How useful is elastography in the follow-up of achilles tendon repair? / Quão útil é a elastografia no acompanhamento do reparo do tendão do calcâneo?

ABSTRACT Introduction: In addition to conservative modalities in the treatment of Achilles tendon injuries, open, percutaneous and minimally invasive semi-open techniques, as well as biological open surgical repair methods are used as surgical options. Compression elastography is one of the methods used for the follow-up of treatment in Achilles tendon injuries. Methods: 23 patients were included in our study between July 2013 and June 2014, as long as they had at least 4 years of follow-up. In the final control, the intact side and the operated side were both examined and compared. The variables were the American Orthopedic Foot and Ankle Score (AOFAS) which is measured as a functional score considering plantar flexion and dorsiflexion; calf circumference; Achilles tendon anteroposterior (AP) diameter; and elastographic examination. Results: The strain ratio value and AP diameter of the patients was significantly higher on the operated side than on the non-operated side (p <0.001). There was no significant difference between the plantar flexion and dorsiflexion degrees on the operated side of the patients(p> 0.05). No correlation was observed between strain ratio and AOFAS (p: 0,995). Conclusion: Elastography is not a useful technique to evaluate functional results on long-term tendon healing. Level of Evidence III; Retrospective comparative study.

RESUMO Introdução: Além de métodos mais conservadores de terapia, utilizam-se, como opções cirúrgicas para o tratamento das lesões do tendão do calcâneo, técnicas abertas, percutâneas e semiabertas minimamente invasivas, bem como métodos cirúrgicos de reparo aberto. A elastografia por compressão é um dos métodos utilizados para o acompanhamento do tratamento das lesões do tendão do calcâneo. Métodos: Entre julho de 2013 e junho de 2014, 23 pacientes com pelo menos 4 anos de seguimento foram incluídos em nosso estudo. No controle final, o lado intacto e o lado operado foram examinados e comparados. As variáveis foram o American Orthopaedic Foot and Ankle Score, que foi medido como pontuação funcional por meio da flexão plantar e dorsiflexão; a circunferência da panturrilha; o diâmetro anteroposterior (AP) do tendão do calcâneo; e exame elastográfico. Resultados: O índice de tensão e o diâmetro AP dos pacientes foram significativamente maiores no lado operado do paciente que no lado não operado. Não houve diferença significativa entre os graus de flexão plantar e dorsiflexão dos pacientes no lado operado (p> 0,05). Não foi observada correlação entre strain ratio e AOFAS(p: 0,995). Conclusão: Acreditamos que a elastografia não seja uma técnica útil para avaliar os resultados funcionais na cicatrização do tendão em longo prazo. Nível de evidência III; Estudo comparativo retrospectivo.

Comparison of changes in the ankle after unicondylar knee arthroplasty and high tibial osteotomy / Comparação clínica e radiológica das alterações no tornozelo após artroplastia unicondilar do joelho e osteotomia tibial alta

ABSTRACT Objectives: We aimed to compare the changes in the coronal alignment of the ankle joints and their clinical effects after high tibial osteotomy (HTO) and unicondylar knee arthroplasty (UKA). Methods: 50 HTO and 54 UKA patients who were operated on for medial knee osteoarthritis between 2013 and 2018 were retrospectively evaluated. The hip-knee-ankle angle (HKA), the medial proximal tibial angle (MPTA), the tibial plafond inclination (TPI) and the talar inclination (TI) angles were measured before and after operation. Visual analog scale (VAS), short form 36 (SF-36), and ankle-hindfoot scale (AHS) scores of both groups were evaluated and recorded. Results: Angular changes in the HKA, MPTA, TPI and TI values showed significantly greater values in the HTO group (p<0.001). When asymptomatic and symptomatic cases were compared, it was found that changes in the HKA, TPI and TI values were significantly greater in symptomatic cases in the HTO group (p<0.05). A significant decline was observed in the VAS, SF-36 and AHS scores in the HTO group in the postoperative period (p<0.05). In intergroup evaluations, a significant decline was detected in pain and functional scores of the HTO group when compared to the UKA group (p<0.05). Conclusion: Unicondylar knee arthroplasty can be a good alternative to HTO in selected cases for postoperative ankle complaints. Level of Evidence III; Therapeutic Studies Investigating the Results of Treatment.

