How Many Bundles Does the Anterior Cruciate Ligament Consist of? A Case Report.

In some cases with anterior cruciate ligament (ACL) injury, physical examination and magnetic resolution imaging cannot clearly identify whether the ACL is intact or partially or completely ruptured. A 40-year-old female patient was admitted to our clinic with complaints of knee pain. After the requested examinations, we could not clearly identify whether the ACL was intact or partially or completely ruptured. Arthroscopic knee surgery was planned for the patient. In diagnostic arthroscopy, it was also determined that there was a multibundle ACL that was not surrounded by the synovium and was tight in the figure 4 position. The surgery was completed by repairing the meniscal tear. It was seen in the current case report that the ACL was a multibundle structure without overlying synovium around. In such cases, it is difficult to evaluate the ACL, and it should be kept in mind that there may also be variations of the ACL.

COMPARISON OF CHANGES IN THE ANKLE AFTER UNICONDYLAR KNEE ARTHROPLASTY AND HIGH TIBIAL OSTEOTOMY.

Objectives: We aimed to compare the changes in the coronal alignment of the ankle joints and their clinical effects after high tibial osteotomy (HTO) and unicondylar knee arthroplasty (UKA). Methods: 50 HTO and 54 UKA patients who were operated on for medial knee osteoarthritis between 2013 and 2018 were retrospectively evaluated. The hip-knee-ankle angle (HKA), the medial proximal tibial angle (MPTA), the tibial plafond inclination (TPI) and the talar inclination (TI) angles were measured before and after operation. Visual analog scale (VAS), short form 36 (SF-36), and ankle-hindfoot scale (AHS) scores of both groups were evaluated and recorded. Results: Angular changes in the HKA, MPTA, TPI and TI values showed significantly greater values in the HTO group (p<0.001). When asymptomatic and symptomatic cases were compared, it was found that changes in the HKA, TPI and TI values were significantly greater in symptomatic cases in the HTO group (p<0.05). A significant decline was observed in the VAS, SF-36 and AHS scores in the HTO group in the postoperative period (p<0.05). In intergroup evaluations, a significant decline was detected in pain and functional scores of the HTO group when compared to the UKA group (p<0.05). Conclusion: Unicondylar knee arthroplasty can be a good alternative to HTO in selected cases for postoperative ankle complaints. Level of Evidence III; Therapeutic Studies Investigating the Results of Treatment.

Objetivos: Nosso objetivo foi comparar as alterações noalinhamento coronal das articulações do tornozelo e seus efeitos clínicos após osteotomia tibial alta (OTA) e artroplastia unicondilar do joelho (AUJ). Métodos: 50 pacientes de HTO e 54 de AUJ operados de osteoartrite medial do joelho entre 2013 e 2018 foram avaliados retrospectivamente. O ângulo quadril-joelho-tornozelo (QJT), o ângulo tibial proximal medial (ATPM), a inclinação do platô tibial (IPT) e os ângulos de inclinação talar (IT) foram medidos no pré- e pós-operatório. A escala visual analógica (VAS), forma curta 36 (SF-36), e a escala tornozelo-retropé (ETR) de ambos os grupos foram avaliadas e registradas. Resultados: Alterações angulares nos valores de QJT, ATPM, IPT e IT mostraram valores significativamente maiores no grupo OTA (p<0,001). Quando os casos assintomáticos e sintomáticos foram comparados, verificou-se que as alterações nos valores de QJT, IPT e IT foram significativamente maiores nos casos sintomáticos no grupo OTA (p<0,05). Observou-se declínio significativo nos escores VAS, SF-36 e ETR no grupo HTO no pós-operatório (p<0,05). Nas avaliações intergrupos, foi detectado declínio significativo na dor e nos escores funcionais do grupo OTA quando comparado ao grupo AUJ (p<0,05). Conclusão: Em casos de queixas pós-operatórias quanto ao tornozelo, a artroplastia unicondilar do joelho pode ser uma boa alternativa para OTA. Nível de evidência III; Estudos Terapêuticos Investigando Resultados de Tratamento.

