Autologous osteochondral transplantation provides succesful recovery in patients with simultaneous medial and lateral talus osteochondral lesions.

OBJECTIVE: The aim of this study was to evaluate the success of simultaneous medial and lateral autologous osteochondral transplantation (AOT) in patients with both medial and lateral osteochondral lesions of the talus (OLT) who could not be treated with bone marrow stimulation techniques or whose previous treatments failed. METHODS: Five patients who underwent medial and lateral talus AOT in the same session due to simultaneous OLT on medial and lateral talar dome were included in this retrospective study. All the patients were male, and the mean age was 34.8 (range = 26 - 42) years. Double osteochondral grafts were placed separately to the medial and lateral talar dome at the same session. Location and size of the OLT, additional ligament injuries, and postoperative evaluation of the graft were evaluated through magnetic resonance images (MRIs). The criteria of Berndt and Harty, Single Assessment Numeric Evaluation (SANE), American Orthopedic Foot and Ankle Society Score (AOFAS), visual analogue scale (VAS) score, and Tegner Activity Score were assessed preoperatively and at the last follow-up. RESULTS: All patients had suffered an injury with inversion of the foot while daily or sports activity. Average duration of symptoms from onset to osteochondral grafting was 25.2 months. The mean follow-up time was 61 months. The radiological evaluation showed OLT with Stage 4 or 5, anterior talofibular ligament injury and deltoid ligament strain observed in all of the patients. With the numbers available, pre and post-operative comparisons showed a significant increase in patients' satisfaction rate and significant decrease in VAS scores as well as an increase in AOFAS scores with the numbers available. No complications were encountered. CONCLUSION: Simultaneous AOT for medial and lateral OLT appears to be a reliable surgical procedure with satisfactory clinical results. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Can we use intraoperative femoral tunnel length measurement as a clue for proper femoral tunnel placement on coronal plane during ACL reconstruction?

INTRODUCTION: Successful anterior cruciate ligament (ACL) reconstruction is dependent on correct placement of both tibial and femoral tunnels. The purpose of this study is to investigate whether we can use intraoperative femoral tunnel length measurement to estimate the correct femoral tunnel placement on coronal plane. METHODS: This prospective study comprised 164 consecutive patients who underwent ACL reconstruction surgery. Transtibial or anteromedial portal technique is used for drilling the femoral tunnels. The length of the femoral tunnel was measured during the operation. The femoral tunnel coronal plane angle was calculated on the postoperative tunnel radiographs. A statistical comparison was made of the lengths of the tunnel, the techniques used drilling and the femoral tunnel angles. RESULTS: The far anteromedial portal was used in 81 (49%) cases and the transtibial technique in 83 (51%) cases. The mean femoral tunnel length was 42 ± 6.4 mm and the mean femoral tunnel coronal angle was 41.1° ± 11.6. The tunnel angle in the transtibial technique was determined as significantly low compared to the far anteromedial portal technique (32.6°:49.8°) and the tunnel length was significantly longer (45.8:38.1 mm) (p < 0.001). In the statistical analysis, it was found that a patient with a tunnel length of 41 mm and above had a 92.1% likelihood of femoral tunnel angle below 45°. CONCLUSION: Femoral tunnel length can be used as a clue for intraoperative evaluation of the femoral tunnel position. If the femoral tunnel length is greater than 41 mm, the coronal plane orientation of the femoral tunnel will be improper and not at a desired position.

Prediction of the quadruple hamstring autograft thickness in ACL reconstruction using anthropometric measures.

