Effect of adjuvant hyperbaric oxygen on healing of cartilage lesions treated with microfracture: an experimental study in rats.

PURPOSE: The purpose of this experimental study was to investigate the effect of hyperbaric oxygen (HBO2) therapy combined with microfracture technique in the treatment of cartilage lesions. METHODS: Adult Wistar rats (n=44) were divided into six groups. In Groups A, B, C and D, ICRS* (* International Cartilage Repair Society) grade 4 cartilage lesions were made on the femoral sulcus of both knees. Lesions were microfractured on the left knees; the right knees had no further procedure. Groups E and F had no surgery. Groups A, C and E received HBO2 therapy once a day, six days a week postoperatively. Groups B, D and F had no HBO2 therapy. The animals in Groups A, B, E and F were sacrificed after two weeks; Groups C and D were sacrificed after four weeks. Semiquantitative scale - including filling of defect (microfracture hole), reparative tissue thickness, cell morphology and subchondral bone maturation - was used for evaluation. The Mann-Whitney test was used to compare individual and total scores. RESULTS: Total scores of the two-week group with adjuvant HBO2 therapy were significantly higher (P=0.0007) than the two-week standard treatment group. Except for subchondral bone maturation, individual scores were significantly higher in the two-week group with adjuvant HBO2 therapy. Total scores of the four-week groups were similar. Among individual scores of the four-week groups, filling of the defect (microfracture hole), and subchondral bone maturation were significantly higher (P=0.01, P=0.03) in groups with adjuvant HBO2 therapy. CONCLUSIONS: Adjuvant HBO2 therapy accelerates the healing process of cartilage lesions treated with microfracture in rats.

The effect of environmental pH change on bovine articular cartilage metabolism: implications for the use of buffered solution during arthroscopy?

PURPOSE: The purpose of this study is to determine the immediate effects of pH change on the metabolism of bovine chondrocytes. METHODS: Bovine osteochondral explants were pre-cultured and placed in Ringer's lactate solution. Thirty explants were randomly divided into 3 groups. Buffered Ringer's lactate, pH 7.2, was used in Group I; buffered Ringer's lactate, pH 7.4 (normal bovine knee joint pH), was used in Group II; and this group was also set as the control group. Buffered Ringer's lactate, pH 7.6, was used in Group III. All specimens were soaked for 2 h. RNA yield analyses were performed to evaluate the changes in cartilage metabolism at different pH levels. RESULTS: Mean RNA yields of (hypoxia-induced factor) 1α that were immersed at pH 7.2 and 7.6 were 10.5- and 9.9-fold from base, respectively, which were lower compared to explants at pH 7.4 which was found as 15.2-fold. Mean RNA yields of aggrecan that were immersed at pH 7.2 and 7.6 were 12.2- and 13.6-fold from base, respectively, which were lower compared to explants at pH 7.4 which was found as 20-fold. RNA yields of collagen type II at pH 7.2 and 7.6 were 16.1- and 16.6-fold from base, respectively, which were lower compared to explants immersed at pH 7.4 which was found as 22.1-fold. CONCLUSION: The findings of the presented study suggest that short-term exposures to both acidic and basic pH may have effects on chondrocyte function. Our findings also indicate that exposures to solutions with a pH different from normal by only 0.2 unit could suppress chondrocyte metabolism and RNA synthesis. CLINICAL RELEVANCE: Using buffered irrigation solutions with a pH closer to the normal joint pH could be more physiologic and causes less ultra-structural damage than regular irrigation solutions. LEVEL OF EVIDENCE: II.

Prediction of semitendinosus and gracilis autograft sizes for ACL reconstruction.