RESUMO Objetivos: Nosso objetivo foi comparar as alterações noalinhamento coronal das articulações do tornozelo e seus efeitos clínicos após osteotomia tibial alta (OTA) e artroplastia unicondilar do joelho (AUJ). Métodos: 50 pacientes de HTO e 54 de AUJ operados de osteoartrite medial do joelho entre 2013 e 2018 foram avaliados retrospectivamente. O ângulo quadril-joelho-tornozelo (QJT), o ângulo tibial proximal medial (ATPM), a inclinação do platô tibial (IPT) e os ângulos de inclinação talar (IT) foram medidos no pré- e pós-operatório. A escala visual analógica (VAS), forma curta 36 (SF-36), e a escala tornozelo-retropé (ETR) de ambos os grupos foram avaliadas e registradas. Resultados: Alterações angulares nos valores de QJT, ATPM, IPT e IT mostraram valores significativamente maiores no grupo OTA (p<0,001). Quando os casos assintomáticos e sintomáticos foram comparados, verificou-se que as alterações nos valores de QJT, IPT e IT foram significativamente maiores nos casos sintomáticos no grupo OTA (p<0,05). Observou-se declínio significativo nos escores VAS, SF-36 e ETR no grupo HTO no pós-operatório (p<0,05). Nas avaliações intergrupos, foi detectado declínio significativo na dor e nos escores funcionais do grupo OTA quando comparado ao grupo AUJ (p<0,05). Conclusão: Em casos de queixas pós-operatórias quanto ao tornozelo, a artroplastia unicondilar do joelho pode ser uma boa alternativa para OTA. Nível de evidência III; Estudos Terapêuticos Investigando Resultados de Tratamento.

Reverse sural flap: Our clinical experience with car tire injuries in the anterolateral aspect of the foot.

BACKGROUND: Defects due to car wheel injury at the anterolateral aspect of the foot are challenging due to the characteristics of the region and the trauma. The aim of this study was to present the results of the patients whose skin defects on the dorsolateral aspect of the foot due to tire injuries were treated with reverse sural artery fasciocutaneous flaps. METHODS: Fourteen patients with a mean age of 26.9 years (range: 5-46 years) who experienced loss of tissue at the dorsolateral aspect of the foot due to tire injury between the years 2000 and 2014 were evaluated retrospectively. The mean defect size was 27.1 cm2. The patients were followed up for observing the tissue coverage and complications throughout a mean period of 32.4 months. RESULTS: Despite the development of marginal necrosis in two flaps in the early period, tissues in all cases were successfully covered without requiring additional reconstruction. Primary donor site coverage was achieved in all patients without any donor site problems. CONCLUSION: In case of tire injuries at the anterolateral aspect of the foot, low complication and high success rates can be achieved with a case-based approach with reverse sural artery fasciocutaneous flap coverage.

Can fracture healing be accelerated by serum transfer in head trauma cases? An experimental head trauma model in rats.

OBJECTIVES: In this study, we aimed to investigate whether the positive union effect caused by head trauma could be transferred between individuals. MATERIALS AND METHODS: Seventy-two male rats with an average weight of 375 g were used in this study and divided into four groups including 18 in each group. Group 1 consisted of serum donor rats that were exposed to head trauma, while Group 2 consisted of study rats with long bone fractures that were given the serum obtained from the rats in Group 1, Group 3 included control rats with isolated long bone fractures, and Group 4 included control rats with both head trauma and long bone fractures. For radiological evaluation, the ratio of the width of the callus to the width of the neighboring diaphysis was considered as the callus-to-diaphyseal ratio in the study and control groups. Histopathological and radiological evaluations was made on Days 10, 20, and 30. RESULTS: In evaluation of the radiological data regarding the callus-to-diaphyseal ratio, Group 3 was found to have significantly lower radiological values than Group 4 on Day 10 (p=0.006). Group 2 had significantly higher values than Group 3 (p=0.02). On Day 20, Group 2 exhibited significantly higher radiological values than Group 3 (p=0.004), but lower than Group 4 (p=0.032). As for Day 30, Group 2 exhibited significantly higher radiological values than Group 3, but lower than Group 4 (p=0.001). In the evaluation of the Huo scores obtained for histopathological evaluation, there was no significant difference among the groups on Days 10, 20, and 30 (p=0.295, p=0.569, and p=0.729, respectively). CONCLUSION: Our study results suggest that the osteoinductive effect after head trauma can be transmitted between individuals by means of serum transfer.

