Serdar Yüksel

Comparison of the early period effects of bone marrow-derived mesenchymal stem cells and platelet-rich plasma on the Achilles tendon ruptures in rats

ABSTRACT Introduction: This study aims to histopathologically, biomechanically, and immunohistochemically compare the fourth-week efficiencies of local platelet-rich plasma (PRP) and bone marrow-derived mesenchymal stem cell (rBM-MSC) treatments of the Achilles tendon ruptures created surgically in rats. Materials and Methods: The study included 35 12-month-old male Sprague Dawley rats, with an average weight of 400–500 g. Five rats were used as donors for MSC and PRP, and 30 rats were separated into MSC, PRP, and control groups (n = 10). The Achilles tendons of the rats were cut transversely, the MSC from bone marrow was administered to the MSC group, the PRP group received PRP, and the control group received physiological saline to create the same surgical effect. In previous studies, it was shown that this physiological saline does not have any effect on tendon recovery. Thirty days after the treatment, the rats were sacrificed and their Achilles tendons were examined histopathologically, immunohistochemically, and biomechanically. Results: The use of rBM-MSC and PRP in the Achilles tendon ruptures when the tendon is in its weakest phase positively affected the recovery of the tendon in histopathologic, immunohistochemical, and biomechanical manners compared to the control group (p < 0.05). While the levels of pro-inflammatory cytokines TNF-α, IFNγ, and IL 1β were significantly low, the levels of anti-inflammatory cytokines and growth factors playing key roles in tendon recovery, such as IL2, VEGF, transforming growth factor-beta, and HGF, were significantly higher in the MSC group than those of the PRP and control groups (p < 0.05). In the MSC group, the (mm) value was significantly higher (p ˂ 0.05) than that in the PRP and control groups. Conclusion: rBM-MSC and PRP promote the recovery of the tendon and increase its structural strength. The use of PRP and MSC provides hope for the treatment of the Achilles tendon ruptures that limit human beings’ functionalities and quality of life, particularly for athletes. It is thought that the use of MSC can be more effective for tendon healing; hence, more extensive and advanced studies are needed on this topic.

Comparison of intramedullary nailing and minimal invasive plate osteosynthesis in the treatment of simple intra-articular fractures of the distal tibia (AO-OTA type 43 C1-C2).

Objective The aim of this study was to compare midterm functional and radiographic results of minimal invasive plate osteosynthesis (MIPO) with intramedullary nailing (IMN) of simple intra-articular distal tibial fractures (AO-OTA type 43 C1-C2). Methods Seventy-three simple intra-articular distal tibial fracture patients were evaluated retrospectively. All were treated between 2009 and 2014. The average age of the patients was 40.3 years. Thirty-seven patients were treated with IMN and 36 patients were treated with MIPO. Fibular plate osteosynthesis was applied in 5 cases (13.5%) in the IMN group and in 23 patients (63.9%) in the MIPO group. Results Functional results and complications of IMN and MIPO methods were assessed in 73 patients. The average union time was 16.4 ± 2.7 weeks in the IMN group and 15.2 ± 1.8 weeks in the MIPO group (p = 0.079). The average Olerud-Molander Ankle Score was 87.8 ± 8.1 in the IMN group and 81.5 ± 11.8 in the MIPO group (p = 0.013). Four patients in the IMN group experienced valgus malunion, while it was not observed in any patients in the MIPO group (p = 0.042). Recurvatum malunion was detected in 10 patients in the MIPO group and not seen in the IMN group (p = 0.001). Ankle dorsiflexion angle was 25.8 ± 4.5° in the IMN group and 33.3 ± 8.9° in the MIPO group (p = 0.000). Conclusion Simple intra-articular distal tibial fractures are successfully treated with IMN and MIPO. Prevalence of valgus malunion was higher in the IMN group and recurvatum was more prevalent in the MIPO group. MIPO is the first preference according to the literature; however, successful results have been obtained with IMN in this fracture pattern. Level of Evidence Level III, Therapeutic Study.

Effect of platelet-rich plasma for treatment of Achilles tendons in free-moving rats after surgical incision and treatment

OBJECTIVE The purpose of this study is to investigate, both histopathologically and biomechanically, the effect of platelet-rich plasma (PRP) on surgically repaired Achilles tendon rupture recovery in rats. METHODS The study included 25 17-month-old male Sprague-Dawley rats with an average weight of 500-550 g. Five rats were used as donors, while 20 rats were separated as PRP group (n=10) and control group (n=10). The Achilles tendons of the rats were cut transversely, and PRP was administered to the PRP group, while the control group received serum physiologically to create the same surgical effect. In previous studies, it was shown that this serum does not affect tendon recovery. Fifteen and 30 days post-treatment, the rats were sacrificed, and their Achilles tendons were extracted and examined histopathologically and biomechanically. RESULTS Based on the obtained findings, it was observed that the histopathologic Movin and Bonar scores of PRP group on the 15th and 30th day post-treatment were significantly lower than those of the control group (p=0.019, p=0.017, respectively), while no significant difference was found in maximum force (Fmax) values in biomechanical measures on the 15th and 30th day post-treatment. CONCLUSION It is thought that PRP use in Achilles tendon ruptures positively affects histopathological recovery in the early period, but that it does not produce the same biomechanical effect. We believe that PRP use for qualified tendon recovery is histopathologically beneficial.

