Scapular Dyskinesis, Shoulder Joint Position Sense, and Functional Level After Arthroscopic Bankart Repair.

BACKGROUND: Scapular kinesia is an important component of glenohumeral rhythm and shoulder stability. No studies have evaluated scapular dyskinesis and its relationship to shoulder proprioception in patients who have undergone arthroscopic Bankart repair (ABR). PURPOSE: To investigate scapular dyskinesis, proprioception, and functional level after ABR. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: This study included 13 male patients who underwent ABR (ABR group; mean age, 30 years; range, 24-36 years) and 13 sex- and age-matched healthy individuals (control group). The age, height, weight, and dominant side of all participants were collected. Scapular dyskinesis was evaluated using the lateral scapular slide test and the scapular dyskinesis test; proprioception was measured by the active angle reproduction test using a smartphone goniometer application, and functional level was assessed using the upper-quarter Y-balance test for dynamic stability as well as the Rowe score and Walch-Duplay score for quality of life and return to activities of daily living. RESULTS: The presence of static scapular dyskinesis in the neutral position, at 45° of abduction, and at 90° of abduction as well as the presence of dynamic scapular dyskinesis was higher in the ABR group compared with the control group (P ≤ .04 for all). Shoulder joint position sense (absolute error) at 40° and 100° of shoulder elevation and shoulder functional level according to the Rowe score were worse in the ABR patients compared with the healthy controls (P ≤ .02 for all). Dynamic scapular dyskinesis was negatively related to shoulder joint position sense at 40° of shoulder elevation (r = -0.64; P = .01). Static scapular movement as measured on the lateral scapular slide test was moderately related to the Rowe score (r = 0.58; P = .03). CONCLUSION: Scapular kinematics and proprioception should be evaluated after ABR. Treatment approaches to improve scapular control and proprioceptive sense should be included in the rehabilitation program for patients after ABR.

Long-term results of arthroscopic medial reefing for patellar instability.

BACKGROUND: The purpose of the study was to investigate the long-term outcomes of the all-inside arthroscopic medial reefing (AAMR) procedure for patellar instability and the factors that affect successful outcome. METHODS: In this retrospective study, AAMR with suture was performed in 16 knees of 15 patients who had at least one patellar dislocation and did not experience a decrease in pain and who did not have a major radiological bony abnormality. Preoperatively, Tegner and Lysholm scales were used; for the final evaluation Tegner, Lysholm, Kujala and Knee injury and Osteoarthritis Outcome Score (KOOS) were used. RESULTS: The average age of the patients at the time of operation was 18 years (range: 11-36 years). The average follow-up time was 118.3 months (range: 85-143 months). Six of the 16 knees (37.5%) exhibited re-dislocation. Preoperatively, the mean Lysholm and Tegner were 66.5 and 4.0, respectively; and postoperatively increased to 89.3 (P = .001) and 4.66, respectively. At the final follow-up, mean Kujala was 89.3 (good), and mean KOOS was 91.4. In all patients with re-dislocation, fewer than four knots were used, and none of the patients with four knots exhibited re-dislocation. Re-dislocations occurred in two, two, one and one patients at two, three, five and eight years, respectively. CONCLUSIONS: The AAMR technique is associated with minimal incisional scarring and an increase in functional scores. It is also associated with a high risk of re-dislocation compared with other methods. If the technique still needs to be used, despite the high re-dislocation rate, at least four knots should be applied.

The effect of systemic corticosteroid treatment on the immunolocalisation of Notch-1, Delta, CD105 and CD166 in rat articular cartilage.

We studied the immunolocalisation of the stem cell-specific markers Notch-1, Delta, CD105 and CD166 in rat articular cartilage and analysed the effect of systemic corticosteroid treatment on the patterns of distribution of cells labelling for these markers. Female Wistar rats were separated randomly into two groups: the control group (n=8) was injected with isotonic salt solution and the corticosteroid group (n=8) was injected with 10 mg/kg intramuscular corticosteroid (methylprednisolone) once a week for a period of 8 weeks. Femoral head specimens from each group were obtained at the end of the treatment and processed for routine histological and immunohistochemical examinations. Quantitative data were obtained by H-SCORE and statistical evaluations were performed. The immunolocalisation of all markers was more apparent in the superficial zone and decreased through the deeper zones in all groups. However, the intensity of labelling was much less obvious in the group treated with corticosteroid compared to control. H-SCORE analysis confirmed that in the group treated with corticosteroid, the intensity of Notch-1, Delta, CD105 and CD166 labelling had decreased significantly compared to control (p<0.05). In conclusion, based on the immunolocalisation of stem cell-specific markers Notch-1, Delta, CD105 and CD166, the data suggest that the stem cells may continue to exist in adult rat articular cartilage. It was also observed that systemic corticosteroid treatment may effect the immunolabelling intensity of these markers, suggesting that corticosteroid treatment may reduce the function and the regenerative capacity of these cells in articular cartilage.

