The Effect of a Stretch and Strength-Based Yoga Exercise Program on Patients with Neuropathic Pain due to Lumbar Disc Herniation.

STUDY DESIGN: Randomized controlled trial. OBJECTIVE: To investigate the effect of a stretch and strengthbased yoga exercise program on neuropathic pain due to LDH. SUMMARY OF BACKGROUND DATA: LDH with neuropathic pain influences treatment outcomes negatively. Most yoga poses include the parameters of spinal training and help reduce pain and disability in patients with low back injuries. We hypothesized that yoga positively affects both LDH and neuropathic pain by increasing mobilization, core muscle strength, and spinal and hamstring flexibility. METHODS: In total, 48 patients with neuropathic pain due to LDH were randomly assigned to a control group and a yoga group. All patients underwent a patient education program. In addition, the selected yoga exercise was taught and performed to the yoga group for one hour twice weekly for 12 weeks. Neuropathic pain (Douleur Neuropathique 4 for diagnosis; Leeds Assessment of Neuropathic Symptoms and Signs for severity), low back pain (the short-form of McGill Pain Questionnaire), disability (Oswestry Disability Index), and function (modified Schober and passive knee extension test) were measured blind before and at the one-, three-, and six-month follow-ups. The patient global assessment was applied at the six-month followup. The intention-to-treat analysis was performed in this study. RESULTS: The intention-to-treat analysis showed a statistically significant difference in neuropathic pain, patient global assess ment, low back pain, disability, and function in favor of the yoga group at post-treatment. The between-group effect sizes were moderate at six-months follow-up. CONCLUSION: It was determined that the selected stretch and strength-based yoga exercise could be a promising treatment option for neuropathic pain due to LDH. LEVEL OF EVIDENCE: 2.

The importance of Böhler's angle in calcaneus geometry: A finite element model study.

OBJECTIVES: Calcaneal fractures are the most common tarsal fractures following a foot-ankle trauma. The Böhler's angle is an important measurable angle before, during, and after surgery. In this study, we aimed to investigate correlation between Böhler's angle, calcaneal strength, and subtalar joint stress using a finite element analysis (FEA). PATIENTS AND METHODS: Between January 2016 and December 2016, computed tomography (CT) scans were used with MIMICS® software for FEA. The ankle and foot of a 23-year-old male person with a height of 180 cm and weighing 80 kg was modeled as reference. Raw coronal CT images were obtained in Digital Imaging and Communications in Medicine format with the resolution of 512X512 pixels and 0.3-mm slice intervals in 135 kV. The structures including tibia, fibula and 26 other bones (talus, calcaneus, cuboid, navicular, three cuneiforms, five metatarsals, and 14 components of phalanges), cartilage and ligamentous tissues were modeled to form ankle joint. After determining Böhler's angle as 35 degrees for the reference model, a fracture line was created on calcaneus. Calcaneus was remodeled with the Böhler's angle of 45, 40, 30, 25, 20, 10, and 0 degrees respectively. All models were transferred to ANSYS software for FEA and the loads on the lower extremities with normal posture were applied on models. RESULTS: Analysis of all models based in the reference model revealed that maximum tension values on calcaneus increased, while the Böhler's angle decreased, indicating a statistically significant difference. The decreased Böhler's angle indicated statistically significantly higher maximum tension values (p=0.04). Action force in subtalar joint was evaluated by comparing with the forces in reference model. The increased Böhler's angle was found to be associated with statistically significantly decreased amount of load on subtalar joint. The decreased Böhler's angle was related to the statistically significantly increased amount of load on subtalar joint. CONCLUSION: Our study results suggest that decreased Böhler's angle increases the possibility of subtalar arthrosis, although overcorrection of the Böhler's angle seems not to increase the risk of subtalar arthrosis.

Medical and surgical treatment of meralgia paresthetica.

