Discoid Double-layered Lateral Meniscus: A Case Report.

Introduction: Abnormalities of the double-layered meniscus are rare and can be difficult to diagnose. The main pathology in this abnormality, which is predominantly seen in the lateral compartment, is an accessory meniscus lying over the normal meniscus. Anatomically, this structure can appear in different forms. Although other meniscal abnormalities associated with a double-layered meniscus have been reported, this case presents a previously undescribed type in the literature. Case Report: A 12-year-old girl presented to our clinic with complaints of knee locking and pain. When the patient underwent arthroscopy, an accessory incomplete discoid meniscus was found overlying the normal lateral meniscus. We performed an excision of the upper accessory meniscus and the patient had no problems during 3 years of follow-up after surgery. Conclusion: Abnormalities of the lateral meniscus are rare and can be difficult to diagnose. In cases where we suspect a meniscal abnormality, a proper arthroscopic examination should be performed and if a discoid meniscus is seen, it should be considered that this may be a double-layered meniscus.

Lesion prevalence and patient outcome comparison between primary and recurrent anterior shoulder instability.

BACKGROUND: The purpose of this study was to compare lesion prevalence and treatment outcomes in patients with primary and recurrent anterior shoulder instability. METHODS: Patients who were admitted to the institution with a diagnosis of anterior shoulder instability and who underwent arthroscopic surgery between July 2006 and February 2020 were retrospectively evaluated. Minimum follow-up duration of the patients was 24 months. The recorded data and magnetic resonance imaging (MRI) of the patients were examined. Patients aged ≥40 years, with a history of shoulder region fracture, inflammatory arthritis, a history of epilepsy, multidirectional instability, nontraumatic dislocation, and off-track lesions were excluded from the study. Shoulder lesions were documented and patient outcome evaluation was made with the Oxford Shoulder Score (OSS) and visual analog scale (VAS). RESULTS: A total of 340 patients were included in the study. The mean age of patients was 25.6 years (±6.49). The recurrent instability group had a significantly higher rate of anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions compared to the primary instability group (40.6% vs. 24.6% respectively) (P = .033). Twenty-five patients (43.9%) had superior labrum anterior and posterior (SLAP) lesions in the primary instability group and 81 patients (28.6%) had SLAP lesions in the recurrent instability group (P = .035). OSS increased for both primary (from 35 [16-44] to 46 [36-48]) (P = .001) and recurrent instability groups (from 33 [6-45] to 47 [19-48]) (P = .001). There was no significant difference between the groups regarding postoperative VAS and OSS scores (P > .05). CONCLUSIONS: Successful results were obtained in patients younger than 40 years with both primary and recurrent anterior shoulder instability after arthroscopic treatment. ALPSA lesion prevalence was higher whereas SLAP lesion prevalence was lower in patients with recurrent instability. Although the postoperative OSS was comparable between the patient groups, the failure rate was higher in the recurrent instability patients.

Comparison of balance and function in the long term after all arthroscopic ATFL repair surgery.

INTRODUCTION: We compared the balance, ROM, clinical scores, kinesiophobia and functional outcomes of patients after all-arthroscopic ATFL repair surgery with the non-operated side and healthy control group. MATERIALS AND METHODS: Twenty-five patients with follow up time 37.32 ± 12.51 months and twenty-five healthy controls participated in the study. Postural stability was evaluated with the Biodex® balance system by measuring overall (OSI), anterior-posterior (API), and mediolateral (MLI) stability index. Dynamic balance and function were measured using the Y-balance test (YBT) and single-leg hop test (SLH). Limb symmetry index for SLH and contralateral comparisons (YBT, OSI, API, MLI) was performed. The AOFAS score and the Tampa Scale of Kinesiophobia (TSK) were applied. Two subgroups were created (with OLT and without OLT). RESULTS: There was no statistically significant difference between subgroups. There was no statistically significant difference between bilateral OSI, API, MLI values and YBT anterior reach distances of all groups. Single leg OSI (0.78 ± 0.27/0.55 ± 0.12), API (0.55 ± 0.22/0.41 ± 0.10), and MLI (0.40 ± 0.16/ 0.26 ± 0.08) values were significantly worse and YBT posteromedial (73.88 ± 15.70/89.62 ± 12.25), posterolateral reach (78.03 ± 14.08/92.62 ± 8.25) and the SLH distance (117.14 ± 27.84/165.90 ± 20.91) were significantly lower on the patients than controls (p < 0.05), respectively. In contralateral comparisons, all reach distances on YBT were similar and SLH limb symmetry index of the operated side was 98.25%. AOFAS scores of the patients were 92.62 ± 11.13, TSK scores were 46.45 ± 11.32, and 21 patients (84%) had kinesiophobia. CONCLUSION: AOFAS score, limb symmetry index, and bilateral balance of the patients were successful; however, there is single-leg postural stability insufficiency and kinesiophobia. Although the extremity symmetry index of the operated side of the patients was 98.25, the fact that these values are lower than those of the healthy control may have been caused by kinesiophobia. During the long-term rehabilitation, kinesiophobia should be considered and single-leg balance exercises should be monitored during the rehabilitation period. LEVEL OF EVIDENCE: Level III.

