Esra Circi

Correlations of isokinetic measurements with tendon healing following open repair of rotator cuff tears.

The aim of this study was to investigate the correlation of tendon integrity following open cuff repairs with functional and isokinetic strength measurements. Twenty-six shoulders of 25 patients were included in this study. At the final follow-up, 14 repairs (53.8%) were intact and 12 repairs (46.2%) had failed on magnetic resonance imaging (MRI). Mean UCLA score at latest follow-up was 28.5 and mean Constant score was 80.3. Constant scores were found to be significantly low for the failed group. Age was found to be significantly related to failed repair. Fatty infiltration stage in the failed repair group was significantly high, and a strong positive correlation for both groups existed pre and postoperatively. When both groups were compared, the failed group was found to have significantly low measurements at extension and internal rotation. Despite high failure rates, functional results were satisfactory. Increased age and fatty infiltration stage decrease success.

The effects of extracorporeal shock waves on carrageenan-induced Achilles tendinitis in rats: a biomechanical and histological analysis

OBJECTIVE The aim of this study was to investigate the influence of low-dose extracorporeal shock waves (ESW) on the healing potential of Achilles tendinitis in the rat. METHODS The 36 adult Sprague-Dawley rats used in this study were randomly divided into four groups. Group A (n=10) were injected with carrageenan, Group B (n=10) were injected with carrageenan and received ESW, Group C (n=10) received ESW only, and Group D (n=6) was a sham group. Rats were injected with 10 microliters of 3% carrageenan or a saline solution eight times during a one-week period with a subcutaneous needle. One week following the final injection, ESW was applied at a rate of 500 impulses in 5 minutes at 2 bars (comparative to 0.09 mJ/mm²) to rats in Groups B and C. Rats were sacrificed three weeks later. Tensile strength, inflammation, and vascularity and collagen density were measured. RESULTS Failure of the tendon ultimate loads was significantly lower in the study groups than in the control group (p<0.05). Collagen fiber density was higher in the control group than in the other groups (p=0.59). No other histological differences were found. CONCLUSION Low-dose ESW has a negative effect on tendon tensile strength in this animal model.

The effect of oophorectomy on epidural fibrosis after laminectomy: an experimental study in rats.

OBJECTIVE The aim of this study was to examine the effect of oophorectomy in the formation of epidural fibrosis in a rat laminectomy model. METHODS Thirty-six 12-month-old adult female Sprague-Dawley rats were used in this study. Rats were evenly divided into two groups; oophorectomized and sham-operated. Bilateral oophorectomy was performed on the 18 rats in the oophorectomized group. Three weeks after oophorectomy, rats in both groups underwent complete bilateral laminectomy at the L2 and L3 vertebral levels. Rats were divided into 3 equal groups and sacrificed in groups of 4 at the 4th, 8t, and 12th weeks postoperatively and the lumbar spine excised en bloc, fixed and decalcified. Sections were stained with hematoxylin and eosin and Massons trichrome were used to evaluate epidural fibrosis, acute inflammation, chronic inflammation, and vascular proliferation. RESULTS The mean histological sum grade of the epidural fibrosis was greater in the oophorectomized group (p>0.05). CONCLUSION Endogenous estrogen could have an effect on epidural fibrosis formation after lumbar laminectomy in rats.

Modified Simmonds-Menelaus procedure for moderate or severe adult hallux valgus

OBJECTIVE The purpose of this study was to present the clinical and radiological results of modified Simmonds-Menelaus technique, performed as a proximal, medially-based, open-wedge osteotomy of the first metatarsal, in cases of moderate or severe adult hallux valgus deformity. METHODS Fifty-one feet of 47 patients underwent surgery due to hallux valgus. Mean age was 41.2±14.0 years, and mean follow-up period was 99.5±36.0 months. Patients were evaluated with standing anteroposterior (AP) and lateral radiographies obtained in the preoperative and early postoperative periods, and during final follow-up. The parameters of hallux valgus angle (HVA), intermetatarsal angle (IA), metatarsal distal phalangeal angle (MDPA), and first metatarsal length (ML) were measured. For clinical evaluation, American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal (MTP-IP) scale was used. RESULTS Mean preoperative HVA was 36.9°±7.3°, mean early postoperative HVA was 16.6°±6.2°, and mean final postoperative HVA was 28.9°±11.5°. Mean preoperative IA was 17.3°±4.5°, mean early postoperative IA was 8.8°±3.6°, and mean final postoperative IA was 14.3°±4.9°. Mean AOFAS hallux MTP-IP score was 71.9±20.1 at final follow-up. CONCLUSION From studies in the available literature, it is not clear whether the proximal open-wedge osteotomy technique itself is unsuccessful in adults or the lack of internal fixation led to failure. Application of an adequate fixation material should be used in order to avoid the collapse of the graft and to maintain the correction of the radiological parameters.

