Tibial Press-Fit Fixation Technique in Anterior Cruciate Ligament Reconstruction Surgery.

Implant-free press-fit tibial fixation technique has recently gained popularity in anterior cruciate ligament reconstruction because it does not cause tunnel widening, does not cause complications associated with additional fixation materials, allows bone-to-bone healing, and does not cause defects in revision surgery. Bone-patellar tendon autograft offers the advantage of direct bone-to-bone integration of the graft, and anterior knee pain is less expected than bone-patellar tendon-bone autograft. This technical report includes details of arthroscopic ACL reconstruction of patellar tendon-tibial tubercle bone autograft distal press-fit fixation technique. We call this the Kocabey distal press-fit technique.

Assessment of learning in simulator-based arthroscopy training with the diagnostic arthroscopy skill score (DASS) and neurophysiological measures.

PURPOSE: Virtual arthroscopic training has become increasingly popular. However, there is a lack of efficiency-based tracking of the trainee, which may be critical for determining the specifics of training programs and adapting them for the needs of each trainee. This study aims to evaluate and compare the measures obtained with a non-invasive neurophysiological method with The Diagnostic Arthroscopy Skill Score (DASS), a commonly used assessment tool for evaluating arthroscopic skills. METHODS: The study collected simulator performance scores, consisting of "Triangulation Right Hand", "Triangulation Left Hand", "Catch the Stars" and "Three Rings" and DASS scores from 22 participants (11 novices, 11 experts). These scores were obtained while participants underwent a structured program of exercises for the fundamentals of arthroscopic surgery training (FAST) and knee module using a simulator-based arthroscopy device. During the evaluation, data on oxy-hemoglobin and deoxy-hemoglobin levels in the prefrontal cortex were collected using the Functional Near-Infrared Spectroscopy (fNIRS) imaging system. Performance scores, DASS scores, and fNIRS data were subsequently analyzed to determine any correlation between performance and cortex activity. RESULTS: The simulator performance scores and the DASSPart2 scores were significantly higher in the expert group compared to the novice group (200.1 ± 28.5 vs 172.5 ± 48.9, p = 0.04 and 9.4 ± 5.6 vs. 5.4 ± 5.6 p = 0.02). In the expert group, fNIRS data showed a significantly lower prefrontal cortex activation during fundamental tasks in the FAST module, indicating significantly more efficient mental resource use. CONCLUSION: The analysis of cognitive workload changes during simulation-based arthroscopy training revealed a significant correlation between the trainees' DASS scores and fNIRS data. This correlation suggests the potential use of fNIRS data and DASS scores as additional metrics to create adaptive training protocols for each participant. By incorporating these metrics, the training process can be optimized, leading to more efficient arthroscopic training and better preparedness for clinical operations. LEVEL OF EVIDENCE: III.

Tibial Press-Fit Fixation Technique in Anterior Cruciate Ligament Reconstruction.

Implant-free press-fit tibial fixation technique has gained popularity recently due to the problems in bone tunnel expansion, defect, and revision surgery due to the tibial fixation material preferred in anterior cruciate ligament surgery. Patellar tendon-tibial bone autograft offers several advantages in anterior cruciate ligament reconstruction. We describe a tibial tunnel preparation method and the use of patellar tendon-bone graft in the implant-free tibial press-fit technique. We call this the Kocabey press-fit technique.

Clinical significance of serum lncRNA H19, GAS5, HAR1B and linc01783 levels in Parkinson's disease.

Background and purpose:

Long noncoding RNAs (lncRNAs) are highly expressed in the brain and alterations in their levels have been shown in many neurodegenerative disorders. Evidence has shown that lncRNAs play role in the onset and progression of Parkinson’s disease (PD) and it can be used as a potential therapeutic target. Our purpose was to detect whether the serum levels of four candidate lncRNAs H19, GAS5, HAR1B and LINC01783 are related with the clinical findings and treatment of PD or not. 

