Tacettin Ayanoglu

Grade of coracoacromial ligament degeneration as a predictive factor for impingement syndrome and type of partial rotator cuff tear

BACKGROUND The purpose of this study was to investigate the role of coracoacromial ligament degeneration and specific anatomic parameters in the etiology of partial-thickness rotator cuff tears. MATERIALS AND METHODS This study retrospectively assessed 96 patients (mean age, 50.1 years [17-76]; 34 men, 62 women) diagnosed with bursal-side and articular-side rotator cuff tears with a history of failed conservative treatment and persistent shoulder pain who underwent arthroscopic surgery. Video records of the surgery were used to evaluate the type of cuff tear, grade of coracoacromial ligament degeneration, and associated pathologic changes; preoperative magnetic resonance images were used to measure acromioglenoid angle, supraspinatus glenoid angle, and subacromial distance. RESULTS Most of the patients with articular-side tears demonstrated grade 0 and grade 1 coracoacromial ligament degeneration, whereas patients with bursal-side tears had grade 1 and grade 2. There was a significant positive correlation between the grade of coracoacromial ligament degeneration and bursal-side partial rotator cuff tears, whereas no correlation was observed with articular-side tears. There was no significant difference between bursal-side and articular-side partial cuff tears regarding acromioglenoid angle, supraspinatus glenoid angle, and subacromial distance. CONCLUSIONS Grade 1 and grade 2 coracoacromial ligament degeneration is a strong predictive factor for impingement syndrome in the etiology of bursal-side partial cuff tears and can guide the surgeon to consider ligament release and débridement or acromioplasty in these patients.

The evaluation of two different surgical approaches in total hip arthroplasty according to the patient satisfaction, plantar pressure distribution and trendelenburg sign

The aim of this prospective study was to analyze the results of two different surgical aproaches for total hip arthroplasty as Trendelenburg sign, plantar pressure distribution with the help of dynamic pedobarography and clinical results by Harris Hip Score. A total of 28 patients who underwent unilateral total hip arthroplasty using two different types of lateral approach as conventional lateral Hardinge approach and intermuscular Hardinge approach described by Pai were included in this study. Plantar pressures have maesured by EMED-SF pedobarography device and analysed by the help of a commercial software; that seperates the foot to the four different parts which are called masks. TrendelenburgÂ’s sign has been estimated as grade 1 and grade 2 by the method which was described by Hardcastle and Nade. Clinical outcome was measured by comparing Harris Hip Scores pre-operatively and postoperatively at last clinic visit. In both groups after the two years from the surgery; total contact time has increased at the operation side when the results were compared before the surgery at the same side and at the other side after the surgery. Also when we looked at the first and second masks which show the significant part of the stance phase; contact areas have similarly increased and the changes at the peak pressures were similar as contact areas. In both groups Harris Hip score was increased significantly after the operation. This is the first study to compare two different lateral approaches by pedobarographic analysis, clinical evaluation and functional scoring. The fuctional and clinical early results are similar in both lateral hip approaches for total hip arthroplasty when superior gluteal nerve protection, conjuant tendon repair and postoperative rehabilitation have done well.

