Clinical and Functional Outcomes of Suture Versus Headless Screw Fixation for Tibial Eminence Fractures in Children.

BACKGROUND: Suture and screw fixations are widely used to treat tibial eminence fractures (TEFs). Although a few biomechanical and clinical studies have compared suture fixation (SF) and screw fixation in the treatment of TEFs in children, no comparative clinical studies are available regarding headless screw fixation (HSF). PURPOSE: To evaluate the clinical and functional outcomes of children with TEF who underwent SF and HSF. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The study included 24 patients treated with either SF (11 patients) or HSF (13 patients) within 1 month of TEF (type 2 or 3) without associated ligamentous and bone injury between 2015 and 2020. All patients were evaluated at a minimum 2-year follow-up in terms of Lysholm score, Tegner activity level, International Knee Documentation Committee subjective score, and isometric strength test. Knee stability was compared based on the Lachman test, pivot-shift test, and KT-1000 arthrometer side-to-side difference. RESULTS: No significant differences were found between the 2 groups in terms of Lysholm score, Tegner activity level, and International Knee Documentation Committee subjective score at follow-up. All patients were able to resume their daily activities within 6 months after the injury. However, flexion deficits (6°-10°) were found in 2 patients in the SF group and 1 patient in the HSF group, and extension deficits (3°-5°) were found in 3 patients in the SF group and 1 patient in the HSF group, without significant intergroup difference. Stability based on the Lachman test, pivot-shift test, and KT-1000 arthrometer side-to-side difference was also similar between the 2 groups at follow-up. No statistically significant difference was found between the 2 groups in isometric tests performed. CONCLUSION: The present study is the first to compare the clinical and functional results of SF and HSF techniques. The HSF technique demonstrated comparable clinical and functional outcomes, suggesting its potential as an alternative to the SF technique.

Histomorphometric and biomechanical evaluation of the osseointegration around micro- and nano-level boron-nitride coated titanium dental implants.

INTRODUCTION: Titanium dental implants has been coated with different materials such as polymers and biomimetic agents, bone morphogenetic protein, calcium phosphate to enhance surface properties of the titanium implants for osseointegration. The aim of this study was to evaluate the bone tissue healing around Boron Nitride-coated (BN-coated) titanium implants histomorphometrically and biomechanically and also observe the effect of different coating thicknesses on osseointegration. MATERIALS AND METHODS: BN was coated on dental titanium implants with two different coating thicknesses by using RF magnetron sputtering system. Totally fifty-four implants were inserted into the tibias' of 12 New Zealand rabbits bilaterally under general anesthesia. All animals were sacrificed after 4-weeks. Bone-implant contact (BIC) and new bone area/total area ratios (BATA) were calculated. Also, the removal torque (RT) test was performed. RESULTS: The highest new bone area in the medullary cavity was around the nano-BN-coated surface with 15.70%. In micro-BN-coated surface and control group, this ratio was determined as 10.48% and 8.23%, respectively. The BIC ratios in upper-side of implants and cortical-associated BIC ratios in lower-side were found significantly higher in control and micro-BN-coated group than nano-BN-coated group (p < 0.05). Similar BIC values were observed between control and micro-BN-coated groups (p > 0.05). BATA values did not show statistically significant differences between all three groups (p > 0.05). The RT values measured in all groups were found comparable and no statistically significant differences were found (p > 0.05). CONCLUSION: No inflammatory reaction developed around any implant. Relatively more new bone formation around nano-BN-coated titanium implants indicates the promising osseoinductive effect of BN coating. BN-coated implants showed similar biomechanical and histomorphometrical outcomes to that of the conventional titanium implants through a 4-week evaluation period.

Micro-ct findings of concentrated growth factors (cgf) on bone healing in masquelet's technique-an experimental study in rabbits.

