Mehmet Erduran

Proprioception of the knee joint in patellofemoral pain syndrome

OBJECTIVES The importance of proprioception in the etiology, treatment, and prevention of sports injuries and joint diseases has become increasingly clear. The purpose of this study was to investigate knee proprioception in patients with patellofemoral pain syndrome (PFPS). METHODS The study included 28 patients (18 females, 10 males; mean age 28 years; range 16 to 48 years) with a clinical diagnosis of unilateral PFPS and 27 normal volunteers (13 females, 14 males; mean age 26 years; range 19 to 32 years) without any complaint related to the knee. The mean duration of complaints was 35.8 weeks (range 2 weeks to 3 years). In both patient and control groups, proprioception of the knee was measured by means of active joint position sense at four different target angles (15 degrees , 30 degrees , 45 degrees , 60 degrees ) with the use of a digital goniometer and the results were compared. RESULTS Proprioceptive errors were greater at all target angles in the affected knees compared to those measured in the contralateral knees and both knees of the controls. Differences between affected knees and contralateral knees ranged from 1.01+/-0.25 degrees to 1.65+/-0.43 degrees and were significant at three target angles (15 degrees , 30 degrees , 60 degrees ; p<0.05). Comparisons between the affected knees and both knees of the controls also showed significant differences at all target angles ranging from 2.48+/-0.92 degrees to 3.87+/-2.46 degrees (p<0.001). Errors obtained in the normal knees of the patients were also significantly greater compared to those seen in both knees of the controls, exceeding 2.7 degrees at some target angles (p<0.001). CONCLUSION Our results show that patients with PFPS have impaired proprioception in the affected knee accompanied by significant losses in the proprioception of the contralateral normal knee. Based on these findings, proprioceptive rehabilitation techniques should be incorporated into the treatment of PFPS.

The BstUI and DpnII Variants of the COL5A1 Gene Are Associated With Tennis Elbow

Background: Tennis elbow entails pain and tenderness over the lateral epicondyle. The exact cause of the condition is not fully understood. Type V collagen is a minor fibrillar collagen that intercalates with type I collagen and forms collagen fibrils. It is encoded by the COL5A1 gene. Sequence variants within COL5A1 3′-UTR have been implicated in musculoskeletal diseases. Purpose: To determine whether rs12722 (BstUI C414T polymorphism) and rs13946 (DpnII C230T polymorphism) of the COL5A1 gene are associated with an increased risk of tennis elbow. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 152 patients with tennis elbow and 195 healthy participants were enrolled in this study. The rs12722 (BstUI C414T) and rs13946 (DpnII C230T) polymorphisms were investigated with the polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) method. Results: There was a significant difference in both BstUI and DpnII genotype frequencies between patients with tennis elbow and healthy participants. The A2 allele of BstUI and the B1 allele of DpnII were significantly underrepresented in the patient group. Conclusion: Individuals with the BstUI A1 allele and DpnII B2 allele of the COL5A1 gene have a high likelihood of developing symptoms of the tennis elbow. This is the first study reporting that rs12722 and rs13946 SNPs (single nucleotide polymorphisms) are genetic risk factors for tennis elbow.

Inheritance of the accessory navicular bone.

Abstract The accessory navicular bone is one of the most symptomatic bones of the foot. Although it has been reported to be present in various members of the same family, there is a lack of knowledge about its inheritance in the literature. We examined three families and suggest that it has an autosomal dominant trait with incomplete penetrance.

Short-Term Clinical Outcomes After First Metatarsal Head Resurfacing Hemiarthroplasty for Late Stage Hallux Rigidus