Do subscapularis tears really result in superior humeral migration

Objectives The aim of this study was to analyse the effect of subscapularis tear on superior humeral excursion (SHE) and acromiohumeral distance (AHD). The hypothesis was that subscapularis tears do not result in superior humeral excursion. Methods Patients who underwent shoulder arthroscopy between August of 2011 and 2015 were reevaluated. Those with isolated Bankart lesion were used as control group and included in the Group 1, isolated full-thickness supraspinatus tear in the Group 2, isolated subscapularis tear in the Group 3, and combined subscapularis and supraspinatus tear in the Group 4. The mean SHE and AHD measurements on magnetic resonance imaging of these groups were compared to reveal any difference in superior humeral migration (SHM). Results There were 30 patients in each group. The mean age of Group 1 (26.44 ± 8.34) was younger than the other 3 groups. The mean AHD and SHE were higher in Group 1 and 3 (Mean AHD: 12.89 ± 2.24 and 12.28 ± 1.9, respectively. Mean SHE: −3.2 ± 0.99 and −2.78 ± 0.64, respectively) than Group 2 and 4 (Mean AHD: 6.2 ± 1.78 and 6.16 ± 1.52, respectively. Mean SHE: 0.72 ± 0.65 and 1.24 ± 0.63, respectively). The AHD and SHE were strongly correlated with each other (Pearson correlation coefficient = 0.184). The inter-observer and intra-observer correlation of the measurements of SHE on MRI were excellent with intraclass correlation coefficient of 0.95 and 0.94, respectively. Conclusion Subscapularis tears do not lead to SHM and subacromial impingement. However, superior rotator cuff tears can still lead to SHM and subacromial impingement even when subscapularis tendon is intact. Level of evidence Level III, diagnostic study.

Incidence of accompanying intraarticular lesions in patients treated with arthtroscopic surgery for acromioclavicular degeneration

Purpose: Acromioclavicular joint degeneration is a common disease that causes antero-superior shoulder pain. İn physical examination regional pain at acromioclavicular joint can occur with cross-body adduction or internal rotation. Surgery should be planned if the patient has not relieved with minimum 6 months of nonoperative treatment, and has no infection or instability. In this study, we aimed the incidence of accompanying intraarticular conditions in patients applied arthroscopic distal clavicula resection. Method: Documents and intraoperative videos of 128 patients undergone artroscopic distal clavicula resection between 2005-2014 has been analyzed restospectively. The incidence of other intraarticular conditions accompanying acromioclavicular arthritis. Results: The average of the age of the 128 patients was 56,9(18-70). 43 of them were male (%33,6) and 85 were female (66,4). 3 (%2,3) patients had anterior instability and treated with Bankart repairment. 50 patients had Superior Labrum Anterior Posterior (SLAP) lesion (39,1) (SLAP1:12, SLAP2:36, SLAP4:1, SLAP5:2). 37 of the were treated with SLAP repairment. Bufford complex had been spotted in one patient. 19 (%14,8) patients had accompanying biceps lesions. 2 patients had biceps brachii long head rupture. 10 patients had been treated with biceps tenotomy, 3 atients had been treated with biceps tenodesis. 7 (%5,5) patients had accompanying subscapularis lesion and treated with repairment. 58(%45,3) patients had accompanying rotator cuff tears (12 partial, 45 total, 1 massive) and48 treated with repairment. In conclusion; 100 (%78,1) 128 patients had accompanying intraarticular lesions needed surgical intervention Outcomes: The most common complication of distal clavicle resection is pain as a result of insufficient resection and instability due to aggressive resection. İndications sould be chosen carefully to avoid complications and for patient satisfaction. After evaluation of the accompanying lesions that require operative treatment, acromioclavicular lesion should be evaluated again. In our study accompanying lesions can be unnoticed using open surgery, as a consequence incomplete treatment and low patien satisfaction. In radographic imaging, if acromioclavicular arthritis is not compatible with clinical symptoms it is essential to evaluate accompanying lesions, on the other hand it should not be forgotten that acromioclavicular arthritis can imitate other lesions