Procedural Outcomes of Double Vs. Single Fluoroscopy for Fixing Supracondylar Humerus Fractures in Children: A Case-Control Study.

BACKGROUND: Supracondylar humerus fractures (SHFs) are frequently seen in the pediatric population. The aim of this study was to compare single- and double-fluoroscopy methods for the closed reduction and percutaneous pinning (CRPP) of Gartland type 2 and type 3 SHFs. MATERIALS AND METHODS: Forty patients who underwent surgery between March 2016 and April 2018 were evaluated retrospectively. Twenty-one patients (group 1) who received double fluoroscopy and 19 patients (group 2) who had single fluoroscopy were evaluated. The preparation period, surgical duration, radiation exposure time, fracture types, sex distributions, distribution of sides, radiologic results at the third month, cosmetic and functional results, and the incidence of complications were recorded. RESULTS: The mean age of the patients in group 1 and group 2 was 4.76 and 4.68 years, respectively. The mean preparation time of group 1 was 11.3 min; whereas in group 2, it was 8.7 min (p < 0.01). The mean surgical duration was 31.76 min in group 1, and 40.47 min in group 2 (p < 0.01). The mean radiation exposure time in group 1 and group 2 was 41.19 and 47.36 s, respectively (p = 0.04). There were statistically significant differences between the two groups in terms of the preparation period, surgical duration, and radiation exposure time. Radiation exposure time and surgical duration were significantly shorter in group 1; the preparation period was shorter in group 2. CONCLUSIONS: The double-fluoroscopy technique can significantly reduce surgical duration and radiation exposure time during surgery while treating SHFs of children.

Does radiological evaluation of endobutton positioning in the sagittal plane affect clinical functional results in single-bundle anterior cruciate ligament reconstruction?

INTRODUCTION: Sports injuries are increasing today due to the increased interest in sports. The most common injured knee ligament is the anterior cruciate ligament (ACL) in sport injuries. Accordingly, surgical treatment of the ACL is performed frequently. In this study, it was aimed to retrospectively evaluate whether the location of an endobutton on lateral knee radiography was effective on knee functional scores in patients who underwent ACL reconstruction. MATERIALS AND METHODS: One hundred thirty patients who underwent ACL reconstruction between January 2015 and February 2019 were identified. The patients were divided into three groups according to the location of the endobutton on lateral radiographs taken in the postoperative period. Group 1 patients were classified as anterior, group 2 as middle, and group 3 as posterior according to the location of the endobutton. Functional scoring, physical examination tests, comparative thigh diameter measurements, and single-leg hop tests were compared between the groups. It was evaluated as to whether there was a statistically significant difference between the groups. RESULTS: There were 38 patients in group 1, 63 patients in group 2, and 29 patients in group 3. The mean age was 29.1 in group 1, 29.1 in group 2, and 29.7 in group 3. The mean follow-up period of the patients was 18.4 months in group 1, 19.1 months in group 2, and 21.4 months in group 3. The average Lysholm score was 92.9 in group 1, 93.3 in group 2, and 91.7 in group 3. The mean modified Cincinnati scores were 27.0, 27.1, and 26.6, respectively, in the groups. The mean IKDC score of the subjective knee assessments was 92.5, 92.8, and 91, respectively, according to the groups. The average thigh atrophy value was 1 cm, 1 cm, and 1.2 cm, respectively, in the groups. In the single-leg hop test, 34 patients in group 1 jump to over 85% of the distance compared with the intact side, while 58 patients in group 2, and 23 patients in group 3 were successfully able to jump this distance. The effect of the placement of the endobutton in the anterior, middle or posterior was not statistically significant on functional scores and physical examination results. In patients with endobuttons in the middle, functional scores were found better than in those with anterior or posterior placement. CONCLUSIONS: No statistically significant differences were found in clinical functional results when comparing patients' endobutton location on femur. For this reason, surgical time should not be extended using unnecessary extra effort to change the orientation of the exit hole during surgery.