Comparison of changes in the ankle after unicondylar knee arthroplasty and high tibial osteotomy / Comparação clínica e radiológica das alterações no tornozelo após artroplastia unicondilar do joelho e osteotomia tibial alta

ABSTRACT Objectives: We aimed to compare the changes in the coronal alignment of the ankle joints and their clinical effects after high tibial osteotomy (HTO) and unicondylar knee arthroplasty (UKA). Methods: 50 HTO and 54 UKA patients who were operated on for medial knee osteoarthritis between 2013 and 2018 were retrospectively evaluated. The hip-knee-ankle angle (HKA), the medial proximal tibial angle (MPTA), the tibial plafond inclination (TPI) and the talar inclination (TI) angles were measured before and after operation. Visual analog scale (VAS), short form 36 (SF-36), and ankle-hindfoot scale (AHS) scores of both groups were evaluated and recorded. Results: Angular changes in the HKA, MPTA, TPI and TI values showed significantly greater values in the HTO group (p<0.001). When asymptomatic and symptomatic cases were compared, it was found that changes in the HKA, TPI and TI values were significantly greater in symptomatic cases in the HTO group (p<0.05). A significant decline was observed in the VAS, SF-36 and AHS scores in the HTO group in the postoperative period (p<0.05). In intergroup evaluations, a significant decline was detected in pain and functional scores of the HTO group when compared to the UKA group (p<0.05). Conclusion: Unicondylar knee arthroplasty can be a good alternative to HTO in selected cases for postoperative ankle complaints. Level of Evidence III; Therapeutic Studies Investigating the Results of Treatment.

RESUMO Objetivos: Nosso objetivo foi comparar as alterações noalinhamento coronal das articulações do tornozelo e seus efeitos clínicos após osteotomia tibial alta (OTA) e artroplastia unicondilar do joelho (AUJ). Métodos: 50 pacientes de HTO e 54 de AUJ operados de osteoartrite medial do joelho entre 2013 e 2018 foram avaliados retrospectivamente. O ângulo quadril-joelho-tornozelo (QJT), o ângulo tibial proximal medial (ATPM), a inclinação do platô tibial (IPT) e os ângulos de inclinação talar (IT) foram medidos no pré- e pós-operatório. A escala visual analógica (VAS), forma curta 36 (SF-36), e a escala tornozelo-retropé (ETR) de ambos os grupos foram avaliadas e registradas. Resultados: Alterações angulares nos valores de QJT, ATPM, IPT e IT mostraram valores significativamente maiores no grupo OTA (p<0,001). Quando os casos assintomáticos e sintomáticos foram comparados, verificou-se que as alterações nos valores de QJT, IPT e IT foram significativamente maiores nos casos sintomáticos no grupo OTA (p<0,05). Observou-se declínio significativo nos escores VAS, SF-36 e ETR no grupo HTO no pós-operatório (p<0,05). Nas avaliações intergrupos, foi detectado declínio significativo na dor e nos escores funcionais do grupo OTA quando comparado ao grupo AUJ (p<0,05). Conclusão: Em casos de queixas pós-operatórias quanto ao tornozelo, a artroplastia unicondilar do joelho pode ser uma boa alternativa para OTA. Nível de evidência III; Estudos Terapêuticos Investigando Resultados de Tratamento.

Does anterolateral ligament injury change the treatment option in patients with partial ACL tears?

Patients with ACL tears with ALL injury have more clinical complaints (instability, feeling of the pop on the knee or knee sliding). patients have ALL injury with partial ACL tears, It is unclear whether the choice of treatment will be conservative or surgical. This study aimed to determine the effect of anterolateral ligament (ALL) status, whether intact or ruptured, on the choice of conservative or surgical treatment in patients with partial anterior cruciate ligament (ACL) tears. Between 2015 and 2019, patients with suspected partial ACL tears were identified on both physical examination and MR imaging. 122 patients who had partial ACL tears and also status of patient's ALL could be evaluated by radiologist were included in the study, retrospectively. Sixty-two patients who underwent ACL reconstruction were determined as group 1, and 60 patients who did not undergo ACL reconstruction were defined as group 2. In patients with partial ACL rupture with or without ACL reconstruction, it was evaluated whether a ruptured or non- ruptured ALL was effective in this decision of conservative or surgically. The MRIs of patients with partial ACL tears were evaluated by a radiologist and it was concluded that the ALLs of 50 patients were ruptured, and 72 were intact. The ALLs of 36 patients in group 1 were ruptured, and 26 patients were intact. Fourteen patients in group 2 had ruptured ALLs, 46 patient's ALLs were intact. Seventy-two percent of the patients with partial ACL tears who had ruptured ALLs in MRI underwent ACL reconstruction. It was found that ACL reconstruction was performed more frequently in patients with partial ACL tears with ALL rupture. Therefore, we believe that preoperative evaluations of ALLs using MRI in patients with partial ACL tears are essential for surgical planning.