Meralgia paresthetica (MP) is a painful mononeuropathy that causes paresthesia, tingling, stinging or a burning sensation in the thigh's anterolateral part due to the entrapment of the lateral femoral cutaneous nerve under the inguinal ligament. The treatment options for MP include conservative or interventional management and must follow an algorithm. The objective is to eliminate the underlying cause if known. In the present study, four patients with MP who were successfully treated with either conservative or interventional management are presented. The advantages and disadvantages of neurolysis (decompression and transposition) and neurectomy procedures for surgical treatments are discussed.

Lay abstract Meralgia paresthetica (MP) is a tingling, stinging or burning sensation on the thigh due to the compression of the nerve that gives sensation to the skin on the thigh. Constrictive clothing, obesity and pregnancy are common causes of MP. However, it can also be caused by local trauma or diseases such as diabetes. In most cases, MP can be treated with preventive measures such as wearing loose-fitting clothes and losing weight. In severe cases, treatment may require surgery.

Effect of soft tissue thickness on crestal bone loss of early loaded implants with platform switching: 1- and 5-year data.

Objectives: The aim of this retrospective study was to evaluate the effect of vertical soft tissue thickness (STT) on crestal bone loss (CBL) of early loaded implants after 1 and 5 years. Method and materials: Forty-four tapered implants with platform switching and conical connection were placed in the posterior mandible and maxilla to rehabilitate edentulous sites. STT at implant sites was divided into two groups: thin (n = 21, mean STT = 2.0 ±â€¯0.3 mm) and thick (n = 23, mean STT = 3.0 ±â€¯0.8 mm). The implants were loaded after 6 to 8 weeks. Survival and success rates and CBL were measured after 1 and 5 years. Results: The survival and success rates at 1 and 5 years were 100% and 97.8%, respectively. At the 1-year follow-up, the CBL of the thin and thick gingival groups was 0.96 ±â€¯0.49 and 0.55 ±â€¯0.41 mm, respectively; the difference was statistically significant (P = .004). At 5 years, the CBL of the thin and thick gingiva groups increased to 1.12 ±â€¯0.84 and 0.65 ±â€¯0.69 mm, respectively; the difference was not statistically significant (P = .052). Conclusion: At 1 year, the CBL was more pronounced at sites with a thin gingiva; at 5 years the difference between the groups was not statisically significantly different. Within the limitations of this study, early loading of implants with platform switched and conical connection was safe.

Comparison of mesenchymal stem cell sheets and chondrocyte sheets in a rabbit growth plate injury model

Background/aim: The treatment of posttraumatic deformities and differences in length between the extremities resulting from physeal injury remains controversial. The aims of this study were to compare the efficacy of tissue-engineered, monolayer, and allogeneic mesenchymal stem cell sheets and chondrocyte sheets for physeal arrest treatment and to investigate cell sheet technology as a novel method for cell transplantation in physeal cartilage repair. Materials and methods: A proximal tibial physeal injury was induced in New Zealand rabbits. Allogeneic mesenchymal stem cells (MSCs) and chondrocytes were cultured in temperature-responsive culture dishes and applied to the iatrogenic partial growth plate defects in single-sheet grafts (cell sheets). Treatment efficacy was determined using radiological measurements, as well as histological and immunohistochemical staining. Results: Treatment with MSCs and chondrocytes prevented endochondral ossification in the physeal plate, and bone growth resumed after treatment in both the MSC and chondrocyte cell groups. We found significant differences in radiological evaluations between pre- and posttreatment measurements in both MSC and chondrocyte groups. Transplanted cells were observed in the damaged area in both of the groups, which differentiated in the direction of growth plate cartilage. Conclusion: Our results support the hypothesis that MSC or chondrocyte transplantation using the cell-sheet technique described in the present study aids in the regeneration of cartilage tissue during physeal arrest after growth plate damage.

Presence of ROS in Inflammatory Environment of Peri-Implantitis Tissue: In Vitro and In Vivo Human Evidence.