PURPOSE: The aim of this study was to predict the hamstring graft sizes prior to anterior cruciate ligament reconstruction surgery in adults by using preoperative magnetic resonance imaging (MRI). METHODS: Fifty-one patients with anterior cruciate ligament rupture were prospectively evaluated. Diameter and cross-sectional areas of the gracilis and the semitendinosus tendons at two different levels were measured separately by preoperative MRI. In surgery, harvested gracilis and semitendinosus tendons were measured individually (2-stranded) and together (4-stranded) by using a graft sizing block. Radiological and operative sizes of the grafts were compared by Pearson's correlation test. ROC analysis was done to determine a possible cutoff value for the preoperative measurements. RESULTS: There were statistically significant correlations between the MR cross-sectional areas of gracilis, semitendinosus, gracilis + semitendinosus and intraoperative graft sizes of 2-stranded gracilis, 2-stranded semitendinosus and 4-stranded gracilis + semitendinosus tendons [P < 0.05]. No significant correlation was observed between the MR diameters of the gracilis, semitendinosus, gracilis + semitendinosus tendons and intraoperative graft sizes of 2-stranded gracilis, 2-stranded semitendinosus and 4-stranded gracilis + semitendinosus tendons [n.s]. CONCLUSION: Cross-sectional areas of the hamstring tendons in MR images can be used to estimate the sizes of hamstring grafts prior to anterior cruciate ligament reconstruction surgery which may be very helpful to predict possible graft insufficiencies and take precautions if needed. LEVEL OF EVIDENCE: Level IV.

Pretzel knot compared with standard suture knots.

PURPOSE: Aim of this paper is to compare the biomechanical properties of the Pretzel knot with the selected arthroscopic knots and to test the mechanical safety of this knot. The hypothesis was that the Pretzel knot may have equal or better mechanical properties than the arthroscopic knots tested in this study. METHODS: SMC, Giant, Dines, Nicky's, Tennessee Slider knots were chosen for comparison. Original and backed configuration of knots were prepared with no. 2 braided polyester sutures. Cyclic loading and load to failure tests were performed. Parameters tested were loop security, maximum elongation and load at failure. Number of steps needed for preparation of each knot was also recorded. One-way ANOVA for repeated measures was performed for all knots. RESULTS: Steps needed for preparation were 2 for Pretzel and Tennessee Slider, 3 for Nicky's, SMC and Dines and 4 for Giant. The Pretzel knot in original configuration had significantly better loop security compared to SMC, Dines, Nicky's and Tennessee knots (P = 0.01). Loads at failure were not significantly different between knots in their original configurations. Giant and Dines knots showed better maximum elongations in cyclic loading (P = 0.0059) and load to failure tests (P = 0.0001). Backing up the knots with 3-RHAPs eliminated most of these significant differences. CONCLUSIONS: Clinically, simplicity and safety are two important components in arthroscopic knot tying. Despite its simple configuration, Pretzel knot has some similar and increased mechanical properties compared to the tested knots that are widely used.

Clinical outcome comparison of suprapectoral and subpectoral tenodesis of the long head of the biceps with concomitant rotator cuff repair: A systematic review.

BACKGROUND: Simultaneous repairs of rotator cuff and biceps tenodesis can be managed by tenodesis of long head of biceps tendon to a subpectoral or suprapectoral area. This review investigated long head of biceps tendon tenodesis with concomitant rotator cuff repair and evaluated the clinical outcomes and incidences of complications based on tenodesis location. METHODS: Medline, Cochrane, and Embase databases were searched for published, randomized or nonrandomized controlled studies and prospective or retrospective case series with the phrases "suprapectoral," "subpectoral," "tenodesis," and "long head of biceps tendon". Those with a clinical evidence Level IV or higher were included. Non-English manuscripts, review articles, commentaries, letters, case reports, and sole long head of biceps tendon tenodesis articles were excluded. RESULTS: From 481 studies, 13 were chosen. In total, 1194 subpectoral and 2520 suprapectoral tenodesis cases were investigated. Postoperative Constant-Murley and American Shoulder and Elbow Surgeons mean scores showed similar good results. In terms of complication incidences, while transient nerve injuries were more commonly seen in patients with subpectoral tenodesis, persistent bicipital pain and Popeye deformity are mostly seen in patients with suprapectoral tenodesis. DISCUSSION: Biceps tenodesis to suprapectoral or subpectoral area with concomitant rotator cuff repair demonstrated similar outcomes. Popeye deformity and persistent bicipital pain were higher in suprapectoral area and transient neuropraxia was found to be higher in subpectoral area.Level of evidence: IV.

Adhesion reduction after knee surgery in a rat model by mitomycin C.

