The potential of posterior cruciate ligament buckling phenomenon as a sign for partial anterior cruciate ligament tears.

INTRODUCTION: Diagnosis of a partial tear of the anterior cruciate ligament (ACL) can be challenging with physical examination and imaging techniques. Although magnetic resonance imaging (MRI) has high sensitivity and specificity for diagnosing complete ACL tears, its effectiveness may be limited when it is used to diagnose for partial tears. The hypothesis of the present study is that the posterior cruciate ligament (PCL) buckling phenomenon, which is a secondary sign of complete ACL tears on MRI, may be a useful method for diagnosing partial ACL tears. MATERIALS AND METHODS: The data of 239 patients who underwent knee arthroscopy in a single institution between 2016 and 2022 were analyzed retrospectively. Patients were divided into three groups based on the condition of their ligaments: partial tears, complete tears and intact ligaments. To evaluate the buckling phenomenon on sagittal T2-weighted MRI, measurements of the posterior cruciate ligament angle (PCLA) and the posterior cruciate ligament-posterior cortex angle (PCL-PCA) were conducted in each group. Subsequently, the ability of these two measurement methods to distinguish partial tears from the other groups was assessed. RESULTS: Both methods provided significantly different results in all three groups. Partial tears could be distinguished from intact ligaments with 86.8% sensitivity, 89.9% specificity when PCLA < 123.13° and 94.5% sensitivity, 93.2% specificity when PCL-PCA < 23.77°. Partial tears could be distinguished from complete tears with 79.5% sensitivity, 78.4% specificity when PCLA > 113.88° and with 86.1% sensitivity, 85.3% specificity when PCL-PCA > 16.39°. CONCLUSION: The main finding of the present study is that the PCLA and PCL-PCA methods are useful on MRI for diagnosing partial ACL tears. PCLA value between 113°-123° and PCL-PCA value between 16°-24° could indicate a partial ACL tear. With these methods, it is possible to distinguish partial tears from healthy knees and reduce missed diagnoses. In addition, the differentiation of partial and complete tears by these methods may prevent unnecessary surgical interventions. LEVEL OF EVIDENCE: Level III.

Does glenoid bone loss accompany posterior shoulder instability with only labral tear? A magnetic resonance imaging-based study.

BACKGROUND: The primary aim of this study was to investigate bone loss in the glenoid with magnetic resonance imaging in posterior shoulder instability with only a labral tear. METHODS: A total of 76 patients operated on because of posterior and anteroposterior shoulder instability only with a labral tear between 2006 and 2019 (n = 40 and n = 36, respectively) were included in this study. The instability type, a presence of an additional superior labrum anteroposterior (SLAP) lesion, the number of dislocations, and the magnetic resonance imaging-based measurements (the glenoid diameter and the bone defect size in the glenoid, the Hill-Sachs lesion [HSL] and the reverse HSL [rHSL] length, the angle and the arc length of HSL and rHSL, and the humerus head diameter and its area) were analyzed. RESULTS: The size of the anterior glenoid defect, the rHSL measurements (length, angle, and arc length), and the ratio of the anterior glenoid defect size to the glenoid diameter were significantly higher for anteroposterior instability (P < .01) cases. There was no significant difference (P = .49, .64, and .82, respectively) for the presence of an additional SLAP pathology, the glenoid diameter, the posterior glenoid defect, and the ratio of the posterior glenoid defect size to the glenoid diameter in posterior and anteroposterior instability groups. The increased number of dislocations was associated with increased rHSL length and total arc length (P = .04 and .03, respectively). An additional SLAP lesion in posterior shoulder instabilities was not associated with the bone defect size (P = .29). CONCLUSION: Although the posterior shoulder instability with only a labral tear is likely to cause a bone defect, we have shown that the instability is not expected to be caused by the bone defect. Therefore, this study points out that only soft tissue repair without considering the bone defect could be promising in this patient group.

Does the presence of arthroscopically detected stage 1-2 glenohumeral osteoarthritis have any clinical impact on the outcome of arthroscopic rotator cuff repairs?