Prediction of clinical outcomes of single- and double- bundle anterior cruciate ligament reconstruction techniques using magnetic resonance imaging.

BACKGROUND: The objective of the study is to compare the clinical results of the single-bundle (SB) and double-bundle (DB) anterior cruciate ligament (ACL) repairing techniques using magnetic resonance imaging (MRI). METHODS: Thirty-eight patients were randomized by block randomization into two different groups of ACL reconstruction: DB (n=19) and SB techniques (n=19). MRI evaluation and clinical examination with modified Cincinnati Knee Rating Score and Lysholm knee scores were performed pre-operatively and at the end of a follow-up period of 36 months. RESULTS: No significant differences were found in the ACL angle, posterior cruciate ligament angle, and tibial translation between the DB and the SB groups. Regarding the clinical scores, there were no significant differences between the techniques. As for the correlation of radiologic results with clinical scores in the SB group, there was a strong and significant correlation between the post-operative ACL angle values and the Lysholm clinical score (r=-0.66; p=0.002). CONCLUSION: The post-operative ACL angle can predict the degree of clinical recovery in patients undergoing SB ACL reconstruction.

Procedural Outcomes of Double Vs. Single Fluoroscopy for Fixing Supracondylar Humerus Fractures in Children: A Case-Control Study.

BACKGROUND: Supracondylar humerus fractures (SHFs) are frequently seen in the pediatric population. The aim of this study was to compare single- and double-fluoroscopy methods for the closed reduction and percutaneous pinning (CRPP) of Gartland type 2 and type 3 SHFs. MATERIALS AND METHODS: Forty patients who underwent surgery between March 2016 and April 2018 were evaluated retrospectively. Twenty-one patients (group 1) who received double fluoroscopy and 19 patients (group 2) who had single fluoroscopy were evaluated. The preparation period, surgical duration, radiation exposure time, fracture types, sex distributions, distribution of sides, radiologic results at the third month, cosmetic and functional results, and the incidence of complications were recorded. RESULTS: The mean age of the patients in group 1 and group 2 was 4.76 and 4.68 years, respectively. The mean preparation time of group 1 was 11.3 min; whereas in group 2, it was 8.7 min (p < 0.01). The mean surgical duration was 31.76 min in group 1, and 40.47 min in group 2 (p < 0.01). The mean radiation exposure time in group 1 and group 2 was 41.19 and 47.36 s, respectively (p = 0.04). There were statistically significant differences between the two groups in terms of the preparation period, surgical duration, and radiation exposure time. Radiation exposure time and surgical duration were significantly shorter in group 1; the preparation period was shorter in group 2. CONCLUSIONS: The double-fluoroscopy technique can significantly reduce surgical duration and radiation exposure time during surgery while treating SHFs of children.

Does radiological evaluation of endobutton positioning in the sagittal plane affect clinical functional results in single-bundle anterior cruciate ligament reconstruction?

INTRODUCTION: Sports injuries are increasing today due to the increased interest in sports. The most common injured knee ligament is the anterior cruciate ligament (ACL) in sport injuries. Accordingly, surgical treatment of the ACL is performed frequently. In this study, it was aimed to retrospectively evaluate whether the location of an endobutton on lateral knee radiography was effective on knee functional scores in patients who underwent ACL reconstruction. MATERIALS AND METHODS: One hundred thirty patients who underwent ACL reconstruction between January 2015 and February 2019 were identified. The patients were divided into three groups according to the location of the endobutton on lateral radiographs taken in the postoperative period. Group 1 patients were classified as anterior, group 2 as middle, and group 3 as posterior according to the location of the endobutton. Functional scoring, physical examination tests, comparative thigh diameter measurements, and single-leg hop tests were compared between the groups. It was evaluated as to whether there was a statistically significant difference between the groups. RESULTS: There were 38 patients in group 1, 63 patients in group 2, and 29 patients in group 3. The mean age was 29.1 in group 1, 29.1 in group 2, and 29.7 in group 3. The mean follow-up period of the patients was 18.4 months in group 1, 19.1 months in group 2, and 21.4 months in group 3. The average Lysholm score was 92.9 in group 1, 93.3 in group 2, and 91.7 in group 3. The mean modified Cincinnati scores were 27.0, 27.1, and 26.6, respectively, in the groups. The mean IKDC score of the subjective knee assessments was 92.5, 92.8, and 91, respectively, according to the groups. The average thigh atrophy value was 1 cm, 1 cm, and 1.2 cm, respectively, in the groups. In the single-leg hop test, 34 patients in group 1 jump to over 85% of the distance compared with the intact side, while 58 patients in group 2, and 23 patients in group 3 were successfully able to jump this distance. The effect of the placement of the endobutton in the anterior, middle or posterior was not statistically significant on functional scores and physical examination results. In patients with endobuttons in the middle, functional scores were found better than in those with anterior or posterior placement. CONCLUSIONS: No statistically significant differences were found in clinical functional results when comparing patients' endobutton location on femur. For this reason, surgical time should not be extended using unnecessary extra effort to change the orientation of the exit hole during surgery.