The purpose of the present study was to evaluate the short-term results of metatarsal head resurfacing hemiarthroplasty in the treatment of advanced hallux rigidus. We reviewed 14 consecutive patients (5 males [35.71%], 9 females [64.29%]; mean age, 58.7 ± 7.4 years). These patients underwent first metatarsal head resurfacing hemiarthroplasty (HemiCAP(®)) for hallux rigidus from March 2010 to September 2012 at our institution. According to the Coughlin and Shurnas clinical and radiographic classification, 10 feet (71.43%) were classified as grade III and 4 (28.57%) as grade IV. We clinically rated all patients before surgery and at the final follow-up visit using the American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal scale, the visual analog scale for pain, and first metatarsophalangeal joint (MTPJ) range of motion. The mean follow-up duration was 24.2 ± 7.2 (range 12 to 36) months. The mean preoperative hallux metatarsophalangeal-interphalangeal scale score was 33.9 ± 9.8 (range 22 to 59), and it increased to 81.6 ± 10.1 (range 54 to 96; p < .05) postoperatively. The mean preoperative 10-cm visual analog scale for pain score was 8.4 ± 0.9 (range 7 to 10), which decreased to 1.21 ± 1.2 (range 0 to 5; p < .05) postoperatively. The mean preoperative MTPJ range of motion was 22.8° ± 7.7° (range 15° to 45°), which increased to 69.6° ± 11.8° (range 50° to 90°; p < .05) postoperatively. None of the 14 patients experienced component malalignment or loosening, infection, or neurovascular compromise during the follow-up period. One patient (7.14%) experienced postoperative pain and subsequently underwent first MTPJ arthrodesis. From the results of our investigation, first MTPJ arthroplasty is an effective treatment modality that can reduce pain and increase motion in the case of advanced hallux rigidus.

Pseudomyogenic (Epithelioid sarcoma-like) hemangioendothelioma with bone invasion.

AIM Pseudomyogenic (epithelioid sarcoma-like) hemangioendothelioma is a rare local aggressive vascular tumor. Herein we present a 54-year-old male patient with a tumor on his index finger. CASE The patient presented with a 1-year history of pain and swelling that progressively exacerbated. Bone invasion was observed on the middle phalanx via direct radiography. Histopathological examination findings were compatible with epithelioid sarcoma-like hemangioendothelioma. CONCLUSION To the best of our knowledge is the first case report of epithelioid sarcoma-like hemangioendothelioma with bone invasion.

Is Sp1 binding site polymorphism within COL1A1 gene associated with tennis elbow

Tennis elbow defines a condition of pain and tenderness over the lateral epicondyle of the humerus. The exact aetiology of the injury is not yet fully understood. The major constituent of tendons is type 1 collagen which is encoded by COL1A1 gene. The aim of the study was to determine whether Sp1 binding site polymorphism (SNP rs1800012; 1546G/T) within the intronic region of COL1A1 gene is associated with tennis elbow. One hundred and three tennis elbow patients and one hundred and three healthy subjects without any history of previous ligament or tendon injuries were recruited for this genetic association study. All participants were genotyped for the COL1A1 Sp1 binding site polymorphism by using PCR-RFLP method. There were no observed statistical differences in the genotype (p=0.17) or allele (p=0.11) distributions between the groups. G allele frequency in patients and controls was 82.5% and 76.21%, and T allele frequency was 17.5% and 23.79% respectively. This study has shown that there is no association between this polymorphism and tennis elbow within the population studied.

Rigid fixation of the lumbar spine alters the motion and mechanical stability at the adjacent segment level.

OBJECTIVES This study aims to examine the motion and stability of the adjacent segment following rigid fixation of the lumbar spine. MATERIALS AND METHODS The study included 17 fresh-frozen lamb lumbar spines (including the sacrum to T12). Biomechanical testing was performed using an axial compression testing machine. Axial compression was applied to all the specimens using a loading speed of 5 mm min-1. A specifically designed fixture was used to generate torque ≤8400 Nmm. The fixture was used with each specimen to achieve flexion and extension, axial neutral compression, and right and left bending. All specimens were tested intact, and again after implantation using posterior pedicle screws and rod fixation. During testing intervertebral displacement at the adjacent level (L5-S1) was recorded continuously via extensometry. RESULTS Axial compression and superior-inferior displacement were lower in the adjacent segment (L5-S1) than anterior-posterior displacement following rigid fixation. Statistical analysis showed that there was a numerical difference and a significant change between the intact spine and the adjacent segment in the axial compression and extension positions (p<0.027). The intact spines demonstrated the maximum displacement and the difference in extension positions were significant (p<0.015). CONCLUSION Rigid fixation of the lumbar spine altered the range of motion at the adjacent segment level. As such, abnormal stress on the adjacent segment causes spinal instability, which may subsequently cause facet joint degeneration and low back pain.

