Rustu Nuran

Modified Fulkerson osteotomy in recurrent patellofemoral dislocations

OBJECTIVES We evaluated the results of a modified Fulkerson technique performed for the treatment of recurrent patellofemoral dislocations. METHODS The study included 17 knees of 16 patients (11 males, 5 females; mean age 25 years; range 15 to 43 years) who were operated on by the same surgeon for patellofemoral alignment disorders. The mean duration of complaints was 3.4 years (range 1 to 12 years). Preoperatively, the number of recurring dislocations were 1 to 5 in three knees, 6 to 10 in five knees, and more than 10 in nine knees, and all the patients had a positive apprehension test and a Q angle exceeding 15 degrees. All the knees were assessed by preoperative and postoperative radiographs and computed tomography, which showed both subluxation and patellar tilt in all the knees, and trochlear dysplasia in two knees preoperatively. During surgery, diagnostic arthroscopy was performed in all the patients. The skin incision consisted of two horizontal incisions for cosmetic reasons. Surgical treatment was comprised of lateral patellar release to correct patellar tilt, and a modified Fulkerson osteotomy to correct patellofemoral malalignment, and medial plication in three knees. The patellofemoral congruity following lateral release, and the position of the patella following osteotomy and anteromedialization of the tibial tuberosity were checked arthroscopically. On control examinations, the patients were administered functional scoring questionnaires developed by Kujala et al. and Crosby and Insall. Radiographic grading of osteoarthritis was made according to the classification developed by Iwano et al. and modified by Palmer et al. The mean follow-up period was 2.6 years (range 24 to 53 months). RESULTS During arthroscopy, eight knees had severe (Outerbridge grade III-IV) and nine knees had moderate (grade I-II) retropatellar cartilage damage. Follow-up evaluations showed effusion in two knees, subluxation in two knees, and a positive apprehension test in three knees. The mean flexion loss was 8 degrees (range 0 degrees to 20 degrees ). One patient who had an extension loss of 10 degrees regained full extension following a six-week physical therapy program. Postoperative computed tomography scans showed that patellar tilt and subluxation were corrected in all but two knees. Preoperative radiographies showed degenerative arthritis in the tibiofemoral joint in one knee (5.9%), and in the patellofemoral joint in seven knees (41.2%). The number of knees with degenerative changes increased postoperatively to three knees (17.3%) in the tibiofemoral joint, and to 11 knees (64.7%) in the patellofemoral joint. According to the Crosby-Insall scoring system, five knees had excellent, seven knees had good, and five knees had moderate scores. The mean Kujala score was 82.6 (range 44 to 100) postoperatively. CONCLUSION Our results show that, with appropriate indications, the modified Fulkerson method is associated with successful results in the treatment of recurrent patellofemoral dislocations.

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].

Genetic Basis of Orthopedic Diseases

Genetics is a diverse subject concerned with variation and heredity in all living organisms. In clinical practice, the main significance of genetics is in elucidating the role of genetic variation and mutation in the etiology of a large number of disorders.

Anterior Shoulder Instability

Anterior shoulder instability; which is the most common type of all shoulder instabilities, needs to be evaluated carefully to achieve good prognosis. Every case should be evaluated by its own and proper treatment options should be planned according to this. Anatomy and biomechanics of the shoulder joint, especially the knowledge about the static and the dynamic factors are so important. In addition to the instability terminology; hyperlaxity which is a physiological condition should be mastered as well. For the proper treatment; correct diagnosis and the addressing of the involved pathology are two main points. Good history with proper physical examination and radiology are the crucial steps for the diagnosis. Acute anterior shoulder luxation with the first episode has totally a different treatment algorithm than recurrent anterior shoulder instability. The incidence of re-dislocation after the first episode is between 30% and 100%.; and the risk of re-dislocation will be higher if the first episode is at the age of 20 or below. The activity level is also important; especially patients with contact sports are in great risk. Generally our approach to acute anterior dislocation is conservative, but in recurrent anterior instability cases the aim of surgical treatment is to have anatomical reconstruction of the pathological lesion which is the fixation of capsulolabral tissue on the glenoid. Bony lesions, which might be the main reason of the failure should be evaluated carefully.

Dislocation of os trigonum presenting as a loose body in the ankle.

UNLABELLED Dislocation of the os trigonum presenting as a loose body is a rare clinical entity. In this report, we describe the case of a 34-year-old male who presented with symptoms of acute left ankle pain that was aggravated by motion and weight bearing. He also displayed lateral collateral ligamentous laxity, without the presence of an effusion. Radiographic inspection revealed a 10 x 15-mm loose body within the ankle joint cavity. Arthroscopic intervention showed the loose body to be round and smooth, and it could not be deformed with the tip of a probe, although it could be displaced up to 5 mm with ankle manipulation, in particular with inversion stress of the ankle. The loose body was removed with an arthroscopic forceps. Based on its location within the ankle, and the lack of any articular cartilage on the removed joint fragment, we determined the loose body to represent a dislocated os trigonum. The rarity of this case presentation makes one consider the association of symptomatic os trigonum with ankle instability. LEVEL OF CLINICAL EVIDENCE 4.