Histopathological and immunohistochemical investigation of the local and systemic effects of tranexamic acid on the healing of the Achilles tendon in rats.

OBJECTIVES: This study aims to compare the effects of systemic and local applications of tranexamic acid (TXA) on tendon healing using a rat Achilles tendon injury model. PATIENTS AND METHODS: Thirty-six adult male albino Wistar rats (aging 3-4 months; weighing 350 to 400 g) were used in this study conducted between December 2019 and January 2020. The Achilles tendon was performed bilateral tenotomy and surgically repaired. Postoperatively, 1 mL of TXA was administered to each leg locally in the local group, whereas 2 mL of TXA was intraperitoneally administered in the systemic group. The control group was left untreated. Half of the rats were sacrificed on Day 15 and the other half on Day 30. Tendon healing was evaluated with the Bonar and the Movin scoring systems and immunohistochemical methods. RESULTS: The systemic group had the highest Bonar and Movin scores on Day 15. All groups exhibited tendon healing on Day 30, with no significant differences among the groups. The tenocyte morphology was found to be more impaired in both TXA groups on Day 30 (p=0.013). Ground substance scores were lower in the systemic group on Day 30 (p=0.028). The fiber structure and arrangement scores were higher in the systemic group on Day 15 (p=0.007 and p=0.032). Immunohistochemical analyses showed that galectin-3 values exhibited a significant difference in all groups on Day 30 (p=0.020). In all groups, it was determined that type I collagen values showed an increasing trend on Day 30, compared to the values on Day 15, whereas type III collagen values showed a decreasing trend. CONCLUSION: Our results demonstrated that local and systemic use of TXA does not impair tendon healing. Although advanced studies are needed, our study suggests that TXA application reduces the development of fibrosis.

CHANGES IN BONE MINERAL DENSITY AFTER TOTAL KNEE ARTHROPLASTY.

OBJECTIVE: We aimed to investigate the change in bone mineral density (BMD) in the first postoperative year in patients that underwent total knee arthroplasty (TKA) due to primary osteoarthritis of the knee. METHODS: Preoperative and first postoperative year dual-energy X-ray absorptiometry measurements of 76 patients with knee osteoarthritis, who undergone surgery between 2016 and 2018 due to the recommendation for TKA, were statistically evaluated in the study. RESULTS: Of the 19 patients with a normal BMD in the preoperative period, 73.7% (n = 14) continued to have a normal BMD in the postoperative period. Of the 34 patients with a low BMD (osteopenia) in the preoperative period, 91.2% (n = 31) did not show any change, whereas osteoporosis was observed in two patients (5.9%) in the postoperative period. Of the 23 patients with osteoporosis in the preoperative period, 95.7% (n = 22) did not show any change, whereas osteopenia was observed in one patient (4.3%) in the postoperative period. Both the T and Z scores of the spine (L1-L4) and proximal femur showed a slightly positive trend, however, with an insignificant statistical difference (p ≥ 0.05). CONCLUSION: Patients that underwent TKA experienced a statistically insignificant bone gain at the spine and proximal femur twelve months after the surgery. Level of Evidence III, Therapeutic Studies Investigating the Results of Treatment.

OBJETIVO: O objetivo foi investigar a alteração na densidade mineral óssea (DMO) no primeiro ano pós-operatório em pacientes submetidos à Artroplastia Total do Joelho (ATJ) por osteoartrite primária do joelho. MÉTODOS: As medidas de absortiometria radiográfica com dupla energia no pré-operatório e no primeiro ano pós-operatório de 76 pacientes com osteoartrite do joelho, operados entre 2016 e 2018 devido à indicação de ATJ, foram avaliadas estatisticamente no estudo. RESULTADOS: Dos 19 pacientes com DMO normal no pré-operatório, 73.7% (n = 14) continuaram com DMO normal no pós-operatório. Dos 34 pacientes com baixa DMO (osteopenia) no pré-operatório, 91.2% (n = 31) não apresentaram alteração, enquanto osteoporose foi observada em dois pacientes (5.9%) no pós-operatório. Dos 23 pacientes com osteoporose no pré-operatório, 95.7% (n = 22) não apresentaram alteração, enquanto osteopenia foi observada em um paciente (4.3%) no pós-operatório. Os escores T e Z da coluna vertebral (L1-L4) e do fêmur proximal mostraram uma tendência levemente positiva, mas a diferença foi estatisticamente insignificante (p ≥ 0.05). CONCLUSÃO: Os pacientes submetidos à ATJ apresentaram um ganho ósseo estatisticamente insignificante na coluna vertebral e no fêmur proximal doze meses após a cirurgia. Nível de Evidência III, Estudos Terapêuticos - Investigação dos resultados do tratamento.