INTRODUCTION: A recent histopathological and immunohistochemical study has proved that the addition of concentrated growth factors (CGF) to the Masquelet's technique contributes to the quality of the membrane formed, in respect of inducing inflammation and proliferation, maintaining vascularization on large diaphyseal bone defects, and increasing the number of stem cells. The aim of the study is comparison of radiological results of this combination treatment by micro-CT. MATERIALS AND METHODS: The study was planned on a critical bone defect model in rabbit radius. Group I and Group III were the control groups to which only the Masquelet's technique is applied. Group II and Group IV were CGF groups in addition to the Masquelet's technique. CGF was prepared by centrifugation of rabbit's own blood. For early phase, Groups I and II were evaluated in the 8th week, while for late phase, Group III and Group IV were evaluated in the 12th week. Groups were compared in terms of bony union radiologically by micro-CT(µCT) (New Bone Volume (NBV), Total Bone Volume (TBV) and NBV/TBV) and histopathologically. RESULTS: The structural parameters, including NBV, TBV, NBV/TBV were higher in the early- (8th week) and late-phase (12th week) CGF group. There was no statistically significant difference between CGF and control groups in early phase, (p = 0.153), while in late phase, CGF group was significantly higher of new bone volume than the control group, 246.3 mm3 (196.1-258) and 169.6 mm3 (154.3-235.9), respectively (p = 0.028). For early phase, control group was significantly lower than late-phase control group, 121.8 mm3 (88.8-144.4) and 169.6 mm3 (154.3-235.9), respectively (p = 0.006). The ratio of New Bone Volume to Total Bone Volume (NBV/TBV ratio) in CGF groups was significantly higher compared to the control groups 27.3% (24.7-29.6), 35.3% (32.1-38.6) (p = 0.032) and 39.7% (36.7-41.6), 55.3% (52-57.5) (p = 0.002), respectively. Histopathologically, Microscopic New Bone Formation had no statistically significant difference between control and CGF groups in early phase (8th week) (p = 0.153), while in late phase (12th week), CGF group had significantly higher amount of new bone formation than the control group, 0.29 µm2 (0.27-0.36), 0.51 µm2 (0.42-0.59), respectively (p = 0.008). CONCLUSION: The addition of CGF to the Masquelet's technique is an important method for supporting new bone formation in large diaphyseal bone defects. LEVEL EVIDENCE: Level III, therapeutic/care management.

Combined clinical test and magnetic resonance imaging have similar diagnostic values in the diagnosis of subscapularis tear.

PURPOSE: The aim of the present study was to compare the diagnostic values of clinical tests and magnetic resonance imaging (MRI) which used for the diagnosis of subscapularis (SSc) tears in the patients who underwent arthroscopic rotator cuff surgery. METHODS: Two-hundred and nine consecutive patients who underwent arthroscopic rotator cuff surgery between 2015 and 2019 were analyzed. The lift-off test, belly-press test and bear-hug test were performed preoperatively. 1.5 T MRI scans of all patients were evaluated for SSc integrity. The diagnostic values of both clinical tests and MRI were calculated. SSc tears were graded according to Fox and Romeo. Arthroscopic findings were used as the gold standard for diagnosis of SSc tears. RESULTS: There were 54 SSc tears accounting for an prevalence of 29%. The BHT showed the greatest sensitivity for both type II-II-IV (73.3%) and all types of (68.5%) SSc tears. The sensitivity and specificity of the combined test and MRI were 91.1-87.2% and 93.3-90.8% in Type II-III-IV SSc tears, respectively, and 81.5-88.6% and 88.9-94.7% in all SSc tears, respectively. There were no statistically significant difference between combined test and MRI in terms of sensitivity and specificity (n.s.). CONCLUSION: The present study is the first that compared both clinical tests and MRI with arthroscopic findings in terms of sensitivity and specificity in the same patient group. A combination of clinical tests increases their diagnostic values and shows similar sensitivity and specificity as MRI. LEVEL OF EVIDENCE: I.

Should We Prefer Magnetic Resonance Imaging to Physical Examination in Meniscal Tears.

The aim of this study was to compare the sensitivity, specificity, accuracy, positive and negative predictive values of magnetic resonance imaging (MRI), and clinical examination in the diagnosis of meniscus tears with the findings obtained from the knee joint arthroscopy. A retrospective study was made of 452 patients who underwent knee arthroscopy due to meniscus tears between 2012 and 2017. Physical examination was performed using the Thessaly's, McMurray's, and Joint line tenderness tests (JLTT). On preoperative MRI, medial meniscal tears were observed in 292 patients, lateral meniscal tears in 96 patients, and medial and lateral meniscal tears in 64 patients. According to the arthroscopy results, 284 patients had medial meniscal tears, 108 patients had lateral meniscal tears, and 60 patients had medial and lateral meniscal tears. Sensitivity and specificity of the JLTT was determined as 93 and 86% respectively for medial meniscal tears and 94 and 89% for lateral meniscal tears. The McMurray's test was 60% sensitive, 68% specific for medial meniscal tears (MMT), and 73% sensitive and 68% specific for lateral meniscus tears (LMT). The Thessaly's test was 93% sensitive and 87% specific for medial meniscal tears; and 94% sensitive and 88% specific for LMT. Compared with the arthroscopic findings, MRI was observed to have sensitivity of 94% for MMT and 84% for LMT. For specificity, the values were 89% for MMT and 91% for LMT. Accuracy was 89% for MMT and 86% for LMT. In comparison with the arthroscopic findings, the triple test was determined to have sensitivity of 92% for MMT and 89% for LMT. The specificity was 88% for MMT and 91% for LMT. The results of this study showed that a combination of selected physical examination methods is as sensitive as MRI in the diagnosis of meniscus tears.