Proprioceptive comparison of allograft and autograft anterior cruciate ligament reconstructions.

The aim of this study is to search if there is any proprioceptive difference between auto and allograft anterior cruciate ligament (ACL) reconstructions, and also to determine if there is any relationship between instrumented anterior knee laxity and proprioception after an ACL reconstruction. The following four groups were constituted for this purpose: group I, control group; group II, autograft reconstructions; group III, allograft reconstructions and group IV, people with injured ACLs. Each group consisted of 20 patients/volunteers. Two subgroups were constituted according to the findings of KT-1,000 laxity testing in group II and III; patients/volunteers found to have a laxity of 3 mm or less were enrolled in the normal subgroup and those with a laxity of more than 3 mm were enrolled in the lax subgroup. Two proprioceptive tests were used: threshold to detect passive motion (TDPM) and joint position sense (JPS) by using Cybex Norm dynamometer. Patients underwent ten tests and the discrepancy in degrees was averaged for ten trials. Comparisons were made to evaluate the proprioceptive differences between groups/subgroups; ANOVA and t test was used for comparisons where appropriate, and the significance was set at P < 0.05. There was a significant difference in degrees between patients with injured ACLs and the other three groups in TDPM evaluations (injured: 1.93 degrees vs. control: 1.03 degrees , autograft: 1.01 degrees , allograft: 0.96 degrees ; P < 0.001). Auto and allograft reconstructions were not different from each other and controls. Allo and autograft ACL reconstructions are not different from each other according to proprioceptive measurements. Also, proprioception is not correlated to postoperative anterior knee laxity; many variables involve joint proprioception and mostly the anterior knee laxity may not be the sole determining element, and a lax ACL still may fulfill some of its afferent arc functions as long as it bridges the femur and tibia.

[Osteochondral allograft transplantation in the knee]. / Dizde osteokondral allogreft transplantasyonu.

Despite significant improvements for the past 20 years in the treatment of full-thickness chondral defects with the use of chondroprotective biological methods (microfracture, autologous chondrocyte transplantation, osteochondral autograft, and periosteal graft), the treatment of large osteochondral defects in young and physically active population is still challenging. Alternatives for the treatment of chondral defects exceeding 3 cm in size are limited, and among them, allografts have been used longer than any other treatment methods with the most favorable results. The success rates for osteochondral allograft transplantation have been reported as 95%, 71%, and 66% at 5, 10, and 20 years, respectively. Factors that adversely affect long-term results include advanced age, allograft transplantation to both sides of the joint, inappropriate loading, osteoarthritis, and osteonecrosis due to steroid use. Today, as a result of improvements in tissue-organ transplantation, increased availability of fresh tissue from donors, and increased demand from patients and physicians, there has been growing interest in the use of osteochondral allografts in selected patients to delay arthroplasty for chondral defects.

Injured rabbit ACL treated by radiofrequency. Effects of cyclic loading.

BACKGROUND: Radiofrequency treatment is increasingly used to treat shoulder instability. Patients are asked to restrain their physical activities after this treatment but there is no precise information concerning the necessity for the restrain. METHODS: There were two groups of ten specimens each. Treatment group specimens were stretched to subfailure injury, treated by a radiofrequency probe, and then cyclically loaded. Control group specimens were stretched to the same subfailure injury, Sham treated, and then cyclically loaded. Between each step of the experiment in both groups there was a relaxation test to examine the ligament viscoelastic properties. At the end, each ligament was stretched to failure and the load-elongation curve obtained. FINDINGS: Relaxation forces decreased after the subfailure injury in both groups (average 76% and 81% of intact state, in treatment and control groups, respectively). In the treatment group, the relaxation forces first increased after the radiofrequency treatment (average 99% of intact state), and then decreased after the cyclic loading (average 50% of intact state). The treated ligaments failed at lower loads and smaller deformations than the controls. INTERPRETATION: The radiofrequency treatment restored viscoelastic properties of the injured ligaments, but cyclic loading degraded these. Protection of the treated ligament is advised during the immediate post-operative period.

