Çetin Işık

Augmented Fixation With Biodegradable Subacromial Spacer After Repair of Massive Rotator Cuff Tear

Unsuccessful outcomes after repair of massive rotator cuff ruptures accompanied by muscle atrophy and fatty degeneration are frequently associated with inadequate management and secondary tears. We report the functional differences after rotator cuff rupture repair with a biodegradable spacer application. In these patients, rotator cuff rupture repair should provide coverage of the humeral head. Subsequently, acromioplasty should be performed to allow adequate space for the subacromial spacer. Thereafter measurement of the intra-articular space required for application of the biodegradable spacer is performed. Using this method can decrease the rate of tears by providing a safe subacromial space in cases of massive rotator cuff rupture.

The comparison of plate-screw and tension band techniques in the osteosynthesis of Danis-Weber Type A and B lateral malleolar fractures.

OBJECTIVE The aim of this study was to compare the clinical and radiological results of plate-screw and tension band fixation in isolated Danis-Weber Type A and B lateral malleolar fractures. METHODS A total of 135 cases of lateral malleolar fractures (82 Danis-Weber Type B and 53 Type A) operated on in 4 different centers and 6 orthopaedic clinics between November 2005 and December 2010 were reviewed retrospectively. Eigthy-one patients (55 Type B and 26 Type A) had lateral 1/3 tubular plate and screw fixation (Group 1), while the remaining 54 patients (27 Type B and 27 Type A) were operated on with tension band technique (Group 2). The clinical and radiological results of the groups were compared. Student t test was used in statistical analysis. RESULTS The mean length of surgical incision scar was 4.9 cm (4.5-5.4 cm) for Type A fractures and 6.8 cm (5.6-7.5 cm) for Type B in Group 1 and 4.0 cm (3.5-5.2 cm) for Type A and 5.3 cm (5.0-5.9 cm) for Type B fractures in Group 2. Radiological union was obtained at mean of 10 weeks (7-13 weeks) in Group 1 and 9 weeks (7-12) in Group 2. The implant had to be removed in 12 patients in Group 1 and in one patient in Group 2. The mean AOFAS Score was 90 (72-100) and 92 (70-100) in Groups 1 and 2, respectively. CONCLUSION Both plate-screw and tension band techniques revealed excellent results in isolated Danis-Weber Type A and B fractures. The tension band technique may be an alternative fixation method in the treatment of these fractures.

Robotic arthroscopic surgery: a new challenge in arthroscopic surgery Part-I: Robotic shoulder arthroscopy; a cadaveric feasibility study.

Arthroscopy of the shoulder is a well‐established diagnostic procedure which has widespread application. Advances in technology and the search for more minimal invasive surgery will always offer new techniques in any surgical field. Robotic technology is such an advance, offering technical advantages over standard laparoscopic approaches. The aim of the present study is to test whether robotic surgery can be used while performing shoulder arthroscopy or not.

Impact of fibular torsion and rotation on chronic ankle instability

BACKGROUND The fibula is known not to involve in transmission of weight but known simply as an ankle stabilizer. However, its main function in stabilizing the ankle remains obscure. Since the fibula has an impact on torsion and rotation of the ankle, its effect on lateral ankle instability should be investigated. MATERIALS AND METHODS Twenty patients with lateral ankle instability (Group 1) and 19 healthy volunteers (Group 2) were included in the study. The tibiofibular and talofibular relationships were evaluated using MRI images. Fibular torsion and rotation angles were calculated using a new method. Range of motion of the ankle joint was investigated while the knee was at flexion (90°) and extension (0°). The comparisons performed between the 2 groups and independent from the groups were statistically evaluated and, the p value of <0.05 was considered as statistically significant. RESULTS A significant difference was found between the two groups for age (p<0.05). There were no statistically significant differences between the right and left sides for all measurements in the group 1 and 2 (p>0.05). There was a statistically significant difference between the two groups in dorsal flexion when the knee is at flexion (90°) and extension (0°) position. There was also a statistically significant difference between the two groups in plantar flexion which was measured while the knee was at extension (0°) position. No statistically significant difference was found between both groups in terms of fibular torsion and rotation. However, independent from the groups when the patients were divided into 2 groups according to whether the fibula localized posteriorly or not, in patients with posteriorly localized fibula it was demonstrated that the fibular torsion and rotation was increased significantly. CONCLUSION We did not detect any relationship between fibular torsion and rotation and ankle instability. However, independent from the groups when the patients were divided into 2 groups according to whether the fibula localized posteriorly or not, we realized that in patients with posteriorly localized fibula, fibular torsion and rotation significantly increased. This finding did not explain the cause of instability. However, it may gain significance with new further studies regarding ankle instability.

