Mustafa Karahan

Self-assessment of general health status in patients with five common shoulder conditions****

The SF-36 Health Survey is a patient self-administered general health status evaluation designed to measure the impact of disease on an individuals perception of his or her health. Five hundred forty-four patients with five common shoulder conditions (anterior glenohumeral instability (149 patients), complete reparable rotator cuff tear (111 patients), adhesive capsulitis (100 patients), glenohumeral osteoarthritis (67 patients), and impingement (117 patients)) completed the SF-36 Health Survey before undergoing treatment. When compared with U.S. general population norms, the patients with each of these shoulder conditions had statistically significant decreases in their health for Physical Functioning, Role-Physical, Bodily Pain, Social Functioning, Role-Emotional, and the Physical Component Summary as measured by the SF-36 Health Survey. Comparison with published data demonstrated that these shoulder conditions rank in severity (in terms of affecting a patients perception of his or her general health) with five major medical conditions (hypertension, congestive heart failure, acute myocardial infarction, diabetes mellitus, and clinical depression). The data presented in this study should serve as a baseline to document the impact of shoulder musculoskeletal conditions and possibly to allow comparison among various methods of operative and nonoperative treatment.

Effective training of arthroscopic skills

Effective training of arthroscopic skills / , Effective training of arthroscopic skills / , کتابخانه دیجیتال جندی شاپور اهواز

Evaluation of Absorbable and Nonabsorbable Sutures for Repair of Achilles Tendon Rupture With a Suture-Guiding Device:

Background: The purpose of this study was to compare the functional and clinical results of Achilles tendon repairs with an Achilles tendon suture-guiding device using nonabsorbable versus absorbable sutures. We hypothesized that the absorbable suture would have clinical results comparable to those of the nonabsorbable suture for Achilles tendon repair with an Achilles tendon suture-guiding system. Methods: From January 2010 to September 2013, 48 consecutive patients who had sustained a spontaneous rupture of the Achilles tendon underwent operative repair with an Achilles tendon suture-guiding device using 2 different suture types. All ruptures were acute. The patients were divided equally into 2 groups according to suture type. In the nonabsorbable suture group, No. 2 braided nonabsorbable polyethylene terephthalate sutures were used, and in the absorbable suture group, braided absorbable polyglactin sutures were used. The average age of the patients was 38 years (range, 28-50 years). Functional outcome scores and complications were evaluated. Results: All patients had an intact Achilles repair after surgery. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot clinical outcome scores were 98 (range, 90-100) in the nonabsorbable suture group and 96.8 (range, 87-100) in the absorbable suture group. All patients returned to their previous work. The absorbable suture group had fewer postoperative complications (0%) than the nonabsorbable suture group (12.5%) (P < .05). Conclusion: Use of an absorbable suture in the treatment of Achilles tendon repair by an Achilles tendon suture-guiding system was associated with a lower incidence of suture reaction; however, functionally the results were not notably different from those using a traditional nonabsorbable suture. We conclude that repair with absorbable sutures is appropriate for Achilles tendon ruptures. Level of Evidence: Level II, prospective comparative study.

Palmaris longus tendon graft versus modified Weaver-Dunn procedure via dynamic button system for acromioclavicular joint reconstruction in chronic cases