Juxta-articular myxoma of the wrist: a case report.

A 16-year-old boy with a 4-month history of pain and a palpable mass in the right wrist was presented to our clinic. Preoperative diagnosis was a ganglion cyst according to symptoms and physical examination. The lesion was removed by marginal resection and histopathologic examination revealed a juxta-articular myxoma. No recurrence was detected at 1-year follow-up evaluation. We report a case of juxta-articular myxoma of the wrist joint.

[Metastatic tumors of the hand in three cases]. / Uç olguda metastatik el tümörü.

Metastatic malignancies of the hand are rare and they usually develop from lung, breast, and kidney tumors. Metastases to the bones of the hand can cause pain, swelling, soft tissue ulceration, and osteolytic destruction. We presented three patients with metastatic tumors of the hand, whose ages were 58 (male), 42 (female), and 40 (male) years. Metastases developed in the thumb and the big toe, metacarpal bone, and the nail bed following treatment for primary tumors of the bladder, colon, and chondrosarcoma of the proximal femur, respectively. One patient underwent amputation of the thumb and the big toe followed by systemic chemotherapy, one patient with metacarpal involvement was treated with Ray amputation, and the latter underwent a biopsy. Histopathological diagnoses were consistent with primary tumors.

Irreducible posterolateral knee dislocation resulting from a low-energy trauma.

A small amount of knee dislocations is included in the irreducible knee dislocations group. In such instance, medial femoral condyle is buttonholed through the gap formed by medial retinacular and capsular structures and this prevents reduction. In this study, we present two cases in which there were irreducible posterolateral knee dislocations resulting from a low-energy trauma. In both cases, dimple sign produced by the invagination of the medial retinacular structures and capsule and ecchymosis medially were noted. Soft tissue invaginated between the trochlea and intercondylar notch was extracted by open reduction.

[Osteochondral lesions of the talus in adolescents]. / Ergenlik döneminde görülen talusun osteokondral lezyonlari.

Osteochondral lesions of the talus range from those confined to the hyaline cartilage covering the articular surface to those involving the subchondral bone. The lesion may not be apparent on the surface of the cartilage or it may be confined to the subchondral bone without cartilage involvement. These complex presentations often necessitates the use of computed tomography and magnetic resonance imaging to delineate the exact nature of the lesions. It has been shown that the frequency of osteochondral lesions increase following repetitive ankle sprains. Although the etiology is not well understood, both traumatic and atraumatic causes are thought to be effective. Nevertheless, early diagnosis and treatment of these lesions have improved considerably thanks to the developments in imaging techniques. It seems that arthroscopic chondral reconstruction methods using autologous chondrocyte and osteochondral transplantations will gain much interest in the near future.

Radiofrequency treatment weakens the fatigue characteristics of rabbit anterior cruciate ligament.

OBJECTIVE: To evaluate the radiofrequency treatment applied to an intact anterior cruciate ligament, and to quantify the mechanical effects of controlled cyclic loading (simulating activities of daily living) post-treatment. DESIGN: An in vitro radiofrequency energy application to the rabbit anterior cruciate ligament and cyclic loading of the treated ligament. BACKGROUND: Effect of cyclic loading on the radiofrequency treated ligament in a controlled environment is not known. METHODS: In the treatment group radiofrequency treatment was applied to an intact ligament and then the ligament was cyclically loaded for 3000 cycles, and stretched-to-failure. Control group was similar to treatment, except that the radiofrequency treatment was not applied. The cyclic loading (approximately 6% tensile strain) was kept below the injury threshold of the rabbit anterior cruciate ligament and was designed to simulate loading post-treatment. A relaxation test (5% constant strain for 180 s) was used to compare the results at different steps in the experiment; within each group and between the two groups. RESULTS: Relaxation force increased in the treatment group (average 108% of intact, P<0.05), but decreased after the cyclic loading (average 71% of intact, P<0.05). There were significant differences in the force-deformation-failure curves between the treatment and control groups: average treated ligament failed at 59% and 57% of the control values respectively for the deformation and force (P<0.05). CONCLUSIONS: Using radiofrequency treatment makes rabbit anterior cruciate ligament weaker following cyclic loading. RELEVANCE: The radiofrequency treatment weakens the anterior cruciate ligament, and therefore, it perhaps should be protected until healing and adaptation restore its full strength.