Use of contact pressure-sensitive surfaces as an indicator of graft tension in medial patellofemoral ligament reconstruction

BackgroundNo previous description has been made about an objective method to test the graft resistance in MPFL reconstruction intraoperatively. In our study, we aimed to obtain intraoperative objective data about the graft resistance using contact pressure-sensitive surfaces and measuring pressure formed under the graft.Materials and methodsIn 2012, double-layered contact pressure-sensitive Fuji Prescale Film bands were placed under MPFL in 15 fresh-frozen high above-knee amputates (Group 1) and under graft in 10 patients who underwent MPFL reconstruction (Group 2). Measured values at different flexion angles were compared between and in groups.ResultsStatistical analysis was performed by Student’s t test. It has been found that the pressure under the graft was higher in patients having reconstruction as compared to the pressure under natural MPFL. Decreasing pressure values were observed with increasing flexion angles in both groups.ConclusionContact pressure-sensitive surfaces provided objective data when placed under the graft in natural MPFL and during surgery. Therefore, they may be used as an objective marker providing information about graft resistance.

Microfracture technique versus carbon fibre rod implantation for treatment of knee articular cartilage lesions

Purpose To compare the microfracture technique with carbon fibre rod implantation for treatment of knee articular cartilage lesions. Methods 10 men and 30 women aged 22 to 56 (mean, 37.4) years underwent microfracture (n=20) or carbon fibre rod implantation (n=20) for International Cartilage Repair Society grade 3 to 4 knee articular cartilage lesions after a mean of 12.2 months of viscosupplementation and physiotherapy. Clinical outcome at 6 and 12 months was assessed using the Tegner-Lysholm score and modified Cincinnati score. Magnetic resonance imaging (MRI) outcome at 12 months was assessed by a radiologist. The modified magnetic resonance observation of cartilage repair tissue (MOCART) score was evaluated. Results The 2 groups were comparable in terms of age, body mass index, lesion location, lesion size, duration of symptoms, and coexisting pathology. The microfracture group had a higher preoperative Tegner-Lysholm score (39.4±7.3 vs. 34.4±4.9, p=0.015) and modified Cincinnati score (36.4±7.2 vs. 30.4±4.0, p=0.002) than the carbon fibre rod group. At 12 months, change in both scores was significant within each group (p<0.001) and was higher in the microfracture than carbon fibre rod group (p<0.001). MRI showed minimal regenerative tissue. Lobulation, oedema, and hypertrophy were more commonly found in the regeneration tissue after carbon fibre rod implantation than microfracture. At 12 months, the MOCART score was higher in the microfracture than carbon fibre rod group (59 vs. 47, p<0.001). Conclusion Microfracture is superior to carbon fibre rod implantation in terms of clinical and radiological outcome.

Strain ratio measurement of femoral cartilage by real-time elastosonography: preliminary results

ObjectiveThe purpose of this study was to evaluate strain ratio measurement of femoral cartilage using real-time elastosonography.MethodsTwenty-five patients with femoral cartilage pathology on MRI (study group) were prospectively compared with 25 subjects with normal findings on MRI (control group) using real-time elastosonography. Strain ratio measurements of pathologic and normal cartilage were performed and compared, both within the study group and between the two groups.ResultsElastosonography colour-scale coding showed a colour change from blue to red in pathologic cartilage and only blue colour-coding in normal cartilage. In the study group, the median strain ratio was higher in pathologic cartilage areas compared to normal areas (median, 1.49 [interquartile range, 0.80–2.53] vs. median, 0.01 [interquartile range, 0.01–0.01], p < 0.001, respectively). The median strain ratio of the control group was 0.01 (interquartile range, 0.01–0.01), and there was no significant difference compared to normal areas of the study group. There was, however, a significant difference between the control group cartilage and pathologic cartilage of the study group (p < 0.001).ConclusionsElastosonography may be an effective, easily accessible, and relatively simple tool to demonstrate pathologic cartilage and to differentiate it from normal cartilage in the absence of advanced imaging facility such as MRI.Key Points• Elastosonography uses colour-maps and strain ratios for evaluating tissue deformability.• Colour change from blue to red and increased strain ratio represent softening.• Normal cartilage shows decreased compressibility, represented by blue colour and low strain ratio.• Pathologic cartilage shows increased compressibility, represented by red colour and high strain ratio.• Elastosonography may be used for differentiating pathologic cartilage from normal cartilage.