Is Cyclic Exercise Performed before Tibial Fixation Effective on Grafts during Anterior Cruciate Ligament Reconstruction?

OBJECTIVES: The necessity of cyclic exercise to pre-stretch the autograft before tibial fixation during ACL reconstruction is unknown. In this study, we evaluated whether there was a statistically significant difference between the results of patients who underwent cyclic exercise by way of physical examinations, knee joint stability tests, and functional evaluation tests, compared with the patients who underwent ACL reconstructions with or without cyclic exercise. METHODS: Between March 2016 and May 2018, 59 patients with at least eight months' follow-up of an ACL reconstruction were identified. Thirty patients (Group 1) who underwent cyclic exercise before tibial fixation and 29 patients (Group 2) who did not undergo cyclic exercise were evaluated and compared. RESULTS: The mean age of the patients in Group 1 and Group 2 was 25.9 (range, 18-36) years and 25.2 (range, 18-35) years, respectively. The mean follow-up period in Group 1 was 14.6 (range, 8-22) months and 13.5 months in Group 2 (range, 8-21 months).The mean Lysholm scores of Group 1 and 2 were 95.1 (range, 83-100) and 87.1 (range, 78-100), respectively. The modified Cincinnati scores of Groups 1 and 2 were 28.7 (range, 24-30) and 26.2 (range, 21-30). The mean IKDC subjective knee evaluation scores in Groups 1 and 2 were 91.9 (range, 83-100) and 86.7 (range, 75-100). The mean thigh atrophy was 1.5 cm in Group 1 and 2.5 cm in Group 2. In Group 1, 23 patients jumped 85% of the distance compared with the intact side in the single-legged hop test, and 12 patients in Group 2 were able to hop this distance successfully.Group 1 had statistically significantly better results in Lysholm activity scores, modified Cincinnati scores, IKDC subjective knee assessment scores, two-time IKDC activity scale results, comparison of thigh diameters, and single-legged hop tests (p<0.05). No significant difference was found in other examinations and tests. CONCLUSION: Cyclic exercise during the operation had a positive effect on functional scores. We believe that cyclic exercise should be added to the operative procedure.

Analysis of the coracoid morphology with multiplanar 2D CT and its effects on the graft size in the Latarjet procedure.

PURPOSE: In this study, we aimed to reveal the individual differences regarding the size of the coracoid and their effects on the classical and modified Latarjet procedures. METHODS: Computed tomography images of 120 patients (mean age: 41.18 ± 12.01 years) without shoulder complaints or shoulder instability were evaluated retrospectively. The glenoid width, the surgical graft length, and the coracoid total length, width, and thickness were measured using the multiplanar reconstruction method on the Sectra Picture Archiving and Communications System (PACS) system. Age, gender, side, the dominant hand, and the height of the patients were recorded and the correlations between them were investigated. On the created hypothetical model, the current size of the coracoid was evaluated to determine what size of glenoid defects it could repair by employing the classical and the modified Latarjet techniques. RESULTS: There was no significant difference between the right-hand-dominant group and the left-hand-dominant group in terms of coracoid measurement results (p > 0.05). Again, there was no statistically significant difference between the right and the left side regarding the coracoid size (p > 0.05). A positive correlation could be detected only between age and the coracoid width and thickness (p < 0.05). A positive correlation was also found between the glenoid width and the coracoid width and thickness in both shoulders (p < 0.001). Coracoid thickness could fill in the defects that amounted to 40% of the glenoid width, while the coracoid width could fill in for the defects that were 50% of the glenoid width in both genders. CONCLUSION: Our study showed that hand dominance and side were not effective on the coracoid dimensions. In addition, it has been shown that the coracoid dimensions did not have a significant effect in the choice of Latarjet technique in terms of defect repair and that repair rates of up to 40% could be achieved in glenoid defects with both techniques.

