How Many Bundles Does the Anterior Cruciate Ligament Consist of? A Case Report.

In some cases with anterior cruciate ligament (ACL) injury, physical examination and magnetic resolution imaging cannot clearly identify whether the ACL is intact or partially or completely ruptured. A 40-year-old female patient was admitted to our clinic with complaints of knee pain. After the requested examinations, we could not clearly identify whether the ACL was intact or partially or completely ruptured. Arthroscopic knee surgery was planned for the patient. In diagnostic arthroscopy, it was also determined that there was a multibundle ACL that was not surrounded by the synovium and was tight in the figure 4 position. The surgery was completed by repairing the meniscal tear. It was seen in the current case report that the ACL was a multibundle structure without overlying synovium around. In such cases, it is difficult to evaluate the ACL, and it should be kept in mind that there may also be variations of the ACL.

Treatment of persistent large cystic lesions of the humerus with vascularized fibular grafts.

OBJECTIVES: In this study, we aimed to evaluate the short-to-midterm results of the resection and reconstruction of large cystic lesions of the humerus. PATIENTS AND METHODS: Eight male patients (median age: 22.9±10.4 years; range, 12 to 42 years) with large cystic lesions of the humerus operated between January 2017 and December 2019 were retrospectively analyzed. The age of the patients, their previous treatments and follow-up periods, the size and location of the cysts, postoperative functional scores, presence of a union, recurrence of the cyst, and graft resorption were examined. RESULTS: The mean follow-up was 42.8±7.5 (range, 34 to 54) months. Preoperatively, the mean length of the cystic lesions was 15.1±2.6 (range, 10 to 18) cm. At the final follow-up, the patients had a normal range of shoulder flexion-extension, internal rotation-external, abduction-adduction, and elbow flexion-extension, pronation-supination. The patients had a mean DASH score of 1.13±1.1 (range, 0 to 3.3) and MSTS score of 28.75±1.8 (range, 26 to 30) postoperatively. Complications such as pseudoarthrosis, graft resorption, or cyst recurrence were not observed in any of the patients. CONCLUSION: Although the risk of recurrence is low in small cystic lesions of the humerus, it increases as the size of the lesion increases. This reconstruction technique using vascularized fibular grafts, which we applied, seems to be extremely successful in ensuring biological healing and preventing recurrence and complications in patients with large cystic lesions of the humerus.

HOW USEFUL IS ELASTOGRAPHY IN THE FOLLOW-UP OF ACHILLES TENDON REPAIR?

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.

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.

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.

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.

A NEW ANATOMICAL PLATE FOR EXTRA-ARTICULAR DISTAL HUMERAL FRACTURES: BIOMECHANICAL STUDY.

Introduction: We compared the mechanical properties of two fixation techniques for the treatment of extra-articular distal third humeral fractures. Materials and Methods: Two groups were created from twenty-four humeri. Group 1 was instrumented using a new, precontoured, 8-hole (3.5-mm-diameter) locking compression plate (LCP) placed anterolaterally. Group 2 was instrumented using an 8-hole (3.5-mm-diameter) precontoured posterolateral LCP plate placed on the distal humerus. Four-point bending tests and torsion tests were performed until the specimens broke. Results: The four-point bending stiffness test showed that the stiffness of anterolaterally fixed humeri was significantly higher than that of posterolaterally fixed humeri (p<0.05). Torsion testing revealed that posterolateral fixation was associated with better yield strength (p<0.05), but the torsional stiffness did not differ significantly between the two plates (p> 0.05). Conclusions: The anterolateral plate exhibited higher bending stiffness and torsional yield strength than the posterolateral plate. Anterolateral plate fixation can thus be used to manage extra-articular distal humeral fractures. Multiaxial locking screws ensure rigid fixation, allow early elbow motion without olecranon fossa impingement, and prevent iatrogenic injury of the triceps muscle. Level of Evidence I, Therapeutic Studies Investigating the Results of Treatment.