83 patients and 50 healthy controls were included in this study. We assessed how severe the disease is, by using Hoehn Yahr (HY) staging and Unified PD rating scale (UPDRS). Venous blood samples were taken from the participants. Serum samples were centrifuged and stored at -80°C until analysis. Expression levels of these lncRNAs were analyzed by a real-time PCR instrument after RNA isolation and complementary DNA synthesis in the laboratory.

There was no significant difference between PD patients and healthy controls in these lncRNAs’ serum levels. Just as sociodemographic characteristics, also onset type and right or left predominance of the disease, its duration and treatment did not differ in lncRNA levels. Solely, there was a significant negative correlation between GAS5 and HY and UPDRS scores. Patients with family history of PD had significantly higher levels of LINC01783.

Serum lncRNA GAS5 level may be a possible biomarker for disease severity in PD patients. 

Care burden and related factors among informal caregivers of patients with amyotrophic lateral sclerosis.

Objective: Amyotrophic lateral sclerosis (ALS) affects the life of the family caregiver as well as the patient. This study aimed to determine the care burden and related factors among family caregivers of Turkish ALS patients. Methods: This descriptive study was conducted with 108 ALS patients and their informal caregivers through face-to-face interviews at home. The data were collected using the ALS Functional Rating Scale, Zarit Burden Interview, European Quality of Life-Five Dimensions Questionnaire, Multidimensional Scale of Perceived Social Support, and the Hospital Anxiety and Depression Scale. Results: The mean age of the caregivers was 48.1 ± 13.4 years; the vast majority were female, and they were either spouses or children of the patients. While 49.1% reported moderate or severe burden, the quality of life was moderate (mean 70.4 ± 22.8). The caregiver burden was related to sex and the functional state of the patient, as well as caregiver factors such as the relation to the patient, sex, health status, time spent for care, and living in the same house with a limited environment. Walking ability, percutaneous endoscopic gastrostomy, tracheostomy, and communication problems were not associated with the burden. Furthermore, burden was associated with the caregiver's quality of life, social support, anxiety, and depression. Conclusions: The present study draws attention to the fact that the care burden in family caregivers of ALS patients is high and their quality of life is impaired. Our findings reveal that not only ALS patients but also caregivers need to be supported with an organized and planned system.

Suture configuration techniques have no effect on mid-term clinical outcomes of arthroscopic meniscus root repairs.

BACKGROUND: The aim of this study was to evaluate the clinical and radiological outcomes of arthroscopic transtibial pullout repair (ATPR) for the medial meniscus with both two modified loop stitches (TLS) and two simple stitches (TSS) techniques. METHODS: Between January 2013 and January 2016, 41 patients who had undergone ATPR for medial root tears with TLS and TSS techniques were retrospectively evaluated. The mean age at operation was 53 years (range 45-58). The mean follow-up period was 44.6 months (range 26-64). Lysholm knee score was used for clinical evaluation before and after surgery. For all patients, meniscal extrusion distances in the coronal plane were measured using magnetic resonance imaging and were recorded both preoperatively and at final follow-up. RESULTS: There was no difference in terms of meniscus extrusion measurements between groups preoperatively (P > .05). Postoperative meniscus extrusion measurements were 2.1 ± 0.3 and 2.9 ± 0.6 in TLS and TSS groups, respectively. The difference between groups was statistically significant (P < .01). The increase in postoperative Lysholm score was found to be statistically significant in both groups (P < .01). Postoperative Lysholm scores were 88.8 ± 3.7 and 87.6 ± 4.8 in TLS and TSS groups, respectively. The difference between groups was statistically insignificant (P > .05). CONCLUSIONS: There was a significant improvement in Lysholm knee scores postoperatively in patients that underwent transtibial pullout medial meniscus posterior root repair regardless of meniscus reduction level and suture configuration types. Although TLS technique was superior to TSS technique in terms of meniscus reduction, this meniscus reduction did not create any clinical difference at clinical outcome.