Analysis of the coracoid morphology with multiplanar 2D CT and its effects on the graft size in the Latarjet procedure.

PURPOSE: In this study, we aimed to reveal the individual differences regarding the size of the coracoid and their effects on the classical and modified Latarjet procedures. METHODS: Computed tomography images of 120 patients (mean age: 41.18 ± 12.01 years) without shoulder complaints or shoulder instability were evaluated retrospectively. The glenoid width, the surgical graft length, and the coracoid total length, width, and thickness were measured using the multiplanar reconstruction method on the Sectra Picture Archiving and Communications System (PACS) system. Age, gender, side, the dominant hand, and the height of the patients were recorded and the correlations between them were investigated. On the created hypothetical model, the current size of the coracoid was evaluated to determine what size of glenoid defects it could repair by employing the classical and the modified Latarjet techniques. RESULTS: There was no significant difference between the right-hand-dominant group and the left-hand-dominant group in terms of coracoid measurement results (p > 0.05). Again, there was no statistically significant difference between the right and the left side regarding the coracoid size (p > 0.05). A positive correlation could be detected only between age and the coracoid width and thickness (p < 0.05). A positive correlation was also found between the glenoid width and the coracoid width and thickness in both shoulders (p < 0.001). Coracoid thickness could fill in the defects that amounted to 40% of the glenoid width, while the coracoid width could fill in for the defects that were 50% of the glenoid width in both genders. CONCLUSION: Our study showed that hand dominance and side were not effective on the coracoid dimensions. In addition, it has been shown that the coracoid dimensions did not have a significant effect in the choice of Latarjet technique in terms of defect repair and that repair rates of up to 40% could be achieved in glenoid defects with both techniques.

Changes in bone mineral density after total knee arthroplasty / Alterações na densidade mineral óssea após artroplastia total do joelho

ABSTRACT Objective: We aimed to investigate the change in bone mineral density (BMD) in the first postoperative year in patients that underwent total knee arthroplasty (TKA) due to primary osteoarthritis of the knee. Methods: Preoperative and first postoperative year dual-energy X-ray absorptiometry measurements of 76 patients with knee osteoarthritis, who undergone surgery between 2016 and 2018 due to the recommendation for TKA, were statistically evaluated in the study. Results: Of the 19 patients with a normal BMD in the preoperative period, 73.7% (n = 14) continued to have a normal BMD in the postoperative period. Of the 34 patients with a low BMD (osteopenia) in the preoperative period, 91.2% (n = 31) did not show any change, whereas osteoporosis was observed in two patients (5.9%) in the postoperative period. Of the 23 patients with osteoporosis in the preoperative period, 95.7% (n = 22) did not show any change, whereas osteopenia was observed in one patient (4.3%) in the postoperative period. Both the T and Z scores of the spine (L1-L4) and proximal femur showed a slightly positive trend, however, with an insignificant statistical difference (p ≥ 0.05). Conclusion: Patients that underwent TKA experienced a statistically insignificant bone gain at the spine and proximal femur twelve months after the surgery. Level of Evidence III, Therapeutic Studies Investigating the Results of Treatment.