Introdução: Comparamos as propriedades mecânicas de duas técnicas de fixação para o tratamento de fraturas extra-articulares do terço distal do úmero. Materiais e Métodos: Dois grupos foram criados a partir de vinte e quatro úmeros. O Grupo 1 foi instrumentado com uma nova placa de compressão com travamento (LCP) pré-contornada e com oito orifícios (3,5 mm de diâmetro) posicionados anterolateralmente. O Grupo 2 foi instrumentado com uma placa LCP pré-contornada posterolateral com oito orifícios (3,5 mm de diâmetro) colocada na parte distal do úmero. Testes de flexão e testes de torção a quatro pontos foram realizados até que os corpos de prova quebrassem. Resultados: O teste de rigidez à flexão de quatro pontos mostrou que a rigidez dos úmeros fixados anterolateralmente foi significativamente maior do que os úmeros fixados posterolateralmente (p <0,05). O teste de torção revelou que a fixação posterolateral foi associada a melhor força de rendimento (p <0,05), mas a rigidez à torção não diferiu significativamente entre as duas placas (p > 0,05). Conclusões: A placa anterolateral apresentou maior rigidez à flexão e resistência à tração do que a placa posterolateral. A fixação anterolateral da placa pode, portanto, ser usada para tratar fraturas extra-articulares da parte distal do úmero. Os parafusos de travamento multiaxiais garantem uma fixação rígida, permitem o movimento precoce do cotovelo sem causar impacto à fossa do olécrano e previnem lesão iatrogênica do músculo tríceps. Nível de evidência I, Estudos terapêuticos - Investigação dos resultados do tratamento.

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.

A new anatomical plate for extra-articular distal humeral fractures: biomechanical study / Uma nova placa anatômica para fraturas extra-articulares distais do úmero: estudo biomecânico

ABSTRACT Introduction We compared the mechanical properties of two fixation techniques for the treatment of extra-articular distal third humeral fractures. Materials and Methods Two groups were created from twenty-four humeri. Group 1 was instrumented using a new, precontoured, 8-hole (3.5-mm-diameter) locking compression plate (LCP) placed anterolaterally. Group 2 was instrumented using an 8-hole (3.5-mm-diameter) precontoured posterolateral LCP plate placed on the distal humerus. Four-point bending tests and torsion tests were performed until the specimens broke. Results The four-point bending stiffness test showed that the stiffness of anterolaterally fixed humeri was significantly higher than that of posterolaterally fixed humeri (p<0.05). Torsion testing revealed that posterolateral fixation was associated with better yield strength (p<0.05), but the torsional stiffness did not differ significantly between the two plates (p> 0.05). Conclusions The anterolateral plate exhibited higher bending stiffness and torsional yield strength than the posterolateral plate. Anterolateral plate fixation can thus be used to manage extra-articular distal humeral fractures. Multiaxial locking screws ensure rigid fixation, allow early elbow motion without olecranon fossa impingement, and prevent iatrogenic injury of the triceps muscle. Level of Evidence I, Therapeutic Studies Investigating the Results of Treatment.

RESUMO Introdução Comparamos as propriedades mecânicas de duas técnicas de fixação para o tratamento de fraturas extra-articulares do terço distal do úmero. Materiais e Métodos Dois grupos foram criados a partir de vinte e quatro úmeros. O Grupo 1 foi instrumentado com uma nova placa de compressão com travamento (LCP) pré-contornada e com oito orifícios (3,5 mm de diâmetro) posicionados anterolateralmente. O Grupo 2 foi instrumentado com uma placa LCP pré-contornada posterolateral com oito orifícios (3,5 mm de diâmetro) colocada na parte distal do úmero. Testes de flexão e testes de torção a quatro pontos foram realizados até que os corpos de prova quebrassem. Resultados O teste de rigidez à flexão de quatro pontos mostrou que a rigidez dos úmeros fixados anterolateralmente foi significativamente maior do que os úmeros fixados posterolateralmente (p <0,05). O teste de torção revelou que a fixação posterolateral foi associada a melhor força de rendimento (p <0,05), mas a rigidez à torção não diferiu significativamente entre as duas placas (p > 0,05). Conclusões A placa anterolateral apresentou maior rigidez à flexão e resistência à tração do que a placa posterolateral. A fixação anterolateral da placa pode, portanto, ser usada para tratar fraturas extra-articulares da parte distal do úmero. Os parafusos de travamento multiaxiais garantem uma fixação rígida, permitem o movimento precoce do cotovelo sem causar impacto à fossa do olécrano e previnem lesão iatrogênica do músculo tríceps. Nível de evidência I, Estudos terapêuticos - Investigação dos resultados do tratamento.

Does anterolateral ligament injury change the treatment option in patients with partial ACL tears?