Validity and Reliability of the Turkish Version of the Amyotrophic Lateral Sclerosis Assessment Questionnaire.

OBJECTIVE: The aim of this study was to adapt the Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ), developed for the evaluation of quality of life in amyotrophic lateral sclerosis (ALS) patients, into the Turkish society. METHODS: This methodological study was conducted in 92 ALS patients registered in 2 chapters (Istanbul and Izmir) of Turkish ALS-Motor Neuron Diseases Association. The expert opinion and forward-backward translation methods were applied for the linguistic validity of the ALSAQ (long and short versions: ALSAQ-40 and ALSAQ-5, respectively). RESULTS: In the analysis of internal consistency, the Cronbach's α reliability coefficient was .96 for the total scale, whereas it was between .88 and .98 for the 5 dimensions. The dimensions of the long form were correlated with the items of the short form. CONCLUSION: The Turkish versions of the ALSAQ short and long forms are valid and reliable tools to be used in the assessment of the quality of life in ALS patients.

A novel EOG-based wireless rapid communication device for people with motor neuron diseases.

In this study, a new electrooculography (EOG) based system that provides efficient communication for people suffered from motor neuron diseases is presented. The system consists of two distinct devices. The first device operates as a main unit that is activated by the subject's eye movements. This unit is capable of transmitting 10 different command/state messages. These messages enable subject to choose his/her situation such as "I'm fine", "I feel bad", "I'm hungry" and "I'm thirsty". Commands such as "Come", "Go". The number of messages can be increased. The main unit acquires the EOG signal from the subject. Newly developed analogue and digital signal conditioning interprets the eye movements as specific messages and transmits them to the second unit (receiver) using radio frequency transmitter. The messages related to the subject's demands and situation can be heard from both main and receiver unit speakers. The wireless receiver unit is capable of notifying the patient's command by auditory and visual indicators. The realised device was tested by 2 healthy and 2 ALS patients and confirmed to be successful with 100% performance for sending correct messages.

Preoperative parameters and their prognostic value in amyotrophic lateral sclerosis patients undergoing implantation of a diaphragm pacing stimulation system.

INTRODUCTION: Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease with devastating and fatal respiratory complications. Diaphragm pacing stimulation (DPS) is a treatment option in diaphragm insufficient ALS patients. Ventilatory insufficiency depending on diaphragmatic failure is treated by the present study aimed to investigate prognostic value of preoperative clinical and functional characteristics of ALS patients undergoing implantation of a DPS system and to determine appropriate indications for the DPS system. METHODS: The study included 34 ALS patients implanted with DPS system. All patients underwent multidisciplinary and laboratory evaluations before the surgery. The laboratory examinations included pulmonary function tests and arterial blood gas analysis. Survival rates were recorded in a 2-year follow-up after the surgery. RESULTS: Twenty-eight of 34 patients with ALS survived after a 2-year follow-up. These patients were younger than those who died and had the disease for a longer time; however, the differences were not significant. Both right and left hemidiaghragms were thicker in the survived patients (P < 0.0001 for each). Pulmonary function tests revealed no significant differences between the patients who survived. Arterial blood gas analysis demonstrated lower partial pressure of carbon dioxide in the survived patients (P = 0.025). CONCLUSIONS: DPS implantation was more efficacious in ALS patients with mild respiratory failure and thicker diaphragm. Predictors of long-term effectiveness of DPS system are needed to be addressed by large-scale studies.

The triangle between the anterior and posterior cruciate ligaments: an arthroscopic anatomy study.