Surgical treatment of acetabulum posterior wall fractures: Comparison between undercountering and marginal impaction reconstruction method with odd methods.

BACKGROUND: Modern treatment principles for posterior wall fractures have become widespread in the last decade in many countries by means of international or local courses. The purpose of this study was to compare the clinical and radiologic outcomes of acetabulum posterior wall fractures using unconventional methods of fixation, including plates placed in unusual directions, or, in the case of reoperation, only interfragmentary screws. In addition, we examined acetabulum posterior wall fractures treated by open reduction and internal fixation with standard undercountered plates from ischion to iliac bone in latter cases. METHODS: Twenty-one patients who had open reduction and internal fixation of an unstable unilateral fracture of the posterior wall of the acetabulum between 2009 and 2013 were included. Group 1 was composed of 10 former patients who were treated with unconventional methods that included a compression technique with a direct plate or solely screw fixation. Group 2 was composed of latter 11 patients who were treated with standard surgery that included undercountered plates oriented from the ischial tuberosity to the iliac bone proximally and reconstruction of marginal impaction if necessary. The functional outcome was evaluated with the use of the clinical grading system adopted by Merle d'Aubigné and Postel. The Kellgren-Lawrence radiologic criteria were used for the radiologic assessments. The reduction of the fracture, posterior dislocation, marginal impaction, mean fracture particle amount, trochanteric osteotomy and avascular necrosis were compared between the two groups and examined with the Mann-Whitney U test. RESULTS: In Groups 1 and 2, the median score of the modified Merle d'Aubigné and Postel clinical scoring system was 16 (8-18) and 18 (14-18), respectively. The clinical scores between the two groups were statistically significant (p < 0.01). When two groups were compared using the Kellgren-Lawrence radiographic criteria for the development of osteoarthritis, the median value in Groups 1 and 2 was 3 (0-4) and 1 (0-3), respectively (p < 0.01). CONCLUSIONS: This study displays the evolution of the surgical treatment of acetabular fractures of the posterior wall in our clinic. The older methods failed in terms of exposure, diagnosis of fracture anatomy and fixation techniques. Patients treated after the surgeons took courses in this field showed evidence of superior clinical and radiological scores. We attribute these benefits to exposure, definition and treatment of marginal impaction and fixation principles.

Two-Stage Surgery for the Malleolar Fracture-Dislocation With Severe Soft Tissue Injuries Does Not Affect the Functional Results.

Soft tissue injuries associated with malleolar fracture-dislocations may increase postoperative rates of wound complication. Ankle-spanning frame plays a fundamental role in the local damage control orthopedics while gaining time for definitive surgery. The objective of this study was to evaluate the effect of a 2-stage surgery for the unstable malleolar fracture-dislocations with severe soft tissue injuries compared to a 1-stage surgery in terms of the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot-ankle and Olerud-Molander ankle scores (OMAS). We analyzed 45 patients who met our study criteria. The patients were divided into 2 groups according to staged surgeries. Demographic data of patients, comorbidities, alcohol and tobacco use, Tscherne soft tissue injury scores, the AOFAS hindfoot-ankle and OMAS, postoperative complications, total hospitalization times, waiting time between stages, and waiting time from admission to surgery times were investigated. There was a statistically significant difference between the groups in terms of the mean total hospitalization times (p = .007), waiting time from admission to surgery (p < .001), gender (p = .005), and Tscherne soft tissue injury scores (p < .001). The mean AOFAS hindfoot-ankle and OMAS of the groups did not differ statistically at a minimum of 12 months of the follow-up period (p = .094 and p = .126, respectively). A 2-stage surgery can be performed safely in the carefully selected patients with the unstable malleolar fracture-dislocations with Tscherne grades 2 and 3 soft tissue injuries, and this surgery does not affect the postoperative AOFAS hindfoot-ankle and OMAS statistically compared to a 1-stage surgery at a minimum of 12 months of the follow-up period.