RESUMO Objetivo: O objetivo foi investigar a alteração na densidade mineral óssea (DMO) no primeiro ano pós-operatório em pacientes submetidos à Artroplastia Total do Joelho (ATJ) por osteoartrite primária do joelho. Métodos: As medidas de absortiometria radiográfica com dupla energia no pré-operatório e no primeiro ano pós-operatório de 76 pacientes com osteoartrite do joelho, operados entre 2016 e 2018 devido à indicação de ATJ, foram avaliadas estatisticamente no estudo. Resultados: Dos 19 pacientes com DMO normal no pré-operatório, 73.7% (n = 14) continuaram com DMO normal no pós-operatório. Dos 34 pacientes com baixa DMO (osteopenia) no pré-operatório, 91.2% (n = 31) não apresentaram alteração, enquanto osteoporose foi observada em dois pacientes (5.9%) no pós-operatório. Dos 23 pacientes com osteoporose no pré-operatório, 95.7% (n = 22) não apresentaram alteração, enquanto osteopenia foi observada em um paciente (4.3%) no pós-operatório. Os escores T e Z da coluna vertebral (L1-L4) e do fêmur proximal mostraram uma tendência levemente positiva, mas a diferença foi estatisticamente insignificante (p ≥ 0.05). Conclusão: Os pacientes submetidos à ATJ apresentaram um ganho ósseo estatisticamente insignificante na coluna vertebral e no fêmur proximal doze meses após a cirurgia. Nível de Evidência III, Estudos Terapêuticos - Investigação dos resultados do tratamento.

Management of upper extremity war injuries in the subacute period: A review of 62 cases.

OBJECTIVE: In this study, we aimed to describe the relationship between the localization of rarely seen upper extremity war injuries and their complications in the subacute period, and define our preferences for surgery and antibiotic use. METHODS: Patients with an upper extremity war injury who presented to our institution between 2015 and 2018 were retrospectively evaluated. Data regarding demographics, time between injury and presentation, location of injury, type of damage, complications, treatment methods, infection rates and antibiotic use were recorded. Tissue defects, fracture fixation, neurovascular damage, infection development and treatment approaches were analyzed. RESULTS: Sixty-two male patients with isolated upper extremity injuries (mean age: 31.66 ± 8.28 years) were included in the study. The average time between trauma and hospitalization was 14 days. The mean hematocrit (Hct) level at presentation was 36.3 ± 6.8%. Patients had been followed up for an average period of 95.6 ± 32.1 days. Twenty-nine patients (46.8%) had nerve injury, eight (12.9%) had arterial injury that required repair, and 23 had infection (37.1%), of which five developed osteomyelitis. Infection was polymicrobial in nine cases and monobacterial in 14. A positive correlation was found between the presence of fracture and nerve injury (p = 0.013). The frequency of nerve injuries due to gunshot wounds was higher in the mid-section and lower part of the arms and in the proximal forearm when compared to other regions (p = 0.011). The infection rates were significantly higher in patients with fractures (p = 0.033). The mean hematocrit (Hct) level at presentation of the patients with infection (32.1 ± 6.3%) was significantly lower than that of those who did not have infection (38.8 ± 5.9%) (p<0.001). CONCLUSION: Upper extremity war injuries require case-specific solutions. Microbiological samples should be taken prior to empirical antibiotic treatment for infection management and rational antibiotic use principles should be applied according to the culture and antibiogram results. The holistic and ambiguous character of nerve injuries often requires early exploration and combined reconstructive interventions. Arterial injuries can be overlooked by physical examination alone and thus routine angiography should be performed. Completion of the bone and soft tissue reconstructions in the same session using a holistic approach minimizes the possible risks.

Tuberculosis osteomyelitis of the tibia mimicking Brodie abscess: A case report and review of the literature.

BACKGROUND: Tuberculosis osteomyelitis is rarely seen in the diaphyseal bones. It may be confused with Brodie's abscess due to similar clinical, radiological and laboratory findings. Late diagnosis of the disease causes bone destruction. Tuberculosis osteomyelitis of the bone is a rare condition caused by the Mycobacterium tuberculosis. Its incidence has increased in Western countries in recent years due to HIV infection, increasing elderly population and emerging resistant strains. The slow progress of tuberculous osteomyelitis, due to lack of significant elevations in the laboratory values and changes in the radiographic appearance, often leads to confusion with the subtypes of subacute osteomyelitis, defined as Brodie's abscess. These two low-virulence clinical cases often lead to delays in diagnosis and progressive bone destruction. CASE PRESENTATION: We report a 65-year-old male patient who presented to our clinic with pain, swelling and sensitivity in the left leg. Diagnosed with infection in the tibia, the patient had undergone antibiotherapy. However, the patient's symptoms were not resolved and we performed bone curettage and cementation. M. tuberculosis-specific DNA was detected by real-time polymerase chain reaction and the M. tuberculosis complex was produced from the perioperative samples. CONCLUSION: In conclusion, histopathological examination and polymerase chain reaction are essential before surgery of subacute and chronic osteomyelitis with atypical clinical, laboratory and radiological findings for early diagnosis and accurate treatment.