OBJECTIVE: The goal of anterior cruciate ligament (ACL) reconstruction is to place the graft in closest proximity to the native ACL anatomy. This study aims to examine the angular relation between intact anterior and posterior cruciate ligaments (PCL) from an arthroscopic perspective. METHODS: Forty patients (20 male, 20 female) with a mean age of 35.12 (range: 18-40) years that underwent knee arthroscopy for reasons other than ACL rupture were included in the study. Following diagnostic examination and repair of the primary pathology, the triangle between ACL and PCL was seen at different flexion degrees of the knee joint (120, 90, 60, and 30°) through standard anterolateral (AL) and anteromedial (AM) portals. The narrow top angle of the triangle between the long intersecting axes of ACL and PCL was measured using recorded images by 3 blind observers. RESULTS: The average ACL-PCL angle was 61°, (standard deviation±2°) at 90°of knee flexion. The angles were narrower when viewed through the AM portal. The degree of the angles was not affected by age, sex, body mass index (BMI), or the side (right or left) on which the procedure was performed. There was good-to-excellent intra- and interobserver reliability. CONCLUSION: The angular relation between intact ACL and PCL has the potential to provide a better view of the anatomy during arthroscopic ACL surgery. To perform better anatomic reconstructions, it is important to create a 60° angle between the ACL graft and PCL (as viewed through AL portal) at 90°of knee flexion.

Cementless total hip arthroplasty in developmental dysplasia of the hip with end stage osteoarthritis: 2-7 years' clinical results.

Between 2006 and 2011, 102 hips of 78 patients with end-stage osteoarthritis secondary to developmental dysplasia of the hip (DDH) underwent cementless total hip arthroplasty (THA). According to the Crowe's classification, 22 hips (21%) were type 1, 19 hips (18%) were type 2, 22 hips (21%) were type 3 and 39 hips (38%) were type 4 respectively. Functional and clinical analyses were performed by Harris Hip Scores (HHS). There were 73 (71%) excellent or good results according to HHS. The postoperative HHS was significantly lower in patients who underwent femoral shortening (p<0.01). We observed 25 (24.5%) complications in total, 15 (14.7%) of which required revision surgery. The authors concluded that THA for DDH is a safe and a reliable procedure with good clinical outcomes.

Oral Pyogenic Granuloma Associated With a Dental Implant Treated With an Er:YAG Laser: A Case Report.

A pyogenic granuloma is a tumorlike proliferation that occurs slightly more often in females, frequently involving the gingiva in the maxillary region. Clinically, it presents as a sessile or pedunculated exophytic mass with a smooth or lobulated surface, which tends to bleed easily. Its color can range from pink to dark red. The most common treatment is surgical excision. This case report presents a pyogenic granuloma that formed around an implant 7 years after its insertion. Pyogenic granulomas associated with dental implants are extremely rare; this is the fourth reported case and the first case of pyogenic granuloma to be treated with an Er:YAG laser.

Outcomes for revision total knee replacement after unicompartmental knee replacement.

OBJECTIVE: The aim of this retrospective, observational study was to describe the outcomes of total knee replacement (TKR) after failed Oxford phase 3 medial unicompartmental knee replacement (UKR). METHODS: The study included 24 revision TKRs (20 females, 4 males; mean age: 61 years) performed following failed aseptic UKR. Outcomes were assessed using the Knee Society Score (KSS). RESULTS: The most common causes for revision were mobile bearing dislocation and unexplained pain. Mean preoperative KSS was 50.3 (range: 37 to 66) and 82.2 (range: 58 to 97) after TKR. There were 17 excellent, 4 good, 2 fair and 1 poor results. CONCLUSION: The type of UKR performed (cemented versus uncemented) had no effect on TKR success. Revision for failed UKR with TKR appears to be a technically straightforward procedure with satisfactory early clinical results.

Evaluation of dental anxiety in patients undergoing dentoalveolar surgery with laser treatment.