BACKGROUND The hypothesis of this clinical study was that coracoclavicular (CC) reconstruction using autogenic palmaris longus graft through the GraftRope (PLG) system (Arthrex, Inc., Naples, FL, USA) would provide superior clinical and radiologic results compared with modified Weaver-Dunn procedure with the dynamic TightRope (Arthrex, Inc.) system (WDT). METHODS Between 2008 and 2013, 32 patients (average age, 39.7 years; range, 22-60 years) underwent surgical reconstruction of chronic acromioclavicular (AC) joint dislocation. A modified WDT procedure was performed in 16 patients and autogenous PLG was performed in the other 16 patients. Patient data were collected retrospectively, with a final follow-up of 44.9 months (range, 29-60 months). The degree of AC joint displacement was evaluated by measuring the CC distance on the anteroposterior and axillary view. Clinical and functional outcomes were compared by American Shoulder and Elbow Surgeons and the Constant scores at final follow-up. RESULTS Comparison between the WDT and PLG groups showed a significantly better outcome in the American Shoulder and Elbow Surgeons and the Constant scores (P < .01), in favor of the PLG group. Both groups showed an increased CC distance compared with the uninjured side, with a mean difference of 1.1 mm for the PLG and 3.3 mm for the WDT groups. A tolerable loss of reduction within the follow-up time was observed. Reduction loss was higher with the WDT group (P < .05). CONCLUSION CC palmaris longus tendon graft reconstruction with GraftRope system was associated with functional and radiologic benefits. The palmaris longus graft with GraftRope system could be used in chronic cases.

Orthopaedic sports surgery: art or science?

Have you ever known any young resident full of ambition and knowledge but unable to perform a basic bone drilling despite numerous attempts? On the opposite, did you ever meet a young resident, strikingly skillful however missing basic theoretical concepts? It is statistically inevitable that you will encounter both if you have been training young colleagues for an amount of time. It is responsibility of a teaching mentor to identify the qualities and pitfalls of each trainee, from an educational perspective, so you can get the best out of both characters. Despite our profession is also considered an ‘‘art’’, there are three fundamental columns that will define the ‘‘science’’ within a successful surgeon. First, any surgeon should know the anatomy, physiopathology, the diagnostic algorithm and state of the art of treatment methods. The same surgeon should have the motivation to interact, listen and understand the physical and emotional requirements of the human being who came to ask him for help—create empathy. Last but not least, the surgeon should have musculoskeletal ability to perform the planned course of action. From arthroscopic minimally invasive to trauma or arthroplasty revision procedures, basic motor skills must be earned, trained and performed safely and confidently. A motor skill is a function, which involves the precise movement of muscles with the intent to perform a specific act [1]. A motor skill could be defined as discrete acts, such as introducing needle into a joint, or continuous such as arthroscopic partial meniscectomy. Classical way of motor skill teaching based on Halsted’s principles (hands on) is stalled due to various reasons lead by medical-legal issues [2]. However, residents have to be trained effectively until they are expected to operate on patients. A child is not expected to pay a full court game when he starts to learn basketball. He is first taught how to hold, pass and dribble the ball. Development of further fundamental acts of the game will follow. Teaching the residents basic motor skill acts before expecting them to perform a ‘‘full court game’’ seems more suitable [3]. Concerning surgery, the training should be adapted to individual needs, individualized but under a supervised education programme. Joint models, basic motor skill instruments, animal cadavers, simulators and human cadavers fortunately provide the residents suitable ways for learning motor skills [4]. Among these, some are inexpensive and low-fidelity, whereas some are expensive and high fidelity. Moreover, not all institutions will be able to afford every of the referred options. However, you have the responsibility to get the most of what you have. If these measures are presented within an educational philosophy, they will be able to make some change in the motor skill performance of the learner [5]. They need to know that the latest technique is not always the greatest, despite we should not destroy their enthusiasm to develop new options. We must recognize that residents have different skills but, in the end, they all must acquire some basic knowledge and skills. We should not destroy the ‘‘art’’ some of them carry inside; instead we should help them tune it to become effective. We must enhance some brilliant scientific minds in order to make them practical to bring it to operative purposes. J. Espregueira-Mendes (&) Orthopaedic Department, 3B’S, ICVS, Minho University, Porto, Portugal e-mail: jem@espregueira.com

The anterior transfer of the latissimus dorsi tendon—a difficult position to specify