A new method for diagnosis of anterior cruciate ligament tear: MRI with maximum flexion of knee in the prone position: A case control study.

BACKGROUND: The diagnosis of anterior cruciate ligament tear can be made by physical examination and magnetic resonance imaging (MRI) in the supine position. In cases where the tear is partially evaluated on MRI, the choice of treatment may vary. The purpose of the study was to investigate the efficiency of MRI at maximum knee flexion in the prone position and to compare the images with findings of the ACL detected during surgery. MATERIALS AND METHODS: Sixty-one patients with partial ACL tears with meniscal and cartilage lesions requiring arthroscopic knee surgery were included in the study between 2017 and 2019. MRI of these patients was prescribed at maximum knee flexion in the prone position. Then, an arthroscopic operation was performed on 61 patients and the findings (intact, partial or total tear of ACL) were recorded. The ACL was evaluated as being intact and partial or total tear. The statistical significance of the efficacy of MRI in the supine position with the knee at maximum flexion in the prone position was compared. RESULTS: It was found that, of 61 patients with suspected partial ACL tears, 25 patients had intact ACLs, 22 patients had partial tears and 14 patients had total ACL tears, through the interpretation of MRIs of the prone position by the radiologist. In the arthroscopic surgery of 61 patients, 20 patients had intact ACLs, 27 patients had a partial tear and 14 patients had a total tear. The MRI results with maximum knee flexion in the prone position were more compatible with the findings of the arthroscopic surgery. CONCLUSIONS: It could be considered that MRI with maximum knee flexion in the prone position may also be guiding in the diagnosis and treatment of patients with partial anterior cruciate ligament rupture.

Arthroscopic Hemitrapeziectomy and Suture Button Suspensionplasty in the Treatment of First Carpometacarpal Joint Eaton-Littler Stage 2-3 Arthrosis.

Background Degenerative arthritis of the first carpometacarpal (CMC) joint is a common degenerative condition in the hand. Many different surgical procedures have been applied for years. However, in the studies there is no consensus about the superiority of one technique to another. Questions/Purposes In this study, we evaluated the results of the patients with first CMC Eaton-Littler stage 2-3 arthrosis who were operated to prevent first metacarpal joint lateral subluxation and migration with arthroscopic hemitrapeziectomy and suture button suspensionplasty. Patients and Methods Between 2011 and 2014, 21 patients (16 female, five male) were evaluated retrospectively. Mean age was 52.3 years. The preoperative and postoperative assessments were performed with visual analog scale (VAS) and disabilities of the arm, shoulder, and hand score (DASH) scores. The Kapandji's thumb opposition score was used to assess thumb range of movement. The patients were assessed after arthroscopy according to Badia classification. Results Mean follow-up period was 50.1 months. According to Badia classification, seven patients were found to be type 2 and 14 patients were type 3. The mean preoperative Kapandji's score was 7.6 and the mean postoperative Kapandji's score was 9.2. The mean VAS values were 8.2 preoperatively and 1.9 postoperatively. The mean preoperative DASH value was 23.4 and the mean postoperative DASH value was 5.5. The mean preoperative grip strength was 66.2 and the mean postoperative grip strength was 75.1. The mean preoperative pinch strength was 14.8 and the mean postoperative pinch strength was 20.2. Conclusion Arthroscopic hemitrapeziectomy and suture button suspensionplasty is a minimal invasive technique and can be performed with low morbidity in the treatment of first CMC joint Eaton-Littler stage 2-3 arthrosis. By this technique, the patients' existing instability and pain problems can be solved. Complications, such as loosening of the suture button at the first metacarpal at the postoperative period due to direct trauma to the first CMC joint, could be avoided using a new suture button. Type of Study/ Level of Evidence Therapeutic IV.

