The Clinical Results of Percutaneous Drilling in the Treatment of Chronic Lateral Epicondylitis.

AIM: Lateral epicondylitis is one of the leading orthopedic problems encountered in daily practice. Treatments are more symptomatic than curative. Percutaneous drilling is a minimally invasive method that provides satisfactory results. The aim of this study was to evaluate patients who had undergone percutaneous drilling for chronic lateral epicondylitis. MATERIAL AND METHOD: The study included 31 patients who underwent surgical percutaneous drilling because of chronic lateral epicondylitis between 2018 and 2021. The patients were evaluated with respect to demographic characteristics, including age, gender, body mass index (BMI), occupation, education level, hobbies, dominant side, and smoking status. The VAS (Visual Analog Scale) pain scores, PRTEE score (Patient-Rated Tennis Elbow Evaluation - a lateral epicondylitis function scale), and Roles-Maudsly score were examined preoperatively and at one and 12 months postoperatively together with grip strength measured with a Jamar hand dynamometer. RESULTS: Statistically significant improvements were determined in the VAS score during activity from 8.9 preoperatively to 2.06 at 12 months postoperatively (p<0.01), and in the PRTEE score, from 64.12 preoperatively to 20.61 at 12 months postoperatively (p<0.01). The Roles-Maudsly score at 12 months postoperatively was determined to be excellent in 13 (41.9%) patients, and good in 14 (45.2%). Mean grip strength increased from 69.55 before treatment to 90.97 at the end of 12 months postoperatively. CONCLUSION: Autobiological treatments are at the forefront of current treatments for tendinopathies. Percutaneous drilling is a closed method and can be considered an ideal method in the treatment of tendinosis caused by inflammation and mesenchymal stem cells (MSCs) contained in hematoma. It is also an advantageous treatment method for patients with aesthetic concerns as it does not leave any scar tissue and has a low risk of complications.

[Anterior cruciate ligament injuries: does surgical treatment with autograft versus allograft option affect the clinical results?]. / On capraz bag yaralanmalari: otogreft ve allogreft seçenekleriyle cerrahi tedavi klinik sonuçlari etkiler mi?

BACKGROUND: We investigated the clinical outcome of anterior cruciate ligament (ACL) reconstructions with allograft or autograft. METHODS: We retrospectively evaluated 82 patients who underwent arthroscopic ACL reconstruction with anterior tibial tendon (ATT) allograft (n = 52) or quadrupled hamstring tendon (QHT) autograft (n = 30). The patients were assessed using the IKDC (International Knee Documentation Committee) and Lysholm knee scores and functional (one leg hop) and laxity (pivot-shift, Lachman, anterior drawer) tests. RESULTS: The two groups were similar with respect to age and sex distribution, operated side, preoperative period and associated injuries (p > 0.05). Results were satisfactory in both groups, but there was no statistically significant difference between the groups with respect to IKDC and Lysholm scores, functionality and ligament laxity (p > 0.05). However, effusions were more frequent in the QHT group compared to the ATT group. CONCLUSION: Our results suggest that differences in graft options for ACL reconstruction have no effect on the clinical outcome. Allografts with to-be-developed solutions to immune response may be a good alternative in ACL reconstruction.

Oral vitamin C and E combination modulates blood lipid peroxidation and antioxidant vitamin levels in maximal exercising basketball players.

Oxidative stress occurs during maximal exercise, perhaps as a result of increased consumption of oxygen. Vitamins C and E can overcome the effects of antioxidants in exercise. We investigated the effects of supplementation with a combination of vitamin C and E (VCE) on blood lipid peroxidation (LP) and antioxidant levels following maximal training in basketball players.Blood samples were taken from 14 players (group A) and divided into two subgroups namely maximal training (group B) and maximal training plus VCE groups (group C). Group B maximally exercised for 35 days. VCE was supplemented to group C for 35 days and blood samples were taken from group B and C. Plasma and hemolyzed erythrocyte samples were obtained from the players.Erythrocyte glutathione peroxidase (GSH-Px) activity and plasma vitamin E concentration were lower in group B than in group A, whereas plasma and erythrocyte LP levels were higher in group B than in group A. Plasma vitamin A, vitamin E, erythrocyte GSH-Px, and reduced glutathione (GSH) values were higher in group C than in groups A and B although LP levels in plasma and erythrocytes were lower in group C than in group A and B. beta-Carotene values did not change in the three groups.In conclusion, VCE supplementation in maximal exercising basketball players may strengthen the antioxidant defense system by decreasing reactive oxygen species (ROS).