The purpose of this study was to investigate the effect of Mitomycin C on reduction in intra-articular fibrotic adhesion formation after knee surgery. Twenty female Wistar Albino rats were divided into two equal study groups. After skin incision, the right knees of animals were opened through a medial parapatellar approach, and the medial and lateral sides of the femoral condyle were exposed. A partial capsulotomy and synovectomy were performed. In group I, Mitomycin C was applied in the articular cavity of rats after hemostasis. An identical volume of sterile normal saline was applied in group II, which served as controls. All rats received weekly (6 weeks) intra-articular both Mitomycin C and saline starting from the day of operation. Animals were killed at 45 days after surgery. The presence and severity of osteo-capsular adhesion was assessed with both macroscopic and microscopic adhesion scoring systems. Results of macroscopic observations showed a significant reduction in both incidence and severity of adhesions in group I compared to group II. Histologically, adhesions in group I were thinner with less collagenic fibers. Microscopic determination of adhesion formation was less in group I, and the difference between groups was statistically significant. Our results suggest that post-operative administration of Mitomycin C may be considered a promising preventive therapy for the reduction in fibro-adhesive scars and consequent stiffness after knee surgery.

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.

The Pretzel knot: a new simple locking slip-knot.

Arthroscopic knot tying is an important part of arthroscopic shoulder surgery. The "Pretzel" knot is a new locking slip-knot, which is simple to learn and prepare. It can slide easily to maintain desired tension and can be locked by a simple maneuver.

A basic arthroscopy course based on motor skill training.

Aim of this study is to introduce, evaluate, and propose a basic arthroscopy training course with interactive methods as using bovine knees, joint models but mainly focusing on practices with motor skill-learning devices. This study presents the results of a skill training program which is based on "motor skill training" theory and using "bovine knees" to simulate a specific task as arthroscopy both in education and evaluation. The participants gave feedback regarding their expectations, fulfillment, and self-evaluation on the degree of their improvement levels, after which their skills were evaluated by an expert while they performed the arthroscopic procedure. During this evaluation of the task, a four-dimensional checklist which was prepared previously by the consensus of three experts was used, and a global grading of each rater was added at the end of the checklist. In this 2-day course, small group teaching sessions are integrated with active and experiential learning methods consisting of short presentations by the educators, demonstrations using joint models and audio-visual teaching material, and significant continuous feedback by the teachers during the proceedings. Participants' expectations and post-course feedback results were obtained using a brief questionnaire which involved mostly open-ended questions. The self-rating of "own basic diagnostic arthroscopy skill" on a scale of 0-10 was completed by the participants both previous to and following the course to establish a student-centered learning environment. Overall rating of the course was asked on a 1-5 (poor-excellent) Likert scale. The questioning of the participants who took part in the course during the last five terms involved a 100% feedback. The overall rating of the course was 4.36 ± 0.47 on the 1-5 scale. The majority of the participants (90%) mentioned that the course met their expectations. The most beneficial activities were accepted to be the arthroscopic procedure applications on bovine knee, repetition of the manipulations under the supervision of the trainers, continuous feedback by experienced staff, and chance for immediate correction during the procedures (35/64). Pre- and post-course self-ratings of the participants inquiring about their ability to perform an arthroscopy alone showed significant improvement (4.2 vs. 7.7 P = 0.000, paired samples t test). All participants were found to be competent in the evaluation of their diagnostic arthroscopy skills on bovine knees. To design a skill teaching course based on the needs of the trainees, focusing on basic motor skill training exercises, and using bovine knee as a simulator is a safe, inexpensive, humanistic, and replicable method that proves a foundation for basic arthroscopic skills learning prior to patient encounter.

Effect of partial medial meniscectomy on the proprioceptive function of the knee.