BACKGROUND: : Rotator cuff rupture (RCR) and glenohumeral osteoarthritis (GHO) are two common disorders of the shoulder joint. However, there are very few reports that examine the relationship between them. This study aimed to present at least two years' clinical results of arthroscopic rotator cuff repair of full-thickness and massive tears accompanied by arthroscopically detected early-stage osteoarthritis. METHODS: From August 2016 to December 2017, three hundred and twenty patients with total or massive rotator cuff tears were evaluated retrospectively. Thirty-five patients who were determined as stage 1 and 2 according to the Outerbridge scale for cartilage lesions were found appropriate for investigation. Patients were assessed using the University of California Los Angeles (UCLA) score, and a visual analog scale (VAS) score before surgery and at the final follow-up. The American Shoulder and Elbow Surgeons (ASES) shoulder score was used to evaluate the final outcomes and compare the UCLA shoulder scores. RESULTS: The UCLA scores increased from the preoperative value of 19.1 ± 3.2 to 29.8 ± 4.8 at the last follow-up and increased by an average of 10.7 ± 6.0 (p < 0.001). The median VAS score decreased from the preoperative value of 3.0 to 1.0 (p < 0.001). Besides, the mean ASES score was found as 80.2 ± 10.6. An excellent positive correlation was found between postoperative UCLA scores and ASES scores (r = 0.887; p < 0.001). DISCUSSION: To the best of our knowledge, this is one of the first arthroscopic comparative studies about the effect of early glenohumeral osteoarthritis on clinical outcomes after rotator cuff tear treatment. Finding good and excellent results up to 71% after RCR repair in patients with early-stage osteoarthritis was an indication that arthroscopic repair could be planned as the first-line treatment option for RCR pathologies in patients with early-stage degenerative arthritis without considering the rerupture rate.

Is arthroscopic surgery as successful as open approach in the treatment of lateral ankle instability?

PURPOSE: To evaluate the clinical results of arthroscopic repair and open Ahlgren-Larsson method in patients with chronic lateral ankle instability. METHODS: We retrospectively evaluated 60 patients who were operated in our clinic between 2010 and 2018 with the diagnosis of chronic lateral ankle instability. Preoperative and postoperative clinical evaluations were performed with AOFAS ankle-hindfoot score, FAOS, and VAS scores. RESULTS: Sixty patients with chronic lateral ankle instability were evaluated. 28 patients were treated with Ahlgren-Larsson method, and 32 patients were treated with arthroscopic repair. Follow-up duration was 35 ± 12 months for the open surgery group and 19 ± 2 months for the arthroscopic surgery group. The mean age of the arthroscopy group was 44 ± 9; the mean age of the open surgery group was 46 ± 11. There was no significant difference between the groups in terms of demographic features (age, sex, BMI). Postoperative clinical improvement was observed in both groups. There was no statistically significant difference between the groups in terms of functionality. However, there was a statistically significant difference in VAS in terms of pain and patient satisfaction in favor of arthroscopy group. CONCLUSIONS: Ahlgren-Larsson method and arthroscopic repair technique are safe and effective for chronic lateral ankle instability. Arthroscopic technique may be preferred for pain and patient satisfaction as it is less invasive and less morbid. LEVEL OF EVIDENCE: II.

Evaluation of proprioception in patients who underwent ACL reconstruction: measurement in functional position

Background/aim: Anterior cruciate ligament (ACL) injuries cause mechanoreceptor loss in the joint; therefore, proprioceptive deficits are observed after injury. In particular, proprioceptive measurements made in the functional position give more accurate results, and this is an area that requires further studies. This study aimed to evaluate proprioception in patients who had undergone ACL reconstruction (ACLR) in functional positions used in daily life (closed kinetic chain position), according to joint angles where ACL injuries occur more frequently, in comparison with healthy controls. Materials and methods: Thirty-four participants who underwent ACLR using a hamstring tendon graft (aged 29.18 ± 8.16 years; body mass index (BMI), 26.58 ± 4.02 kg/cm2) and 31 healthy participants (aged 27.35 ± 5.74 years; BMI, 24.76 ± 2.98 kg/cm2) were included. Proprioception was assessed with an active angle repetition test, using an inclinometer in the closed kinetic chain position while standing. Participants were asked to perform single-leg squats until the angle at the knee joint was 30°. After the targeted angle was defined, the participants were asked to find the targeted angle. The difference between the targeted angle and the angle reached by the participants was calculated. Results: A statistically significant difference in the active joint position sense was found among the ACLR extremity, uninvolved extremity, and control extremity (p < 0.05). The proprioceptive sense between the two extremities in the ACLR group was similar, and the proprioceptive sense was worse than that of the control group. Conclusion: To our knowledge, this is the first study to evaluate closed kinetic chain position in patients who underwent ACLR, and it showed that proprioceptive sense was still poor in patients with ACLR compared with the control group, even if an average of 24 months have elapsed since surgery.