Accuracy of the Polar S810i(TM) Heart Rate Monitor and the Sensewear Pro Armband(TM) to Estimate Energy Expenditure of Indoor Rowing Exercise in Overweight and Obese Individuals.

Accurately assessing the energy expenditure (EE) of different types of physical activity is important for exercise prescription in obese individuals. The aim of this study was to examine the accuracy of the Polar S810i Heart Rate Monitor and SenseWear Pro Armband (SWA) for estimating energy expenditure (EE) during indoor rowing versus indirect calorimetry (IC). 43 overweight and obese adults (16 men, 27 women, BMI = 31.2 ± 3.7) participated in the study. Within a week after a maximal incremental test on a rowing ergometer, EE was assessed with Polar S810i, SWA and IC during two different intensities of rowing exercises (at 50% VO2max and 70% VO2max) on a Concept II ergometer. Data were analyzed with Pearson's product moment correlations and repeated measures ANOVA. Post hoc multiple comparisons were performed using the Bonferroni test. Bland-Altman plots were created to assess the agreement between the EE estimates and IC measurements. At 50% VO2max, Polar S810i and SWA significantly overestimated EE by 0.5 ± 0.50 kcal·min(-1) (p < 0.001) and by 0.9 ± 0.92 kcal·min(-1) (p < 0.001), respectively. At 70% VO2max, no significant differences were found between the SWA and IC, and between Polar S810i and IC measurements. Bland-Altman plots showed good agreements between the measured EE and estimates by Polar S810i and SWA at 70% VO2max. At 50% VO2max, there was a poor agreement between SWA and IC measurements. There were high correlations among three methods at both intensities (r = 0.82 to r = 0.95). In conclusion, Polar S810i and SWA showed reasonable concordance with IC for measuring EE of the moderate intensity exercise but not the lower intensity exercise on indoor rowing in the participants of this study. Polar S810i and SWA might be useful to assess EE during indoor rowing for overweight and obese individuals who try to manage their body weight, but it is necessary to develop exercise and population specific algorithms to enhance the accuracy of SWA to estimate energy expenditure during various intensities of physical exercises. Key pointsPolar S810i and SWA when compared to the indirect calorimetry, provide reasonable estimates of energy expenditure on rowing ergometer at the moderate exercise intensity, but not at the low exercise intensity.The monitor of the Concept II Model D rowing ergometer significantly overestimated the energy expenditure during low and moderate intensity exercises. However there was a moderate correlation between EE estimates of this device and indirect calorimetry measurements.

Effect of electromagnetic field induced by radio frequency waves at 900 to 1800 MHz on bone mineral density of iliac bone wings.

OBJECTIVE: Telecommunication has gained a different meaning in daily life with the introduction of the mobile phone system. However, electromagnetic pollution has increased in parallel to this improvement. In this study, we aimed to investigate the effects of electromagnetic waves emitted from cellular phones operating at a frequency of 900 to 1800 MHz on the bone mineral density of the human iliac bone wings, which are the most common carriage sites for mobile phones. MATERIALS AND METHODS: A total of 150 male volunteer participants were included in this study. The mean age was 31.85 years, and the age range was between 21 and 57 years. The participants were separated into 2 groups based on as follows: iliac side exposed to electromagnetic wave (group 1) and unexposed side (group 2). Of the total number of participants, 122 were carrying their phones on their right iliac wings, whereas 28 were carrying their phones on their left iliac wings. The mean daily carriage duration was 14.7 hours (between 12 and 20 h), and the mean duration for cellular phone use was 6.2 years (between 4 and 9 yr). Mineral bone density was measured using dual-energy x-ray absorptiometry in the right and the left iliac wings of all the participants. The SPSS 15 software (SPSS Inc, Chicago, IL) was used for statistical analysis. In the comparison of the 2 sides, Student t test was performed and P < 0.05 was considered significant. RESULTS: The mean dual-energy x-ray absorptiometry values measured from group 1 were slightly lower than those from group 2, but there was no statistically significant difference between the groups (P > 0.05). In addition, the mean values of group 1 were not as low as those measured in osteopeny or osteoporosis cases. CONCLUSIONS: Current data may suggest that taking into consideration cellular phone use when iliac bone graft is necessary in clinical practice would constitute an important factor for more favorable outcomes.

