Onur Hapa

Treatment of plantar fasciitis using four different local injection modalities: a randomized prospective clinical trial.

BACKGROUND To determine the effectiveness of four different local injection modalities in the treatment of plantar fasciitis. METHODS In a prospective randomized multicenter study of plantar fasciitis, 100 patients were divided into four equal groups and were treated using four different methods of local injection: group A was treated with 2 mL of autologous blood alone; group B, an anesthetic (2 mL of lidocaine) combined with peppering; group C, a corticosteroid (2 mL of triamcinolone) alone; and group D, a corticosteroid (2 mL of triamcinolone) combined with peppering. The outcome was defined by using a 10-cm visual analog scale and modified criteria of the Roles and Maudsley score 3 weeks and 6 months after the injection and compared with the pretreatment condition. RESULTS The successful results in all of the groups after injections were higher than those in the pretreatment condition (P = .000). In groups C and D, in which local corticosteroid injections were used, excellent results were obtained, with superior effect in the group in which peppering was used (P < .05). CONCLUSIONS In the treatment of plantar fasciitis, combined corticosteroid injections and peppering is effective and produces better clinical results.

A Comparison Between a Retrograde Interference Screw, Suture Button, and Combined Fixation on the Tibial Side in an All-Inside Anterior Cruciate Ligament Reconstruction A Biomechanical Study in a Porcine Model

Background Effective soft tissue graft fixation to the tibial tunnel in all-inside anterior cruciate ligament reconstructions has been reported to be a problem and may lead to retrograde pullout at ultimate load testing. Hypothesis A combined retrograde bioabsorbable screw and cortical-cancellous suture button suspension apparatus would gain stiffness from the button and strength from the screw, thus providing for a larger pullout ultimate load, yield load, and stiffness when compared with either fixation alone in an all-inside anterior cruciate ligament reconstruction. Study Design Controlled laboratory study. Methods Eighteen porcine tibias (average bone mineral density of 1.46, measured by dual-energy x-ray absorptiometry scan) and 18 bovine extensor tendon allografts were divided into 3 groups retrograde bioabsorbable screw fixation, cortical-cancellous suture button suspension apparatus fixation, and combined fixation in the tibia, with 6 specimens per group. They were biomechanically tested with cyclic (500 cycles, 50-250 N, 1 Hz) and load-to-failure (20 mm/min) parameters. Results During cyclic testing, the retrograde screw—only group had a larger cyclic displacement (2.98 ± 2.28 mm) than the suture button with retrograde screw combination group (1.40 ± 0.34 mm). The combination fixation group also produced a higher cyclic stiffness (161.93 ± 61.81 N/mm) than the retrograde screw—only group (91.59 ± 43.26 N/mm). In load-to-failure testing, the retrograde screw with suture button combination group withstood significantly higher initial failure forces (873.87 ± 148.74 N) than the retrograde screw—only (558.44 ± 126.33 N) and suture button—only (121.76 ± 40.57 N) groups. Additionally, ultimate loads were also significantly higher for the combination group (1027 ± 157.11 N) than either the retrograde screw group (679.00 ± 109.44 N) or the suture button group (161.00 ± 29.27 N). The retrograde screw with suture button combination group showed significantly higher pullout stiffness (152.50 ± 46.37 N/mm) than either the retrograde screw—only group (78.31 ± 12.85 N/mm) or the suture button—only group (25.79 ± 9.30 N/mm). Conclusion Soft tissue grafts fixed with a combination of a retrograde screw and a suture button were able to withstand higher initial failure and ultimate failure loads and were also stiffer than grafts fixed with either a retrograde screw or a suture button alone. Clinical Relevance These findings may prove useful in providing additional stability when using an all-inside technique in a difficult case, or in a patient with poor bone stock, and may also be useful as an alternative to more commonly used tibial tunnel soft tissue fixation techniques.

ACL fixation devices.