Analyses of composition, distribution of cellular and extracellular matrix components, and molecular analysis of mitochondria related genes of bone loss in the presence of inflammatory environment in humans was the aim of the present project. As a human model we chose peri-implantitis. Morphological analyses were performed by means classical histological, immunohistochemical, and SEM (scanning electron miscroscopy) test. Gene expression analysis was performed to evaluate epithelium maturation, collagen fiber production, and genes related to mitochondrial activity. It was found that a well-defined keratinocyte epithelium was present on the top of all specimens; a distinct basal lamina was present, as well as desmosomes and autophagic processes related to the maturation of keratinocytes. Under this epithelium, a full inflammatory cell infiltrate was present for about 60% of the represented by plasma cells. Collagen type I fibers were present mainly in the form of fragmented cord tissue without cells. A different distribution of blood vessels was also present from the apical to the most coronal portion of the specimens. High levels of genes related to oxidative stress were present, as well as the activation of genes related to the loss of ability of osteogenic commitment of Mesenchymal stem cells into osteoblasts. Our study suggests that peri-implantitis lesions exhibit a well defined biological organization not only in terms of inflammatory cells but also on vessel and extracellular matrix components even if no difference in the epithelium is evident, and that the presence of reactive oxygen species (ROS) related to the inflammatory environment influences the correct commitment of Mesenchymal stem cells.

High tibial osteotomy in obese patients: Is successful surgery enough for a good outcome?

INTRODUCTION: Knee osteoarthritis is the most common articular pathology. High tibial osteotomy (HTO) is a frequently used treatment procedure in medial osteoarthritis of the knee joint. We aimed to reveal factors that affect clinical and radiologic outcomes by evaluating the efficacy of HTO in patients with BMI ≥30 kg/m2 who were not appropriate for prostheses considering their activity, degree of pain, and age. MATERIAL AND METHOD: HTO was performed using the medial open wedge technique who presented to the orthopedics polyclinic with symptoms of knee pain, whose BMI was over 30 kg/m2. All patients were diagnosed as having mechanical axis deviation and isolated medial compartmental arthrosis between 2013 and 2015.The clinical and radiologic follow-ups of patients were performed on day 45, at month 3, month 6, and after 1 year. The knee scoring system from the American Knee Society (AKS), and range of motion (ROM) were used in the functional evaluation of the patients. RESULT: Eighteen patients were included in the study. Thirteen patients (72.2%) were women and 5 (27.8%) were men. Preop axis score was found significantly lower compared with the axis scores at postop month 6 and in final follow-up, the postoperative final follow-up axis score was found significantly lower than the axis score at month 6 (p < 0.05). CONCLUSION: We anticipated in our study that the better outcomes obtained in the early period might be maintained for longer in parallel with weight loss and decreased BMI in the postoperative period. We believe that it is important to perform complication-free HTO with the correct technique, and by organizing a rapid and systematic weight loss process.

The effect of Korean red ginseng on mesenchymal stem cells from healthy and osteoporotic human bone marrow.

BACKGROUND: Osteoporosis is a disease characterized by an increase in bone fragility as a result of decreased bone mass and weakening of the bone structure. There are studies on the relationship between osteoporosis and hearing and balance system. The goal of this study was to compare the proliferation and osteogenesis induction properties of mesenchymal stem cells derived from healthy and osteoporotic individuals to better understand the healing properties of Korean red ginseng (KRG) and Panax ginseng-Avena Sativa-Tribulus Terrestris mixture (PAT). MATERIALS AND METHODS: Osteoporotic and healthy MSCs were isolated successfully in culture conditions. The proliferation levels of cells treated with different doses of KRG and PAT were compared by Water-Soluble Tetrazolium-1 (WST-1) assay. Alkaline phosphatase (ALP) assay was performed by selecting the most effective KRG dose in proliferation. RESULTS: Morphology of isolated cells and the expression of cell surface antigens have been detected as similar. The WST-1 assay showed that KRG was effective on the proliferation of osteoporotic cells. The levels of ALP in osteoporotic cells treated with KRG is increased depending on the differentiation day compared to healthy cells. CONCLUSION: KRG triggered an increase in intracellular ALP levels of osteoporotic MSCs. It suggests that KRG on osteoporotic cells is influential in stimulating osteogenesis and may be useful in osteoporotic patients.

A new study of hindfoot endoscopy: Foreign body excision from the hindfoot.