Influence of custom-made mouth guards on strength, speed and anaerobic performance of taekwondo athletes.

The purpose of this study was to test the influence of custom-made mouth guards on strength and anaerobic performance of taekwondo athletes. The study included 21 (11 male and 10 female) trained subjects participating in taekwondo. Anaerobic power and anaerobic capacity, isokinetic quadriceps and hamstring strength, handgrip strength, isometric lower extremity and back strength, 20 m sprint time, squat and counter movement jumping height were measured in two randomized conditions: with or without custom-made (CM) mouth guards. No significant differences were observed between the two conditions (with or without CM mouth guards) in 20 m sprint time, jumping tests, handgrip strength, isometric leg or back strength. On the other hand, peak power and average power in Wingate Anaerobic Test and Hamstring Isokinetic Peak Torque significantly increased as a result of wearing mouth guard (P < 0.05). In conclusion, we can suggest that taekwondo athletes can use CM mouth guards without any negative effects on their strength and anaerobic performance.

[The efficacy of low- and high-molecular-weight hyaluronic acid applications after arthroscopic debridement in patients with osteoarthritis of the knee]. / Gonartrozlu hastalarda artroskopik debridman sonrasi düsük ve yüksek molekül agirlikli hiyalüronik asit uygulamalarinin etkinligi.

OBJECTIVES: We evaluated the efficacy of viscosupplementation with low- or high-molecular-weight hyaluronic acid (HA) preparations following arthroscopic debridement (AD) in patients with osteoarthritis of the knee. METHODS: The study included 45 patients (19 men, 26 women; mean age 53 years; range 41 to 66 years) with Kellgren-Lawrence grade 2-3 osteoarthritis of the knee. Following AD, the patients were randomized to three groups to receive three intra-articular injections of 2 ml hylan G-F 20 (Synvisc, n=16), five intra-articular injections of 2 ml sodium hyaluronate (Hyalgan, n=14), and no injections (controls, n=15). Injections were administered at one-week intervals. All the patients were evaluated with pain, stiffness, and functional capacity scores of the WOMAC (Western Ontario and McMaster Universities) osteoarthritis index before and 6 and 12 months after AD. RESULTS: Two patients and three patients complained of transient pain in Synvisc and Hyalgan groups, respectively. WOMAC scores showed significant decreases in all the groups at 6 and 12 months. There were no significant differences between the three groups with respect to improvement in WOMAC scores at 6 months. However, compared to the control group, differences between pre- and posttreatment scores at 12 months were significantly greater in the Synvisc (p=0.004) and Hyalgan (p=0.003) groups, with no significant difference between the two HA groups (p>0.05). CONCLUSION: Our findings show that AD is beneficial in osteoarthritis of the knee in patients with appropriate indications, viscosupplementation increases the efficacy of treatment, and that low- and high-molecular-weight HA preparations have similar efficacy.

Comparison of buccal and intramuscular dexmedetomidine premedication for arthroscopic knee surgery.