INTRODUCTION: The aim of this study was to assess the proprioception of the partial meniscectomized knee and to assess if there is an effect on the knee proprioception. MATERIALS AND METHODS: We performed a case-control study involving patients with meniscus tear at the posterior horn of medial meniscus. Group 1 composed of 19 patients, with an average age of 26.3 years, who were enrolled after sustaining an injury to the medial meniscus. Twenty healthy individuals, with an average age of 25.1, without history of knee injury, constituted Group 2. In order to document the proprioceptive capabilities of the knee, angle reproduction tests were performed. RESULTS: At a mean of 2 years after the surgery, there was no difference between the meniscectomized and healthy knee regarding the angle deviations in the lower flexion angles (15 degrees , 30 degrees , 45 degrees ). However, mean knee joint position sense (KJPS) at 60 degrees reproduction in Group 1 and 2 was 64.3 (SD 5.3) and 69.2 (SD 4.9), respectively. Concomitantly, mean KJPS at 75 degrees reproduction in Group 1 and 2 were 80.1 (SD 6.59) and 74.4 (SD 5.6), respectively. Paired t test showed a statistically significant difference between Group 1 and 2 when compared to control angle deviations at 60 degrees and 75 degrees reproductions (P < 0.05). CONCLUSION: KJPS of the patients in meniscectomized group was poorer than the patients in healthy knee group at 60 degrees and 75 degrees knee flexion degrees. Those results indicated that even a partial absence of menisci causes a deterioration of proprioceptive functions of the knee.

The effect of loop size on loop security and elongation of a knot.

INTRODUCTION: While repairing a teared rotator cuff tendon with suture anchors and horizontal mattress suture configurations, knots should be secure at time zero while approximating the tendon to the bone, otherwise any failure in loop security may cause undesired clinical results. Optimum distance between suture limbs passed through the tendon, in other words the bite size, is still not clear in the literature. The aim of this study was to test the effect of loop size, which is directly related to the bite size, on loop security and elongation of a knot. HYPOTHESIS: We hypothesized that a knot with a smaller loop size would be more secure. We asked if a knot with shorter circumference (1) would offer a better knot security; (2) would produce less elongation following repeated traction cycles. MATERIAL AND METHODS: Two parallel metal rods in 3.0mm diameter were fixed to load cells of dynamic testing machine. Four groups, from A to D, had the initial rod to rod distances of 2-4-6-8mm respectively (n=10). Surgeon's knots were prepared with 2/0 Ultrabraid® sutures around the rods. A tension meter was used for tying each half hitch under equal tension. Crosshead distances were recorded after 7N pre-load and subsequent 1000 repetitive cyclic loads between 7-30N. RESULTS: Elongations after a 7N preload for groups A to D were 0.107mm (±0.006), 0.143mm (±0.018), 0,16mm (±0.025), 0.185mm (±0.018) respectively. This increase was significant (p<0.05, power>0.95) between each group except between groups B and C. Maximum elongations after 1000th cycle for groups A to D were 0.32mm (±0.124), 1.12mm (±0.333), 1.162mm (±0.211), 1.292mm (±0.241) respectively. Only samples in group A (0.732mm±0.124) elongated significantly less than others (p<0.05, power >0.95). No knots unravelled or ruptured. DISCUSSION: This study basically reports that a knot with a shorter loop circumference has superior properties regarding loop security and resistance to elongation. From the perspective of clinical importance, shorter distance between suture limbs of mattress configuration may provide a more secure fixation of the rotator cuff tendon to the bone. LEVEL OF EVIDENCE: II.

The Clinical and Biomechanical Performance of All-Suture Anchors: A Systematic Review.

PURPOSE: This systematic review aimed to clarify the relative strengths and weaknesses of the all-suture anchors (ASAs) in both clinical and experimental studies. Our hypothesis was that there would be similar clinical and experimental data for ASAs regarding the biomechanical properties, clinical outcomes and complication rates. METHODS: A systematic review of MEDLINE and Embase databases was performed. The inclusion criteria for clinical studies were both retrospective or prospective study design and minimum 1-year follow-up; for biomechanical studies, the inclusion criteria were performance on either cadaver and animal bones or synthetic surfaces. Studies were excluded if the studies were not in English or if they were review articles, commentaries, letters, case reports, or technical notes. The risk of bias assessment was done using the Methodological Index for Non-randomized Studies (MINORS) tool. RESULTS: We included 13 experimental and 3 clinical studies. The least displacement under cyclic loading was recorded with Q-Fix. Failure mode was mostly by suture breaking for the Q-Fix, whereas anchor pullout was the most common for the others. Cadaver humerus' greater tuberosity seemed to be less durable for the ASAs. Tests on cadaver glenoid showed similar biomechanical properties when compared to a control anchor. Studies investigating clinical and radiologic findings were very few, and only 3 case series were included in this review. Clinical findings of patients treated with ASAs for instability and rotator cuff repair showed satisfactory results and little increase in the complication rate (retear or revision surgery because of loose anchor). CONCLUSIONS: ASAs have similar or better biomechanical properties compared to regular anchors. Low-profile design seems to be an important advantage. Case series can not distinguish between the possible clinical benefits and/or risks. CLINICAL RELEVANCE: ASAs have similar biomechanical properties when compared with other types of anchors. Their strength and performance vary with anatomic location, which may influence clinical success.