Is there any effect of presence and size of os trigonum on flexor hallucis longus tendon lesions?

BACKGROUND: It was hypnotized that presence and larger size of os trigonum (OT) can affect flexor hallucis longus tendon (FHL), so tenosynovitis, degeneration and partial tear can be developed. METHODS: A total of 98 (Study group: 50, Control: 48) subjects included to study and compered status of FHL lesions. Sagittal length and axial width of OT were measured on MRI to determine effect of OT on FHL lesions and correlated with arthroscopic findings. RESULTS: FHL tenosynovitis (p: 0,025), degeneration (p: 0,01) and partial tear (p: 0.008) was identified statistically high in study group. Statistical analysis revealed that as length of OT increased, frequency of degeneration (p: 0.03) and partial tear (p: 0.00) of FHL increased. CONCLUSION: Analyzes were showed that the presence of os trigonum had an important role on the FHL pathologies. Additional finding of study was to demonstrate that possibility of FHL lesion increased as length of OT extended. LEVELS OF EVIDENCE: Level 3.

The high frequency of superior labrum, biceps tendon, and superior rotator cuff pathologies in patients with subscapularis tears: A cohort study.

BACKGROUND: The purpose of this study was to assess the frequency of superior labrum anterior posterior (SLAP) lesions, long head of biceps tendon (LHBT) pathologies, and superior rotator cuff tears accompanying subscapularis tears. We hypothesised that LHBT lesions, superior rotator cuff tears, and especially SLAP lesions were very frequent with subscapularis tears. METHODS: The digital files of patients who underwent shoulder arthroscopy were reviewed retrospectively. One hundred and eleven patients with subscapularis tears evident on surgery videos were examined. Superior labrum, LHBT, and superior rotator cuff lesions were investigated by the authors of this study. The statistical analyses were made with SPSS statistics software, and significance was set at P < 0.05 value. RESULTS: There were 111 patients with both subscapularis tears and surgery videos. The mean age was 58.09 ± 10.21, and 63.1% of the patients were female. 98.2% of the 111 patients had a SLAP lesion. 7.2% of those were SLAP I and 91% were SLAP II lesions while 1.8% were healthy. The 75.7% of the patients had a LHBT pathology, and 83.8% had superior cuff tear. CONCLUSIONS: Subscapularis tears were almost always accompanied by SLAP lesions. On the other hand, biceps tendon pathologies and superior rotator cuff tears were also very frequent with subscapularis tears. LEVEL OF EVIDENCE: Prognostic study, Level IV (retrospective cohort study).

Subscapularis Tendon Slip Number and Coracoid Overlap Are More Related Parameters for Subcoracoid Impingement in Subscapularis Tears: A Magnetic Resonance Imaging Comparison Study.

PURPOSE: To investigate the effects of the subscapularis tendon slip number (STSN) and coracoid morphology by magnetic resonance imaging in patients with and without subscapularis tears. METHODS: Patients who underwent shoulder arthroscopy between February 2004 and June 2015 were re-evaluated. Those with a subscapularis tear (study group) and those with other pathologies (control group) were compared with each other. Magnetic resonance imaging scans and surgery videos of the patients were reassessed. Transverse and sagittal coracohumeral distance (CHD), coracoid overlap (CO), coraco-coracoid base angle (CBA), coracoglenoid distance (CGD), and STSN were measured. RESULTS: The study and control groups comprised 141 and 78 patients, respectively. The mean age was 57.01 ± 10.95 (similar in both the groups). The mean transverse CHD and sagittal CHD were not different between the groups and also between female and male patients. For the study and control groups, the mean CBA and CGD values were also similar. The mean CO was 24.01 ± 4.9 and 21.29 ± 4.58 for the study and control groups, respectively (P < .001). With the receiver operating characteristic curve of the CO, the sensitivity was 62% and the specificity was 64% at the cutoff value of 22.85 mm. The STSN was in the range between 1 and 6; the STSN was 3 or less in 61.5% of the study group and in 38.5% of the control group (P = .005). CONCLUSIONS: The CO was the most valuable parameter predicting any potential subcoracoid impingement, and the STSN was inversely correlated with subscapularis tears. However, in predicting a potential subcoracoid impingement, the CHD measurements were not significant, as well the CGD and CBA. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Arthroscopic-Assisted Latissimus Dorsi Tendon Transfer for Massive, Irreparable Rotator Cuff Tears: Technique and Short-Term Follow-Up of Patients With Pseudoparalysis.