CHANGES IN BONE MINERAL DENSITY AFTER TOTAL KNEE ARTHROPLASTY.

OBJECTIVE: We aimed to investigate the change in bone mineral density (BMD) in the first postoperative year in patients that underwent total knee arthroplasty (TKA) due to primary osteoarthritis of the knee. METHODS: Preoperative and first postoperative year dual-energy X-ray absorptiometry measurements of 76 patients with knee osteoarthritis, who undergone surgery between 2016 and 2018 due to the recommendation for TKA, were statistically evaluated in the study. RESULTS: Of the 19 patients with a normal BMD in the preoperative period, 73.7% (n = 14) continued to have a normal BMD in the postoperative period. Of the 34 patients with a low BMD (osteopenia) in the preoperative period, 91.2% (n = 31) did not show any change, whereas osteoporosis was observed in two patients (5.9%) in the postoperative period. Of the 23 patients with osteoporosis in the preoperative period, 95.7% (n = 22) did not show any change, whereas osteopenia was observed in one patient (4.3%) in the postoperative period. Both the T and Z scores of the spine (L1-L4) and proximal femur showed a slightly positive trend, however, with an insignificant statistical difference (p ≥ 0.05). CONCLUSION: Patients that underwent TKA experienced a statistically insignificant bone gain at the spine and proximal femur twelve months after the surgery. Level of Evidence III, Therapeutic Studies Investigating the Results of Treatment.

OBJETIVO: O objetivo foi investigar a alteração na densidade mineral óssea (DMO) no primeiro ano pós-operatório em pacientes submetidos à Artroplastia Total do Joelho (ATJ) por osteoartrite primária do joelho. MÉTODOS: As medidas de absortiometria radiográfica com dupla energia no pré-operatório e no primeiro ano pós-operatório de 76 pacientes com osteoartrite do joelho, operados entre 2016 e 2018 devido à indicação de ATJ, foram avaliadas estatisticamente no estudo. RESULTADOS: Dos 19 pacientes com DMO normal no pré-operatório, 73.7% (n = 14) continuaram com DMO normal no pós-operatório. Dos 34 pacientes com baixa DMO (osteopenia) no pré-operatório, 91.2% (n = 31) não apresentaram alteração, enquanto osteoporose foi observada em dois pacientes (5.9%) no pós-operatório. Dos 23 pacientes com osteoporose no pré-operatório, 95.7% (n = 22) não apresentaram alteração, enquanto osteopenia foi observada em um paciente (4.3%) no pós-operatório. Os escores T e Z da coluna vertebral (L1-L4) e do fêmur proximal mostraram uma tendência levemente positiva, mas a diferença foi estatisticamente insignificante (p ≥ 0.05). CONCLUSÃO: Os pacientes submetidos à ATJ apresentaram um ganho ósseo estatisticamente insignificante na coluna vertebral e no fêmur proximal doze meses após a cirurgia. Nível de Evidência III, Estudos Terapêuticos - Investigação dos resultados do tratamento.

Changes in bone mineral density after total knee arthroplasty / Alterações na densidade mineral óssea após artroplastia total do joelho

ABSTRACT Objective: We aimed to investigate the change in bone mineral density (BMD) in the first postoperative year in patients that underwent total knee arthroplasty (TKA) due to primary osteoarthritis of the knee. Methods: Preoperative and first postoperative year dual-energy X-ray absorptiometry measurements of 76 patients with knee osteoarthritis, who undergone surgery between 2016 and 2018 due to the recommendation for TKA, were statistically evaluated in the study. Results: Of the 19 patients with a normal BMD in the preoperative period, 73.7% (n = 14) continued to have a normal BMD in the postoperative period. Of the 34 patients with a low BMD (osteopenia) in the preoperative period, 91.2% (n = 31) did not show any change, whereas osteoporosis was observed in two patients (5.9%) in the postoperative period. Of the 23 patients with osteoporosis in the preoperative period, 95.7% (n = 22) did not show any change, whereas osteopenia was observed in one patient (4.3%) in the postoperative period. Both the T and Z scores of the spine (L1-L4) and proximal femur showed a slightly positive trend, however, with an insignificant statistical difference (p ≥ 0.05). Conclusion: Patients that underwent TKA experienced a statistically insignificant bone gain at the spine and proximal femur twelve months after the surgery. Level of Evidence III, Therapeutic Studies Investigating the Results of Treatment.

