Follow-up of Serum Creatine Phosphokinase Levels after Ultrasound Guided Suprainguinal Fascia Iliaca Block with Bupivacaine in Total Knee Arthroplasty Patients: An Observational, Controlled Study.

OBJECTIVE: To determine the myotoxicity of bupivacaine on muscles after suprainguinal fascia iliaca block for postoperative analgesia in total knee arthroplasty (TKA) patients through changes in serum creatine phosphokinase (CPK) levels during the perioperative period. STUDY DESIGN: Observational study. Place and Duration of the Study: Postoperative Recovery Room department of Anaesthesiology and Reanimation, Samsun University, Samsun, Training and Research Hospital, Samsun, Turkiye, between December 2022 and February 2023. METHODOLOGY: Patients undergoing for the procedure of TKA surgery were recruited. (40 controls and 42 SIFIB groups). Serum CPK levels were evaluated preoperatively, at postoperative 6th hour and 24th hour. RESULTS:  From total 82 patients, 42 of them who received SIFIB as a component of multimodal analgesia had serum CPK levels comparable to those in the control group at all time points (p>0.05). While the increase in CPK level at 6th hour relative to baseline was significant in both groups (p<0.05), only the block group demonstrated a statistically significant difference between the 6th and 24th hours (p<0.05). CONCLUSION: SIFIB administration did not result in severe bupivacaine-induced myotoxicity in comparison to the control group. SIFIB administration is a safe option when used as part of multimodal analgesia in TKA. KEY WORDS:  Bupivacaine, Creatine phosphokinase, Myotoxicity, Regional anaesthesia.

Does Adding an IPACK Block to the Suprainguinal Fascia Iliaca Block Improve the Quality of Analgesia in Patients Undergoing Knee Arthroplasty under Spinal Anesthesia? A Retrospective Cohort Study.

Background and Objectives: Total knee arthroplasty (TKA) is a commonly performed orthopedic procedure, and is often accompanied by significant postoperative pain. The supra-inguinal fascia iliaca block (SIFIB), similar to an anterior lumbar plexus block, is frequently used in hip surgeries. The interspace between the popliteal artery and capsule of the posterior knee (IPACK) block is a regional anesthesia technique that targets the posterior innervation of the knee capsule. This retrospective study aimed to compare the analgesic effects of SIFIB and SIFIB + IPACK on patients undergoing TKA under spinal anesthesia. Materials and Methods: This retrospective study revealed the data collected from a tertiary hospital. Patient data were gathered for individuals who underwent unilateral TKA under spinal anesthesia during the period between 1 January 2023 and 1 September 2023. Inclusion criteria comprised patients falling within ASA class I-III, those following a standardized perioperative analgesia regimen, and individuals receiving opioids via a patient-controlled analgesia device (PCA) as part of their postoperative pain management strategy. Patients were grouped as SIFIB and SIFIB + IPACK according to the performed regional anesthesia technique. Results: In the study, the data of 88 patients in total, 61 in the SIFIB group and 27 in the IPACK group, were analyzed. The 24 h cumulative morphine consumption was similar in the SIFIB and SIFIB + IPACK groups (10.62 ± 6.58 mg vs. 12.55 ± 8.84 mg, respectively; p: 0.258). The NRS scores of the groups were similar in all time frames. Conclusions: Our study reveals that combining IPACK with SIFIB in the multimodal analgesia plan does not provide additional benefits in terms of postoperative opioid consumption and pain scores in patients undergoing unilateral THA under spinal anesthesia.

Post-Operative Modified All-Inside ACL Reconstruction Technique's Clinical Outcomes and Isokinetic Strength Assessments.