PURPOSE: To describe a modified technique for arthroscopic-assisted transfer of the latissimus dorsi tendon in a selected group of patients with irreparable rotator cuff tears and pseudoparalysis and to evaluate its short-term results. METHODS: Fifteen patients with irreparable rotator cuff tears and pseudoparalysis treated by arthroscopic-assisted latissimus dorsi tendon transfer were included. The mean patient age was 61.53 ± 6.24 years (range, 52-71 years). Patients were assessed with physical examination, University of California Los Angeles (UCLA) Score and Constant-Murley score, as well as visual analog scale score at a mean follow-up of 26.4 ± 2.58 months (range, 24-31 months). RESULTS: At final follow-up, mean UCLA score increased to 27.47 ± 6.31 compared with the preoperative UCLA score of 6.53 ± 2.1 (P < .001). Constant-Murley score was 21 ± 7.41 and 59.73 ± 13.62 (P < .001), visual analog scale pain score was 7.47 ± 1.06 and 2.47 ± 0.91 (P < .001), active forward flexion was 58° ± 21.11° and 130° ± 30.05° (P < .001), active abduction was 51° ± 21.64° and 129.67° ± 25.45° (P < .001), and active external rotation was 13.33° ± 21.68° and 32° ± 18.03° (P < .001) preoperatively and postoperatively, respectively. Mean acromiohumeral distance was 3.13 ± 1.40 mm preoperatively, whereas it was 5.67 ± 1.67 mm postoperatively (P < .001). No significant complications requiring a revision surgery was observed during the final follow-up. CONCLUSIONS: The modified technique of arthroscopic-assisted transfer of the latissimus dorsi tendon is a feasible, minimally invasive option for the surgical treatment of irreparable rotator cuff tears in a subset of patients with pseudoparalysis. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Lesser tuberosity cysts and their relationship with subscapularis tears and subcoracoid impingement.

BACKGROUND: We aimed to evaluate cysts in the lesser tuberosity of humeral head seen on magnetic resonance imaging (MRI) and their relationship with subcoracoid impingement and subscapularis tears evident on arthroscopic surgery videos. Our hypothesis was that the cysts would be more frequent with subscapularis tears and in the case of subcoracoid impingement. METHODS: Patients who underwent shoulder arthroscopy between January 2010 and January 2016 were retrieved to evaluate subscapularis tears on surgery videos and lesser tuberosity cysts (LTC), coracohumeral distances (CHD) on both sagittal oblique and transverse sections of MRI retrospectively. There were 137 patients meeting the study criteria with subscapularis tear evident on surgery video and having preoperatively studied magnetic resonance images. All the tears were classified according to the Lafosse's system. The control group was constituted with 121 patients who underwent shoulder arthroscopy and were diagnosed with no subscapularis tear. Then, any statistically significant relationship between these parameters was investigated by the use of statistics software. RESULTS: The mean age (57), gender distribution (female for 67.1%), and involved shoulder (right for 62.8%) rate of the groups were statistically similar. The existence rate of LTC was 55.5% and 19% for the study and control groups, respectively (P = .000). The study group was then evaluated in two groups regarding the existence of a cyst in the lesser tuberosity. There was no statistical difference between these two groups in terms of coracohumeral distances and tear type (P > .05). The study group was also divided into two depending on the transverse section CHD whether it was under 7 mm or not. There was still no statistical difference between these subgroups in terms of a cyst existence (P > .05). The supraspinatus tear rate and age distribution was also not differing in patients with and without LTC. CONCLUSIONS: The LTCs were significantly associated with subscapularis tears, and could be used as an indicator in the interpretation of MRI scans. However, there was no relationship between the subcoracoid impingement and LTCs.

Is kinesiophobia associated with functional outcome measures in patients following medial patellofemoral ligament reconstruction?

