Rotator cuff-quality of life scale: adaptation to Turkish.

PURPOSE: The adaptation of scales to the native language and cultural setting of the patient is essential for obtaining more reliable results in scientific studies. In this study, the rotator cuff-quality of life scale (RC-QoLS) was translated into Turkish, and validity and reliability testing was performed on the scale. METHODS: The scale was first translated into Turkish and then from Turkish to English by another language specialist. Subsequently, the two translations were evaluated by two orthopaedic surgeons who had comprehensive knowledge of English to create the final Turkish version of RC-QoLS. The scale was used for the assessment of 54 patients (average age 56 years) with rotator cuff tear scheduled for surgery. The scale was completed by each patient two times with 1-week interval. RESULTS: The Cronbach's alpha coefficients ranged between 0.895 and 0.980 and intraclass correlation coefficients ranged between 0.807 and 0.976, this rendered all domains reliable. The scale gave results very near to those obtained by the original questionnaire with respect to the constructed validity and internal consistency as well as domain relationships. CONCLUSIONS: In general, the Turkish version of the RC-QoLS is a valid and reliable test with high differentiating power that may be used in the evaluation the quality of life of patients with RC tear in patients who are native Turkish speaker. The use of the Turkish version of RC-QoLS may contribute to the making of a more reliable evaluation in the studies on RC problems in the Turkish society.

Effect of radiofrequency microtenotomy on degeneration of tendons: an experimental study on rabbits.

INTRODUCTION: Radiofrequency microtenotomy is used to enhance healing by increasing vascularity in the degenerated tendon. In the present study, the effect of radiofrequency microtenotomy (Rf-mt) treatment on tendon degeneration was investigated. MATERIALS AND METHODS: A total of 32 New Zealand rabbits were enrolled in the current study. Experimental degeneration was performed by injecting prostaglandin E1 (PGE1) into the bilateral Achilles tendons of rabbits. After excluding 4 rabbits with an infection on the injection site, 4 other rabbits were sacrificed to define the histopathologic changes in the tendons. The remaining 24 rabbits were divided into 2 groups: the control group and the Rf-mt group. In the control group, the Rf-mt device was only applied to the Achilles tendon without running the device. In the Rf-mt group, the Rf-mt device was applied bilaterally at the fourth energy level for 500ms to an area within 2cm proximal to the insertion site at 0.5cm intervals in order to form a grid. Six rabbits from each group were sacrificed at 6 and 12 weeks. The Achilles tendons were evaluated histopathologically by a modified Movin scale and by immunohistopathologic staining for vascular endothelial growth factor and type 4 collagen. RESULTS: After the PGE1 injection, findings similar to chronic degenerative tendinopathy were observed. The Rf-mt group showed significant improvement in vascularity in the histopathological and immunohistochemical examination (P<0.05). However, there was no significant difference in healing between the control and Rf-mt groups (P>0.05). CONCLUSIONS: Rf-mt treatment increases vascularity in degenerated tendons but does not create difference to facilitate the healing process comparing control group.

The "butterfly" suture technique for meniscal repair.

One of the important factors effecting meniscal healing is the strength of primary fixation obtained by repairing technique. From this perspective, it is important to choose the technique ensuring a higher primary fixation strength for meniscal repairs. We described a new technique for meniscal repair called "butterfly" technique using Viper device and hypothesized that high primary fixation strength can be obtained with this technique. The study was performed on calve knees. Full-thickness longitudinal tears 2 cm in length and 3 mm medial from the periphery were created in corpora of medial menisci of 14 calves. After creating tears, menisci were divided into two equal groups. In Group 1, two vertical loop sutures 1 cm apart were placed using a Viper device. Whereas in Group 2, tears were repaired using "butterfly" sutures. The mean load to failure was 156.3 ± 13.1 and 186 ± 15.8 N in Group 1 and 2, respectively (p = 0.002). The fixation strength in Group 2 was significantly higher than in Group 1. We suggest that, using Viper device and all-inside "butterfly" suturing techniques, meniscal ruptures with appropriate locations can be repaired with higher primary fixation strength.

Mid-term clinical and radiological outcomes of arthroscopic repair of isolated and combined subscapularis tears: A single-center experience.