BACKGROUND AND OBJECTIVE: Anterior cruciate ligament (ACL) injuries are very common among the athletic population. ACL reconstruction (ACLR) performed because of these injuries is one of the procedures performed by orthopedic surgeons using different grafting methods. This study aims to compare the data related to post-operative 6-month isokinetic strength values, strength-related asymmetry rates, time parameters, and joint angle in athletes who underwent ACLR with the Modified All-inside (4ST) technique, on both the healthy knee (HK) and the ACLR-applied sides. MATERIALS AND METHODS: A total of 20 athletes from various sports on whom the 4ST ACLR technique had been applied by the same surgeon were evaluated retrospectively. Lysholm, Tegner, and International Knee Documentation Committee (IKDC) scores of the patients were obtained pre-operative and at 6 months post-operative. Isokinetic knee extension (Ex) and flexion (Flx) strengths on the HK and ACLR sides of the patients were evaluated with a series of four different angular velocities (60, 180, 240, and 300°/s). In addition to peak torque (PT) and hamstring/quadriceps ratio (H/Q) parameters, the findings were also evaluated with additional parameters such as joint angle at peak torque (JAPT), time to peak torque (TPT), reciprocal delay (RD), and endurance ratio (ER). RESULTS: There was a significant improvement in the mean Lysholm, Tegner, and IKDC scores after surgery compared with pre-operative levels (p < 0.05). As for PT values, there were significant differences in favor of the HK in the 60, 180, and 300°/s Ex phases (p < 0.05). In terms of the H/Q and (hamstring/hamstring)/(quadriceps/quadriceps) (HH/QQ) ratios, there were significant differences at 300°/s (p < 0.05). In terms of JAPT, there were significant differences in the 300°/s Ex and 180°/s Flx phases (p < 0.05). In terms of TPT, there were significant differences in the 300°/s Ex phase (p < 0.05). In terms of RD and ER, no significant difference was observed between the HK and ACLR sides at any angular velocity. CONCLUSIONS: Although differences were observed in PT values, particularly in the Ex phase, this did not cause a significant change in H/Q ratios. Similar results were observed for additional parameters such as JAPT, TPT, RD, and ER. The results show that this ACLR technique can be used in athletes in view of strength gain and a return to sports.

Evaluation of Psoas Muscle Atrophy and the Degree of Fat Infiltration After Unilateral Hip Arthroplasty.

OBJECTIVE: Atrophy of the muscles around the hip and thigh has been reported in patients with hip osteoarthritis (OA). Total hip arthroplasty (THA) reduces pain and improves quality of life and activity levels. Muscle strength of the hip and thigh also improves after THA. This study aimed to determine whether there is significant psoas muscle atrophy and to evaluate the degree of fat infiltration after unilateral hip arthroplasty. SUBJECT AND METHODS: Patients who underwent unilateral total hip arthroplasty for primary hip osteoarthritis and who had lumbar vertebra magnetic resonance imaging (MRI) for any reason in the one-year preoperative and postoperative period were evaluated retrospectively. The degree of fat infiltration was also graded visually based on a modified Goutallier rating system. RESULTS: The study was conducted with a total of 58 patients aged between 38 and 75, including 15 males and 43 females. Compared to the preoperative psoas muscle area values on the operated sides of the patients participating in the study, the decrease in the postoperative psoas muscle area was found to be statistically significant (p:0.000; p<0.05). Furthermore, the decrease in psoas muscle area on the non-operated side of the patients was also statistically significant (p:0.000; p<0.05). There was also a positive correlation between preoperative and postoperative psoas muscle areas (p:0.000; p<0.05). CONCLUSION: Early identification of psoas muscle mass reduction may allow for a more proactive psoas strength improvement program to improve post-operative function and mobility.

Patellar Tendon Reconstruction Using Peroneus Longus Tendon Autograft Following Revision Knee Arthroplasty: A Case Report.

Patellar tendon rupture is a rare but serious complication resulting in loss of knee extension that may develop during and after total knee arthroplasty and negatively affects the patient's quality of life. There are a number of surgical options available, from primary repair to reconstruction. Peroneus longus tendon autograft has begun to be used for knee extensor mechanism repair in recent years. In this case report, we aimed to present the case of a patient with traumatic patellar tendon rupture after revision knee arthroplasty. In conclusion, patellar tendon reconstruction using peroneus longus tendon autograft can be considered a successful method in selected patients following knee arthroplasty. It allows early rehabilitation via stable graft fixation and provides good clinical and functional outcomes in the late period.

The Relationship between Lower Extremity Functional Performance and Balance after Anterior Cruciate Ligament Reconstruction: Results of Patients Treated with the Modified All-Inside Technique.