Investigation of the biomechanical and histopathological effects of autologous conditioned serum on healing of Achilles tendon

Objective The aim of this study to evaluate the effects of autologous conditioned serum (ACS) on the healing of transected rat Achilles tendons via the assessment of biomechanical and histological parameters. Methods The study was conducted on 45 male Sprague–Dawley rats. Five rats were used as donors for ACS preparation. Animals were randomly assigned to the experimental or control group. In both groups, the Achilles tendon was cut transversally and then sutured. In the placebo control and ACS-treated groups, saline or ACS, respectively, was injected into the repair zone three times after surgery. Ten rats from each group (ACS group, n = 20; control group, n = 20) were euthanized at days 15 and 30 after surgery for histopathological (n = 5) and biomechanical (n = 5) testing. The histopathological findings were interpreted using the Bonar and Movin scales. Tendon remodelling was evaluated via the immunohistochemical staining of collagen type 3. Biomechanical effects were assessed by tensile testing. Results The Bonar and Movin scale scores were significantly better in the ACS-treated group on both day 15 (p = 0.003 and p = 0.003, respectively) and day 30 (p = 0.005 and p = 0.004, respectively). The immunohistochemical density of collagen type 3 was significantly lower in the ACS-treated group on day 30 (p = 0.018). The type 1/3 collagen ratios of the groups were similar on days 15 and 30, as determined by Sirius Red staining (p = 0.910 and p = 0.133, respectively). In the biomechanical assessment results, the ACS-treated groups maximum load to failure values were significantly higher on day 15 (p = 0.049). Conclusion Injection of ACS had a positive effect on the histopathological healing of rat Achilles tendons on days 15 and 30 and on biomechanical healing on day 15. ACS treatment contributed to lowering the collagen type 3 density by day 30. According to our study, ACS may be favourable for the treatment of human Achilles tendon injuries and tendinopathies.

Is intramedullary nailing applicable for distal tibial fractures with ankle joint extension

OBJECTIVES This study aims to evaluate the functional and radiographic results and treatment complications of AO/OTA (Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopaedic Trauma Association) type 43C1 and C2 fractures treated with intramedullary nailing. PATIENTS AND METHODS We retrospectively evaluated 35 AO/OTA type 43C1 and C2 patients (26 males, 9 females; mean age 39.8±16.9 years; range 19 to 82 years) treated with intramedullary nailing. Two interfragmentary screws out of nail were applied in 10 patients (29%), while one interfragmentary screw out of nail was applied in 17 patients (49%). Intramedullary nailing was applied in eight patients (23%) without external screws. Fracture union, union time, alignment problems, and complications were evaluated. Clinical evaluation of patients was conducted using the Olerud and Molander score and by measuring the ankle joint range of motion. RESULT Union was achieved in all 35 patients. Mean union time was 16.5±2.8 weeks (range 12 to 24 weeks) and mean Olerud and Molander score was 88±8.24. Varus deformity was detected in one patient, valgus deformity was detected in two patients, and rotation deformity was detected in one patient. Superficial infection was detected in three patients (9%). Deep infection was not detected in any patient. CONCLUSION Intramedullary nailing is not contraindicated for simple intra-articular distal tibial fractures. In these fractures, intramedullary nailing performed in accordance with its technique, with an additional percutaneous screw if necessary, is a successful treatment option with high fracture union rates, high functional results, and low complication rates.

Histopathological, immunohistochemical, and biomechanical effects of splenectomy on Achilles tendon healing in rats