OBJECTIVE: The aim of this study was to evaluate the mid-term clinical and radiological results of patients who underwent arthroscopic subscapularis (SSC) tendon repair and to address the possible effect of repair technique(single or double row), tear pattern, and concomitant procedures among supraspinatus tears and long head of biceps tendon (LHBT) pathologies on outcomes and failure parameters. METHODS: 45 patients (24 female; mean age = 55.9 years, age range = 37 - 78) who underwent arthroscopic repair of an SSC tear between January 2009 and December 2016 were retrospectively identified and included inthe study. Pre- and postoperative internal rotation strength and shoulder joint range of motion angles were measured. Clinical outcomes were assessed by Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES), Constant-Murley, Rotator cuff-quality of life (RC-QoL), and University of California Los Angles (UCLA) scores preoperatively and at the final follow-up. RESULTS: The mean follow-up was 45.2 (range = 36-104) months. 14 patients had isolated SSC tears. The mean preoperative VAS, ASES, Constant-Murley, RC-QoL, and UCLA scores for all patients were respectively 8.6, 21.2, 24, 28.9, and 12. Significant improvement was observed in each clinical outcome at the final follow-up: 0.96, 88.4, 86.4, 90.2, and 32.2, respectively. Improvement in outcome scores was more prominent in patients with Lafosse grade I and II SSC tendon tears repaired by singlerow technique and in patients with concomitant supraspinatus tendon repairs. The mean preoperativeinternal rotation strength according to theOxford scalewas 3.4 (±0.6) / 5 and raised to 4.7 (±0.4) / 5 at the final follow-up (P <.001).Although concomitant biceps interventions significantly improved the outcome scores; this improvement was not clinically significant. Failure was only seen in 6 patients with high-grade (Lafosse III or IV) tears. CONCLUSION: Significant improvement in clinical outcomes and lower failure ratios were more prominent in patients with Lafosse grade I or II tears than grade III or IV. Concomitant biceps interventions made a positivecontribution to the clinical outcome. Early diagnosis and repair seem to be advantageous before low-grade SSC tendon tears turn into high-grade tears. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

A Practical Method for Obtaining True Lateral Elbow X-rays in a Paediatric Age Group: Lateral Elbow X-ray in the Standing Salute Position.

INTRODUCTION: Paediatric elbow fractures constitute 10% of all paediatric fractures. Radiological interpretation of the immature elbow is difficult due to its cartilaginous structure. We aimed to describe an X-ray technique in paediatric patients to obtain true lateral elbow X-rays and to prevent the repeat X-ray shots. MATERIALS AND METHODS: Radiographs of 39 children, with a mean age of 48.17 months (range; 7-84 months), with elbow trauma were included. All elbow lateral radiographs were taken in the 90º flexion position. In the first group, radiographs were taken using the standard technique(lateral radiographs in shoulder internal rotation). In the second group, lateral radiographs of the elbow were taken while the patient was standing and the forearm was elevated passively with 90° shoulder abduction and 90° elbow flexion (standing salute position). Three criteria were examined from the graphs to determine the true lateral elbow graphy. RESULTS: In group 1 (n = 20) and group 2 (n = 19), lateral elbow radiographs were evaluated. No statistically significant differences were found between the groups, in terms of mean age and distal humeral fractures. In group 2; the presence of humeroulnar joint space, partial coronoid superposition of the radius head and presence of the hourglass formation were significantly higher. DISCUSSION: It is clear that radiographs taken in appropriate positions decreases diagnostic errors. In our study, the ratio of correct lateral radiographs was significantly higher in the radiograph group in the standing salute position, suggesting this method was safe for accurate lateral radiographs, in accordance with our hypothesis.

Osteoid osteoma of the trapezium: case report.

Osteoid osteoma is a benign bone tumor representing approximately 10% of all benign bone tumors. Although osteoid osteoma of the long bones and carpus is frequent, the location in the trapezium is extremely rare. We found only one other report in the literature regarding osteoid osteoma of the trapezium.

[Overlooked primary hyperparathyroidism presented with fractures: case report]. / Kiriklarla gelen atlanmis primer hiperparatiroidi olgusu: Olgu Sunumu.

In the present paper, we report a female patient with multiple cystic lesions of bone arising from the primary hyperparathyroidism and pathological femur and contralateral tibia fractures at the level of these cystic lesions (osteitis fibrosa cystica). The patient's history revealed that she was admitted to a medical center with vague symptoms such as sudden onset of dyspepsia, loss of appetite, myalgia, arthralgia, fatigue, and weight loss six years ago but no disease was diagnosed. Loss of appetite and loss of weight continued. She had been walking only by assisted ambulation for the last year. However, primary hyperparathyroidism was overlooked until our examination. The fractures were managed by interlocking nailing and grafting after confirming with biopsy that the fractures were due to osteitis fibrosa cystica. The fractures healed uneventfully. In conclusion, it is essential to evaluate patients with these vague symptoms with full biochemical screening and radiological examination for the early detection of the disease.