BACKGROUND AND OBJECTIVES: Anterior cruciate ligament (ACL) ruptures are common injuries, and ACL reconstruction (ACLR) is among the most common surgical procedures in sports surgery. Our research aims to compare the 6-month post-operative results of the modified all-inside (MAI) ACLR technique, single leg hop tests (SLHT), and Y balance tests applied in different directions on the operated and non-operated sides. MATERIALS AND METHODS: A retrospective cohort of 22 male recreational athletes who underwent MAI ACLR techniques performed by the same surgeon were evaluated. The functional knee strengths of the participants on the operated and non-operated sides were evaluated with five different tests of SLHTs: single hop for distance (SH), triple hop for distance (TH), crossover triple hop for distance (CH), medial side triple hop for distance (MSTH), and medial rotation (90°) with hop for distance (MRH). Their dynamic balance was evaluated with the Y balance Test. RESULTS: Compared to pre-operative levels, there was a significant improvement in the mean Lysholm, Tegner, and IKDC scores during the post-operative period (p < 0.05). There was a difference between SH, THD, CHD, MSTH, and MRH on the operated and non-operative sides (p < 0.05). There was no difference between Y balance scores on the operated and non-operative sides, and there were no differences between LSI scores resulting from SLHTs (p > 0.05). There were no significant relationships between YBT (composite scores) and SH, TH, CH, MSTH, and MRH distances in the healthy leg (p > 0.05), but a significant correlation with only CH in the ACL leg (p < 0.05). CONCLUSIONS: Our research shows that sixth-month post-operative SLHT findings were lower on the ACL side compared to the healthy side in patients tested with the MAI ACLR technique. However, when these scores are evaluated in terms of balance, it can be seen that both sides reveal similar findings. The similarity of LSIs in SLHTs applied in different directions, and balance scores of ACL and healthy sides revealed that the MAI technique is also an ACLR technique that can be used in athletes from a functional point of view.

Patellofemoral Angle, Pelvis Diameter, Foot Posture Index, and Single Leg Hop in Post-Operative ACL Reconstruction.

Background and Objectives: Anterior cruciate ligament (ACL) injuries occur as a result of the deterioration of the static and dynamic stability of the knee. One of the structures involved in providing static stability is the patellofemoral angle (Q angle). The aim of this study was to investigate the relationships between Q angle, pelvis diameter, lower extremity length, and foot posture index (FPI) in patients who had undergone ACL reconstruction (ACLR) with the semitendinosus/gracilis (ST/G) technique on both the operated and non-operated sides. Materials and Methods: Twenty-five male recreational athletic patients between the ages of 18 and 35 who had undergone semitendinosus/gracilis (ST/G) anterior cruciate ligament reconstruction at least 6 months earlier were included in the study. Femur length, lower extremity length, pelvis diameter, and Q angle measurements, total foot posture index (FPI) scores, and single leg hop (SLH) and triple hop distance (THD) test results were determined on the operated and non-operated sides. Results: When the findings of the patients were evaluated statistically between the operated and non-operated sides, no significant differences were found in Q angle, femur length, and lower extremity length (p > 0.05). In terms of FPI scores, a significant difference was found only in the inversion/eversion of the calcaneus (CALC) parameter (p < 0.05). When the single hop test (SLHT) results were evaluated statistically on the operated and non-operated sides, the results were in favor of the non-operated side (p < 0.05). In the correlation analysis conducted for both the operated and non-operated sides, positive and significant correlations were found only between SLH and THD (p < 0.05). No significant difference was found in the other parameters. Conclusions: The fact that ST/G ACLR 6th month post-operative findings revealed similar results in Q angle, lower extremity length, and total FPI scores between the operated and non-operated sides showed that the 6-month process did not cause a difference in these parameters. However, it was found that the operated sides showed lower findings compared to non-operated sides for SLHTs, although these findings were within normal ranges in terms of the limb symmetry index.

Traditional and Additional Isokinetic Knee Strength Assessments of Athletes; Post-Operative Results of Hamstring Autograft ACL Reconstruction.