BACKGROUND: This study aimed to investigate the potential relationship between kinesiophobia and functional outcomes in patients following medial patellofemoral ligament reconstruction (MPFLr). METHODS: Twenty-one patients (six males, 15 females) who underwent MPFLr between 2016 and 2020, (23.57 ± 9.49 years old) with a mean follow up period of 52.33 ± 24.82 months were included in the study. Following an assessment of patellar stability and alignment, kinesiophobia levels, function and balance were measured. The kinesiophobia was measured using the Tampa Scale of Kinesiophobia, while functional outcomes were assessed with the single-leg hop test, Y-Balance test and single-leg sway index. The self-reported function was measured by Kujala patellofemoral score and Lysholm knee score. RESULTS: The patients exhibited kinesiophobia scores of 43.10 ± 6.90. A negative correlation existed between kinesiophobia and both the Kujala scores (r = -0.75, P < 0.001) and the Lysholm scores (r = -0.79, P < 0.001). Moderate negative correlations were observed between kinesiophobia and the single-leg hop distance (r = -0.64, P < 0.01), as well as in Y-Balance test anterior reach distance (r = -0.51, P < 0.01) and posterolateral reach distance (r = -0.55, P < 0.01). Additionally, a low negative correlation was noted between kinesiophobia and Y-Balance test posteromedial reach distances (r = -0.43, P = 0.05), as well as the total sway index (r = -0.46, P = 0.04). CONCLUSIONS: A high level of kinesiophobia was strongly correlated with self-reported functional scores and moderately correlated with measured functional outcomes. The findings underscore a notable prevalence of kinesiophobia following biomechanically successful MPFLr. Investigating the impact of kinesiophobia on outcomes after MPFLr may provide a better understanding of patient recovery.

Proprioception After Primary Repair of the Anterior Cruciate Ligament.

BACKGROUND: Primary repair of the anterior cruciate ligament (ACL) has some potential advantages over the reconstruction technique, which include but are not limited to better knee sensation due to preservation of the natural ACL tissue in patients compared with tendon graft. Proprioception is impaired after ACL injuries and the sense of the joint position is lost. PURPOSE/HYPOTHESIS: The purpose of this study was to compare arthroscopic ACL primary repair and ACL reconstruction techniques clinically and functionally and analyze the differences in proprioception. It was hypothesized that primary repair would restore knee joint proprioception more successfully because the original tissue of the ACL is preserved. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 63 patients (34 underwent reconstruction and 29 underwent primary repair between 2017 and 2020) and 33 healthy controls, as well as the healthy knees of the operated groups, were evaluated between 24 and 48 months (mean, 29 months) postoperatively. Patients with proximal femoral avulsion tears and stump quality suitable for repair underwent primary repair, and those with tears outside these criteria underwent reconstruction using hamstring tendon autograft. Proprioception was evaluated using the active joint position sensation method during weightbearing, with a digital inclinometer used to measure differences between the target and achieved flexion angles of 15°, 30°, and 60°. RESULTS: At 15° of knee flexion, the deviation angles for the healthy knee of the reconstruction and primary repair groups were significantly smaller than those of the control group (P < .001), but there was no statistically significant difference between the groups in terms of deviation angle at 30° and 60° of flexion. The deviation angle of the operated knees was statistically significantly larger in the reconstruction group than in the primary repair group at all angles. The deviation angles at 15°, 30°, and 60° were 2.83°, 2.66°, and 2.66° in the reconstruction group and 1.00°, 1.00°, and 1.33° in the primary repair group, respectively (P < .001). There was no statistically significant difference between the reconstruction and primary repair groups in terms of clinical scores. CONCLUSION: Primary ACL repair can preserve proprioception in a well-selected patient group. In short-term follow-up, primary repair of the ACL in patients with proximal femoral avulsion tears and stump quality suitable for repair appears to be proprioceptively protective. Future studies are needed to clarify the long-term consequences of primary repair on proprioception in a larger population.

Radiological Evaluation of Distal Tibiofibular Joint Anatomy Variations in Patients with and Without Syndesmotic Injury.