The effect of the dimensions of the distal femur and proximal tibia joint surfaces on the development of knee osteoarthritis

The aim of this study was to determine whether the dimensions of the distal femur and proximal tibia joint surfaces affect the etiology of knee osteoarthritis (OA). The study comprised the records of 1,324 patients who had been admitted to hospital with knee pain. Anterioposterior (AP) and lateral radiographs of the knee were taken. Using the Kellgren‐Lawrence Scale, the patient group comprised Stages 2, 3, and 4 radiographs and the controls comprised Stages 0 and 1 radiographs. Four lengths were measured for each patient in both groups: femur mediolateral (femur ML), tibia mediolateral (tibia ML), femur anteroposterior (femur AP), and tibia anteroposterior (tibia AP). Osteophytes were not included in the measurements in the patient group. All the measurements were repeated by two researchers at two different times. The groups were compared in terms of these measurements and the correlations between them. The mean femur ML length was significantly greater in the patient group than the control group (P = 0.032) and the mean femur AP length was significantly less (P = 0.037). In addition, the difference between the femur ML and AP lengths was significantly high in the patient group (P < 0.001). The difference between the tibia and femur ML lengths was significantly high in the patient group (P < 0.001) and the difference between the tibia and femur AP lengths was higher in the control group (P = 0.001). A longer femur ML and a shorter femur AP, together with a greater difference between these two lengths and a greater difference between the tibia ML and femur ML lengths, could be a risk factor for developing knee OA. More extensive anatomical and biomechanical studies in the future will enable these results to be corroborated. Clin. Anat. 28:672–677, 2015.

Is coracoacromial arch angle a predisposing factor for rotator cuff tears

PURPOSE The aim of the present study was to investigate whether coracoacromial arch angle is a predisposing factor for rotator cuff tears. METHODS Shoulder magnetic resonance imaging (MRI) examinations of 40 patients having shoulder arthroscopy due to rotator cuff tears and 28 patients with normal MRI findings were evaluated retrospectively. Acromio-humeral distance, coraco-humeral distance, the angle between the longitudinal axis of the coracoacromial ligament and longitudinal axis of the acromion (coracoacromial arch angle), and thickness of the coracoacromial ligament were measured. RESULTS In patients with rotator cuff pathology the mean coraco-humeral distance was 7.88±2.37 mm, the mean acromio-humeral distance was 7.89±2.09 mm, and the mean coracoacromial arch angle was 132.38°±6.52° compared to 11.67±1.86 mm, 11.15±1.84 mm, and 116.95°±7.66° in the control group, respectively (P < 0.001, for all). In regression analysis, all three parameters were found to be significant predictors of rotator cuff tears. The mean thickness of the coracoacromial ligament was not significantly different between the patient and control groups (0.95±0.30 mm vs. 1.00±0.33 mm, P > 0.05). CONCLUSION Acromio-humeral and coraco-humeral distances are narrower than normal limits in patients with rotator cuff tears. In addition, coracoacromial arch angle may be a predisposing factor for rotator cuff tears.

Arthroscopic treatment of osteochondral lesions of the talus: Nanofracture versus hyaluronic acid-based cell-free scaffold with concentration of autologous bone marrow aspirate

Purpose: We aimed to evaluate the early clinical and radiological outcomes of arthroscopic one-stage treatment with hyaluronic acid-based cell-free scaffold (HACS) in combination with a concentration of autologous bone marrow aspirate (CBMA) technique compared to nanofracture (NF). Methods: A retrospective evaluation was made of all the patients with focal osteochondral lesions of the talus that were treated between January 2012 and January 2015. Ninety-eight patients met the criteria and were enrolled in the study. Forty-six patients (group 1) were treated with arthroscopic one-stage treatment with CBMA in combination with an HACS. Fifty-two patients (group 2) were treated with NF. Patient demographics and cartilage defect characteristics, the AOFAS and VAS scoring systems were compared between groups. In the evaluation of cartilage repair tissue, the magnetic resonance observation of cartilage repair tissue (MOCART) scoring system was used. Results: No significant differences were determined between the two groups in terms of age (p = 0.874), body mass index (p = 0.621), defect size (p = 0.485), defect depth (p = 0.674), follow-up time (p = 0.512). A significant clinical difference was determined between the two groups according to the AOFAS and VAS scores (p = 0.028, p = 0.046, respectively). The mean MOCART score of group 1 was significantly higher (p = 0.041). Conclusions: Both NF and HACS with CBMA techniques are beneficial in treatment of osteochondral lesions of the talus. Better clinical and radiological results, in addition to higher cartilage quality, could be obtained with HACS with CBMA technique compared to NF.