Background and Objectives: Anterior cruciate ligament (ACL) injuries are common injuries in athletes, and, accordingly, ACL reconstruction (ACLR) is one of the most common orthopedic surgical procedures performed on athletes. This study aims to compare the 6-month post-operative isokinetic knee strength evaluations of the semitendinous/gracilis (ST/G) ACLR technique performed on healthy (HK) and ACLR knees of athletes. Materials and Methods: A retrospective cohort of 29 athletes from various sports branches who underwent ST/G ACLR technique by the same surgeon were evaluated. The isokinetic knee extension (Ex) and flexion (Flx) strength of the patients on the HK and ACLR sides were evaluated with a series consisting of three different angular velocities (60, 180, and 240°/s). In addition to the traditional evaluations of peak torque (PT) and hamstring/quadriceps (H/Q) parameters, the findings were also evaluated with additional parameters such as the joint angle at peak torque (JAPT), time to peak torque (TPT), and reciprocal delay (RD). Results: There was a significant improvement in the mean Lysholm, Tegner, and IKDC scores after surgery compared with preoperative levels (p < 0.05). As for the isokinetic PT values, there were significant differences in favor of HK in the 60°/s Flx, 180°, and 240°/s Ex phases (p < 0.05). In addition, there was a significant difference in the 60° and 180°/s Flx phases in RD (p < 0.05). In H/Q ratio, TPT, and JAPT values, no significant difference was observed between HK and ACLR at all angular velocities. Conclusions: The findings showed that the ST/G 6-month post-operative isokinetic knee strength in athletes produced high results in HK, and, when evaluated in terms of returning to sports, the H/Q ratios on the ACLR side were sufficient to make the decision to return to sports. It was found that the ACLR side was slower than the HK side in the reciprocal transitions, particularly in the Flx phase. We believe that this results from the deformation of the hamstring muscle after reconstruction of the ST/G ACLR side.

Pre- and Post-Operative Hamstring Autograft ACL Reconstruction Isokinetic Knee Strength Assessments of Recreational Athletes.

Background and Objectives: Anterior cruciate ligament (ACL) injuries are common injuries with a high incidence among people with high physical activity levels. Therefore, ACL reconstruction (ACLR) is one of the most common surgical procedures performed in sports medicine. This study aims to compare the pre- and 6-month post-operative isokinetic knee strengths in healthy (HK) and ACL knees of patients who underwent semitendinous/gracilis (ST/G) ACLR. Materials and Methods: A retrospective cohort of 21 recreational athletes who underwent ST/G ACLR by the same surgeon were evaluated. The pre- and 6-month post-operative isokinetic knee extension (Ex) and flexion (Flx) strengths of the HK and ACLR patients were evaluated in a series consisting of three different angular velocities (60, 180 and 240°/s). Of all the findings, peak torque (PT) and hamstring/quadriceps (H/Q) parameters were evaluated. Results: There was a significant improvement in post-operative Lysholm, Tegner and IKDC scores compared to pre-operative scores (p < 0.05). There were significant differences in pre-operative and post-operative knee Ex and Flx strengths at angular velocities of 60°, 180° and 240°/s in both the ACLR and HK groups (p < 0.001). There was no significance at 240°/s Flx for ACLR (p > 0.05). As for H/Q ratios, there was a significant difference between pre- and post-operative values only at 60°/s angular velocity in both ACLR and HC (p < 0.005). Conclusions: The pre-operative and 6-month post-operative results of the ST/G ACLR showed that there was a high level of recovery, particularly in quadriceps strength, while the increase in strength was less in the hamstring. The significance observed at 60°/s in H/Q ratios was within normal ranges. It can be argued that the ST/G ACLR method is feasible for people with high physical activity levels and for athletes.

Associations between the radiographic phenotypes and the presence of metabolic syndrome in patients with knee osteoarthritis.