RESUMO Objetivo: O objetivo foi investigar a alteração na densidade mineral óssea (DMO) no primeiro ano pós-operatório em pacientes submetidos à Artroplastia Total do Joelho (ATJ) por osteoartrite primária do joelho. Métodos: As medidas de absortiometria radiográfica com dupla energia no pré-operatório e no primeiro ano pós-operatório de 76 pacientes com osteoartrite do joelho, operados entre 2016 e 2018 devido à indicação de ATJ, foram avaliadas estatisticamente no estudo. Resultados: Dos 19 pacientes com DMO normal no pré-operatório, 73.7% (n = 14) continuaram com DMO normal no pós-operatório. Dos 34 pacientes com baixa DMO (osteopenia) no pré-operatório, 91.2% (n = 31) não apresentaram alteração, enquanto osteoporose foi observada em dois pacientes (5.9%) no pós-operatório. Dos 23 pacientes com osteoporose no pré-operatório, 95.7% (n = 22) não apresentaram alteração, enquanto osteopenia foi observada em um paciente (4.3%) no pós-operatório. Os escores T e Z da coluna vertebral (L1-L4) e do fêmur proximal mostraram uma tendência levemente positiva, mas a diferença foi estatisticamente insignificante (p ≥ 0.05). Conclusão: Os pacientes submetidos à ATJ apresentaram um ganho ósseo estatisticamente insignificante na coluna vertebral e no fêmur proximal doze meses após a cirurgia. Nível de Evidência III, Estudos Terapêuticos - Investigação dos resultados do tratamento.

The Effect of Tranexamic Acid and Tourniquet Use on Tibial Cement Penetration in Primary Total Knee Arthroplasties.

BACKGROUND: In this study, our aim was to compare the effects of tourniquet and tranexamic acid (TXA) use on tibial cement penetration in primary total knee arthroplasty (TKA) using radiograph images. In addition, we also aimed at investigating the effects of age, gender, body mass index (BMI), and bone mineral density on cement penetration. METHODS: One hundred seventy patients who underwent TKA for primary osteoarthritis were retrospectively evaluated. TXA was administered to patients in group 1 (n = 96), and tourniquet application was used in patients in group 2 (n = 74). Tibial cement penetration was evaluated radiologically on a total of 4 zones: 2 anteroposterior and 2 lateral zones. In addition, age, gender, BMI, and bone mineral density were recorded in each group. RESULTS: The mean cement penetration in the total study population was 2.34 ± 0.24 mm, with a mean of 2.33 ± 0.25 mm in the TXA group and a mean of 2.35 ± 0.24 mm in the tourniquet group (P = .453). A negative correlation was detected between BMI and anteroposterior 1 values in the total and TXA groups (P = .022 and P = .029). In the evaluation of the differences between genders, significantly higher penetration values were observed only in the females in the tourniquet group (P = .024). CONCLUSIONS: The use of TXA instead of a tourniquet does not reduce the depth of cement penetration in TKA. The clinical implications of individual-induced penetration differences may be significant for future implant survival.

Assessment of the Glenoid Morphology Based on Demographic Data in the Turkish Population.

PURPOSE: In this study, our aim was to evaluate the glenoid version, height, and width measurements based on gender, side, age, height, and hand dominance in the Turkish population using computed tomography (CT) images. METHODS: In our study, CT images of 140 patients (62 females and 78 males; mean age: 39.6 years) who had no shoulder complaints were evaluated retrospectively. Glenoid version (GV), AP diameter (width), and SI diameter (height) on both shoulders were measured on the CT images. Correlations between patient gender, side, age, height, and hand dominance and the GV and size were evaluated. RESULTS: The right shoulder had a mean GV of -0.93 ± 7.80 degrees and the left shoulder had a GV of -0.88 ± 6.63 degrees (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (p > 0.05). The mean AP diameter of the glenoid was 26.57 ± 3.02 mm in the right shoulder and 26.33 ± 3.01 mm in the left shoulder (. CONCLUSION: Hand dominance had an effect on the glenoid version, while patient gender, age, and height had an effect on the glenoid size. The glenoid width in the Turkish population was similar to that of the European and American populations, and the glenoid height was similar to that of the Asian population. Our GV values were similar to those of the Asian population and more anteverted compared to the Western population. We believe that our findings will be useful in preoperative planning and in the production of implants for our population.