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.

Preventing blood-induced joint damage with the use of intra-articular iron chelators: an experimental study in rabbits.

INTRODUCTION: This animal model was designed to evaluate the effect of intra-articular iron-chelator treatment in the prevention of blood-induced joint disease. METHOD: Thirty domestic male rabbits were divided into three equal groups. One milliliter of homologous blood was injected into the left knee of each rabbit in groups 1 and 2. In the second group, 0.1 ml desferroxamine mesilate (DM) was also injected to the blood. In group 3, the animals received injections of 0.1 DM which was mixed with equal amounts of sterile saline solution. The joints were injected three times each week for 12 weeks. At the end of 12 weeks, the knee joints of each rabbit were examined. RESULTS: The synovium in group 1 was found statistically significantly thicker than in group 2. Obvious erosion and ulceration of the cartilage were seen in all joints in group 1 and absent in group 2. Iron-chelator treatment reduced the formation of blood-induced joint damage in rabbit knees by inhibiting the iron-catalyzed formation of destructive oxygen metabolites that has an effect on joint cartilage and synovium.

Dislocation of os trigonum presenting as a loose body in the ankle.

UNLABELLED: Dislocation of the os trigonum presenting as a loose body is a rare clinical entity. In this report, we describe the case of a 34-year-old male who presented with symptoms of acute left ankle pain that was aggravated by motion and weight bearing. He also displayed lateral collateral ligamentous laxity, without the presence of an effusion. Radiographic inspection revealed a 10 x 15-mm loose body within the ankle joint cavity. Arthroscopic intervention showed the loose body to be round and smooth, and it could not be deformed with the tip of a probe, although it could be displaced up to 5 mm with ankle manipulation, in particular with inversion stress of the ankle. The loose body was removed with an arthroscopic forceps. Based on its location within the ankle, and the lack of any articular cartilage on the removed joint fragment, we determined the loose body to represent a dislocated os trigonum. The rarity of this case presentation makes one consider the association of symptomatic os trigonum with ankle instability. LEVEL OF CLINICAL EVIDENCE: 4.

[Correlation of basic motor skills with arthroscopic experience]. / Temel motor becerilerin artroskopik deneyim ile iliskisi.

OBJECTIVES: One of the methods in motor skill teaching is to furnish the students with the individual skills drawn from the target procedure. This method requires identification and defining of all components of the target procedure. This study aimed to define basic motor skills composing arthroscopic skillfulness. METHODS: A total of 42 orthopedists (mean age 38+/-8 years) were enrolled. The study group was comprised of 17 experienced orthopedists working at least for 10 years as a specialist and performing more than 50 arthroscopic procedures per year. The control group included 25 young orthopedists or residents having an arthroscopic experience of less than three years. All the participants were assessed simultaneously and in the same experimental setting. Each participant was tested after having been shown to use in vitro skill development instruments simulating arthroscopic basic motor skills. RESULTS: Compared to the control group, the experienced group had significantly higher mean age (42 vs. 34.4 years), longer duration of arthroscopic experience (12.4 vs. 1.6 years), and greater number of the arthroscopies performed per year (93.9 vs. 26.9) (p=0.000). The mean anticipation time (p=0.028) and two-arm coordination time (p=0.043) were significantly shorter in the experienced group. In correlation analysis, duration of arthroscopic experience was correlated with the mean anticipation time (r=-0.41, p=0.008) and two-arm coordination time (r=-0.33, p=0.033). In addition, the mean anticipation time decreased significantly as the number of arthroscopies increased (r=-0.446, p=0.003). CONCLUSION: Some basic motor skills correlate with arthroscopic competence. The use of these motor skill instruments in arthroscopy training may aid to improve arthroscopic skills.