OBJECTIVE: The aim of this study was to determine whether simple anthropometric measurements, such as height, weight, body mass index (BMI), age, and thigh circumference can be used to accurately predict the diameter of hamstring tendons for anterior cruciate ligament (ACL) reconstruction surgery. METHODS: One hundred sixty-four consecutive male patients who underwent ACL reconstruction using quadruple hamstring autograft between January 2010 and December 2011 were prospectively evaluated. Anthropometric measurements including height, weight, BMI, age and thigh circumference were recorded preoperatively. The thickness of the quadruple hamstring autograft was intraoperatively determined using sizing cylinders. Correlation coefficients (Pearson's r) and stepwise, multiple linear regression were used to determine the relationship between the outcome variable (hamstring graft diameter) and the predictor variables (age, height, weight, BMI, thigh circumference). RESULTS: Correlation analysis revealed a positive relation between the height, weight and graft thickness (p=0.000 and p=0.002, respectively). Taller and heavier patients tended to have thicker quadrupled hamstring graft. However, age, thigh circumference, and BMI did not correlate with the graft thickness (p=0.700, p=0.290 and p=0.727, respectively). Stepwise, multiple linear regression indicated that height was statistically important as a predictor for hamstring graft diameter (R2=0.157, p=0.0001) and yielded the following regression equation for predicting quadrupled hamstring graft thickness: graft thickness = [(height in cm) x 0.052) - 1.07] mm. CONCLUSION: Height can be used as a practical and accurate measurement to preoperatively predict quadruple hamstring graft diameter in male patients. Identification of possible hamstring tendon autograft insufficiency allows for preoperative determination of additional graft source possibilities, resulting in a more prompt surgical strategy.

Mechanical performance of hybrid Ilizarov frames containing full-threaded Schanz screws.

Modification of circular Ilizarov frames is necessary to overcome the difficulties in pin positioning due to unfavorable anatomic site or local soft-tissue conditions. Hybrid frame configurations consisting of half pins or full-threaded schanz screws are widely used in clinical practice. This study compared the mechanical performance of hybrid frames and a standard system. One standard and five modified hybrid systems were tested under axial compression, four-point bending, and torsional forces. Systems modified with full-threaded schanz screws showed a higher stiffness than half pin modifications and exhibited a similar mechanical performance of a standard system.

[The effects of exercise on articular cartilage]. / Egzersizin eklem kikirdagina etkileri.

The effect of exercise on articular cartilage has been assessed on animal models and on humans using various imaging techniques. Joint cartilage, whose water content decreases itself thanks to its unique permeable medium, maintains load distribution and joint function together with the synovial fluid under physiologic conditions and sports activities. The adaptive capacity of joint cartilage is limited under various conditions such as excessive load bearing or prolonged immobilization; however, when these factors are reversed deformed cartilage returns to its former state under normal conditions. Due to its adverse effect on joint cartilage, immobilization period following cartilage damage or operation should be as short as possible for wound healing. It is reported that exercise contributes to cartilage healing and reduces risk for injury, and that moderate exercise can even decrease the number of cases requiring arthroplasty. Conversely, excessive (harsh) exercise may be associated with increased cartilage damage or degenerative changes. Despite the presence of osteophytic changes in joint cartilage of athletes performing mild sports activities, these may not result in osteoarthritis due to the adaptive feature of joint cartilage. In contrast, the risk for osteoarthritis is increased in professional sportsmen exposed to acute repetitive impact and torsional loading. This article reviews the influence of controlled, passive-active exercise on healing, and on the development of osteoarthritis and the short- and long-term changes in articular cartilage associated with exercise and participation in sports of different duration and intensity.

Arthroscopy of the knee in pre-adolescent children.

INTRODUCTION: Arthroscopic operations performed in the pediatric age group constitute less than 5% of all arthroscopies. Diagnostic accuracy is reported to be lower than the procedures in adult patients. The incidence of pathologies also varies in the literature. We aimed at assessing the diagnostic accuracy of arthroscopy and review the incidence of pathologies in pre-adolescent patients. MATERIALS AND METHODS: In the period April 1990-January 2002, 50 pre-adolescent patients underwent knee arthroscopy after clinical and radiological assessment. Average age was 10.24 (1-13) with a male-to-female ratio of 34:16. RESULTS: Discoid lateral meniscus was found to be the most common pathology encountered in 17 cases followed by infection and synovitis in 8 cases each. Diagnostic accuracy of arthroscopy correlated with preoperative clinical and radiologic evaluation was 90%. Arthroscopy findings were negative in two cases. Two cases of plica syndrome and one case of chondral injury were mistaken for medial meniscal tear. Final diagnosis was familial Mediterranean fever in one case of synovitis and knee fusion was performed at follow-up due to progressive degenerative changes. No other patient required reoperation. CONCLUSION: Arthroscopy is a safe procedure with minor morbidity allowing treatment of various intraarticular knee disorders. Diagnostic accuracy of the procedure may increase with careful preoperative work-up.