Residual foreign bodies are usually observed inside the body after foreign body penetration injuries. However, foreign bodies inside or near the joints are rarely encountered. In the case study included in this report, the case of a foreign body in the posterior ankle region of a 10-year-old child is presented, along with a new study highlighting the technique of its excision with hindfoot endoscopy. The visualization and capture of a foreign body within this region, and its relation to endoscopic excision, has been reported as being a support for hindfoot endoscopy. The aim of this article is to highlight the need for the provision of a low threshold arthroscopic hindfoot surgery in children who display the appropriate symptoms. The purpose of this surgery is to efficiently remove intra-articular hindfoot loose bodies and to gain functionally improved results, when compared with open techniques.

There is No Remarkable Difference Between Pedicle Screw and Hybrid Construct in the Correction of Lenke Type-1 Curves.

AIM: To compare the deformity correction success of segmental pedicle screw and hybrid instrumentation for the treatment of Lenke type-1 adolescent idiopathic scoliosis (AIS) curves. MATERIAL AND METHODS: Surgically treated Lenke type-1 scoliosis patients were retrospectively evaluated and data of 26 patients treated with hybrid instrumentation were included in the first group. In this group, all patients had been operated with hooks at the thoracic part and transpedicular screws at the lumbar part. The second group included 26 patients operated with all segment transpedicular screws. Cobb angles of curves, flexibility, apical vertebral translation (AVT), coronal body balance, kyphosis and lordosis were measured. All measurements and correction ratios were compared between the groups. RESULTS: There were no significant differences between the two groups for preoperative thoracic and lumbar Cobb angles, thoracic and lumbar curve flexibility, coronal balance, AVT, kyphosis and lordosis. However, the postoperative thoracic correction ratio was significantly different between the two groups. CONCLUSION: Segmental screw instrumentation had better results for thoracic curve correction than hybrid instrumentation for the treatment of Lenke type-1 curves. Good results may be achieved with both techniques to provide sagittal balance.

Relationship Between Third Mandibular Molar Angulation and Distal Cervical Caries in the Second Molar.

Third lower molar partially erupted is commonly encountered in dental practice. This situation challenges clinicians with the dilemma whether to remove or to monitor it, because this molar can cause pathology of the adjacent second molar. The aim of this retrospective study is to evaluate the relationship between third mandibular molar and distal cervical caries in second molar. This retrospective study analyzed 55 digital orthopantograms of adult patients and a total number of 95 mandibular third molars were assessed for eruption status, angulation, radiographic evidence of caries or restoration in the mandibular third molar, and radiographic evidence of caries or restoration in the distal surface of the mandibular second molar. The distal cervical caries in second molar is associated with fully erupted and partially erupted wisdom molar in horizontal, mesioangular and vertical position and less with presence of caries in third molar. There are caries lesions in distal second molars in mesioangular position when adjacent third molar is caries free.

A simple suture-guiding device for minimally invasive Achilles tendon repair.

BACKGROUND: Our hypothesis is to utilize a simple suture-guiding device for minimally invasive repair of Achilles tendon without any extra cost with a minimal risk of rerupture. The purpose of this study is to investigate the results of our minimally invasive technique for Achilles tendon repair using a simple ovarian clamp for suture guiding. MATERIALS AND METHODS: Twenty patients with acute Achilles tendon rupture were treated with minimally invasive repair by an expert orthopaedic surgeon. Instead of an Achillon device, an ovarian clamp was directed to the proximal and distal parts of the Achilles tendon. All data relating to daily activities, walking, climbing stairs, sports activity, American Orthopaedic Foot and Ankle Society (AOFAS) and Thermannscores were recorded. Sural nerve was evaluated with physical examination for paraesthesia, hyperaesthesia, lateralis cruris and foot pain in all patient controls. RESULTS: The average AOFAS score was 97.06 (76-100). All patients had intact Achilles tendon at last control. No rerupture was observed. Average time taken to return to work was 30.8 days (28-60 days). After 6 months, all patients returned to their previous sports activities. CONCLUSION: For Achilles tendon ruptures, minimally invasive repair techniques have shown successful results with low complication rates. Besides their success, some suture-guiding devices bring extra costs for patients or health insurance. Minimally invasive techniques may be performed with devices without any extra cost. Our new suture-guiding device provides knot placement under paratenon like Achillon device to improve outcomes, provides early return to work and minimizes the complications. Finally, our suture-guiding device has no extra cost.

