Tekin Kerem Ulku

Evaluation of Absorbable and Nonabsorbable Sutures for Repair of Achilles Tendon Rupture With a Suture-Guiding Device:

Background: The purpose of this study was to compare the functional and clinical results of Achilles tendon repairs with an Achilles tendon suture-guiding device using nonabsorbable versus absorbable sutures. We hypothesized that the absorbable suture would have clinical results comparable to those of the nonabsorbable suture for Achilles tendon repair with an Achilles tendon suture-guiding system. Methods: From January 2010 to September 2013, 48 consecutive patients who had sustained a spontaneous rupture of the Achilles tendon underwent operative repair with an Achilles tendon suture-guiding device using 2 different suture types. All ruptures were acute. The patients were divided equally into 2 groups according to suture type. In the nonabsorbable suture group, No. 2 braided nonabsorbable polyethylene terephthalate sutures were used, and in the absorbable suture group, braided absorbable polyglactin sutures were used. The average age of the patients was 38 years (range, 28-50 years). Functional outcome scores and complications were evaluated. Results: All patients had an intact Achilles repair after surgery. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot clinical outcome scores were 98 (range, 90-100) in the nonabsorbable suture group and 96.8 (range, 87-100) in the absorbable suture group. All patients returned to their previous work. The absorbable suture group had fewer postoperative complications (0%) than the nonabsorbable suture group (12.5%) (P < .05). Conclusion: Use of an absorbable suture in the treatment of Achilles tendon repair by an Achilles tendon suture-guiding system was associated with a lower incidence of suture reaction; however, functionally the results were not notably different from those using a traditional nonabsorbable suture. We conclude that repair with absorbable sutures is appropriate for Achilles tendon ruptures. Level of Evidence: Level II, prospective comparative study.

Palmaris longus tendon graft versus modified Weaver-Dunn procedure via dynamic button system for acromioclavicular joint reconstruction in chronic cases

BACKGROUND The hypothesis of this clinical study was that coracoclavicular (CC) reconstruction using autogenic palmaris longus graft through the GraftRope (PLG) system (Arthrex, Inc., Naples, FL, USA) would provide superior clinical and radiologic results compared with modified Weaver-Dunn procedure with the dynamic TightRope (Arthrex, Inc.) system (WDT). METHODS Between 2008 and 2013, 32 patients (average age, 39.7 years; range, 22-60 years) underwent surgical reconstruction of chronic acromioclavicular (AC) joint dislocation. A modified WDT procedure was performed in 16 patients and autogenous PLG was performed in the other 16 patients. Patient data were collected retrospectively, with a final follow-up of 44.9 months (range, 29-60 months). The degree of AC joint displacement was evaluated by measuring the CC distance on the anteroposterior and axillary view. Clinical and functional outcomes were compared by American Shoulder and Elbow Surgeons and the Constant scores at final follow-up. RESULTS Comparison between the WDT and PLG groups showed a significantly better outcome in the American Shoulder and Elbow Surgeons and the Constant scores (P < .01), in favor of the PLG group. Both groups showed an increased CC distance compared with the uninjured side, with a mean difference of 1.1 mm for the PLG and 3.3 mm for the WDT groups. A tolerable loss of reduction within the follow-up time was observed. Reduction loss was higher with the WDT group (P < .05). CONCLUSION CC palmaris longus tendon graft reconstruction with GraftRope system was associated with functional and radiologic benefits. The palmaris longus graft with GraftRope system could be used in chronic cases.

Proprioception After Ankle Injury, Surgery, and Rehabilitation

This chapter discusses ankle joint proprioceptive level after injury, surgery, and rehabilitation from a proprioceptive, neuromuscular control basis. The chapter also includes proprioceptive and kinesthetic consideration after injury/surgery, and therapeutic considerations that optimize ankle and lower extremity function.

Fracture Reduction and Fixation by Knots

Fixations of fragments are the main aim of orthopedic trauma surgery. Although wires, screws, and plates are the popular fixation materials, sutures also have an important role [1, 2]. Most surgeons thought that hardware have more strength at the fixation side than sutures. We can easily say that it is true for large and messy fragments. But if the fragments are comminuted, osteoporotic, and fragile, hard fixation materials may give harm to the fracture sites and makes the procedure more complicated [3, 4]. Specially, fixations with sutures are useful for the treatment of fractures with tendon or ligament avulsion. At this time use of sutures could be an option for the fixation, which can give less harm to the small and fragile fracture ends. By using sutures as fixation material, the surgeons can use bone-tendon junction as a buttress side. Suture fixations can be used in various types of fractures. In this chapter, we describe major fields that suture fixation is the most favored type of fixation.

