Sercan Akpinar

Clinical and isokinetic comparison between tenotomy and tenodesis in biceps pathologies

OBJECTIVES The purpose of this study to compare clinical and isokinetic results of patients who underwent biceps tenotomy or tenodesis for chronic tenosynovitis. METHODS Arthroscopic biceps tenotomy, arthroscopy assisted or arthroscopic biceps tenodesis were done in 20 patients who had diagnosis of chronic tenosynovitis and in whom conservative treatment was not helpful. Rotator cuff repair and acromioplasty was performed in 18 patients and acromioplasty alone in two patients in addition to biceps surgery. Arthroscopic biceps tenotomy was done in 10 patients (5 female, 5 male; mean age 63, range 53-75), 10 patients underwent tenodesis out of which arthroscopy assisted biceps tenodesis was done in 8 patients and all arthroscopic biceps tenodesis was done in 2 patients (4 female, 6 male; mean age 57, range 49-66). All patients were evaluated with Constant and UCLA scores preoperatively and postoperatively. The average follow-up of the patients 3,1 years (between 1-8 years). Isokinetically elbow flexion and forearm supination were compared using the Cybex (Biodex 3, Cybex Biomedical System, NY, USA) machine. Pre-operative results of each group were compared with the postoperative results, using Mann-Whitney U test. RESULTS Preoperative average constant scores of tenotomy group were 64.40, whereas postoperative scores were 89.50 (p=0.002), and preoperative average constant scores of tenodesis group were 62.80, whereas postoperative scores were 86.70 (p=0.003). Preoperative average UCLA scores of tenotomy group were 23.20 whereas postoperative UCLA scores 22.60 (p=0.003), preoperative average UCLA scores of tenodesis group were 30.00 whereas postoperative UCLA scores was 29.20 (p=0.004). In both groups statistically significant improvement of UCLA and Constant scores was detected. Comparison between Constant, UCLA scores and isokinetic measurements of both groups showed no statistically significant difference (p>0.05). No complication was noted. CONCLUSION In the treatment of chronic tenosynovitis, biceps tenodesis and tenotomy of long head of biceps showed similar clinical, functional, isokinetic and cosmetic results. No Popeye deformity was seen in the tenotomy group.

Hallucal sesamoid osteonecrosis: an overlooked cause of forefoot pain.

Four cases of osteonecrosis of hallucal sesamoids are reported here. Surgical excision of necrotic sesamoid tissue yielded satisfactory results, with the patients reporting no residual pain. Although it has not been frequently addressed in the literature, avascular necrosis of the sesamoid bones should be considered in the differential diagnosis of persistent forefoot pain.

Prospective evaluation of the functional and anatomical results of arthroscopic repair in small and medium-sized full-thickness tears of the supraspinatus tendon.

OBJECTIVE The purpose of this study was to analyze the relation between tendon integrity and functional results following the arthroscopic treatment of small- and medium-sized rotator cuff tears. METHODS Arthroscopic repair was performed on 26 consecutive patients (21 women, 5 men;mean age: 55.9 years; range: 33-72 years) with small- and medium-sized tears of the supraspinatus tendon. Patients were postoperatively evaluated at 12 and 24 months using the Constant and UCLA functional outcome scores and ultrasound examinations. RESULTS The supraspinatus tendon did not heal in nine patients (34.6%) and was partially healed in three (11%), 12 months after surgery. Mean postoperative Constant and UCLA scores of these patients were 73.1 and 27.8, respectively, which were not significantly different from those with an intact tendon on the final follow-up (Constant: 78 and UCLA: 30; p=0.107 and p=0.164). Both rating systems reflected significant improvement with treatment (p<0.01). The mean age of patients with a re-tear was 66.8 years, which was significantly higher than those with an intact repair (54 years; p<0.01). CONCLUSION The arthroscopic repair of small and medium-sized supraspinatus tendon tears yields good long-term results independent of tendon integrity. Healing potential may be decreased with increased age.

Comparison of repair techniques in small and medium-sized rotator cuff tears in cadaveric sheep shoulders

OBJECTIVE The aim of this study was to compare new knotless single-row and double-row suture anchor techniques with traditional transosseous suture techniques for different sized rotator cuff tears in an animal model. METHODS The study included 56 cadaveric sheep shoulders. Supraspinatus cuff tears of 1 cm repaired with new knotless single-row suture anchor technique and supraspinatus and infraspinatus rotator cuff tears of 3 cm repaired with double-row suture anchor technique were compared to traditional transosseous suture techniques and control groups. The repaired tendons were loaded with 5 mm/min static velocity with 2.5 kgN load cell in Instron 8874 machine until the repair failure. RESULTS The 1 cm transosseous group was statistically superior to 1 cm control group (p=0.021, p<0.05) and the 3 cm SpeedBridge group was statistically superior to the 1 cm SpeedFix group (p=0.012, p<0.05). The differences between the other groups were not statistically significant. CONCLUSION No significant difference was found between the new knotless suture anchor techniques and traditional transosseous suture techniques.