Figure 1 Highest possible latissimus dorsi anterior transfer positiond1 inferior half to 1 inferior third of subscapularis tendon. To the Editor:: We have read the article regarding anterior transfer of the latissimus dorsi and teres major in irreparable subscapularis tear with great interest. The study perfectly describes the possible transfer of these tendons to the lesser tuberosity in terms of length, angulation, and tension in 3 static positions. On the basis of their results, the authors have rightfully concluded that it is feasible to anteriorly transfer the latissimus dorsi and teres major in irreparable subscapularis tears. However, it is not possible to say the same about the authors’ claim of low neurovascular injury risk. First of all, assessment of the risk of neurovascular damage is highly subjective and only visual, so such a conclusion would require quantification of contact. Second, the authors only refer to compression risks, whereas elongation and stretching are not discussed. Third, the authors assess contact only at 3 points; the nerves could have contacted and then moved away between the designated angles. Fourth, radial and axillary nerves are not evaluated. Finally, excising the deltoid may create a complete release of the axillary nerve tension, specifically for internal rotation issues, and will not objectively analyze the damage risks for the nerve during movements. We have observed obvious contact of the latissimus dorsi tendon with neurovascular structures in a single surgical case almost 2 years ago after a pilot study on 2 cadaveric shoulders that was presented recently. In our single experience, with this situation, we were forced to transfer the tendon to the lower aspect of the lesser tuberosity because of apparent nerve injury risk (Fig. 1). On the basis of the current results, it is not possible to conclude that the technique has a ‘‘low risk of neurovascular injury’’ until further evidence is collected. We would appreciate if the authors would kindly comment on the points to which we have drawn their attention.

Massive Retracted Rotator Cuff Tear: Treatment Options

Treatment of irreparable massive rotator cuff tears remains challenging and controversial. The decision-making process includes surgeon personal experience as well as scientific evidence. A thorough knowledge of existing treatment options and indications is crucial to achieve the best outcome. The chapter provides an overview of the different available treatments, including: scaffold augmentation, superior capsule reconstruction, subacromial biodegradable spacer, tendon transfers, up to reverse shoulder replacement.

Literature Review of Suture Materials

Sutures are used on a daily basis in orthopedic surgery for a wide variety of purposes. Although mostly depended onto the surgeon preferences, the selection of suture material is based on the tissues to be repaired. As surgical procedures and the handled tissues vary, it is important to understand the basic types of the suture materials. Synthetic suture materials overcome the use of natural suture materials for years. With modern sutures, it is likely to perform many surgical procedures with more confidence. This review will cover several different features of suture materials that are commonly used.

On Field Testing After Anterior Cruciate Ligament Reconstruction

ACL injuries in football are frequently encountered because of their high-intensity axial and valgus forces due to their competitive natural and challenging condition. Despite developing surgical techniques and rehabilitation protocols, approximately two-thirds of the operated athletes, 1 year after the operation, are seen to not be able to turn back their pre-injury sports conditions. Isokinetic force tests, subjective assessment forms, and functional performance tests have been argued generally in the literature to be back-to-sport determinants. Isokinetic tests are used to assess lower extremity strength. Clinical tests including force tests and laxity measurements that are done after the ACL surgery and rehabilitation are found to be poorly compatible with all patients’ functional abilities, and functional tests have been developed to help assess whether the athlete is ready to return to unlimited activity with surgery and treatment results. The back-to-sport criterion includes that there must be at least 85% of difference between the healthy side and the hamstring and quadriceps strength measured by the bound tests and the tolerance of patients in sport-specific. There are a variety of field tests and applications for the removal of side-by-side asymmetries in the athletes and for the examination of different dynamics together. The content of this study is to indicate the importance of the functional testing, the back-to-sport criteria of the athlete after the ACL injury, and the varieties and applications of the field test.

Tissue Engineering and New Biomaterials

Tissue engineering became one of the hot topics of medicine just after the review article by Langer and Vacanti in 1993 with title “Tissue Engineering,” and today tissue engineering is known to be a multidisciplinary field that applies the principles of engineering and life sciences toward the development of biological substitutes that restore, maintain, or improve tissue function or a whole organ [1]. The strategies of tissue engineering or in other words “regenerative medicine” require both relation and communication of cells with tissue by signaling pathways [1–3].