Secure graft fixation for anterior cruciate ligament reconstruction is an important goal. Optimally, graft fixation allows for an aggressive postoperative rehabilitation program with the goals of immediate full range of motion, full weight bearing, and an early return to athletic activity. Current anterior cruciate ligament reconstruction techniques advance soft tissue grafts with or without bone plugs into the joint to replace the damaged ligament. Segments of these grafts are fixed within a bone tunnel or on the periosteum at a distance from the normal ligament attachment site. The graft fixation should be secure, allow normal tendon healing, and provide the graft construct with biomechanical properties, which approach that of the native ligament. Several different fixation devices are available for anterior cruciate ligament construction.

Effect of platelet-rich plasma on tendon-to-bone healing after rotator cuff repair in rats: an in vivo experimental study

OBJECTIVE The purpose of this experimental study was to analyze the effects of local autologous platelet-rich plasma (PRP) injection on tendon-to-bone healing in a rotator cuff repair model in rats. METHODS Rotator cuff injury was created in 68 left shoulders of rats. PRP was obtained from the blood of an additional 15 rats. The 68 rats were divided into 4 groups with 17 rats in each group; PRP group (Week 2), control group (Week 2), PRP group (Week 4), and control group (Week 4). Platelet-rich plasma or saline was injected to the repair area intraoperatively. Rats were sacrificed 2 and 4 weeks after the surgery. Histological analysis using a semiquantitative scoring was performed on 7 rats per group. Tendon integrity and increases in vascularity and inflammatory cells and the degree of new bone formation were evaluated and compared between the groups. The remaining tendons (n=10) were mechanically tested. RESULTS Degree of inflammation and vascularity were less in the study group at both time intervals (p<0.05). Tendon continuity was better in the study group at 2 weeks (p<0.05). Obvious new bone formation was detected in the control group at 4 weeks (p<0.05). Biomechanically, platelet-rich plasma-treated specimens were stronger at 2 weeks (p<0.05). CONCLUSION Local autologous PRP injection may have beneficial effects on initial rotator cuff tendon-to-bone healing and enhance initial tendon-to-bone healing remodeling. This may represent a clinically important improvement in rotator cuff repair.

Bilateral patellar tendon rupture in a child: a case report.

Patellar tendon rupture in children is very rare. When it occurs, patellar tendon is usually ruptured either from the upper end as a sleeve fracture of the patella or from lower end as an avulsion fracture of the tibial tuberosity. In this report, we present the case of an otherwise healthy 9-years-old boy who had subsequent bilateral patellar tendon ruptures through the midparts, which has not been published previously in the literature. Treatment was performed with primary end-to-end repair, reinforcement with cerclage wires and fresh-frozen achilles tendon augmentation for both sides.

Does platelet-rich plasma enhance microfracture treatment for chronic focal chondral defects? An in-vivo study performed in a rat model

OBJECTIVE The purpose of the present study was to compare the effectiveness of platelet-rich plasma (PRP) + microfracture and microfracture treatments in the healing of chronic focal chondral defects. METHODS The study included 57 adult male Sprague-Dawley rats. Forty-two rats were divided into three groups of 14 rats with a chondral defect (control, microfracture only, PRP+microfracture). The remaining 15 rats were used to produce the PRP preparation. The rats were then euthanatized at 3 and 6 weeks after treatment and examined. Histological analysis using the modified Pineda scoring system and immunohistochemical staining for Type 2 collagen were performed. RESULTS At both time intervals, control group histological scores (Week 3: 8.8±1.2, Week 6: 8.5±0.7) were higher than microfracture (Week 3: 6.8±1.0, Week 6: 7.1±0.6) and PRP+microfracture (Week 3: 6.4±1.3, Week 6: 5.7±1.2) scores (p<0.05). The microfracture group score was higher at Week 6 than the PRP+microfracture group (p<0.05). The degree of Type 2 collagen staining was higher at Week 6 in the PRP+microfracture group and was unique in showing staining at the cell membrane. CONCLUSION The addition of PRP application to microfracture treatment appears to enhance cartilage healing in chronic focal chondral defects.