[A case of multiple congenital anomalies including agenesis of the anterior cruciate ligament]. / On çapraz bag agenezisini de içeren çoklu dogustan anomalili bir olgu.

Congenital absence of the anterior cruciate ligament (ACL) is a very rare anomaly. It is usually diagnosed during arthroscopic intervention. We presented a 15-year old male patient whose diagnosis was based on findings of physical examination and magnetic resonance imaging. Congenital absence of the ACL was associated with femoral shortening, dysplasia of the tibial intercondylar eminence, valgus knee, and compensatory scoliosis. Since the patient had no instability symptoms, and due to the presence of a negative pivot-shift test and multiple congenital anomalies, surgical treatment was not considered.

[Tuberculosis of the knee joint: a case report]. / Diz eklemi tüberkülozu: olgu sunumu.

Tuberculosis may develop in the skeletal system apart from its primary location, the lungs. A 22-year-old male patient presented with complaints of severe pain and swelling in the left knee and difficulty in walking. The symptoms first appeared 12 years before and he underwent open surgical debridement and arthroscopic debridement at two other centers, at which time aspiration cultures taken from the knee yielded no growth. Physical examination showed a painful left knee with swelling, increased temperature, effusion, and limited range of motion. Based on history, physical examination, radiological studies, and laboratory findings, knee osteoarthritis was considered secondary to nonspecific septic arthritis and knee arthrodesis was performed. At surgery, marked destruction of articular cartilage and synovial hypertrophy were observed. In addition, a cavitary lesion was detected, about 1 x 1 cm in size, in the lateral femoral condyle without articular involvement. Biopsy cultures taken from the lesion showed growth of Mycobacterium tuberculosis in the third week. This enabled a diagnosis of tuberculosis of the knee joint and antituberculous drug therapy was instituted. At six months postoperatively, the patient was on antituberculous treatment and had a painless knee.

[Approach to cartilage lesions and algorithm for treatment]. / Kikirdak lezyonlarina yaklasim ve tedavi algoritmasi

Cartilage symptoms in the knee may be encountered in various forms in orthopedic practice. The first stage from history to treatment is to establish the diagnosis; if the diagnosis is made as a cartilage lesion in the knee, priority must be given to current treatment approaches. The surgeon must provide information regarding etiology, defect thickness, lesion size, the containment of cartilage, localization, stability, meniscal integrity, anatomic alignment of the knee, previous assessments, radiological assessment (direct radiography, magnetic resonance imaging), and general, medical, and systemic conditions, and family history. In this review, a treatment algorithm is presented for the management of articular cartilage lesions.

[Primary surgical repair with the Krackow technique combined with plantaris tendon augmentation in the treatment of acute Achilles tendon ruptures]. / Akut Asil tendonu yirtiklarinda Krackow yöntemiyle primer tamir ve plantaris tendonu ile güçlendirmenin uzun dönem sonuçlari.

OBJECTIVES: We evaluated the long-term results of acute Achilles tendon ruptures treated with primary end-to-end repair with the Krackow technique combined with augmentation using the plantaris tendon. METHODS: Thirty-six patients (31 males, 5 females; mean age 34 years; range 21 to 42 years) underwent primary surgical repair for acute Achilles tendon ruptures. Most of the patients (31/36) were involved in regular sportive activities. Surgery included end-to-end repair with the Krackow technique (locking-loop) combined with plantaris tendon augmentation. All the patients received a standardized progressive postoperative rehabilitation program. The results were evaluated with respect to time to return to work and preinjury activity levels and by a scoring system covering objective and subjective parameters. The mean follow-up was 54 months (range 28 to 78 months). RESULTS: At surgery, 34 patients (94.4%) and two patients (5.6%) were found to have complete and partial ruptures, respectively. The mean operation time was 50 minutes (range 40 to 70 minutes). The patients returned to work after a mean of eight weeks (range 6 to 9 weeks) and to preinjury sportive activities after a mean of 17 weeks (range 14 to 20 weeks). The overall mean scoring was good (88 out of 100) at the end of a year follow-up. Early or late complications included superficial wound infections in five patients and partial rupture recurrence in one patient. CONCLUSION: Our results showed that the Krackow technique combined with plantaris tendon augmentation and a rehabilitation protocol aiming early motion enabled physiological tendon healing.