BACKGROUND: We aimed to investigate the associations between the radiographic phenotypes and the presence of metabolic syndrome (MetS) in patients with knee osteoarthritis (OA). METHODS: We evaluated women age 40 and over who presented to our outpatient clinics with knee pain and fulfilled the clinical and radiographic criteria for the classification of idiopathic OA of the knee. Patients were categorized into two groups concerning dominant radiographic phenotype. We included consecutive 50 patients in each group. All patients were evaluated in terms of MetS according to the revised diagnostic criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), as well as the World Health Organization (WHO). RESULTS: Overall, MetS prevalence was found to be 79% according to the NCEP ATP III-MetS criteria and 65% according to the WHOMetS criteria. Prevalence of MetS was higher in the joint space narrowing (JSN)-dominant group compared to the osteophyte (O)- dominant knee OA group, but the difference did not reach statistical significance. However, in subgroup analysis (54 patients) in which we excluded patients with a past medical history of type 2 diabetes mellitus (DM), the prevalence of NCEP ATP III-MetS was statistically significantly higher in the JSN-dominant group compared to the O-dominant group [22 (75.9%) vs. 12 (48%), respectively, p = 0.03]. Logistic regression analysis in the subgroup demonstrated that the presence of NCEP ATP III-MetS was an independent risk factor for JSN-dominant knee OA phenotype [OR and 95% CI = 3.48 (1.09-11.13)]. DISCUSSION: The prevalence of MetS is quite high in patients with knee OA and is particularly pronounced in patients with JSNdominant radiographic phenotype. Moreover, our results suggest that MetS is an independent risk factor for JSN-dominant knee OA in patients with no past medical history of DM.

A Comparison of the Effects of Grayanotoxin-Containing Honey (Mad Honey), Normal Honey, and Propolis on Fracture Healing.

OBJECTIVES: Delayed healing and non-union of fractures have a significant effect upon patient morbidity. Studies have therefore largely concentrated on accelerating fracture healing. This study was intended to compare the effect of "mad honey" and propolis on fracture healing using radiological and histopathological analysis. SUBJECTS AND METHODS: Femur fracture was surgically performed on 48 rats, followed by fixation. Animals were then divided into 8 groups: 2 control groups (15- and 30-day) and 6 treatment groups (15- and 30-day normal honey, 15- and 30-day "mad honey," and 15- and 30-day propolis). Rats were sacrificed at the end of these periods, and radiological and histological examinations were performed. RESULTS: Radiological healing in the propolis group after 15-day therapy was statistically better than in the control (p = 0.004) and normal honey (p = 0.006) groups. After 30-day therapy, healing in the propolis group (p = 0.005) and grayanotoxin-containing "mad honey" group (p = 0.007) were significantly better than in the control group. Histologically, there was a statistically significant difference between the 15-day propolis group and the other groups (control, honey, mad honey: p = 0.003, p = 0.003, and p = 0.002, respectively). We also found a statistically significant difference when the 30-day propolis group (p = 0.005) and "mad honey" group (p = 0.007) were compared to the control group. CONCLUSIONS: This study shows that grayanotoxin-containing "mad honey" and propolis can accelerate fracture healing.

An Extremely Rare Condition: Unilateral and Isolated Temporalis Muscle Hypertrophy.

Unilateral and isolated temporalis muscle hypertrophy is an extremely rare condition causing cosmetic problems and pain in the temporal region. Up to date, 8 isolated and unilateral cases were reported in the English literature. In this article, the authors report 2 new cases of unilateral isolated temporal muscle hypertrophy.

Ginkgo Biloba improves bone formation during fracture healing: an experimental study in rats.

OBJECTIVES: Ginkgo biloba extract (EGb 761) is a plant extract obtained from the leaves of the G. biloba tree. The aim of this study was to assess the histological and radiological effects of G. biloba extract on fracture healing in an experimental fracture model using rat femurs. METHODS: Forty-eight female Sprague-Dawley rats (weight: 195-252 g; age: 20 weeks) were used in the study. The rats were randomly divided into six groups (n=8). A transverse fracture was made in the middle of the right femur of each rat and fixed with a Kirschner wire. The G. biloba groups received 60 mg/kg oral G. biloba extract once daily. No medication was given to the control groups. On days 7, 21 and 35, both sets of femurs were evaluated radiologically and histopathologically. RESULTS: Histological evaluation revealed that the G. biloba groups had significant differences at 21 and 35 days (p<0.05). The G. biloba group showed a significant difference in terms of bone formation on day 21 when compared to the control group (p<0.05). CONCLUSIONS: This study indicated that the use of G. biloba extract accelerated fracture healing. Both radiological and histological differences were detected, but the histological differences were more remarkable. Level of Evidence I, High Quality Randomized Trial.