IS FUNCTIONAL OUTCOME BETTER AFTER ARTHROPLASTY FOR TROCHANTERIC FRACTURES IN OLDER ADULTS?

OBJECTIVES: This article evaluated functional recovery and mortality after surgery to repair trochanteric fracture with regard to treatment technique through one year of follow-up. METHOD: Eighty consecutive patients with trochanteric fractures were divided into two groups according to treatment technique (osteosynthesis and arthroplasty). We evaluated patient data including age, sex, time to surgery, total hospital stay, transfusion volume, and functional status according to FIM (Functional Independence Measure) scores. Scores for FIM were assessed three times: prior to fracture, six months after surgery, and one year after surgery. RESULTS: Patients who received osteosynthesis had shorter hospital stays than arthroplasty patients. The arthroplasty group had significantly higher functional independence six months after surgery, while no difference was detected one year after surgery. Patient age, transfusion volume, and FIM scores were detected as significant predictors of mortality. CONCLUSION: Trochanteric fractures lead to unavoidable functional loss, although this can be reduced in the short term by treating with arthroplasty instead of osteosynthesis. Age, transfusion and functional situation predict one-year mortality for patients with trochanteric fractures. The patient's functional situation must be considered when choosing treatment for trochanteric fractures in order to reduce patient morbidity. Level of Evidence II; Therapeutic prospective study.

OBJETIVO: Este artigo avaliou a recuperação funcional e a mortalidade após cirurgia de fratura do quadril com relação à técnica de tratamento durante um ano de acompanhamento. MÉTODO: Oitenta pacientes consecutivos com fraturas trocantéricas foram divididos em dois grupos, de acordo com a técnica de tratamento (osteossíntese e artroplastia). Avaliamos os dados dos pacientes quanto a idade, sexo, tempo até a cirurgia, estadia hospitalar total, volume de transfusão e estado funcional de acordo com a pontuação da MIF (Medida de Independência Funcional). A MIF foi avaliada três vezes: antes da fratura, seis meses e um ano após a cirurgia. RESULTADOS: Os pacientes submetidos à osteossíntese tiveram menor tempo de hospitalização do que os pacientes de artroplastia. O grupo artroplastia teve independência funcional significativamente maior seis meses depois da cirurgia, enquanto nenhuma diferença foi detectada um ano após a cirurgia. Idade, volume da transfusão e a pontuação MIF dos pacientes foram detectadas como preditores importantes da mortalidade. CONCLUSÃO: As fraturas trocantéricas levam à perda funcional inevitável, embora ela possa ser reduzida a curto prazo com a artroplastia ao invés da osteossíntese. A idade, a transfusão e a situação funcional são preditores significativos de mortalidade em um ano em pacientes com fraturas trocantéricas. A situação funcional dos pacientes deve ser considerada ao escolher o tratamento de fraturas trocantéricas para reduzir a morbidade dos pacientes. Nível de Evidência II; Estudo prospectivo terapêutico.

Is functional outcome better after arthroplasty for trochanteric fractures in older adults? / O resultado funcional é melhor depois da artroplastia para fraturas trocantéricas em idosos?

ABSTRACT Objectives: This article evaluated functional recovery and mortality after surgery to repair trochanteric fracture with regard to treatment technique through one year of follow-up. Method: Eighty consecutive patients with trochanteric fractures were divided into two groups according to treatment technique (osteosynthesis and arthroplasty). We evaluated patient data including age, sex, time to surgery, total hospital stay, transfusion volume, and functional status according to FIM (Functional Independence Measure) scores. Scores for FIM were assessed three times: prior to fracture, six months after surgery, and one year after surgery. Results: Patients who received osteosynthesis had shorter hospital stays than arthroplasty patients. The arthroplasty group had significantly higher functional independence six months after surgery, while no difference was detected one year after surgery. Patient age, transfusion volume, and FIM scores were detected as significant predictors of mortality. Conclusion: Trochanteric fractures lead to unavoidable functional loss, although this can be reduced in the short term by treating with arthroplasty instead of osteosynthesis. Age, transfusion and functional situation predict one-year mortality for patients with trochanteric fractures. The patient's functional situation must be considered when choosing treatment for trochanteric fractures in order to reduce patient morbidity. Level of Evidence II; Therapeutic prospective study.