Introduction: Syndesmosis injuries are a common and debilitating problem affecting the ankle joint, but the precise causes of these injuries remain unclear. In the current retrospective study, it was aimed to investigate the relationship between variations in the distal tibiofibular syndesmosis and surgically proven syndesmosis injuries. Patients and Method: A total of 57 patients with surgically proven syndesmosis injuries and 51 patients without syndesmosis injuries were included as the control group. Computed tomography (CT) scans were used to measure six anatomical features 1 cm proximal to the tibiotalar joint, including the anterior facet length (a), posterior facet length (b), angle between the anterior and posterior facets (c), fibular incisura depth (d), tibia thickness (e), and fibula thickness (f). Results: Comparing the measurements of the patients with and without syndesmosis injury, it was demonstrated that the anterior facet length (a) (p = 0.022) was shorter and the a-b difference (anterior facet length-posterior facet length difference) (p = 0.010) tended toward negative values. Pearson correlation analysis demonstrated that a (r = - 0.211, p < 0.033) and a-b (r = - 0.254, p = 0.010) measurements were strongly negatively correlated with syndesmosis injury. Discussion: Our study findings suggest that the shortness of the anterior facet and the difference in length are related to syndesmosis injuries. To the best of our knowledge, this is the first study to report this relationship with syndesmosis. This study sheds light on the underlying mechanisms of syndesmosis injury, which could help clinicians in the diagnosis, treatment, and prevention of this common ankle injury.Level of evidence: Level 4: case-control study.

Interscalene block applied by an experienced anesthesiologist has a good anesthetic effect, a long duration of action, and less postoperative pain after arthroscopic shoulder procedures independent of surgery type and operation duration.

OBJECTIVES: This study aims to evaluate the severity of postoperative pain and the time to the onset of pain after arthroscopic surgical treatment of rotator cuff tear or instability under interscalene block. PATIENTS AND METHODS: Between October 2015 and June 2016, a total of 172 patients (82 males, 90 females; mean age: 47.9±16.9 years; range, 15 to 83 years) who underwent shoulder arthroscopy under interscalene block by a single surgeon were retrospectively analyzed. The relationship between the postoperative 24-h Visual Analog Scale (VAS), the time to the onset of pain with the type of surgical procedure (rotator cuff repair, n=101 or instability surgery, n=71), and the duration of surgery (<30 min n=92; ≥30 min n=80) was examined. RESULTS: No significant relationship was found between the type of surgical procedure, VAS scores, and the onset of pain after the block (p=0.577 and p=0.780, respectively). No significant relationship was found between the operation duration, and VAS, and the onset of pain after the block (p=0.570 and p=0.408, respectively). The mean duration until the start of postoperative pain was 734±313 (range, 60 to 1,440) min. There was no statistically significant difference in the need for rescue analgesics at the postoperative 24th h and the duration of surgery between the two groups (p=0.393 and p=0.675, respectively). CONCLUSION: Our study results show no significant difference in the time for the onset of postoperative pain and the VAS scores according to the characteristics of the surgical procedure, operation duration, or age and sex of the patient. Shoulder arthroscopy performed by experienced surgeons under interscalene block eliminates the need for analgesics within the first 12 h postoperatively.

The Correlation of the SLAP II Lesion Findings Between Physical Examination, Magnetic Resonance Imaging, and Arthroscopic Surgery.

OBJECTIVES: The aim of this study is to demonstrate the importance of clinical diagnosis by comparing with preoperative physical examination and magnetic resonance imaging (MRI) images in patients who were arthroscopically diagnosed as having Superior Labrum Anterior-Posterior (SLAP) II lesions. MATERIALS AND METHODS: 134 patients, arthroscopically diagnosed as SLAP II, established the study group, and 200 patients who underwent shoulder arthroscopy for the other pathologies established the control group. Preoperative clinical examination of the patients, MRI findings, and the arthroscopic findings of the patients were recorded. RESULTS: Out of the patients diagnosed with a SLAP II lesion, 107 (79.9) of those had an MRI finding while only 60 (30%) of the control group had it. The O'Brien test results of the patients diagnosed with SLAP were positive in 111 (82.8%) while those diagnosed with intact superior labrum were positive in 132 (66%). Of the 134 patients with a SLAP II lesion, 89 (66.4%) had both O'Brien test positiveness and MRI finding, and 129 (96%) had at least one positive result of the O'Brien test or MRI examination. CONCLUSION: The O'Brien test and MRI examination are not capable enough to indicate a SLAP lesion one by one, because of the low sensitivity and specificity. But, combining the test with MRI findings provides more trustable information about the superior labrum.

Effect of Metatarsal Head Shape on the Development of Hallux Valgus Deformity: 10 Years of Natural Follow-up.

