Mahmut Nedim Aytekin

Immunohistochemical analysis of mechanoreceptors in transverse acetabular ligament and labrum: a prospective analysis of 35 cases.

OBJECTIVE The labrum and transverse acetabular ligament (TAL) are classically described as distinct anatomical structures with abundant mechanoreceptors and free nerve fibers. They deepen the joint and act as natural barriers against dislocation, thus providing additional stability. We hypothesized that severe coxarthrosis leads to elimination of labrum and TAL mechanoreceptors. This study evaluated the microscopic anatomy of the labrum and TAL and specifically investigated the neurological status of these structures. METHODS Labral and TAL specimens from 35 consecutive patients with coxarthrosis undergoing total hip arthroplasty were dissected into a total of 4 specimens per hip. Formaldehyde-fixed specimens were evaluated for the presence of mechanoreceptors and free nerve endings by neurofilament protein and S-100 protein immunohistochemistry and microscopy. RESULTS Mechanoreceptors were identified in the labral (2.3/high power field) but not TAL specimens, with a sharp delineation between the tissues. In contrast, both labrum and TAL showed good vascularity with abundant free nerve fibers within fibrous connective tissue (mean, 2.6 sensory fibers/ high power field vs 3.1/high power field, respectively). CONCLUSION This study demonstrated that the TAL lacks mechanoreceptors. However, TAL and labrum free nerve fibers suggest potential roles as hip pain generators.

Liberação percutânea do dedo em gatilho com micro bisturi oftalmológico vitreorretiniano de lâmina 19

Objective Surgical treatment of trigger finger is usually performed as an outpatient surgery under local anesthesia n this study we present our results of surgical treatment of trigger finger performed with an ophthalmic knife which is less invasive for patient and easer for surgeon. Material and Method 19 gauges microvitreoretinal ophthalmic knifes have a rhombus like edge with both sharp sides. The length of the knife9s cutting side is 3 mm at each side. There were 40 women and 10 men with a mean age of 51.7 ± 5.7 (min: 40 max: 62). The thumb was involved in 32, the index finger in 10, and the middle in 8 patients. The procedure can be performed as an outpatient surgery under local anesthesia. The surface landmarks of the proximal and distal edges of the A1 pulley are marked on the skin. Percutaneous placement of a 25-gauge needle 5mm proximal to the PDC marked the distal extent of the release. The duration of procedure was under five minutes. Clinical examination was repeated on the postoperative 3rd day, 10th day and patients were re-examined or spoken to by telephone at a mean follow-up of 6.4 months. Results Of the 50 digits treated, there was complete resolution of symptoms in 45 digits (90%). 3 thumbs had residual grade 1–2 triggering at the second follow up. 2 patients with locked trigger thumbs had persistent, despite relief of the triggering. Discussion In this study we noted that percutaneous release with a 19 gauges MVR ophthalmic knife is a safe, cheap, quick, less scaring and comfortable treatment.OBJECTIVE: Object of this study is to produce a new technique for percutaneous release of trigger finger using 19 gauge microvitreoretinal (MVR) ophthalmic knife. Conservative treatment of trigger finger includes often local injection of steroid. This has a high rate of failure and repeated injections may be required. METHODS: When conservative treatment fails, open release of the A1 pulley is recommended. Various methods using various instruments have been reported. We used 19 gauge microvitreoretinal (MVR) ophthalmic knife in percutaneous release of trigger finger. RESULTS: We released 50 trigger fingers percutaneously with this knife. CONCLUSION: Satisfactory results were achieved in 45 of them (90%). Level of Evidence: Level IV cases series.

The effect of platelet-rich plasma in bone-tendon integration

BACKGROUND The operative reconstruction of a torn or insufficient anterior cruciate ligament has become a routine surgical procedure in orthopedics. The long-term success of an anterior cruciate ligament reconstruction depends on the ability of the graft to heal adequately in a bone tunnel. Investigators studying reconstructions described healing within a tunnel as osseous ingrowth and incorporation. In particular, helping the healing using autologous material for the best integration process was a new idea that helped us to set up this study. OBJECTIVES The purpose of this study is to show the effect of platelet-rich plasma on bone-tendon healing. MATERIAL AND METHODS Ten New Zealand rabbits were used. The study had 2 groups: (1) a study group including the right extremities of rabbits in which tendon-bone integration was strengthened by plateletrich plasma and (2) a control group including the left extremities of rabbits in which tendon-bone integration was without platelet-rich plasma. On the 56th day postoperatively, the portion of the distal femur containing the tunnel was amputated following the euthanization process for histological evaluation. RESULTS In the histological evaluation of the tendon-integrated bone segments with platelet-rich plasma, the integration of tendon in the bone was successful without any necrosis formation in most of the tissues. However, in the control group without platelet-rich plasma, the integration was distorted in many zones and some cystic morphologies were present. CONCLUSIONS The findings of this study showed that using platelet-rich plasma during tendon-to-bone implantation has positive effects histologically. In the literature, many studies are available that have investigated the effect of platelet-rich plasma on anterior cruciate surgery radiologically. However, the histological findings are more reliable than radiological findings because bone-tendon integration is a biological process.

Tendon-Holding Capacities of Two Newly Designed Implants for Tendon Repair: An Experimental Study on the Flexor Digitorum Profundus Tendon of Sheep

Background: Two main factors determine the strength of tendon repair; the tensile strength of material and the gripping capacity of a suture configuration. Different repair techniques and suture materials were developed to increase the strength of repairs but none of techniques and suture materials seem to provide enough tensile strength with safety margins for early active mobilization. In order to overcome this problem tendon suturing implants are being developed. We designed two different suturing implants. The aim of this study was to measure tendon-holding capacities of these implants biomechanically and to compare them with frequently used suture techniques Materials and Methods: In this study we used 64 sheep flexor digitorum profundus tendons. Four study groups were formed and each group had 16 tendons. We applied model 1 and model 2 implant to the first 2 groups and Bunnell and locking-loop techniques to the 3rd and 4th groups respectively by using 5 Ticron sutures. Results: In 13 tendons in group 1 and 15 tendons in group 2 and in all tendons in group 3 and 4, implants and sutures pulled out of the tendon in longitudinal axis at the point of maximum load. The mean tensile strengths were the largest in group 1 and smallest in group 3. Conclusion: In conclusion, the new stainless steel tendon suturing implants applied from outside the tendons using steel wires enable a biomechanically stronger repair with less tendon trauma when compared to previously developed tendon repair implants and the traditional suturing techniques.

Hava Yastığının Kendiliğinden Açılması İle İlişkili İzole Medial Malleol Kırığı: Vaka Sunumu ve Literatür Taraması

Airbags are automatic passive restrictive type of car safety tools. In the literature, a small number of injuries that is related to spontaneous airbag deployment have been reported. In our article, we reported isolated medial malleolus fracture that is rare and related to spontaneous airbag deployment without any collision. We detected the injury of a twenty nine-year-old woman due to direct trauma as a result of the spontaneous airbag deployment. According to the Pankovich and Shivaram classification system, there was a type B, close, isolated medial malleolus fracture. We have performed open reduction and internal fixation. As a result of a one-year follow up, we detected that the ankle joint is painless, stabile and has a full range of movement. According to our research on literature, our patient is the first medial malleolus fracture case that is related to spontaneous airbag deployment in literature.