OBJETIVOS: O extrato de Ginkgo biloba (EGb 761) é um extrato vegetal obtido das folhas da árvore Ginkgo biloba. O objetivo deste estudo foi avaliar os efeitos histológicos e radiológicos do extrato de Ginkgo biloba sobre a consolidação de fraturas em um modelo experimental de fratura em fêmures de rato. MÉTODOS: Foram utilizados 48 ratos Sprague-Dawley fêmeas (peso: 195-252 g, idade: 20 semanas). Os ratos foram divididos randomicamente em seis grupos (n = 8). Uma fratura transversal foi feita no meio do fêmur direito de cada rato e fixada com fio de Kirschner. Os grupos G. biloba receberam 60 mg/kg de G. biloba por via oral uma vez por dia. Não foi administrada nenhuma medicação aos grupos de controle. Nos dias 7, 21 e 35, ambos os fêmures foram avaliados radiológica e histopatologicamente. RESULTADOS: A avaliação histológica revelou que os grupos G. biloba apresentaram diferenças significativas aos 21 e 35 dias (p < 0,05). O grupo G. biloba mostrou uma diferença significativa em termos de formação óssea no dia 21 quando comparado com o grupo controle (p < 0,05). CONCLUSÕES: Este estudo indicou que o uso de extrato de G. biloba acelerou a consolidação de fraturas. As diferenças radiológicas e histológicas foram detectadas, mas as diferenças histológicas foram mais notáveis. Nível de Evidência I, Estudo Clínico Randomizado de Alta Qualidade.

Ginkgo Biloba improves bone formation during fracture healing: an experimental study in rats / Ginkgo Biloba melhora a formação dos ossos durante a consolidação da fratura: estudo em ratos

ABSTRACT OBJECTIVES: Ginkgo biloba extract (EGb 761) is a plant extract obtained from the leaves of the G. biloba tree. The aim of this study was to assess the histological and radiological effects of G. biloba extract on fracture healing in an experimental fracture model using rat femurs. METHODS: Forty-eight female Sprague-Dawley rats (weight: 195-252 g; age: 20 weeks) were used in the study. The rats were randomly divided into six groups (n=8). A transverse fracture was made in the middle of the right femur of each rat and fixed with a Kirschner wire. The G. biloba groups received 60 mg/kg oral G. biloba extract once daily. No medication was given to the control groups. On days 7, 21 and 35, both sets of femurs were evaluated radiologically and histopathologically. RESULTS: Histological evaluation revealed that the G. biloba groups had significant differences at 21 and 35 days (p<0.05). The G. biloba group showed a significant difference in terms of bone formation on day 21 when compared to the control group (p<0.05). CONCLUSIONS: This study indicated that the use of G. biloba extract accelerated fracture healing. Both radiological and histological differences were detected, but the histological differences were more remarkable. Level of Evidence I, High Quality Randomized Trial.

RESUMO OBJETIVOS: O extrato de Ginkgo biloba (EGb 761) é um extrato vegetal obtido das folhas da árvore Ginkgo biloba. O objetivo deste estudo foi avaliar os efeitos histológicos e radiológicos do extrato de Ginkgo biloba sobre a consolidação de fraturas em um modelo experimental de fratura em fêmures de rato. MÉTODOS: Foram utilizados 48 ratos Sprague-Dawley fêmeas (peso: 195-252 g, idade: 20 semanas). Os ratos foram divididos randomicamente em seis grupos (n = 8). Uma fratura transversal foi feita no meio do fêmur direito de cada rato e fixada com fio de Kirschner. Os grupos G. biloba receberam 60 mg/kg de G. biloba por via oral uma vez por dia. Não foi administrada nenhuma medicação aos grupos de controle. Nos dias 7, 21 e 35, ambos os fêmures foram avaliados radiológica e histopatologicamente. RESULTADOS: A avaliação histológica revelou que os grupos G. biloba apresentaram diferenças significativas aos 21 e 35 dias (p < 0,05). O grupo G. biloba mostrou uma diferença significativa em termos de formação óssea no dia 21 quando comparado com o grupo controle (p < 0,05). CONCLUSÕES: Este estudo indicou que o uso de extrato de G. biloba acelerou a consolidação de fraturas. As diferenças radiológicas e histológicas foram detectadas, mas as diferenças histológicas foram mais notáveis. Nível de Evidência I, Estudo Clínico Randomizado de Alta Qualidade.