Does anterolateral ligament rupture affect functional outcomes in patients who underwent an anterior cruciate ligament reconstruction?

BACKGROUND: Studies have shown that the anterolateral ligament contributes to knee stability. This study aims to compare the results of postoperative physical examinations, knee joint stability tests, and functional assessment tests of patients with intact anterolateral (AL) ligaments and patients with ruptured anterolateral (AL) ligaments. MATERIAL AND METHOD: This study consisted of 101 patients, with at least a 12-month follow-up period, who underwent an anterior cruciate ligament reconstruction between 2010 and 2016, and whose AL ligaments were evaluated by the radiologist with the preoperative and postoperative magnetic resonance images (MRI). Of these patients, 41 had intact AL ligament (Group 1) in MRI and other 60 had ruptured AL ligament (Group 2). Groups were compared according to postoperative physical examinations, knee joint stability tests, and functional assessment tests. RESULTS: The average Lysholm score of Group 1 was 94.9 (range: 81-100), and the score of Group 2 was 87.2 (range: 74-100). The modified Cincinnati score of Group 1 was 28.7 (24-30), while the score of Group 2 was 25.6 (21-30). The average IKDC subjective knee evaluation score of Group 1 was 91.9 (range: 83-100), and the score of Group 2 was 86.6 (range: 75-100). The average thigh atrophy value was 1.5 centimeters (cm) in Group 1 and 2.4 cm in Group 2. Thirty-three patients in Group 1 were able to jump over 85% of the distance in single-legged hop test compared to the intact side, while 16 patients in Group 2 were able to jump over this distance successfully. As a result of the analysis, it was determined that the Lysholm activity scoring results, the Modified Cincinnati scoring results, IKDC subjective knee evaluation results, two-cycle IKDC activity scale results, comparison of thigh diameters and the single-legged hop tests of two groups showed a statistically significant difference, and the results of the patients with intact AL ligaments who underwent an ACL reconstruction were found to be better (p < 0.05). No significant difference was found in other examinations and tests. CONCLUSION: Since the rupture of the AL ligament has negative effects on functional outcomes, we think that the reconstruction of the AL ligament in the same session with the ACL reconstruction or later will have a positive effect on functional outcomes.

Effect of nonoperative concomitant intraarticular pathologies on the outcome of arthroscopic capsular release for adhesive capsulitis of the shoulder.

OBJECTIVE: The aim of this study was to investigate whether coexistent intraarticular lesions are negative prognostic factors for the results of arthroscopic capsular release in frozen shoulder patients. METHODS: Seventy-two patients who met inclusion criteria and underwent arthroscopic capsular release between March 2011 and August 2015 for the frozen shoulder were retrospectively evaluated. The patients were divided into two groups according to existence of concomitant intraarticular pathologies detected during arthroscopy. Preoperative and postoperative functional results were assessed with Constant score and shoulder ranges of motion; and the amount of pain was evaluated using visual analog scale (VAS). RESULTS: Group I consisted of 46 patients (mean age 47.2 years and mean follow-up 26 months) without concomitant shoulder pathologies and group II consisted of 26 patients (mean age 48.6 years and mean follow-up 15 months) with coexistent lesions (SLAP lesions, n = 8; SLAP and partial rupture of the RC, n = 4; SLAP, partial rupture of RC and impingement, n = 10; SLAP and impingement, n = 2; and AC arthritis and impingement, n = 2). Preoperatively, the mean ranges of forward flexion (p = 0.221), abduction (p = 0.065), internal rotation (p = 0.564), Constant (p = 0.148) and VAS (p = 0.365) scores were similar between the groups. After a minimum 12 months of follow-up, all patients significantly improved but no statistically significant difference was detected in the mean ranges of forward flexion (152 vs 150; p = 0.902), abduction (137 vs 129; p = 0.095), external rotation (45 vs 40; p = 0.866), internal rotation (5 vs 5 point; p = 0.474), Constant (82 vs 82.3; p = 0.685) and VAS (1.2 vs 1.2; p = 0.634) scores between the groups. CONCLUSION: The presence of concomitant shoulder pathologies does not appear to affect the clinical outcomes in patients undergoing arthroscopic capsular release for frozen shoulder. LEVEL OF EVIDENCE: Level III, Therapeutic study.