STUDY OBJECTIVE: To compare the sedative, anxiolytic, analgesic, hemodynamic, and respiratory effects of buccal dexmedetomidine with intramuscular (IM) dexmedetomidine for premedication in patients undergoing arthroscopic knee surgery during spinal anesthesia. DESIGN: Randomized, placebo-controlled trial. SETTING: University medical center. PATIENTS: 75 ASA physical status I and II patients undergoing arthroscopic knee surgery with spinal anesthesia. INTERVENTIONS: Patients were randomized to one of three groups for premedication: group B, buccal dexmedetomidine 2.5 microg kg(-1); group IM, IM dexmedetomidine 2.5 microg kg(-1); and group P, buccal 0.9% and NaCl 2 mL. MEASUREMENTS: Noninvasive blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation were recorded. Sedation and anxiety levels were consecutively assessed with Ramsay sedation scores and Visual Analog Scale (VAS) scores of anxiety before premedication, before spinal anesthesia, during surgery, and at the end of surgery. Two, 4, and 8 hours after surgery, sedation levels, postoperative VAS pain scores, and consumption of analgesics (diclofenac sodium) were recorded. MAIN RESULTS: Before spinal anesthesia, during surgery, and at the end of surgery, sedation and anxiety scores of the patients receiving buccal or IM dexmedetomidine were, respectively, higher and lower than in group P. Patients receiving buccal dexmedetomidine (group B) had lower requirement of diclofenac sodium than group P and lower pain scores than groups P and IM. Mild hypotension and bradycardia were observed in the buccal and IM dexmedetomidine patients. CONCLUSIONS: Buccal dexmedetomidine for premedication in arthroscopic knee surgery provided equal levels of sedation and anxiolysis, and more evident analgesia compared with IM dexmedetomidine.

Surgical treatment of osteopetrosis-related femoral fractures: two case reports and literature review.

Osteopetrosis is a rare hereditary disease which is characterized by increased bone density. Bone resorption is insufficient or fails due to the osteoclast defect in osteopetrosis. Half of the patients are asymptomatic and diagnosed incidentally or based on the presence of fracture. Adult onset osteopetrosis usually presents with hip and proximal femoral fractures. Internal fixation can be performed; however, technical challenges may be experienced due to increased bone density. As in other fractures, nonunion or varus malunion of these fractures may occur. Although rare, osteopetrosis may complicate treatment of fractures in such patients. In this study, we aimed to present two new cases of ADO type II with an osteopetrotic femoral fracture along with the clinical and radiological findings in the light of a comprehensive literature review. Orthopaedics surgeons should be aware of intraoperative technical difficulties and possible postoperative complications during the follow-up period. Investigation would be beneficial for the diagnosis of osteopetrosis such the patient with fractures who has minor trauma history and increased bone density in radiography.

Influence of 1800 MHz GSM-like electromagnetic radiation exposure on fracture healing.

BACKGROUND AND AIMS: In this study, we aimed to investigate whether 1800 MHz frequency electromagnetic radiation (EMR) has an effect on bone healing. METHODS: A total of 30 Wistar albino rats were divided into two equal groups. Fractures were created in the right tibias of all rats; next, intramedullary fixations with K-wire were performed. A control group (Group I) was kept under the same experimental conditions except without EMR exposure. Rats in Group II were exposed to an 1800 MHz frequency EMR for 30 min a day for 5 days a week. Next, radiological, mechanical, and histological examinations were performed to evaluate tibial fracture healing. RESULTS: Radiological, histological and mechanical scores were not significantly different between groups (respectively, p = 0.114, p = 0.184 and p = 0.083), and all of these scores were lower than those of the controls. CONCLUSIONS: EMR at 1800 MHz frequency emitted from cellular phones has no effect on bone fracture healing.

Does scapular elevation occur with glenohumeral flexion and abduction? A study through open magnetic resonance imaging and autopsy.

OBJECTIVES: This study aims to reveal whether there is an elevation in scapula during flexion and abduction of the glenohumeral joint. PATIENTS AND METHODS: In the first stage of our study 32 subjects were randomly divided into two groups. The mobility of the scapular notch was examined using open magnetic resonance imaging (MRI) assay when the glenohumeral joint was in flexion in the first group (5 males, 10 females; mean age 21.1 years; range 18 to 24 years) and in abduction in the second group (8 males, 9 females; mean age 22.1 years; range 18 to 27 years) and the motion range was found to be between 0 and 150 degrees. In the second stage of our study, the mobilities of the scapular notch was examined on autopsy during passive humeral mobility. RESULTS: According to the open MRI results, there was no elevation or depression during the passive flexion and abduction of the glenohumeral joint. While the scapular notch migrated slightly to the medial side during abduction of the glenohumeral joint, it did not move during flexion. Also in an autopsy study, we observed that scapula did not move in vertical direction during the glenohumeral abduction and flexion mobilities. CONCLUSION: There is no vertical mobility in the scapula during glenohumeral flexion and abduction. Also, there is no medial mobility during flexion except during abduction.