Comparison of tunnel expansion and isometric muscle strength after ACL reconstruction with single- or dual-bundle hamstring allograft: a prospective, randomized study

OBJECTIVE The aim of this study was to compare tunnel expansion and isokinetic muscle strength after single- and dual-bundle reconstruction of the anterior cruciate ligament (ACL). METHODS This study included 34 patients who underwent ACL reconstruction in our clinic between November 2007 and March 2008. Eighteen patients (average age: 27.3 years; range: 19 to 35 years) underwent single-bundle ACL reconstruction and sixteen patients (average age: 30.1 years; range: 20 to 40 years) underwent dual-bundle ACL reconstruction. Method selection was determined by draw. Isokinetic hamstring and quadriceps muscle strength was tested preoperatively using Biodex 3. Three-dimensional computed tomography of the knee joint was taken in the 2nd and 3rd postoperative month. The three-dimensional computed tomography and isokinetic muscle strength tests were repeated at the 6th month follow-up. Each tunnel was divided into six equal parts, and the tunnel width in the sagittal and coronal planes was measured and the same points in the axial plane were measured in the tunnel area. RESULTS No significant difference was found between the single- and dual-bundle reconstructions in isokinetic muscle strength values. No statistically significant difference was detected between the tunnel expansions in 2nd, 3rd and 6th month tomographies following single- and dual-bundle ACL reconstruction. CONCLUSION Single- and dual-bundle ACL reconstructions seem to provide similar results in terms of early tunnel enlargement and isokinetic muscle strength.

Irreducible dislocation of the knee joint: two-stage treatment

Closed reduction attempts may be unsuccessful after traumatic knee dislocations on rare occasions. The interposition of the soft tissues on the medial aspect of the joint into the femoral condyle and tibial plateau is shown to be the cause of an unsuccessful reduction. In such cases, open reduction is the recommended method of treatment. In our study, we presented a 16-year-old male with an open knee dislocation after a motorcycle accident. As our closed reduction attempt failed, open joint reduction and repair of the medial collateral ligament and retinaculum was performed in the first stage of treatment. In the second stage, arthroscopic anterior cruciate ligament and posterior cruciate ligament reconstructions were carried out.

Comparison of tunnel expansion, isometric muscle strength and clinical condition after anterior cruciate ligament reconstruction with single- or dual-bundle: Randomized, prospective 8 years follow up study

Thirty-one patients who suffered anterior cruciate ligament (ACL) injury and underwent ACL reconstruction (16 single-bundle, 15 double-bundle) with ENDOBUTTON between November 2007 and March 2008 were included in the study. Isokinetic and concentric strength measurements of the quadriceps and hamstring muscles at the 6th month and 8th year were made using a Biodex 3 device at angular velocities of 60°/sec, 120°/sec and 180°/sec. The peak torque and peak torque to body weight ratios were recorded. 3D-CT scans of the joints were performed on the 2nd, 3 rd and 6th month and 8th year. CT slices were divided into six equal parts marking the distance between the femoral and tibial tunnels with the most distant part of the knee joint as L1, and with the entry point on the knee joint as L6. The tunnel length was measured in millimeters and perpendicularly to the tibial axis in the sagittal and coronal planes. Tunnel cross-sectional areas were also measured in mm2 using the same device on axial reconstructions. Clinical evaluations on the 8th year were performed with the IKDC, Tegner and Lysholm knee scoring systems and laxity in the patients was evaluated with the anterior drawer test. Posterolateral tunnel widening was analyzed with the repeated measures ANOVA technique whereas two-way mixed ANOVA was employed in evaluating the anteromedial tunnel widening. Three-way ANOVA was used in assessing the Biodex results and comparison of the scoring systems results were done with the t-test. Results: No difference was found between the groups in terms of IKDC, Lysholm and Tegner scores and anterior drawer test results at the 8th year follow-up (p>0.05). Points where significant amounts of tunnel widening were observed are shown in Table 1. On evaluation of the anteromedial bundles alone, it was observed that double-tunnel reconstruction led to greater widening. No significant difference was found between the groups in terms of muscle strength in the 8th year assessments, however, there was a statistically significant difference between the preoperative and 6th month results (p<0.05). Patients in both groups had better results at the 8th year follow-up when compared to their preoperative and 6th month results. The results of our study confirmed significant amounts of widening at parts of the femoral tunnel close to the knee joint in patients treated with single-bundle or double-bundle ACL reconstruction. However, there is no difference between the groups in terms of clinical results and isometric muscle strengths in the long term. CT sections which are statistically significant widening detected (p<0,05) Side Section Single Bundle Anteromedial Bundle Posterolateral Bundle Sagittal 1,2,6 1,2 3 Femoral Coronal 1,5,6 1,2,6 1 Axial 6 1,2,5,6 1,4 Sagittal 1 1,5,6 3 Tibial Coronal 1,5 4,5,6 Axial 1,2,5,6 2,3,4,5,6 Discussion: It has been suggested that the tunnel widening will lead to failure of the reconstruction. It is hypothesized that, in double-bundle reconstruction, the tunnels will widen more and finally coalesce, which in turn, will result in failure of the reconstruction. In our study, we found no evidence pointing out to a coalescence of the tunnels in the long term. We believe the greater widening in the anteromedial bundle in the double-tunnel surgery vs. the single-tunnel method is due to the smaller diameter of the graft and its greater mobility

Bone pulsating metastasis due to renal cell carcinoma

Pulsation on the bone cortex surface is a rare condition. Pulsative palpation of the superficial-located bone tumors can be misperceived as an aneurysm. Fifty-eight-year-old man is presented with pulsating bone mass in his proximal tibia. During angiographic examination, hypervascular masses were diagnosed both at right kidney and at right proximal tibia. Renal cell carcinoma was diagnosed after abdominal CT scan. Proximal tibia biopsy was complicated with projectile bleeding.