OBJECTIVE: The purpose of this study was to evaluate dental anxiety in patients undergoing apicectomy procedures performed with conventional instruments or an erbium-doped yttrium aluminum garnet (Er:YAG) laser. METHODS: Twenty-eight patients undergoing apicectomy were divided into two groups; roots were removed with an Er:YAG laser in group A (n=14) and with conventional instruments in group B (n=14). All patients completed preoperative State-Trait Anxiety Inventories (STAI) and postoperative questionnaires. RESULTS: Although state anxiety, trait anxiety, and postoperative questionnaire scores were lower in patients undergoing Er:YAG laser treatment than in those treated with conventional instruments, the differences were not statistically significant. CONCLUSIONS: Surgical instruments affect the anxiety levels of dental patients. Even with the STAI scores being lower for patients treated with Er:YAG, use of the Er:YAG laser alone cannot contribute to the resolution of dental anxiety. A patient's individual condition is the major factor influencing that patient's anxiety level.

Cemented versus Uncemented Oxford Unicompartmental Knee Arthroplasty: Is There a Difference?

Purpose. The use of uncemented unicompartmental knee prostheses has recently increased. However, few studies on the outcomes of uncemented unicompartmental knee prostheses have been performed. The purpose of this study was to compare the outcomes of cemented and uncemented Oxford unicompartmental knee arthroplasty. Materials and Methods. This retrospective observational study evaluated the clinical and radiological outcomes of 263 medial Oxford unicompartmental prostheses (141 cemented, 122 uncemented) implanted in 235 patients. The mean follow-up was 42 months in the cemented group and 30 months in the uncemented group. Results. At the last follow-up, there were no significant differences in the clinical results or survival rates between the two groups. However, the operation time in the uncemented unicompartmental knee arthroplasty group was shorter than that in the cemented unicompartmental knee arthroplasty group. In addition, the cost of uncemented arthroplasty was greater. Conclusion. Despite the successful midterm results in the uncemented unicompartmental knee arthroplasty group, a longer follow-up period is required to determine the best fixation mode.

Lyophilised medial meniscus transplantations in ACL-deficient knees: a 19-year follow-up.

PURPOSE: The treatment of meniscal tears has changed since the early 1980s. Meniscus transplantation emerged as a treatment option during that period. This study aims to present the long-term results of the first lyophilised meniscus allograft transplants in Turkey. METHODS: Between 1990 and 1992, four transplants of the medial meniscus combined with anterior cruciate ligament (ACL) reconstruction were performed on patients with a history of medial meniscectomy and anterior knee instability at our institution. For all patients who underwent meniscus lyophilised allograft transplantation and revision ACL reconstruction, clinical outcomes were evaluated over a mean period of 19 years of postoperative follow-up by clinical assessment, Tegner score, Lysholm score, Knee Society Score, radiography and magnetic resonance imaging (MRI). RESULTS: The median value of Tegner score was 3 before index surgery and 2.5 at year 19 postoperatively. The median value of Lysholm score was 60.5 before index surgery and 62.5 at year 19. All of the patients had Outerbridge grade IV osteoarthritis by X-ray examination at year 19. CONCLUSION: Successful meniscus transplantation depends on many factors. This study examines the effect of allografts on these factors and describes experiences with lyophilised allografts in four male patients. LEVEL OF EVIDENCE: IV.

Pin and plate fixation in complex distal humerus fractures: surgical technique and results.

PURPOSE: Complex distal humerus fractures are difficult to fix by conventional methods, especially in comminuted low distal humerus fractures. We propose a technique using small diameter K-wires and a plate on the humeral shaft. METHODS: Between May 2007 and March 2009, 19 patients with poor bone quality showing comminuted or low distal humerus fractures involving the articular surface were referred to our institution and were primarily treated by this technique that we called "pin and plate fixation". We have reviewed all the cases treated by this method. RESULTS: The average age was 46 years. All of the patients were followed up for a mean of 12 months and had a good range of motion (the average total arc of flexion-extension was 99°); the average Disabilities of the Arm, Shoulder and Hand (DASH) score was 18 points. The Mayo Elbow Performance Index was measured and the mean score was 88 in our patients. CONCLUSIONS: In this study, a technique has been evaluated for the treatment of complex distal humerus fractures. We recommend this technique in comminuted, osteoporotic or low distal humerus fractures in which other fixation methods seem difficult or even impossible.