Superior labrum almost always tears following subscapularis injuries

Purpose and Hypothesis: The subscapularis tendon is the major medial support of the long head of biceps tendon (LHBT). Thus, tears of subscapularis may cause biceps tendon subluxation or dislocation. A subluxated biceps tendon may cause a superior labrum injury because of the changed direction of the biceps tendon pulling vector. The purpose of this study is to express the frequency of superior labrum anterior posterior (SLAP) lesions accompanying subscapularis tears. Methods: The digital files of 2010 patients who underwent shoulder arthroscopy were reviewed retrospectively. 141 videos of 141 patients with subscapularis tear were examined in terms of superior labrum and biceps tendon injuries by one of the authors in this study. The results were compared with those of all the 2010 patients who underwent shoulder arthroscopy for any reason. The statistical analysis was made with a statistics programme by the Independent Samples T-Test. Results: There were 113 videos on which the superior labrum and LHBT could be examined precisely. Mean age was 57.8 and 66% of the patients were female. 96.4% of the 113 patients were having a SLAP lesion. 10.6% of those were SLAP I and 89.4% were SLAP II lesion. Out of 2010 patients, the SLAP lesion ratio was 32.2% of which 4.9% were SLAP I. That difference between the patients with and without subscapularis tear was statistically significant. Conclusions: Following the loss of medial support, the LHBT and its pulling vector subluxate anteriorly resulting in a tear of the superior labrum from anterior to posterior. In this study, SLAP lesions were strongly correlated with subscapularis tears as well. Furthermore, the synovial hypertrophy initiated after a superior labrum pathology at superior aspect of the glenoid spreads over the LHBT. An inflamed LHBT firstly degenerates, and then ruptures. According to this study, tears of subscapularis should be repaired when encountered in order to prevent the upcoming secondary intra-articular disorders. Figure 1 Figure shows the concurrent subscapularis tear and SLAP lesion in a patient who underwent shoulder arthroscopy.

Risk factors of recurrence after an arthroscopic stabilisation procedure performed for traumatic anterior shoulder instability in pediatric population

Arthroscopic stabilisation of traumatic anterior shoulder instability is being performed also in pediatric age group, and reports associated with risks of recurrent instability have been presented. The aim of the current study was determining the risk factors of recurrence after the arthroscopic anatomic repair preformed in pediatric age group. 46 patients who underwent arthroscopic Bankart repair for traumatic anterior shoulder instability with the mean age of 17 ±0.8 (15-18) were included in this study. After an average follow-up time of 40.4± 22.7(24-155) months age, gender, dominant side, number of dislocations before surgery, participation in contact sports, Rowe and Oxford shoulder scores, labral lesion type, number of anchor used, and capsular laxity were assessed, and their correlation with recurrence were investigated. Recurrence was encountered in 9 (19,5%) patients, on average, 16.1 ±13.43 months after surgery. The only risk factor of recurrence was found to be the history of five or more times of dislocation before surgery (p=0,006). Although statistically insignificant, when evaluated separately, it was found that patients with contact sports history had double times of recurrence rate if they had ALPSA or SLAP lesion and triple times of recurrence rate if they had capsular laxity. The recurrence rate was found to be 38,4% when accompained by capsular laxity, 50% when accompained by both capsular laxity and ALPSA lesion, and 100% when accompanied by all capsular laxity, ALPSA lesion and contact sports history. Arthroscopic stabilisation of traumatic anterior shoulder instability in pediatric population is an appropriate technique, especially in those with less than five times of dislocation because of the low recurrence rate (3.4%). Surgical procedures that are non-anotomic, such as coracoid transfer or anterior glenoid bone block, should be considered in patients with high risk of recurrence rate after an arthroscopic anatomic repair because of the risk factors like history of five or more times of dislocation, being accompanied by an ALPSA, SLAP lesion, or a capsular laxity and participation in contact sports.

Multiple cervical spinous process fracture (clay shoveler fracture): Case report

Clay-Shoveler’s is fracture of one or more spinous processes to include lower cervical or upper thoracic vertebrae. In this article, it was aimed to investigate possible mechanisms of Clay-Shoveler’s fracture and share radiological results of q case of 11 years (2003) follow-up after the traffic accident. A 25-year-old male patient complained of neck pain spreading to both shoulders, and there was an in-car traffic accident two weeks ago. Patient’s motion restriction was 50% for active flexion, lateral flexion and rotation, and 20% for active extension movement. Imaging revealed a minimal inferior displaced avulsion fracture in C6, C7 and T1 vertebra spinous processes. Patient returned to daily activities in 3rd month after immobilization with medical treatment and neck collar. Clay-Shoveler’s fracture is most commonly seen in T1, then C7, T2, T3 and C6. Surgical treatment is not planned because patient has no limitation of neck movements and neck pain which responds to medical treatment.