BACKGROUND: We investigated the role of first metatarsal head shape in the etiology of hallux valgus. By pedobarographic analysis, we evaluated whether first metatarsal head shape causes an alteration in plantar pressure values that would result in metatarsalgia. METHODS: Referrals to our clinic for metatarsalgia, plantar fasciitis, and calcaneal spur were scanned retrospectively. Patients with severe hallux valgus, pes planus, gastrocnemius stiffness, generalized joint laxity, neuromuscular disease, or a history of lower-extremity orthopedic surgery were excluded. Sixty-two patients with plantar pressure assessment and radiographic evaluation were included. These patients were invited for reassessment after 10 years. Feet were divided into three groups by metatarsal head shape: round, square, and chevron. On anteroposterior radiographs, the hallux valgus and intermetatarsal angles, relative first metatarsal length, lateral sesamoid subluxation, and presence of bipartite sesamoid were noted. Plantar pressure was assessed with pedobarography. RESULTS: Feet with round-shaped first metatarsal heads had a statistically significantly greater progression in hallux valgus angle than the other shapes. Plantar pressures under the first, second and third, and fourth and fifth metatarsals increased with time. This can explain the mechanism of transfer metatarsalgia and painful callosities under the first metatarsal in hallux valgus. There was no correlation between hallux valgus angle, relative metatarsal length, and lateral sesamoid subluxation. CONCLUSIONS: We found a strong relation between round-shaped first metatarsal head and hallux valgus angle progression. No patients had a risk factor responsible for hallux valgus. In other words, this study gives approximately 10-year natural history results in nearly normal feet.

Midterm outcomes after arthroscopic repair of partial rotator cuff tears: A retrospective study of correlation between partial tear types and surgical technique.

OBJECTIVE: Patients who underwent arthroscopic repair for partial rotator cuff tears were evaluated retrospectively. This study purposed to assess the postoperative clinical results of arthroscopic treatment of intratendinous rotator cuff tears and to investigate the effect of the tear type on the postoperative clinical outcomes. METHODS: Overall, 60 patients [36 women and 24 men; mean age: 48.6±12.2 years (range 33-67 years)] who underwent arthroscopic repair of Ellman stage 3 partial rotator cuff tear were evaluated retrospectively. These patients were grouped into the following three groups: articular-sided tears, bursal-sided tears, and intratendinous tears, with 20 patients included in each group. Subacromial decompression, acromioplasty, and tear repair without transforming to full-thickness tear were applied to the bursal-sided tears. The same technique was performed for intratendinous ruptures, with the only technical difference was that the capsular tissue was preserved during debridement of intratendinous tears. The articular-sided tears were transformed to complete tears and repaired arthroscopically. The preoperative and postoperative ASES scores and range of motion improvements were evaluated in all patients. The mean follow-up time was 44±6.5 months (range: 36-62 months). RESULTS: No significant intergroup differences were observed concerning the age and the mean follow-up duration (p=0.524, p=0.665). A similar increase in ASES scores was observed for all three types of tears (bursal-sided tears: 31.09-82.65; articular-sided tears: 35.50--84.00; intratendinous tears: 34.01-83.49). Statistically, no significant intergroup difference was observed concerning ASES score improvement (p=0.585). An increase in mean forward flexion, abduction, and external rotation were observed, especially, a statistically significant increase in flexion (p=0.001) and abduction (p=0.001) in all three types of tears. No patient experienced any intraoperative or postoperative complications. CONCLUSION: The results of arthroscopic treatment of intratendinous tears were similar to the other types of partial tears, and the results of arthroscopic treatment of grade 3 partial rotator cuff tears revealed satisfactory outcomes, regardless of the type of the tear. LEVEL OF EVIDENCE: Level III, Therapeutic study.

Partial and full-thickness rotator cuff tears in patients younger than 45 years.