Iatrogenic lateral meniscus anterior horn injury in different tibial tunnel placement techniques in ACL reconstruction surgery – A cadaveric study

Objectives The aim of this study was to analyze the effect of tibial tunnel positioning in single bundle and double bundle ACL reconstructions on lateral meniscus anterior root. Materials Twelve single knee cadavers were used, 6 for a single bundle ACL reconstruction, which were reamed gradually starting from 8 mm, 9 mm and ended with a 10 mm reamers, while the other 6 were prepared for a double bundle ACL reconstruction in which 7 mm reamer for the AM tunnel and 6 mm reamer for the PL tunnel were used. After drilling, changes of lengths and thicknesses of anterior horns of the lateral menisci were recorded. Results Before drilling, the groups were homogenous for the lateral menisci dimensions. After drilling, no statistically significant difference was noticed between the two groups. However, in single bundle group, 2 anterior horns width injury (1.44 mm and 2.13 mm) with the 9 mm reamer and 3 anterior horns width injury (2.51 mm, 3.55 mm and 4.28 mm) with the 10 mm reamer were recorded. However in double bundle group a single anterior horn width injury (2.82 mm) was recorded. Conclusion Using a greater size reamer in single bundle reconstruction, causes a relatively higher risk of lateral meniscal anterior root injury. Lateral meniscus stability should be examined arthroscopically after reaming with large reamers.

The complete type of suprapatellar plica and lipoma arborescens: a case report

Lipoma arborescens is a rare intra-articular benign lesion. It is characterized by villous lipomatous proliferation of the synovial tissue and its etiology is not certain. Clinical presentation is usually long-standing, painless and slowly progressive swelling of the related joint. Magnetic resonance imaging plays an important role in diagnosis. Diagnosis can be determined by hypertrophied synovial tissue with synovial lining cells containing adipose tissue on examination using a light microscope. The synovial plica of the knee is formed during the embryogenic phase of development. This development is incomplete in many individuals. When the synovial plica of the knee persists, it is transformed into an embryonic relic that is located in either the suprapatellar or midpatellar region of the knee. We present a rare case with both a complete type of suprapatellar plica and a symptomatic lipoma arborescens in the suprapatellar recess.

The influence of suture material on the strength of horizontal mattress suture configuration for meniscus repair

PURPOSE Comparison of the mechanical characteristics of meniscal repair fixation using horizontal sutures and six different sutures under submaximal cyclic and load to failure test conditions may aid physicians in selecting a suture type. METHODS A 2-cm long anteroposterior vertical longitudinal incision was created in six groups of bovine medial menisci. Lesions were repaired using a No. 2 suture either composed of polyester or polyester and ultra high-molecular weight polyethylene (UHMWPE), or UHMWPE and polydioxanone or pure UHMWPE. Endpoints included ultimate failure load (N), pull-out stiffness (N/mm), pull-out displacement (mm), cyclic displacement (mm) after 100cycles, after 500cycles, and mode of failure. RESULTS Polyester suture had lower ultimate load than all groups except the suture composed of polyester and UHMWPE (P<.05). Pure UHMWPE suture had higher ultimate failure load than sutures composed of either polyester or polyester plus UHMWPE (P<.05). Predominant failure mode was suture cutting through the meniscus for the groups except for polyester suture which failed by suture rupture. CONCLUSION Under cyclic loading conditions in bovine meniscus, braided polyester suture fixation provided lower initial fixation strength than fixation with various high strength sutures composed of pure UHMWPE or a combination of absorbable monofilament polydioxanone and UHMWPE, except for combination of polyester and UHMWPE sutures. CLINICAL RELEVANCE Present study does not support the usage of the braided polyester sutures instead of high strength sutures composed either partially or totally of ultra-high molecular weight polyethylene for the horizontal suture configuration of meniscus repair.