Repair of Longitudinal Meniscal Tears by Single or Double Vertical Loop Sutures: In vitro Biomechanical Study under Cyclic Loading.

One of the factors affecting the healing of a meniscus repair is the primary stability of the tear. The purpose of this study is to compare single and double vertical loop (SVL vs. DVL) meniscal suture configurations by measuring elongation under cyclic loading and failure properties under ultimate load. We hypothesized that DVL configuration would have superior biomechanical properties than SVL. Twenty-two intact lateral menisci were harvested from patients who required total knee arthroplasty. A 20-mm longitudinal full-thickness cut was made 3 mm from the peripheral rim to simulate a longitudinal tear. Two groups were formed and group randomization was done according to patient age and gender (SVL group: mean age 68.3 years [range, 58-78 years], five males, six females; DVL group: mean age 67.4 years [range, 59-77 years], six males, five females). Cyclic loading was performed between 5 and 30 N at a frequency of 1 Hz for 500 cycles. Then, the meniscus repair construct was loaded until failure. Statistical analysis was performed using the t-test and the Mann-Whitney's U-test. During the early phases of cyclic loading, three specimens from each group failed because of suture pull out and are excluded from the study. At the end of 500 cycles, there was significantly less displacement in the DVL group than the SVL group (6.13 ± 1.04 vs. 9.3 ± 2.59 mm) (p < 0.05). No significant difference was found between groups regarding ultimate load to failure measurements (p > 0.05). All specimens in SVL and five specimens in DVL groups failed in the form of suture pull out from the meniscus tissue. Longitudinal meniscal tears repaired with DVL configuration had less elongation value under cyclic loading compared with SVL configuration. Because of its superior biomechanical properties, it would be more secure to repair large and instable longitudinal meniscal tears by the DVL technique. This is a level II study.

Biomechanical evaluation of arthroscopic all-inside meniscus repairs.

Viper is a new device for arthroscopically all-inside meniscal repairing. In previous studies about Viper device, procedures were not applied arthroscopically despite this device has been designed for arthroscopic application. In this study, we evaluated primary fixation strength of arthroscopically applied meniscal repair using Viper device to obtain better clinical relevance. Two centimeter in length meniscal tear 2-3 mm far from periferic edge of medial meniscus of 50 calves were created arthroscopically. The menisci were divided into five groups including 10 menisci in each. In group 1, tears were repaired by outside-in vertical loop suture technique with No: 0 PDS. Tears were fixed by all-inside vertical suture by using Viper device with No: 0 PDS in group 2. In meniscal implant groups, RapidLoc, H-Fix, and Clearfix were applied in groups 3,4, and 5, respectively. Primary fixation strength of repairing techniques were evaluated with bio-mechanical testing machine. Fixation strengths determined in groups 1 and 2 were detected as 145 +/- 13 and 136 +/- 33 N, respectively. There was no difference in pull-out strength between groups 1 and 2. Fixation strengths in these two groups were significantly higher compared to groups 3, 4, and 5. There was no significant difference between group 3 (33 +/- 6 N) and 5 (28 +/- 6 N) in terms of fixation strengths whereas fixation strengths of these two groups were significantly higher compared to group 4 (20 +/- 3 N) (P = 0.005, P = 0.018, respectively). All-inside vertical suture technique using Viper device revealed comparable primary fixation strength with outside-in vertical suture technique for meniscal repair. We suggest that the Viper device is safe and reliable for meniscal repair.

The intra-articularly located ligament variation of the first metatarsophalangeal joint.

An intra-articularly located ligament in the first metatarsophalangeal joint of the left foot has been detected in a patient. The intra-articular ligament was dorsomedially attached to the head of the first metatarsal and to the inferior part of the articular face of the base of the proximal phalanx of the big toe. In a literature search we could not find any report of a ligament located intra-articularly in this particular joint. Such a variation may have a role in the etiology of hallux valgus.

"Horizontal butterfly" technique in repair of radial meniscus tears: A biomechanical study.

