Ilhan Ozkan

A comparison of the effect of doxorubicin and phenol on the skeletal muscle. May doxorubicin be a new alternative treatment agent for spasticity

Since spasticity is still an unsolved problem for orthopaedic surgeons, different chemical agents are tried before surgery. Phenol is a chemical agent which has been used for spasticity treatment for a long time. Doxorubicin is an antitumoral agent that has recently been used for chemomyectomy. The intramuscular effects of phenol and two different dose of doxorubicin were compared in that experimental study. In the first group 0.5 mg/0.5 cm3 doxorubicin, in the second group 1 mg/0.5 doxorubicin and in the third group 5% aqueous solution of fenol/0.5 injection were applied into left quadriceps muscle of rats. Degeneration areas were wider in the high dose doxorubicin group (29.9%; 8.5–61), in comparison with the low dose doxorubicin group (6.4%; 3.1–12) and phenol group (4%; 0–14) after 6 weeks. Differences in degeneration area among three groups were statistically significant (P<0.001). The difference was significant between the high dose doxorubicin group and the phenol group (P=0.001) and also between the high dose doxorubicin group and the low dose doxorubicin group (P<0.001). The results of this study suggested that doxorubicin could provide an alternative treatment modality for neuromuscular disease causing spasticity and it has a dose-dependent effect. Further studies are needed for long-term comparison and clinical use of doxorubicin for spasticity treatment.

Preoperative magnetic resonance imaging evaluation of semitendinosus tendon in anterior cruciate ligament reconstruction: Does this have an effect on graft choice?

Background: Anterior cruciate ligament (ACL) reconstruction with ST autograft is sometimes unsuccessful because of harvested thin graft. Magnetic resonance imaging (MRI) can be a useful tool to evaluate the thickness of the graft. This study is performed to evaluate whether there is any correlation between diameters and cross-sectional area (CSA) of the semitendinosus tendon (ST) on the preoperative magnetic MRI and the diameter of the 4-stranded ST autograft in ACL reconstruction. Materials and Methods: Seventy patients who underwent single-bundle ACL reconstruction with 4-stranded ST for full-thickness ACL ruptures were included in this study. Anteroposterior (AP) and mediolateral (ML) diameters of ST at the levels of the joint line (JL) and femoral physeal line (PL), and also CSA at these levels were measured on T2-weighted fat-suppressed MRI examinations. The data obtained were compared with intraoperatively measured diameters of 4-stranded ST autograft. Correlations between variables were evaluated using Spearmans rho. Receiver operating characteristic and area under the curve statistics were used to evaluate the cut-off value for the correlation between 4-stranded ST graft diameter of 8 mm and CSA (mm2) on MRI. Results: On MRI measurements, no correlation was found between AP diameters at the level of the JL and 4-stranded ST diameter (P = 0.180). However, correlations were found between diameter of 4-stranded ST and ML diameter at the level of JL (P = 0.003) and PL (P = 0.002), AP diameter at the level of the PL (P = 0.009), CSA at the level of the JL (P < 0.001) and at the level of PL (P < 0.001). Correlation between the diameter of 4-stranded ST and CSA at both levels was more significant than that between AP-ML diameters of ST and diameter of autograft. The cut-off value for the 8 mm diameter CSA of 4-stranded ST was 5.9 mm2 at the JL and 8.99 mm2 at the PL. Conclusion: Preoperative MRI evaluation of CSA at the JL of the ST is a reliable parameter to predict graft size. Other graft alternatives should better be considered if the CSA of ST is <5.9 mm2 at the level of the JL.

A new guide for condylar blade-plate on distal femoral fractures.

This article presents a new guide used to reduce the risk of malalignment following distal femoral fracture fixation with a 95 degrees angled blade plate.

Developmental patello-femoral displasia (experimental study)

Similar to developmental hip dysplasia patella is an important factor for the development of femoral troclea. This study was performed in an attempt to evaluate the effect of patella on development of femoral trochlea. Thirty two 4 weeks old New Zeeland rabbits were used in this study. Patella of the left knee was dislocated and 4 weeks after, a new operation was performed to relocate the patella to its normal anatomical location (group 1, 16 rabbits). In the second 16 rabbits patella of the left knee was dislocated and no other surgical intervention was performed (group 2). All the non operated right knees were used as the control group (group 3). All the rabbits were sacrificed when they were 6 months old. Computed tomography (CT) was performed to measure femoral sulcus angle and femoral trochlear dept in every knee. Kolmogorov-Smirnov, Anova and Kruskal-Wallis tests were used to evaluate the results. Trochlear sulcus angle was measured as 127.7 degree in group 1, 133.85 degree in group 2 and 127.0 degree in control group. The depth of the trochlear grove is 1.41 mm, 1.15 mm and 1.26 mm respectively. Trochlear sulcus angle and depth that were measured in group 2 were statistically different from group 1 and control group (P<0.05). The most important finding of this study is insufficient development of trochlear sulcus in group 1 in which the patella was dislocated. Bone development is a complex procedure, mechanical stress has an important role on bone morphology. This study showed that patellar impulse is needed for a normal trochlear sulcus development. Similar to developmental hip dysplasia shallow trochlear sulcus due to insufficient patellar impulse can be named as “developmental patello-femoral dysplasia”. Malposition of patella on trochlear grove has an important role in patello-femoral pain syndrolme. Diagnosis and treatment of this malposition in early ages can reduce the incidence of patello-femoral pain syndrome and other patello-femoral abnormalities in adult age. This study demonstrated that, similar to developmental hip dysplasia, patello-femoral dysplasia must be diagnosed and treated in early ages to prevent anatomical abnormalities. Trochlear gtrove in rabit knees Sample photo of trochlear grove for group 2 (right side) group 1 (in the middle) and group 3 (left side).

Clinical Relevance of Gene Therapy and Growth Factors in Sports Injuries

With increasing sports activity, orthopedic surgeons have dealt with more sports-related injuries in recent years. Ligaments, tendons, articular cartilage, meniscal tissue, and muscles are most commonly injured tissues in sports. Some of these tissues have poor healing capacity with poor blood supply. Application of exogenous growth factors has been demonstrated to accelerate and modify the healing process in ligaments, tendons, meniscal tissue, cartilage, and skeletal muscle. Also gene therapy in somatic cells has been widely accepted and it can be thought as the drug delivery method to the target tissue. The aim of the gene therapy in somatic cells at the injury or the inflammation site is the production of growth factors by local cells. By this way the growth factor or a cytokine that can affect the healing process is synthesized by the local cells to modify the healing period.