A new method for diagnosis of anterior cruciate ligament tear: MRI with maximum flexion of knee in the prone position: A case control study.

BACKGROUND: The diagnosis of anterior cruciate ligament tear can be made by physical examination and magnetic resonance imaging (MRI) in the supine position. In cases where the tear is partially evaluated on MRI, the choice of treatment may vary. The purpose of the study was to investigate the efficiency of MRI at maximum knee flexion in the prone position and to compare the images with findings of the ACL detected during surgery. MATERIALS AND METHODS: Sixty-one patients with partial ACL tears with meniscal and cartilage lesions requiring arthroscopic knee surgery were included in the study between 2017 and 2019. MRI of these patients was prescribed at maximum knee flexion in the prone position. Then, an arthroscopic operation was performed on 61 patients and the findings (intact, partial or total tear of ACL) were recorded. The ACL was evaluated as being intact and partial or total tear. The statistical significance of the efficacy of MRI in the supine position with the knee at maximum flexion in the prone position was compared. RESULTS: It was found that, of 61 patients with suspected partial ACL tears, 25 patients had intact ACLs, 22 patients had partial tears and 14 patients had total ACL tears, through the interpretation of MRIs of the prone position by the radiologist. In the arthroscopic surgery of 61 patients, 20 patients had intact ACLs, 27 patients had a partial tear and 14 patients had a total tear. The MRI results with maximum knee flexion in the prone position were more compatible with the findings of the arthroscopic surgery. CONCLUSIONS: It could be considered that MRI with maximum knee flexion in the prone position may also be guiding in the diagnosis and treatment of patients with partial anterior cruciate ligament rupture.

Does anterolateral ligament rupture affect functional outcomes in patients who underwent an anterior cruciate ligament reconstruction?

BACKGROUND: Studies have shown that the anterolateral ligament contributes to knee stability. This study aims to compare the results of postoperative physical examinations, knee joint stability tests, and functional assessment tests of patients with intact anterolateral (AL) ligaments and patients with ruptured anterolateral (AL) ligaments. MATERIAL AND METHOD: This study consisted of 101 patients, with at least a 12-month follow-up period, who underwent an anterior cruciate ligament reconstruction between 2010 and 2016, and whose AL ligaments were evaluated by the radiologist with the preoperative and postoperative magnetic resonance images (MRI). Of these patients, 41 had intact AL ligament (Group 1) in MRI and other 60 had ruptured AL ligament (Group 2). Groups were compared according to postoperative physical examinations, knee joint stability tests, and functional assessment tests. RESULTS: The average Lysholm score of Group 1 was 94.9 (range: 81-100), and the score of Group 2 was 87.2 (range: 74-100). The modified Cincinnati score of Group 1 was 28.7 (24-30), while the score of Group 2 was 25.6 (21-30). The average IKDC subjective knee evaluation score of Group 1 was 91.9 (range: 83-100), and the score of Group 2 was 86.6 (range: 75-100). The average thigh atrophy value was 1.5 centimeters (cm) in Group 1 and 2.4 cm in Group 2. Thirty-three patients in Group 1 were able to jump over 85% of the distance in single-legged hop test compared to the intact side, while 16 patients in Group 2 were able to jump over this distance successfully. As a result of the analysis, it was determined that the Lysholm activity scoring results, the Modified Cincinnati scoring results, IKDC subjective knee evaluation results, two-cycle IKDC activity scale results, comparison of thigh diameters and the single-legged hop tests of two groups showed a statistically significant difference, and the results of the patients with intact AL ligaments who underwent an ACL reconstruction were found to be better (p < 0.05). No significant difference was found in other examinations and tests. CONCLUSION: Since the rupture of the AL ligament has negative effects on functional outcomes, we think that the reconstruction of the AL ligament in the same session with the ACL reconstruction or later will have a positive effect on functional outcomes.

Early clinical and radiological results of minimally invasive total hip replacement.

