotomy for symptomatic pes planovalgus provides pain relief and significant clinical and radiographic correction in the hind foot and forefoot.