Patients with ACL tears with ALL injury have more clinical complaints (instability, feeling of the pop on the knee or knee sliding). patients have ALL injury with partial ACL tears, It is unclear whether the choice of treatment will be conservative or surgical. This study aimed to determine the effect of anterolateral ligament (ALL) status, whether intact or ruptured, on the choice of conservative or surgical treatment in patients with partial anterior cruciate ligament (ACL) tears. Between 2015 and 2019, patients with suspected partial ACL tears were identified on both physical examination and MR imaging. 122 patients who had partial ACL tears and also status of patient's ALL could be evaluated by radiologist were included in the study, retrospectively. Sixty-two patients who underwent ACL reconstruction were determined as group 1, and 60 patients who did not undergo ACL reconstruction were defined as group 2. In patients with partial ACL rupture with or without ACL reconstruction, it was evaluated whether a ruptured or non- ruptured ALL was effective in this decision of conservative or surgically. The MRIs of patients with partial ACL tears were evaluated by a radiologist and it was concluded that the ALLs of 50 patients were ruptured, and 72 were intact. The ALLs of 36 patients in group 1 were ruptured, and 26 patients were intact. Fourteen patients in group 2 had ruptured ALLs, 46 patient's ALLs were intact. Seventy-two percent of the patients with partial ACL tears who had ruptured ALLs in MRI underwent ACL reconstruction. It was found that ACL reconstruction was performed more frequently in patients with partial ACL tears with ALL rupture. Therefore, we believe that preoperative evaluations of ALLs using MRI in patients with partial ACL tears are essential for surgical planning.

Correction of More Hallux Valgus Pathologic Disorders with a Single Distal Osteotomy: A New Surgical Technique.

BACKGROUND: Hallux valgus, one of the most common deformities of the great toe, may cause pain, dysfunction, and impaired gait pattern. In this retrospective study we report the results of a new type of distal metatarsal osteotomy combined with distal soft-tissue release in patients with mild-to-moderate hallux valgus deformity. METHODS: This new technique was used in the management of 32 feet of 31 patients (eight men and 23 women) with mild-to-moderate hallux valgus. Hallux valgus angle, intermetatarsal angle, and distal metatarsal articular angle were measured on preoperative, early postoperative (6-8 weeks), and late (1 year) postoperative radiographs. American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal score was calculated. Sesamoid position, by considering medial sesamoid position, and metatarsal shortness were also measured. RESULTS: Statistically significant differences were detected between the preoperative and late postoperative measurements of the hallux valgus angle, distal metatarsal articular angle, intermetatarsal angle, and sesamoid position parameters in patients operated on with this technique. Improvement was 14° for the hallux valgus angle, 4° for the distal metatarsal articular angle, and 4° for the intermetatarsal angle. Sesamoid position was also improved, and the mean American Orthopaedic Foot and Ankle Society score was significantly improved. Metatarsal shortness greater than 2 mm was observed in two patients without resulting in any clinical discomfort. CONCLUSIONS: This new technique was easy, safe, and promising in patients diagnosed as having mild-to-moderate hallux valgus deformity.

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.

Fixation of Posterior Malleolar Fractures with Posterior Plating Through a Posterolateral Approach.

BACKGROUND: We aimed to evaluate radiologic and clinical outcomes of ankle fractures involving posterior fragments that were fixed with a posterior plate by the posterolateral approach. METHODS: Sixty-five patients who were followed for at least 12 months and were older than 18 years were included. The posterior malleolus fractures were classified according to the Haraguchi classification system with computed tomography (CT). The posterior malleolus fragments were fixed with a plate through a posterolateral approach. Intra-articular step-off, reduction of the posterior malleolar fragment, and fibular position in the incisura were evaluated by early postoperative CT. American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analog scale pain score were used for clinical assessment. RESULTS: The posterior malleolus fractures were classified as Haraguchi type 1 in 45 patients (69.2%), Haraguchi type 2 in 12 patients (18.5%), and Haraguchi type 3 in eight patients (12.3%). No patients showed signs of instability or loss of reduction on direct radiographs during follow-up. Postoperative CT showed no loss of reduction in the posterior malleolus and tibiofibular alignment. On evaluation, there was no intra-articular step-off (<1) in any of the patients. The mean AOFAS score was calculated to be 91.6. The mean visual analog scale score was 1.2. CONCLUSIONS: We conclude that direct posterior fixation with the posterolateral approach can be a good option for ankle fractures involving posterior malleolar fragments.

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.

Is Cyclic Exercise Performed before Tibial Fixation Effective on Grafts during Anterior Cruciate Ligament Reconstruction?