OBJECTIVE: The aim of this study was to evaluate the results of the arthroscopic repair in patients with partial and full thickness rotator cuff tears and less than 45 years of age. METHODS: Fifty patients (26 women and 24 men; mean age: 41.4±3.96 years; range: 31-45) with rotator cuff tear, and who were treated with the arthroscopic repair, were included in the study. Twenty patients had full thickness and 30 had partial-thickness tears. The final functional evaluation was conducted at a mean of 42.4 months (range, 24 to 95 months; SD:13.3). The American Shoulder and Elbow Surgeon (ASES) self-report score and the University of California at Los Angeles Shoulder Score (UCLA Shoulder Score) were used as validated scoring systems. RESULTS: At the final follow-up, the mean ASES and UCLA scores improved significantly to 72.3 and 26.5, respectively, in the full-thickness group (p<0.01). The mean ASES and UCLA scores improved significantly to 70.7 and 25.3, respectively, in the bursal-side group (p<0.01). The mean ASES and UCLA scores improved significantly to 75.3 and 27.1, respectively, in the joint-side group (p<0.01). There were no significant differences between the groups according to the postoperative ASES score (p>0.06) and UCLA score (p<0.37). CONCLUSION: The arthroscopic repair of the joint-sided tears and bursal-sided tears has good functional outcomes as full thickness rotator cuff tears, and the surgical option should be considered in younger population if the conservative treatment fails. LEVEL OF EVIDENCE: Level IV, Therapeutic study.

Is gluteus medius injured in patients treated with a trochanter tip entry intramedullary nail? Clinical, electrophysiological and functional outcomes.

OBJECTIVES: This study aims to assess the functional outcomes, static-dynamic postural stability of patients and evaluate electromyographic activity of gluteus medius (GMed) muscle during gait and spatiotemporal parameters of gait in patients after antegrade intramedullary nailing (IMN) of femoral shaft fractures with trochanter tip entry. PATIENTS AND METHODS: Sixteen patients (15 males, 1 female; mean age 34.8±15.2 years; range, 18 to 58 years) who were treated with an antegrade trochanteric IMN between January 2009 and July 2013 and eight healthy male controls (mean age 39.3±9.8 years; range, 27 to 57 years) were included in this retrospective study. Muscle strength, static and dynamic postural stability and fall risk were evaluated. In addition, spatiotemporal parameters of gait were assessed using a validated wireless inertial sensing device and a wireless electromyography (EMG) device was used to measure electromyographic activity of GMed muscle in both groups. RESULTS: There were significant differences in muscle strength, functional and dynamic balance test scores between operated and intact sides (one-leg hop test score p=0.009, balance test scores p<0.001-0.033). There were significant differences in functional and quality of life physical function test scores between groups (one-leg hop test score p=0.014). However, no significant differences were found in EMG results, dynamics balance, and statics postural stability test scores between groups (p>0.05). CONCLUSION: After isolated femur fracture, patients treated with antegrade trochanteric IMN demonstrated good static and dynamic stability and poor functional outcomes compared to controls. In conclusion, patients with antegrade trochanteric IMN have good balance but poor functional performance; however, further studies are needed to find out the primary reason for these results.

Radiologic Evaluation of the Effect of Distal Tibiofibular Joint Anatomy on Arthroscopically Proven Ankle Instability.

BACKGROUND: Ankle sprains occur frequently in both athletes and the general population. The social and economic consequences can be significant. In an effort to understand the injury, dynamic and static structures around the ankle have been investigated in detail, but anatomical factors predisposing to lateral ankle instability have not been fully clarified. The aim of this study was to radiologically investigate the relationship between bony variations of the distal tibiofibular joint and arthroscopically proven ankle instability. METHODS: Fifty patients with arthroscopically proven ankle instability and 50 patients without instability were included in this study. Measurements were obtained from a magnetic resonance imaging (MRI) section 1 cm proximal to the tibiotalar joint; distal tibiofibular joint anterior facet length (a), posterior facet length (b), angle between the anterior and posterior facets (c), fibular notch depth (d), tibia thickness (e), and fibula thickness (f) was measured. RESULTS: It was found that instability was more frequent when the length of a (P < .001) and e (P < .001) were shorter. In addition, when value of a/b and e/f were evaluated, it was observed that the number of individuals who had instability increased as the ratio became smaller (P < .016-.020, respectively). Pearson correlation analysis indicated strong negative correlation between the values of a-e and instability (r = -0.348, P < .001, and r = -0.328, P = .001; respectively). CONCLUSION: Lateral ankle sprains are common, and a clear understanding of the relevant structures and clinical function of the ankle complex should extend beyond the talocrural joint. This study demonstrated that the presence of narrow anterior facet (a) and thinner tibia (e) were strongly correlated with lateral ankle instability. LEVEL OF EVIDENCE: Level III, retrospective case control study.