Clinical, Histological, and Histomorphometric Evaluation of Demineralized Freeze-Dried Cortical Block Allografts for Alveolar Ridge Augmentation.

Autogenous bone-block grafts are the "gold standard" for block bone grafting, but have several disadvantages. Allografts have the potential to overcome these disadvantages. The purpose of this study was to evaluate the clinical and histomorphometric features of demineralized freeze-dried cortical block allografts (DCBA) used for ridge augmentation. Eleven patients who showed bone deficiencies of <5 mm in the horizontal plane were included in this study. The recipient sites were reconstructed with DCBA. The primary outcomes of interest were bone-width measurements, postoperative clinical evaluations, and histomorphometric analysis of the biopsy samples collected during the implant surgery. Clinical analysis showed that the mean gain in horizontal bone was 1.65 ±â€Š0.14 mm, and that the mean percentage of graft resorption was 5.39 ±â€Š2.18%. On postoperative day 7, edema, pain, and bruising were observed in 18.2%, 0%, and 9.1% of the patients, respectively. In the biopsy samples, the mean percentages of newly formed bone, residual block allograft, and marrow and connective tissue were 40.30 ±â€Š24.59%, 40.39 ±â€Š21.36%, and 19.30 ±â€Š15.07%, respectively. All of the block grafts were successfully integrated into the recipient sites. DCBA may be a viable alternative for treating both deficient maxillary and mandibular alveolar ridges.

How Patients Percept Their Recovery Following Impacted Mandibular Third Molar Coronectomy.

OBJECTIVES: To compare the quality of life (QOL), side effects, risks, and complications following mandibular third molar coronectomy compared with conventional third molar extraction. METHODS: Sixty-nine patients referred for extraction of impacted mandibular third molars were prospectively studied. The decision to perform coronectomy was made according to radiological data indicative of a risk for inferior alveolar nerve injury. The patients were asked to fill out a questionnaire on their QOL during the first postoperative week, and the surgeon was asked to fill out a questionnaire on these patients' demographic, clinical, and radiological details as well as surgery-related data. The study participants were followed up for at least 1 year postoperatively. RESULTS: Thirty-four of the 69 patients underwent coronectomy (study group) and 35 underwent full extraction (control group(. There was no group difference in QOL scores during the first postoperative week. There was no patient of nerve injury in either group. No complications were found in the postoperative period. Two patients of coronectomy necessitate residual tooth removal prior to planned orthodontic treatment. CONCLUSIONS: These patients' QOL are similar to those for patients following total extraction. No difference in side effects following procedure was found between coronectomy and total extraction. CLINICAL RELEVANCE: Coronectomy of impacted mandibular third molars may be offered instead of total extraction in patients presenting radiological characteristics of root proximity to the inferior alveolar nerve.

Pedobarography in the Assessment of Postoperative Calcaneal Fracture Pressure With Gait.

The purpose of the present study was to evaluate the benefits and importance of pedobarography in the diagnosis and treatment of plantar pressure changes in the postoperative follow-up of calcaneus fractures treated with open reduction and internal fixation. The 28 patients included 23 males (82%) and 5 females (18%). The clinical evaluation was performed using the American Orthopaedic Foot and Ankle Society hindfoot scoring system. The Böhler and Gissane angles were measured on the preoperative and postoperative radiographs. In the postoperative follow-up period (mean ± standard deviation 22.25 ± 10.8 months), all the patients underwent analysis with a dynamic pedobarogram. Because the arch index of the operated feet was 29.73% and that of the nonoperated feet was 28.94%, a similar slightly low arch was seen in both feet (p = .078). When the plantar surface maximum pressures were evaluated, a significant reduction was seen in the operated feet in the second, third, fourth, and fifth metatarsals and the medial hindfoot (p < .05). Displaced intra-articular calcaneus fractures resulted in a significant reduction in maximum pressure of the second, third, fourth, and fifth metatarsals and the medial hindfoot. Also, the hindfoot pressure was lateralized. Pedobarography is a simple and useful method for the diagnosis of plantar pressure changes occurring postoperatively.