Bilateral dislocation of the knee with rupture of both patellar tendons. A case report.

Knee dislocations are rare injuries caused by violent trauma. Damage to soft tissues and ligament lesions almost always accompany the injury. Vascular compromise further complicates the situation. We report a case of bilateral posterior knee dislocation with traumatic rupture of both patellar tendons. Treatment consisted of external fixation of both knees. Vascular compromise resolved with reduction and traction pins were placed on both patellae which were connected to the external fixators on following days. Primary repair of patellar tendon was undertaken after gradual distal repositioning of patella. The result is successful with full range of motion. Rupture of patellar tendon should be considered with posterior dislocation of the knee. External fixators provide quick stabilization in case of vascular compromise and can be modified to provide a traction system for distal repositioning of patella which allows primary repair of the patellar tendon.

Comparison of mechanical performance among different frame configurations of the Ilizarov external fixator: experimental study.

The circular frame of the Ilizarov fixator can be modified to reflect anatomic variations and treatment aims. However, these modifications in the frame system cannot always achieve the mechanical performance of the standard frame system. A standard system has two rings in each bone fragment connected by four longitudinal bars on each side of the ring. In this study, the mechanical performances of one standard and eight modified frame systems were compared. Each system was loaded on a material testing machine, with calculation of axial compression, four-point bending, and torsion. As a result, systems that were modified with drop wires and Schanz screws 45 degrees oblique to the wires on the proximal ring provided a mechanical performance closer to the standard system than systems with other modifications.

Clinical analysis of the trigger thumb of childhood.

Trigger thumb of childhood, termed congenital trigger thumb, is a pathology of the flexor pollicis longus tendon with an unknown etiology. In this study, treatment outcomes of 47 trigger thumbs of 36 children were evaluated. There were 18 males and 18 females with a mean age of 34 months (9 months-13 years). Average age of recognition of pathology by the family was 20.5 months (0-8 years). In seven of 11 bilateral cases pathology was recognized simultaneously while in the other four, diagnosis was made at different times. We used conservative treatment for all patients under three years of age, which was unsuccessful. Thus, surgical relase was performed in all cases. In the mean follow-up of seven years (range 5-15), contracture and palpable nodules disappeared. In conclusion, we believe trigger thumb in childhood should be treated surgically and that the term "congenital trigger thumb" should be changed to "developmental trigger thumb".

[An arthroscopic study on the anterior intermeniscal ligament]. / Anterior intermeniskal ligamentin artroskopik degerlendirilmesi.

OBJECTIVES: An arthroscopic study was made on the presence and anatomic features of the anterior intermeniscal ligament with regard to its thickness and attachment patterns to the anterior horn of the menisci, together with its relationship with associated non-traumatic intraarticular disorders of the knee. METHODS: This multicenter study included 136 consecutive patients (80 males, 56 females; mean age 40 years; range 15 to 74 years) in whom the presence of anterior intermeniscal ligament was sought during arthroscopic examination of the knee. Arthroscopic features of the ligament was evaluated by probe. RESULTS: The anterior intermeniscal ligament was detected in 80 knees (58.8%). Its presence did not differ significantly with respect to sex (33 females, 58.9%; 47 males, 58.8%; p>0.05). A cord-like appearance was observed in 19 cases (14%), whereas a membranous-like structure was identified in 61 cases (44.9%), 34 (55.7%) of which could only be detected following synovial abrasion. Attachment patterns according to the Nelson and LaPrade's description showed type A in 47 cases (58.8%), type B in 23 cases (28.8%), and type C in 10 cases (12.5%). Type A was more common among cord-like intermeniscal ligaments, although this did not reach significance (p>0.05). No significant association was found between the presence of the ligament and intraarticular disorders. The detection of discoid lateral meniscus was significantly associated with the presence of a cord-like intermeniscal ligament (p<0.05). Of eight cases with discoid lateral meniscus (5 complete, 3 incomplete), five patients exhibited a cord-like anterior intermeniscal ligament. CONCLUSION: This is the first arthroscopic study to define the anatomy and the incidence of the anterior intermeniscal ligament. Functional features of the ligament should be more clearly demonstrated biomechanically.