INTRODUCTION: It is critical to achieve both proper component positioning and intact muscle balance if satisfactory results are to be attained after total hip replacement (THR). There have been fewer studies on minimally invasive (MI) THR than standard approaches. The objective of this paper is to present the early clinical and radiological results of posterolateral MI THR. MATERIALS AND METHODS: The retrospective analysis of the records of patients undergoing posterolateral MI THR surgery between 2011 and 2014 was the basis of this study. 73 hips of 68 patients were included in the study. The acetabular component and femoral stem positions were measured on plane X-rays. Data on preoperative and postoperative hemoglobin and hematocrit values, as well as transfusion amounts, were also studied. The clinical evaluations were carried out with Harris Hip Scores. RESULTS: The mean HHS at the 3rd postoperative month was 87.60 (±7.70). Of the 73 cases, 61 were within the Lewinnek safe zone. The mean PMFA was 88.12 (±7.63°), which is within the normal ranges. The mean postoperative hemoglobin value was 9.7 g/dl (±1.3) and the mean postoperative hematocrit value was 29.8% (±3.8). A nondisplaced proximal femoral fracture line was evident on the early postoperative X-ray of one patient. One patient experienced early dislocation caused by acetabular component malpositioning and an early acetabular cup revision was necessary. CONCLUSION: MI posterior approach for THR is a method in which the prosthetic components can be properly placed. Posterolateral MI approaches are safe when THR is performed, and afford satisfactory results.

Demographic Characteristics of Paediatric Pelvic Fractures: 10-Years' Experience of Single Paediatric Orthopaedics Clinic.

OBJECTIVE: To evaluate the demographic characteristics of paediatric pelvic fractures. MATERIALS AND METHODS: Retrospective analysis of 26 patients who were hospitalized with the diagnosis of paediatric pelvic fracture between 2000 and 2010 was performed. Age, gender, hospitalization time, mechanism of injury, fracture type, associated injuries, haemoglobin level drop in the first 24 hours, management and blood transfusion requirement, injuries time (month) information were gathered from hospital records. RESULTS: There were 16 male and 10 female patients. Average age was 10.5 (2-16). Average hospitalization time was 3.5 days (1-17). Average haemoglobin level drop in the first 24 hours was 1.51 (0.3-3.6) gr/dL. Mechanisms of the injuries were as following; 14 patients were struck by a car, 10 patients fell from height and 2 patients involved in a vehicle traffic accident. According to the classification of Torode and Zeig; there was 1 type 2, 22 type 3 and 3 type 4 injuries. Injuries' occurrence season were; 12 in spring, 7 in summer and 7 in autumn. All of the patients had been managed conservatively. CONCLUSION: These injuries are rarely seen in children. Their management can be mostly conservative and even with a simple and stable pelvic injury marked bleeding can occur.

Fixation of intertrochanteric femur fractures using Proximal Femoral Nail Antirotation (PFNA) in the lateral decubitus position without a traction table.

OBJECTIVE: The aim of this study was to evaluate whether intertrochanteric femur fractures can be reduced and nailed properly in the lateral decubitus position using Proximal Femoral Nail Antirotation (PFNA) as a fixation device without the use of a traction table. METHODS: The study included 207 patients (81 male and 126 female; mean age: 75 years, range: 22 to 95 years). According to the Evans classification, there were 7 Type 1, 40 Type 2, 33 Type 3, 38 Type 4, 61 Type 5 and 28 reverse oblique fractures. Radiographs were used to measure the tip-apex distance (TAD), the quadrant of the helical blade according to Cleveland and Bosworth, Ikuta's reduction subgroup, collodiaphyseal angle and reduction gaps postoperatively. RESULTS: Mean follow-up time was 20.4 (range: 6 to 38) months. According to Ikuta's classification, 176 (85%) reduced fractures were of subtype N, 15 (7.2%) subtype P and 16 (7.7%) subtype A. Good or acceptable reduction according to the Herman criteria was obtained in 99% of fractures. Mean TAD was 29.2 millimeters. Mean operation time was 57.2 minutes. Optimal blade position (center-center or inferior-center) was achieved in 53.5% of patients and was in the superior-posterior quadrants in only 2.4% of patients. Cut-out complication occurred in 9 patients (4.3%). CONCLUSION: While the nailing of intertrochanteric fractures in a lateral decubitus position does not provide ideal quadrant placement and TAD, results are encouraging probably due to the excellent stability that is provided by PFNA.