INTRODUCTION: Radial meniscus tears are seen in young patients, especially with anterior cruciate ligament ruptures. Repair of complete radial meniscus tear is necessary for the meniscus functions. The most important factor for success of the meniscus repair is primary stability, but it is still unknown which technique is ideal repair technique. AIM: We developed a new suture technique named Horizontal Butterfly (HB). In this novel technique the contact between meniscal tissue and suture is more than Horizontal Loop (HL) that routinely used today. So, we think that this technique will provide better fixation than HL. We aimed to compare 2 repair techniques (HB vs. HL) using human lateral menisci biomechanically with cyclic loading and load to failure tests. MATERIAL-METHOD: We used 22 intact lateral meniscus obtained from patients that operated (total knee replacement) for varus gonarthrosis in our clinic. All menisci were cut radially. In the first group (n:11) menisci were repaired with standard horizontal loop technique, and in the second group (n:11) horizontal butterfly technique were used for repair. All specimens were tested with load to failure test after cyclic loading test (500 cycle X 5-30 N). RESULTS: Both groups have similar failure load (71,4 ± 17,52 N vs. 77,9 ± 28,49 N; p:0,559) and stiffness (24,46 ± 19,19 N vs. 24,48 ± 15,87 N; p:0,818). HB group has less peak displacement (6,26 ± 1,24 mm vs. 8,4 ± 1,92 mm; p:0,010). CONCLUSION: This novel repair technique decreases the amount of displacement according to standard technique while as strong as standard technique routinely used. In this way; we believe that it will increase the rate of healing in clinical use.

Arthroscopic removal of a subperiosteal osteoid osteoma of the talus.

We report a case of a subperiosteal osteoid osteoma on the talar neck that was removed arthroscopically. Intralesional excision, en bloc resection, and percutaneous ablation techniques have all been used for the treatment of osteoid osteoma. For intra-articular osteoid osteomas, arthroscopy-assisted removal of the tumor has been described in a few case reports. Obtaining a nidus fragment for pathologic evaluation is important during arthroscopic removal of intra-articular osteoid osteomas. Sometimes it is not possible to obtain a specimen for pathologic examination. In the present case, the osteoid osteoma on the talar neck was easily located, the nidus was completely removed, and the tumor was extirpated.

[Atraumatic bilateral patellar tendon rupture in a patient receiving steroid therapy]. / Steroid tedavisi görmekte olan bir olguda travmaya bagli olmayan iki tarafli patellar tendon kopmasi.

Atraumatic bilateral patellar tendon rupture is a rare entity. It is usually due to systemic or local disorders causing tendon degeneration. Early diagnosis and surgical treatment are crucial for recovery of knee functions. Atraumatic bilateral patellar tendon rupture was diagnosed in a 31-year-old female patient who had been receiving steroid therapy for seven years due to systemic lupus erythematosus. She underwent patellar tendon reconstruction with the use of semitendinosus and gracilis tendons. After a follow-up of six months, she could walk without crutches and had a full range of motion.

[A case of acromioclavicular dislocation without coracoclavicular ligament rupture accompanied by coracoid process fracture]. / Bir olguda korakoklaviküler ligamanlarin saglam kaldigi akromiyoklaviküler eklem çikigi ve korakoid çikinti kirigi.

Acromioclavicular joint dislocation with intact coracoclavicular ligaments accompanied by fracture of the coracoid process is a rare injury. The patients are treated with conservative and/or surgical methods. A 30-year-old male patient developed type 3 acromioclavicular dislocation and coracoid process fracture due to a fall in the right shoulder. Both injuries were treated surgically. Following open reduction, the acromioclavicular joint was fixed with a Knowles pin, and the coracoid process was fixed with a 4.0-mm malleolar screw. Active-assisted rehabilitation of the shoulder was initiated a week after surgery. The patient returned to office work with a long arm splint at three weeks. Pain-free, active, and complete shoulder movements were seen in the fifth week. The Knowles pin in the acromioclavicular joint was removed under local anesthesia seven months postoperatively. A year after surgery, he resumed full shoulder functions without pain and there were no signs of complications such as heterotopic ossification.

[Combination of microfracture and periosteal transplantation techniques for the treatment of full-thickness cartilage defects]. / Tam kalinlikta kikirdak defektlerinin tedavisinde mikrokirik ve periost transplantasyon tekniklerinin birlikte kullanimi.