Comparison of plasma endothelin levels between osteoporotic, osteopenic and normal subjects

BackgroundIt has been demonstrated that endothelins (ET) have significant roles in bone remodeling, metabolism and physiopathology of several bone diseases. We aimed to investigate if there was any difference between the plasma ET levels of osteoporotic patients and normals.Methods86 patients (70 women and 16 men) with a mean age of 62.6 (ranges: 51–90) years were included in this study. Patients were divided into groups of osteoporosis, osteopenia and normal regarding reported T scores of DEXA evaluation according to the suggestions of World Health Organization. According to these criteria 19, 43 and 24 were normal, osteopenic and osteoporotic respectively. Then total plasma level of ET was measured in all patients with monoclonal antibody based sandwich immunoassay (EIA) method. One-way analysis of variance test was used to compare endothelin values between normals, osteopenics and osteoporotics.ResultsEndothelin total plasma level in patients was a mean of 98.36 ± 63.96, 100.92 ± 47.2 and 99.56 ± 56.6 pg/ml in osteoporotic, osteopenic and normal groups respectively. The difference between groups was not significant (p > 0.05).ConclusionNo significant differences in plasma ET levels among three groups of study participants could be detected in this study.

Immediate incorporated hip spica casting in pediatric femoral fractures: comparison of efficacy between normal and high-risk groups.

Background: Immediate hip spica casting is the most commonly used method for the treatment of pediatric femoral fractures. The main disadvantage of the method is the unacceptable shortening (>25 mm), which may occur during the treatment. Buehler et al described the so-called telescope test to identify the cases with a relatively high risk of unacceptable shortening. On the basis of this test, patients with an overriding of the fracture ends of more than 30 mm have a 20.4 times higher risk of unacceptable shortening compared with those with an overriding of less than 30 mm. This relatively higher risk of unacceptable shortening may be avoided by a hip spica cast, which is incorporated to a distal femoral traction pin. Methods: The study consists of 47 (26 boys and 21 girls) patients. Mean age was 40.3 months (range, 18 months to 6 years). Patients were divided into 2 groups according to the telescope test. Group 1 included patients with telescope test results of more than 30 mm. Group 2 included patients with telescope test results of 30 mm or less. All patients were treated with a hip spica cast, which is incorporated to a distal femoral traction pin within 8 hours of the initial trauma. During cast treatment, patients were followed up by weekly x-ray controls for the first month. Patients were assessed for unacceptable shortening and misalignment. Results: Mean (SD) shortening during cast treatment was 2.9 (5.1) mm on the treated site. Shortening was detected in 16 patients (88.9%) in group 1 and in 7 patients (24.1%) in group 2. A significantly higher number (P < 0.001) of patients developed shortening in group 1. However, unacceptable shortening (>25 mm) did not develop in any patient in both groups. There was no significant frontal plane malalignment in both groups (P > 0.05). Sagittal plane malalignment was significantly higher in group 1 (P < 0.05). Conclusions: Hip spica cast, which is incorporated to a distal femoral traction pin, avoids unacceptable shortening and frontal plane malalignment in pediatric femoral fractures, which even have a relatively high risk of unacceptable shortening based on the so-called telescope test. However, the technique cannot avoid sagittal malalignment. Level of Evidence: Level 3

Out of the ring and into a sling: acute latissimus dorsi avulsion in a professional wrestler: a case report and review of the literature.

We present a 29-year-old professional wrestler who sustained a traumatic latissimus dorsi tendon rupture from its humeral insertion. To our knowledge, this report is the first to describe the use of two small anterior axillary incisions to repair a traumatic avulsion of the latissimus dorsi. Our new surgical approach is an alternative treatment for highly competitive, muscular athletes, while taking the associated nerves and cosmetic appearance into consideration.

Dermal argyria: Cutaneous manifestation of a megaprosthesis for distal femoral osteosarcoma

We present a patient with dermal argyria as a cutaneous manifestation of a silver-coated megaprosthesis used for a distal femoral osteosarcoma. Histological and electron microscopic analyses also showed silver deposition in the dermis.