RESUMO Objetivo: Este artigo avaliou a recuperação funcional e a mortalidade após cirurgia de fratura do quadril com relação à técnica de tratamento durante um ano de acompanhamento. Método: Oitenta pacientes consecutivos com fraturas trocantéricas foram divididos em dois grupos, de acordo com a técnica de tratamento (osteossíntese e artroplastia). Avaliamos os dados dos pacientes quanto a idade, sexo, tempo até a cirurgia, estadia hospitalar total, volume de transfusão e estado funcional de acordo com a pontuação da MIF (Medida de Independência Funcional). A MIF foi avaliada três vezes: antes da fratura, seis meses e um ano após a cirurgia. Resultados: Os pacientes submetidos à osteossíntese tiveram menor tempo de hospitalização do que os pacientes de artroplastia. O grupo artroplastia teve independência funcional significativamente maior seis meses depois da cirurgia, enquanto nenhuma diferença foi detectada um ano após a cirurgia. Idade, volume da transfusão e a pontuação MIF dos pacientes foram detectadas como preditores importantes da mortalidade. Conclusão: As fraturas trocantéricas levam à perda funcional inevitável, embora ela possa ser reduzida a curto prazo com a artroplastia ao invés da osteossíntese. A idade, a transfusão e a situação funcional são preditores significativos de mortalidade em um ano em pacientes com fraturas trocantéricas. A situação funcional dos pacientes deve ser considerada ao escolher o tratamento de fraturas trocantéricas para reduzir a morbidade dos pacientes. Nível de Evidência II; Estudo prospectivo terapêutico.

Calcaneal Avulsion of an Ochronotic Achilles Tendon: A Case Report.

Alkaptonuria is a hereditary disorder of phenylalanine and tyrosine, with an incidence of approximately 1/200,000 to 1/1,000,000. Ochronosis is the accumulation of homogentisic acid and its metabolites in connective tissues such as the tendons, cartilage, and skin. In the present case study, a 50-year-old male presented with a nontraumatic calcaneal avulsion without a previous diagnosis of ochronosis. To the best of our knowledge, little information has been reported of this pathology in the Achilles tendon and the surgical management.

Lateral parapatellar and subvastus approaches are superior to the medial parapatellar approach in terms of soft tissue perfusion.

PURPOSE: The arthrotomy techniques of knee surgery may cause varying degrees of disruption to the tissue blood supply. The aim of this study was to investigate the effects of the medial parapatellar (MPPa), midvastus (MVa), subvastus (SVa) and lateral parapatellar (LPPa) approaches on regional tissue perfusion of the knee. METHODS: In this experimental study, a total of 28 female rabbits were applied with four different arthrotomy techniques as Group MPPa, Group MVa, Group SVa and Group LPPa. The blood supply of the tissue around the knee was examined by scintigraphic imaging including the perfusion reserve and T max, and biochemical alteration of the oxidative stress parameters including malondialdehyde (MDA), fluorescent oxidation products (FlOPs), and histopathological findings were evaluated on tissue samples after 3 weeks. RESULTS: The perfusion reserve was increased in all four groups compared to the healthy, contralateral knees. In the Group LPPa, the vascularity was significantly increased compared to the Group MPPa (p = 0.006). In the examination of biochemical parameters, the increase in MDA levels was statistically significant in the Group MPPa compared with the Group LPPa (p = 0.004), and in the Group MVa compared with the Group LPPa (p = 0.006). The increase in the value of MDA levels was striking in the Group MPPa and Group MVa compared with the control group (p = 0.004, p = 0.004, respectively). The increase in another oxidative stress parameter, the tissue FlOPs levels, was statistically significant in the Group MPPa compared with the control group (p = 0.035). CONCLUSION: The LPPa and SVa caused less oxidative stress and less disruption of the muscle blood supply, in biochemical and scintigraphic parameters, compared to the MPPa and MVa. Therefore, in clinical practice, the SVa is preferable to the MPPa and MVa in total knee arthroplasty and the LPPa should be preferred more frequently in selected cases with critical soft tissue viability.

Arthroscopic treatment of synovial chondromatosis in the ankle joint.