OBJECTIVES: The necessity of cyclic exercise to pre-stretch the autograft before tibial fixation during ACL reconstruction is unknown. In this study, we evaluated whether there was a statistically significant difference between the results of patients who underwent cyclic exercise by way of physical examinations, knee joint stability tests, and functional evaluation tests, compared with the patients who underwent ACL reconstructions with or without cyclic exercise. METHODS: Between March 2016 and May 2018, 59 patients with at least eight months' follow-up of an ACL reconstruction were identified. Thirty patients (Group 1) who underwent cyclic exercise before tibial fixation and 29 patients (Group 2) who did not undergo cyclic exercise were evaluated and compared. RESULTS: The mean age of the patients in Group 1 and Group 2 was 25.9 (range, 18-36) years and 25.2 (range, 18-35) years, respectively. The mean follow-up period in Group 1 was 14.6 (range, 8-22) months and 13.5 months in Group 2 (range, 8-21 months).The mean Lysholm scores of Group 1 and 2 were 95.1 (range, 83-100) and 87.1 (range, 78-100), respectively. The modified Cincinnati scores of Groups 1 and 2 were 28.7 (range, 24-30) and 26.2 (range, 21-30). The mean IKDC subjective knee evaluation scores in Groups 1 and 2 were 91.9 (range, 83-100) and 86.7 (range, 75-100). The mean thigh atrophy was 1.5 cm in Group 1 and 2.5 cm in Group 2. In Group 1, 23 patients jumped 85% of the distance compared with the intact side in the single-legged hop test, and 12 patients in Group 2 were able to hop this distance successfully.Group 1 had statistically significantly better results in Lysholm activity scores, modified Cincinnati scores, IKDC subjective knee assessment scores, two-time IKDC activity scale results, comparison of thigh diameters, and single-legged hop tests (p<0.05). No significant difference was found in other examinations and tests. CONCLUSION: Cyclic exercise during the operation had a positive effect on functional scores. We believe that cyclic exercise should be added to the operative procedure.

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.

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.

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.

The Effect of Tranexamic Acid and Tourniquet Use on Tibial Cement Penetration in Primary Total Knee Arthroplasties.

BACKGROUND: In this study, our aim was to compare the effects of tourniquet and tranexamic acid (TXA) use on tibial cement penetration in primary total knee arthroplasty (TKA) using radiograph images. In addition, we also aimed at investigating the effects of age, gender, body mass index (BMI), and bone mineral density on cement penetration. METHODS: One hundred seventy patients who underwent TKA for primary osteoarthritis were retrospectively evaluated. TXA was administered to patients in group 1 (n = 96), and tourniquet application was used in patients in group 2 (n = 74). Tibial cement penetration was evaluated radiologically on a total of 4 zones: 2 anteroposterior and 2 lateral zones. In addition, age, gender, BMI, and bone mineral density were recorded in each group. RESULTS: The mean cement penetration in the total study population was 2.34 ± 0.24 mm, with a mean of 2.33 ± 0.25 mm in the TXA group and a mean of 2.35 ± 0.24 mm in the tourniquet group (P = .453). A negative correlation was detected between BMI and anteroposterior 1 values in the total and TXA groups (P = .022 and P = .029). In the evaluation of the differences between genders, significantly higher penetration values were observed only in the females in the tourniquet group (P = .024). CONCLUSIONS: The use of TXA instead of a tourniquet does not reduce the depth of cement penetration in TKA. The clinical implications of individual-induced penetration differences may be significant for future implant survival.

Assessment of the Glenoid Morphology Based on Demographic Data in the Turkish Population.

PURPOSE: In this study, our aim was to evaluate the glenoid version, height, and width measurements based on gender, side, age, height, and hand dominance in the Turkish population using computed tomography (CT) images. METHODS: In our study, CT images of 140 patients (62 females and 78 males; mean age: 39.6 years) who had no shoulder complaints were evaluated retrospectively. Glenoid version (GV), AP diameter (width), and SI diameter (height) on both shoulders were measured on the CT images. Correlations between patient gender, side, age, height, and hand dominance and the GV and size were evaluated. RESULTS: The right shoulder had a mean GV of -0.93 ± 7.80 degrees and the left shoulder had a GV of -0.88 ± 6.63 degrees (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (. CONCLUSION: Hand dominance had an effect on the glenoid version, while patient gender, age, and height had an effect on the glenoid size. The glenoid width in the Turkish population was similar to that of the European and American populations, and the glenoid height was similar to that of the Asian population. Our GV values were similar to those of the Asian population and more anteverted compared to the Western population. We believe that our findings will be useful in preoperative planning and in the production of implants for our population.