[Effect of bone cement application on the incidence of deep vein thrombosis in major joint arthroplasties]. / Büyük eklem artroplastilerinde kemik çimentosu uygulamasinin derin ven trombozu sikligina etkisi.

OBJECTIVES: In this study, we have investigated whether the application of bone cement has an effect on the frequency of deep vein thrombosis (DVT) in major joint arthroplasties (MJA). PATIENTS AND METHODS: A total of 95 MJA cases meeting the inclusion criteria of this study between January 2004 and January 2005 were divided into cemented and cementless groups. For prophylaxis, all patients were given low molecular weight heparin (LMWH). The patients were scanned for DVT preoperatively and on the postoperative 12(th) day by color Doppler ultrasonography. RESULTS: In hip arthroplasties, in knee arthroplasties and in general, DVT was seen more frequently in cemented group, however, there was no statistically significant difference between groups in the frequency of DVT (p=0.549, p=0.749 and p=0.462, respectively). Also, there was no significant difference between the results of the different LMWH groups (p=0.616). CONCLUSION: The results of this study shows that bone cement application in MJAs such as hip or knee arthroplasties has no significant effect on the frequency of DVT.

Dental trauma incidence and mouthguard use in elite athletes in Turkey.

Contact sports may lead to dental trauma, which often can be reduced with appropriate preventive measures. While numerous studies exist on this topic for several countries throughout the world, there is a lack of comprehensive descriptive studies in Turkey. The purpose of this study was to investigate the incidence and type of dental injuries associated with three different sports among Turkish elite athletes, who do not contact (volleyball), contact directly (taekwondo) or indirectly (handball) with competition rivals. Additionally, awareness and use of mouthguards were also compared. Thus, during the 2003 and 2004 Turkish National Championships in three sports, 50 taekwondo, 62 handball and 50 volleyball male athletes were interviewed by questionnaire. Results showed that taekwondo and handball athletes experienced significantly more dental trauma than volleyball athletes (P < 0.05). Twelve of the taekwondo (24%), 16 of the handball (26%) and four of the volleyball athletes (8%) experienced at least one type of dental injury. Awareness of mouthguards as a preventive measure against dental trauma was significantly higher among taekwondo and handball athletes (P < 0.05), although a very small percentage in either of these sports actually wore a mouthguard (10 and 0%, respectively). Trauma incidence between direct contact with rival competitors and indirect contact with rival competitors was not significantly different. The incidence of dental trauma in contact sports shows that the awareness and use of mouthguards must be intensified. Mouthguard use should be made compulsory, especially in those sports with high risk for dental trauma.

Do custom-made mouth guards have negative effects on aerobic performance capacity of athletes?

Mouth guards are considered an essential part of equipment for athletes participating in contact sports. The purpose of this study was to evaluate the effect of custom-made mouth guards on the ventilatory gas exchange effects of taekwondo athletes. The subjects were 22 elite athletes aged between 14 and 17 years. To determine the effect of mouth guard use during exercise, oxygen consumption (VO(2)) was measured with a portable gas analysis system while an exercise tolerance test with a shuttle run test protocol was performed. Values with and without mouth guard were compared. Wilcoxon ranks test was used for the statistical analysis. The results show that wearing mouth guards has no significant effect on maximal oxygen uptake (VO(2max)), minute ventilation (VE), tidal volume (VT) and respiratory exchange ratio (RER) while performing maximal exercise (P > 0.05). In conclusion, taekwondo athletes can use custom-made mouth guards without negative effects on their aerobic performance capacity.