INTRODUCTION: Synovial chondromatosis is characterized by the presence of metaplastic cartilage nodules originating from the synovia, bursa and tendon sheaths. Although it is extremely rare in the ankle joint, malignant transformation is possible. The choice of treatment is usually open surgery for excision of loose bodies and synovectomy. Limited data is available concerning arthroscopic approaches. PRESENTATION OF CASE: A 28-year-old male patient was evaluated for pain and swelling of the right ankle joint. Based on the findings of physical examination and radiographic investigations, arthroscopic surgery was performed due to ankle impingement syndrome. A diagnosis of synovial osteochondromatosis was made following the pathological survey. DISCUSSION: Synovial chondromatosis is slowly progressive and is considered to be a self-limiting situation. Treatment strategies are decided on according to the patient's complaints, age and disease stage. Open or arthroscopic surgery. can be performed. Some advantages of arthroscopic surgery are wide visualization areas, easy access to areas difficult to reach, lower morbidity, no necessity for casting and immobilization, early rehabilitation and quick recovery period. CONCLUSION: In conclusion, arthroscopic management can be successful in selected patients with synovial osteochondromatosis localized to the ankle joint.

A staged surgical treatment outcome of type 3 open tibial fractures.

Aim. In these case series which are about type 3 open tibial fractures formed with three different high energy trauma etiologies in different parts of tibia. We aimed to assess our three-stage treatment approach and discuss final results of our elective surgery management with three different fixation methods. Patients and Methods. We assessed 19 patients with type 3 open tibial fractures between 2009 and 2012. Our treatment protocol consisted of three stages. Early intervention in operating room, which including vascular repairs or soft tissue closure, was done if necessary. Definitive surgery was performed using internal or external fixation in the first 15 days. Patients were followed up for at least one year. Last conditions of all our cases were evaluated according to modified Johner and Wruhs criteria. Results. Nine cases were type 3A, seven cases were type 3B, and three cases were type 3C in terms of fracture typing. All patients were followed up for at least one year and mean follow up time was 15 months. In terms of functional and clinical outcome, six cases were evaluated as excellent, eight cases as good, two cases as fair, and three cases as poor. Discussion. Staged treatment option in type 3 open tibial fractures seems to be a good method in reducing complication and achieving the best result. We think that definitive staged treatment protocol including internal fixation with plating or intramedullary nailing (IMN) of the fractures is a reliable method, especially to avoid complications as a result of external fixator and to provide patient rapport.

Arthroscopic treatment of a case with concomitant subacromial and subdeltoid synovial chondromatosis and labrum tear.

Synovial chondromatosis is a disease that seldomly seen in shoulder joint and is related to benign synovial proliferation and synchronous chondral tissue formation within the joint cavity. Patients suffer from progressive restriction of range of motion and shoulder pain. Extra-articular involvement is an extremely rare condition. Degenerative osteoarthritis, joint subluxation, and bursitis are common complications in untreated patients. Open or arthroscopic surgery is suitable while there is no consensus related to superiority of different approaches. We presented an arthroscopic treatment of a male patient, 48 years old with labrum tear and synovial chondromatosis localized in subacromial and subdeltoid region. Advantages of arthroscopic surgery in the presence of intra- and extra-articular combined pathologies are also discussed.

The effect of arthroscopic surgery and intraarticular drug injection to the antioxidation system and lipid peroxidation at osteoarthritis of knee.

OBJECTIVE: To elucidate the effects of arthroscopy and intraarticular hyaluronan therapies on antioxidant enzyme activity and lipid peroxidation. METHODS: This study was conducted between January and May 2005, at the Department of Orthopedics and Traumatology, Suleyman Demirel University, Isparta, Turkey. A total of 60 patients with knee pain who were diagnosed as knee osteoarthritis according to the American College of Rheumatology (ACR) criteria were included in this study and randomly and equally divided into 4 groups. Intraarticular Hylan G-F 20 treatment was given to group 1 for 3 weeks. Intraarticular Hylan G-F 20 treatment plus oral vitamin E were administered to group 2 for 3 weeks. Only arthroscopy treatment was applied to the control group (group 3). Intraarticular Na-hyaluronate treatment was given to group 4 for 5 weeks. Blood and synovial fluid samples were taken from all the patients for biochemical analysis, and the following parameters were measured: superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and malondialdehyde (MDA). RESULTS: There was no significant difference in blood SOD, CAT, GPx levels, and synovial SOD and GPx levels in groups treated with hyaluronan, when compared with the controls. However, there was a significant change in MDA levels in synovial fluid samples of group 1, group 2, and group 4, when compared with the controls. CONCLUSION: In knee osteoarthritis, intraarticular hyaluronan therapy following arthroscopy may diminish lipid peroxidation in synovial fluid.