A biomechanical comparison of the thrust plate prosthesis and a stemmed prosthesis.

The thrust plate prosthesis (TPP) is a neck preserving femoral component in total hip arthroplasty (THA) which may facilitate more precise biomechanical reconstruction of the hip. The purpose of this study was to compare the biomechanical results of the TPP with a conventional THA. We compared anteroposterior radiographs from 60 patients who had undergone cementless THA, with 44 who had undergone a TPP. We measured the hip centre of rotation, femoral offset, limb length, and neck-shaft angle. The horizontal hip centre of rotation, vertical femoral offset, limb length and neck-shaft angle measurements showed a significant difference (p<0.05) in both groups when compared with preoperative values. However, the vertical hip centre of rotation and horizontal femoral offset measurements were different only in TPP patients when compared with preoperative values (p<0.05). When both groups (TPP and THA) were compared only the horizontal hip centre of rotation displayed a significant difference (p=0.003) in favor of the THA. Therefore, we found no difference in restoring the biomechanics of the hip using the two methods, and only the horizontal hip centre of rotation restoration favoured the THA. Our findings indicate that the TPP does not produce more accurate restoration of leg length or offset. Reproduction of hip mechanics after TPP may not be as good as has been suggested.

Thrust plate prosthesis for proximal femoral deformity: a series of 15 patients.

OBJECTIVES: Patients with coxarthrosis and proximal femoral deformity experience problems with total hip arthroplasty. A custom-made prosthesis or a proximal osteotomy is required for such cases, and these also increase the rate of complications. The purpose of this study was to evaluate the results of the thrust plate prosthesis (TPP) in patients with deformity of the proximal femur. METHODS: Fifteen patients (7 females, 8 males) with a mean age of 56.4 years (range 19-75 years) at the time of the surgery were included in the study. The etiology was traumatic coxarthrosis in 12, and nonunion of a femoral neck fracture with osteonecrosis of the femoral head in the remaining three. While the femoral component was a third-generation TPP in all patients, the acetabular component was a Protek expansion cup in 12, and a cementless standard cup in three patients. All operations were performed through a Hardinge approach. Patients were followed up for at least 3 years (range 36-116 months) and evaluated clinically with the Harris Hip Score. RESULTS: The mean preoperative Harris Hip Score increased from 51.2 (range 15-79) to 92.7 (range 60-100) at the latest assessment. In two cases, loosening of the femoral component was observed in zone 3, both 12 months postoperatively. One was replaced by an intramedullary prosthesis, and the other was asymptomatic. CONCLUSION: TPP is a good alternative for patients with malformations of the proximal femur. The use of TPP avoids technical difficulties and a custom-made prosthesis.

Effects of human amniotic fluid and membrane in the treatment of Achilles tendon ruptures in locally corticosteroid-induced Achilles tendinosis: an experimental study on rats.

BACKGROUND: To determine the effects of human amniotic fluid and membrane in the treatment of Achilles tendon ruptures, 72 tendons of 36 Wistar rats were injected with betamethasone sodium phosphate. METHODS: By the end of fourth week, both tendons were tenotomized and repaired, then the samples were divided into three groups. The first group was left untreated after suturing. Human amniotic fluid was injected to the second and amniotic fluid and membrane were both administered to the third group. Twenty-four tendons were scored at the end of the first week, and 24 at the end of the second week histopathologically, and 24 biomechanically at the end of the third week. RESULTS: There was a significant statistical difference only between the histopathological results of Groups 2 and 3 at the first week. CONCLUSIONS: Human amniotic membrane and fluid do not add anything to the healing process of Achilles tendon ruptures in the early phase.