The effects of patello-femoral arthrosis to the outcome of unicompartmental arthroplasty

Purpose: Unicompartmental knee arthroplasty is developed for the treatment of unicompartment arthrosis. Participation of multi compartments to the disease and patello-femoral arthrosis classically form a contraindication for this surgery. Different opinions were reported in literature on this subject. In this study, the effects of the presence of patello-femoral arthrosis on post-operative clinical and functional outcomes and revision process were investigated. Method: Pre-operative magnetic resonance (MR) images of 52 patients undergone medial unicompartmental knee arthroplasty between the years of 2011-2016 who completed minimum 6 months of follow-up period were evaluated. According to the presence of patello-femoral arthrosis, patients were classified into groups as non-arthrosis, grade 1-2 and grade 3-4. Statistical comparison were performed on knee society score (KSS), functional knee society score (fKSS), Oxford knee score (OKS), visual analog scale (VAS) score and post-operative joint range of motion (ROM) results. Results: 24 of 52 patients had no patello-femoral arthrosis. 13 patients were diagnosed with grade 1-2 and 15 patients were diagnosed with grade 3-4 patello-femoral arthrosis. No statistically significant difference was observed in patello-femoral arthrosis groups in average post-operative KSS, fKSS, OKS, VAS values. No revision proceeding was demonstrated in regression analysis. Conclusion: The results obtained from this study demonstrated that patello-femoral arthrosis has no effect on clinical and functional results. Yet, it is also considered that there is no factor to affect the implant survival rate. Having that said, when the number of patients and relatively short follow-up periods are considered, it is our opinion that new studies are required in this matter. lateral x-ray of grade 4 patellofemoral arthrosis despite of grade 4 patellofemoral arthrosis this patient has got perfect clinical and functional outcomes

Results of Arthroscopic Treatment in Unresolved Osgood-Schlatter Disease in Athletes

Purpose: Osgood-Schlatter disease (OSD) is common causes of knee pain in adolescent. Most patients respond to conservative treatment. However surgical treatment has been recommended for unresolved OSD. The aim of this study was to determine the outcomes of arthroscopic ossicle excision in athletes with unresolved OSD. Methods: Between September 2008 and November 2014, arthroscopy was performed 11 knees of 11 patients with OSD. The inclusion criteria were patients who underwent arthroscopic surgery with more than one year follow-up after surgery. Patients have a documented history of OSD with refractory pain over the tibial tubercle for a mean of 15.5 months (range, 7 to 24 months; SD, 7.5 months). The mean age was 23 years (range, 19 to 29 years; SD, 2.8 years). The mean follow-up period was 66.1 months (range, 15 to 96 months; SD, 25.6 months). Results: The mean return the sports activities after the surgery was 6.7 weeks (range 5 to 9 weeks; SD 1.3 weeks). The mean Kujala patellofemoral score improved from 82.9 (range 80 to 88 points; SD 2.6) preoperatively to 98.5 (range 96 to 100 points; SD 1.6) at final follow-up (p<0.01).In addition, the mean Lysholm knee scale was 87.5 (range 86 to 90 points; SD 1.7) in the preoperative period and increased to 96.9 (range 94 to 100 points; SD 2.5) at final follow-up(p<0.01). The mean Tegner activity level was 7.5 (range 6 to 8; SD 0.9) in the preoperative period and increased to 8.5 (range 7 to 9; SD 0.9) after surgery (p<0.01). Conclusions: We investigated the functional outcomes after arthroscopic treatment of unresolved OSD in athletes. In the all athletes, the arthroscopic treatment of OSD yielded satisfactory functional recovery. No postoperative complication were located. All patients were able to return the same level athletic activity. Level of evidence: Therapeutic Level IV. Key terms: Osgood-Schlatter disease, athletes, knee arthroscopy, ununited ossicle