ABSTRACT Purpose: This study aimed to assess Achilles tendon repair in rats following splenectomy to simulate patients with musculoskeletal system injury who had splenectomy after spleen injury, a situation often seen in orthopedics and traumatology practice. Materials and Methods: The study included 32 male Sprague–Dawley rats (10 months old; average weight, 394.5 ± 28.3 g). The rats were fed with standard rodent food ad libitum at 22°C in a dark environment for 12 h. They were divided into two groups, namely the splenectomy (total splenectomy and Achilles tendon repair) and control groups (only Achilles tendon repair; n = 16). Four weeks after the surgery, the rats were euthanized, and their Achilles tendons were examined histopathologically, immunohistochemically, and biomechanically. Results: In the splenectomy group, proinflammatory cytokines, such as interleukin-1β, tumor necrosis factor-α, and interferon-γ, showed significantly lower values than those in the control group (p ˂0.01); moreover, the levels of anti-inflammatory cytokines like vascular endothelial growth factor, transforming growth factor-β1, interleukin-2, interleukin-10, and hepatocyte growth factor were significantly higher than in the control group (p ˂ 0.001). The average ultimate tensile strengths were 2.58 ± 0.5 in the splenectomy and 2.78 ± 0.3 in the control group (p = 0.043). The average values were 0.33 ± 0.5 in the splenectomy and 0.44 ± 0.1 in the control group (p = 0.021). Conclusion: Splenectomy may positively influence Achilles tendon healing through modification of the proinflammatory/anti-inflammatory ratio in favor of anti-inflammatory cytokines by causing a decrease in spleen-originated inflammatory cells.

A rare cause of type 1 complex regional pain syndrome: Osteoblastoma of the talus

We report a 14-year-old boy who presented with pain in the left foot and ankle for about 9 months. The clinical symptoms of the patient suggested complex regional pain syndrome (CRPS). The radiographs and magnetic resonance imaging studies ravealed a bone tumor in the talus, consistent with an osteoblastoma. The patient underwent operative treatment with curettage and grafting. The complaints of the patient completely resolved by 6 months after surgery, and there was no recurrence at the postoperative 23th month follow-up.

Isotretinoin induced achilles tendinopathy: Histopathological and biomechanical evaluation on rats

Objective The aim of the present study was to evaluate histopathological and biomechanical effects of isotretinoin on Achilles tendon. Materials & methods Sixteen rats were divided into two groups including the control group (n = 8) and isotretinoin group (n = 8). The control group received 1.42 ml/kg soy oil per day whereas the isotretinoin group received 15 mg/kg/day (gavage dose 1.42 ml/kg) isotretinoin dissolved in soy oil through gavage method for 6 weeks. Achilles tendons were excised at the end of week 6. The tendon samples were evaluated by hematoxylin-eosin under a light microscope. Quantitative evaluation was performed via Movin and Bonar scoring. A computer-monitored tensile testing machine was utilised for biomechanical testing. Biomechanical characteristics of the tendon samples (elastic modulus, yield force, ultimate tensile force) were measured. Results Histopathological evaluation revealed a significantly higher Movin and Bonar scores in histopathological evaluation. Movin score in isotretinoin group was 4.1 ± 2.5 and it was 2.3 ± 1.0 in control group (p = 0.032). Bonar score in isotretinoin group was 2.9 ± 1.4 and it was 1.6 ± 0.7 in control group (p = 0.022). In line with histopathological evaluation, biomechanical measurements in isotretinoin group (elastic modulus, yield force, ultimate tensile force) were significantly lower than the control group. Elastic modulus in isotretinoin group was 227 ± 27.7 N/mm2 and in control group it was 281.7 ± 38.7 N/mm2 (p = 0.006). In isotretinoin group; yield force was 33.7 ± 4.3 Pa and in control group it was 40.8 ± 5.9 Pa (p = 0.021). Ultimate tensile force in isotretinoin group was 35.7 ± 4.2 Pa and in control group it was 44 ± 7 Pa (p = 0.009). Conclusion The present study detected histopathological and biomechanical negative effect of isotretinoin on Achilles tendon. Therefore, isotretinoin should be questioned in medical history of patients with tendinopathy.

Open Galeazzi fracture with ipsilateral elbow dislocation.

Combination of the Galeazzi fracture and dislocation of the elbow joint in same extremity is very rare. In this article, we report a 26-year-old male patient with a posterolateral dislocation of the elbow and ipsilateral volar type Galeazzi fracture. We performed closed reduction for the elbow dislocation during admission to the emergency department. Patient was taken to the operating room in the sixth hour of his application to emergency department and open wound on the ulnovolar region of the wrist was closed primarily after irrigation and debridement. We performed open reduction and internal fixation of the radial fracture with a dynamic compression plate. After fixation, we evaluated the stability of the elbow joint and distal radioulnar joint. Distal radioulnar joint was unstable under fluoroscopic examination and fixed with one 1.8 mm Kirschner wire in a pronated position. Then, elbow joint was stable. One year after surgery, patient had no pain or sings of instability. At the last follow-up, range of motion of the elbow was 10°-135° and forearm pronation and supination were 70°.

Volar dislocation of the metacarpophalangeal joint of the thumb: A case report

We present an 18 year-old patient with a volar dislocation of the metacarpophalangeal joint of the thumb. Open reduction was performed through a dorsal incision. Because of the soft tissue interposition such as dorsal capsule, volar plate, dislocated extensor pollicis longus and brevis tendons, ruptured ulnar collateral ligament; open reduction, soft tissue and ligament repair are recommended for this type of thumb dislocations.