The effect of alginate scaffolds on bone healing in defects formed with drilling model in rat femur diaphysis.

Alginate (ALG) is a biocompatible and biodegradable polymer. Mechanical weakness is one of the main problems for the alginate-based scaffolds. Various plasticizer additives or modifications tested to improve the mechanical properties. In the presented study, ALG plasticized with triacetin (TA), and tributyl citrate (TBC) than tested on bone healing. In the presented study, the alginate modified with triacetin or tributyl citrate. In-vitro, and in-vivo efficiency of the scaffolds tested on bone tissue regeneration. Scaffolds fabricated by solvent casting, and physicochemical characterizations performed. Monocytes (THP-1) cultured with scaffolds, and macrophage-released cytokines was determined. In-vivo efficacy of the scaffolds was tested in the rat drill hole model. Alginate and tributyl citrate-modified scaffolds have no cytotoxic effect on osteoblastic cells (MC-3T3). Tributyl citrate modification increased tumor necrosis factor-alpha (TNF-alpha) level but did not increase interleukin -1 beta (IL-1 beta) level. In vivo studies showed that osteoblastic growth was significant in alginate and triacetin-modified scaffolds. However, the best values for osteoclastic activity and osteoid tissue formation seen in the triacetin modification. The results demonstrated that the modified alginate scaffolds were more successful than non-modified alginate scaffolds and can used as long-term bone repairing treatments.

Radiographic assessment of bone tunnels after anterior cruciate ligament reconstruction: A comparison of hamstring tendon and bone-patellar tendon-bone autografting technique.

OBJECTIVES: This study aims to compare the postoperative change of femoral and tibial tunnel widths after hamstring tendon (HT) and bone-patellar tendon-bone (BPTB) autografting in primary anterior cruciate ligament (ACL) reconstruction surgery with the anteromedial portal technique. PATIENTS AND METHODS: This case-control and retrospective study included 39 patients (36 males, 3 females; mean age 30.1±7.9; range, 17 to 44 years) who underwent primary ACL reconstruction surgery with either BPTB autografting method (BPTB group, n=18) or HT autografting method (HT group, n=21) between March 2014 and December 2016. Femoral fixation was achieved with bioabsorbable screw in BPTB group and endobutton in HT group. Tibial fixation was achieved with bioabsorbable interference screw in both groups. Femoral and tibial tunnel widths of groups were compared on digital radiographs. RESULTS: When we compared the baseline values with the second-year results, the mean of femoral tunnel widths were significantly lower on radiographs at the second-year evaluation in both groups (p<0.001 for all). However, the means of tibial tunnel widths were significantly lower only in the BPTB group (p<0.001 for BPTB group and p=0.616 for HT group). Change levels of anteroposterior and lateral widths were more prominent in BPTB group than HT group (p<0.001 for all). CONCLUSION: Changes in tunnel widths show us superior ossification in BPTB grafting. This can be explained by superior bone-to-bone healing. As a result of radiological evaluation, we think that BPTB grafting can be more strong and durable.