Treatment of Kienböck disease by lunate core decompression.

PURPOSE: Kienböck disease is characterized by avascular necrosis of the lunate bone, which is usually progressive without treatment. This study examined lunate core decompression for its treatment potential. METHODS: We surgically treated 20 patients with stage 1 to 3b Kienböck disease with lunate core decompression. We evaluated pain, range of motion, functional disability, and radiographic indices in these patients at baseline and 5 years after surgery. RESULTS: The mean age of the patients was 29 years; 16 were men. Ten patients had Lichtman stage 1 disease, 6 had stage 2 disease, 3 had stage 3a, and 1 had stage 3b disease. Range of motion scores showed meaningful improvement. Two patients did not improve with this technique and were revised with radial shortening procedures. CONCLUSIONS: Lunate core decompression is a simple surgical procedure that is effective in the treatment of Kienböck disease. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Stabilization of chevron bunionectomy with a capsuloperiosteal flap.

BACKGROUND: Distal chevron osteotomy (DCO) for mild to moderate hallux valgus deformity is inherently more stable than the other forms of distal metatarsal osteotomy, but complications such as loss of correction, infection, joint stiffness, delayed union, malunion and nonunion can occur. In this study, we evaluated the use of a capsuloperiosteal flap for stabilization of DCO in the treatment of hallux valgus. MATERIALS AND METHODS: A retrospective study was conducted on 59 patients (88 feet) that underwent distal Chevron osteotomy stabilized only with a capsuloperiosteal flap for mild and moderate hallux valgus deformity with a mean followup of 11.3 years. Clinical evaluation was calculated using the hallux score of the American Orthopaedic Foot and Ankle Society (AOFAS). RESULTS: The score improved from a preoperative mean of 52 to a mean of 91.5 points at last followup. Average hallux valgus angle changed from 30.3 degrees preoperatively to 14.2 degrees postoperatively at the last followup. Intermetatarsal angle 1-2 changed from 13.6 degrees preoperatively to 10.2 degrees postoperatively. The correction proved to be consistent with only an average of 3.4-degree correction loss and 4.9-degree loss in the range of motion. Eighty-six feet (97.7%) were pain free. Discomfort with shoewear was absent in 84 feet (95.5%) postoperatively and 24 of 25 (96%) patients were satisfied cosmetically. CONCLUSION: Capsuloperiosteal flap stabilization of distal chevron osteotomy for mild-moderate hallux valgus yielded excellent clinical results at long-term followup.

[The effect of periosteum on the union of the autoclaved bone graft-host bone: experimental study in rabbits]. / Periost dokusunun otoklavize kemik grefti-alici kemik bütünlesmesine etkisi: Tavsanlarda deneysel çalisma.

OBJECTIVES: In this study, we investigated the effect of periosteum on the union of autoclaved segmental bone grafts harvested from rabbit radii and replanted to their beds with intramedullary fixation to host bone. MATERIALS AND METHODS: Segmental bone defects, 15 milimeters long, in the middle of the left radius were created in 16 adult rabbits. The resected bones were autoclaved 15 minutes at 120 °C and reimplanted and fixed with intramedullary Kirschner wires. The rats were divided into two groups; in the first group, eight rabbits' graft-host bone junctions were covered with periosteal flaps and in the second group, graft-host bone junctions were deperiostized. Plain X-rays were taken at 2, 4, 6 and 8 weeks after the operation. At the end of the 8(th) week radiological results were evaluated with modified Yang's radiological scoring system. RESULTS: Radiological results revealed more callus tissue and early, better healing in the first group (mean 10.94), than in the second group (mean 6.06) at 8(th) week. The difference was statistically significant (p=0.04, <0.05). CONCLUSION: Periosteal flaps are biologic tissues that can be easily performed and enhance the healing of graft-host junctions. The periosteal flap technique is effective on the healing of graft-host bone junctions and this technique is worth applying to structural allografts.