Completion repair exhibits increased healing characteristics compared with in situ repair of partial thickness bursal rotator cuff tears

PurposeLittle information is available regarding the healing capacity of in situ and completion repair for the treatment of partial thickness rotator cuff tears. The purpose of the study was to analyze the healing characteristics of both techniques.MethodsTwenty-four adult Sprague–Dawley rats were operated. Partial thickness bursal side tears were created bilaterally at the supraspinatus tendons. Additional 6 rats were used as the sham group. The right shoulders were repaired in situ, and the left shoulders were repaired using the tear completion technique on the 10th day after detachment surgery. Rats were sacrificed on the 10th and 30th days after repair surgery. Type I collagen, the TNF-α concentrations, the number and diameter of fibroblasts, and neovascularization were examined at two different time points.ResultsThe collagen concentration (ng/mg total protein) was significantly increased in both groups at T1 and decreased in the in situ group, whereas completion repair continued to increase at T2 (P < 0.05). The mean fibroblast diameter in the completion repair group continued to increase at both time points (P < 0.05). Neovascularization was significantly increased with tear completion compared with in situ repair (P < 0.05) at T1. No significant (n.s.) differences regarding the TNF-α concentration (pg/mg total protein) were noted for both surgical techniques at T2 (P > 0.05).ConclusionDespite the concerns of detaching the intact tendon, the completion repair technique exhibited increased healing characteristics compared with the in situ technique. The reason for this finding might be the refreshing effect of debridement at the chronic degenerated tendon that could improve the healing response.

Transtibial repair in medial meniscus root avulsions; 2 years clinical results:

Introduction: Medial meniscus posterior root avulsion injuries exhibited a similar extent of increasing contact pressure and decreasing contact area, as that in the total meniscectomized knee and resulting articular cartilage loss in medial compartment of the knee joint. Although partial meniscectomy is the traditional treatment in symptomatic posterior root avulsions, this method can not restore cartilage loss. The recommended surgical treatment for posterior root avulsions is repair in non degenerated knees. Patients and methods: Arthroscopic transtibial repair was performed in 11 patients who were diagnosed as symptomatic posterior root avulsions with clinical examination and magnetic resonance imaging findings and minimum 2 years results were evaluated. There were 8 women and 3 men, and the mean age of the patients were 51 (46-58). The mean time interval between injury and surgery was 4 weeks (5 days and 8 weeks). Conservative treatment was given to all of patients except one, and surgical treatment was performed for patients whose mechanical sypmtoms and pain weren’t relieved at the end of conservative treatment. The repair method was arthroscopic pull-out technique with fixation of the posterior attachment area through a tibial tunnel. Walking 4-6 weeks non-weight bearing with two crutches and physical treatment was given that includes muscle strengthening and range of motion exercises. Patients were evaluated with preoperative and 2 years postoperative Lysholm knee scores, clinical examination and radiographic changes. Results: Mean Lysholm scores were increased preoperative from 55 to postoperative 86 that was found statictically significant. In ten patients complaints were resolved after surgical treatment and daily living began normally after surgery. In one patient arthroscopic partial meniscectomy was done due to rerupture after five months from index surgery. In two patients medial joint space narrowing was found radiologically at the end of two years but there were no clinical complaints. Conclusions: Repair must be considered in symptomatic medial meniscus posterior root avulsions also in older age if there is no degenerative osteoarthritis. The root tear that has similar effects as total meniscectomy will cause cartilage loss if not treated.

Surgical treatment results of hand deformities in patients with Apert syndrome

Objectives: Hand deformities in Apert sydrome are complex pathologies and usually consist of complex syndactyly with distal bony fusion in the 2., 3. and 4th fingers, simple syndactyly in the 5th finger, and short thumb, radial clinodactily and synphalangism. Other accompanying deformities and the presence of craniosynosthosis make the treatment plan even more complex. Because it is such a rare disorder, no standard treatment protocol has yet been developed. Methods: In this study, our aim was to evaluate the early results of our standard treatment protocol for Apert’s hands. We evaluated 7 patients with Apert’s hands who were treated bilaterally between the years of 2008 and 2013. We performed a two-stage surgical protocol, the first of which was the bilateral opening of the border fingers and the second stage was the opening of the middle fingers and web space deepening, osteotomy and collateral release of the thumb. Patients were evaluated according to grasping and pinching ability, graft-flap necrosis and cosmetic satisfaction. Results: The mean age at the first operation was 2.7 years and the mean number of operations was 3 per patient. No patient developed graft-flap necrosis and no patients required amputations. All patients were able to perform grasping and pinching functions and families were satisfied with the cosmetic results. Conclusion: Using a two-stage surgical protocol, achieving satisfactory results with a minimal number of operations is possible in patients with Apert Syndrome.

Arthroscopic Repair of Horizontal Meniscus Tears by Vertical Sutures With Packing Technique

Objectives: The aim of this study is to report short term results of arthroscopic repair of horizontal meniscus tears by vertical sutures with packing technique Methods: Seventeen patients with an average age of 33 years were treated. Repair was performed to the patients that horizontal component of the tear extends into the capsular zone of the meniscus after excision of the unstable, central or flap components of the tears. The repair was performed after rasping and trephination, with vertical sutures that one leg of the suture is on the superior surface of the menisci and the other leg of the suture is under the inferior surface of the menisci by inside-out technique using the zone-specific curved canulas and all-inside technique using all inside meniscal devices. 9 medial and 8 lateral meniscus tears were treated. Results: Evaluation was performed by Lysholm functional knee scores. All patients were followed clinically and radiological by means of MRI to assess meniscus integrity at the repair site with an average follow-up of 12 months. MRI showed a healed meniscus at the repair sites in only five cases (29%) but with no further disruption of the tear components and osteoarthritic changes in all cases. Mean of Lysholm scores improved from 58 preoperatively to 92 postoperatively that was found statistically significant. Conclusion: Repairing of horizontal meniscus tears that extend into capsular zone instead of resection improves activity level and prevents meniscal loss.