OBJECTIVES: Microfracture and periosteal transplantation techniques were combined in order to enhance the quality of repair for the treatment of full-thickness cartilage defects. METHODS: In 40 mature New Zealand white rabbits, a full-thickness cartilage defect of 4 mm was induced on the weight-bearing surfaces of the medial condyles of the right femur. The rabbits were randomly divided into four groups equal in size. Control animals remained untreated following defect induction. Two groups were either treated with periosteal transplantation or the microfracture technique, while the fourth group underwent combination of the two techniques. All the animals were immobilized for two weeks postoperatively. At the end of 12 weeks, the animals were sacrificed and the specimens were removed for evaluation according to the criteria of the ICRS scale (International Cartilage Repair Society), and with respect to newly regenerated cartilage areas and the number of viable chondrocytes. RESULTS: Specimens treated with the combination of the two techniques exhibited significant differences from the other groups in all criteria of the ICRS scale (surface, matrix, cellular distribution, cell viability, and cartilage mineralization) except for subchondral bone criteria. In addition, the mean number of viable chondrocytes and newly regenerated cartilage areas were the highest in this group (p=0.0001). CONCLUSION: Due to markedly improved quality of repair, the combination of the microfracture and periosteal flap techniques seems to be more effective than either of the techniques used alone in the treatment of cartilage defects.

Acetabuloplasty at the anatomic centre for treating Crowe class III and IV developmental hip dysplasia: a case series.

INTRODUCTION: Total hip replacement in patients with developmental dysplasia of the hip (DDH) is a difficult technical procedure for surgeons to perform because of the potential for these patients to have severe anomalies in their bones and soft tissues. MATERIALS AND METHODS: We performed acetabuloplasty in 54 hips from 44 patients by reaming the posterior wall of the native acetabulum and medialising the acetabular component to restore the anatomic centre of hip rotation using a small cup without bone grafting. Median time to post-surgery follow-up was 5 (range 2-14) years. RESULTS: Prosthetic survival rates in patients after 2 and 5 years post hip replacement were 93% (50/54) and 89% (48/54), respectively. 4 patients required early revision because of malposition and instability of the acetabular cup. 3 patients with Crowe type IV dislocations had transient sciatic nerve palsy and 3 had deep vein thrombosis. CONCLUSIONS: Placement of the acetabular shell using posterior bone stock to provide normal hip rotation is a successful alternative technique for acetabuloplasty in patients with DDH.

[Quadrilateral space syndrome: a case report]. / Kuadrilateral bosluk sendromu: Olgu sunumu.

Quadrilateral space syndrome is a rare entity caused by isolated compression of the axillary nerve in the quadrilateral space. A twenty-seven-year-old male patient presented with a poorly localized shoulder pain and point tenderness on the posterior aspect of the shoulder. Magnetic resonance imaging showed a fibrous band causing quadrilateral space syndrome. Surgical excision of the fibrous band was performed and the axillary nerve was released. The patient became symptom-free after surgical decompression.

[A case of congenital pseudarthrosis of the clavicle]. / Dogustan klavikula psödoartrozu: Olgu sunumu.

Congenital pseudarthrosis of the clavicle is a rare condition of unknown etiology. It usually presents as a painless mass in the clavicular region; however, it may sometimes be associated with pain and weakness in the shoulder. We presented a 21-year-old male patient who had pain and weakness in the right shoulder during sportive and daily vigorous activities due to congenital pseudarthrosis of the clavicle. The patient was successfully treated by excision of the ends of the medial and lateral fragments, reconstruction of the defect with a tricortical iliac crest autograft, and internal fixation of the clavicle with a plate and bone screws. After seven months postoperatively, his complaints disappeared, with a full range of motion and Constant score.

Ultrasonographic appearance of the plantar fasciitis.

PURPOSE: To study high frequency sonographic in the examination of plantar fasciitis (PF), which is a common cause of heel pain. MATERIALS AND METHODS: Our study was done with 25 PF (21 unilateral, 4 bilateral) and 15 control cases of similar age, weight and gender. In this study, the plantar fascial thickness (mainly), fascial echogenity and biconvexity were examined using 7.5 MHz linear phase array transducer. Perifascial fluid collection, fascial rupture and fascial calcification that are rarely seen were also examined. RESULTS: The fascial thickness ranges for the PF cases: for the symptomatic heels: 3.9-9.1 mm (mean: 4.75 +/- 1.52 mm), for the asymptomatic heels: 2.0-5.9 mm (mean: 3.37 +/- 1.0 mm) and for the control group: 2.1-4.7 mm (3.62 +/- 0.68 mm). The results were significantly different in Group I for symptomatic heels and the control group statistically for PF (P < .05). The echogenity of plantar fascia and biconvexity of plantar fascia were the major criteria for symptomatic heels. In three heels (10%), perifascial fluid was diagnosed, in three heels (10%) fascial calcification, in one heel (3%) partial fascial rupture. Subcalcaneal spur was encountered sonographically in both cases of Groups I and II. CONCLUSION: Ultrasonography (US) is the first step for PF, because of its easy and quick performance, availability and high sensitivity of diagnosis, low-cost and free radiation.