Arthroscopic excision of an intra-articular osteoid osteoma in the elbow joint

An osteoid osteoma is a rare, small, benign and painful tumour occurring in the extra-articular portion of long bones seen most commonly in the lower extremities. This is a case report of a 23-year-old female patient who underwent arthroscopic resection of an intra-articular osteoid osteoma. The nidus was completely removed by arthroscopic excision. The diagnosis was confirmed by postoperative histopathological analysis. In the case presented we have shown that intra-articular arthroscopy can be successful in the surgical management of benign bony lesions involving the elbow joint. We also present a review of the literature which reports on similar cases or intra-articular disease, preferred methods of surgical management and limitations in histopathological specimen acquisition for diagnosis.

The effectiveness of extracorporeal shockwave treatment in subacromial impingement syndrome and its relation with acromion morphology

Objective The aim of this study was to evaluate the effectiveness of the extracorporeal shock wave therapy in the subacromial impingement syndrome and its relationship with the acromion morphology. Methods Thirty patients (24 women, 6 men) with subacromial impingement were evaluated. The average age of patients was 53.6 ± 9.8 years (range 39–80). Patients were divided into 3 groups according to the acromion morphology. ESWT 1500 at 0.12 am mL/mm2 violence was applied once a week for 3 weeks. Shoulder pain and disability index (SPADI) was used to assess function and pain scores of the patients. The evaluations were made prior to and 12 weeks after the ESWT. Results Thirteen shoulders had type 1 acromion, 11 shoulders type 2 acromion and 6 shoulders type 3 acromion. After ESWT, the SPADI pain score decreased from 16.1 ± 5.1 (7–25) to 10.4 ± 4.9 (1–20); SPADI functional score decreased from 37.3 ± 19.8 (5–70) to 26.7 ± 17.5 (1–60); SPADI total score decreased from 53.4 ± 24.5 (14–95) to 37.1 ± 21.6 (2–74) (p < 0.05; paired t test). In each group better functional outcomes were achieved after ESWT (p < 0.05; paired t test). There were no differences between the groups according to functional outcome both before and after the ESWT treatment (p > 0.05, one way ANOVA test). Conclusion ESWT was found to be effective in the treatment of impingement syndrome both for pain and functional outcome in the early period regardless of acromion morphology. Level of evidence Level IV, Therapeutic study.

Simultaneous ACL–PCL reconstructions with high tibial osteotomy: salvage for an unstable arthritic knee

We present a case of a 28-year-old man with a severe osteoarthritic varus knee after a neglected multiligamentous injury sustained 10 years prior. Simultaneous anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstructions with high tibial osteotomy (HTO) were performed at a single stage. Five years after surgery, there were no signs of effusion and no instability, and the patient could easily kneel down without any discomfort. We think that salvage procedures and biological reconstructions would be the primary choice of surgical treatment in young patients to delay arthroplasty, and it is possible to perform simultaneous reconstructions of ACL and PCL with HTO in a single stage.

A comparison of the open reduction-internal fixation and resection arthroplasty techniques in treatment of Mason Type 3 radial head fractures

Objective The aim of this study was to retrospectively compare a series of patients surgically treated with ORIF or early resection arthroplasty due to isolated comminuted radial head fractures. Methods Between the years 2009 and 2013, 34 patients with isolated comminuted fractures of the radial head (Mason Type 3) had been operated (ORIF in 19 patients, resection arthroplasty in 15 patients). The mean age of the patients in the ORIF group was 38.5 years and 54 years in the resection group. The carrying angle (CA) and ulnar variance were measured bilaterally, and radiographs were reviewed for degenerative elbow arthritis. The Mayo elbow performance score, Turkish version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH-T) and visual analog scale (VAS) were used to evaluate the clinical results. Results The mean follow-up period in the ORIF group was 40.2 months and 44.4 months in the resection group. In the ORIF group, 11 patients were clinically rated excellent, six good, and two fair. In the resection group, seven patients had excellent, five had good, and two had fair scores. We did not find a statistically significant difference between the ORIF and resection groups regarding the clinical and radiological outcomes. Conclusion With these short-term results, resection arthroplasty may be considered an effective method in the treatment of isolated comminuted radial head fractures, as it is less technically demanding and it also allows for early postoperative motion. However, the patients should be evaluated in detail, regarding ligamentous injuries prior to resection arthroplasty. Level of evidence Level III, Therapeutic study.