Functional outcomes of bone marrow aspirate concentrate application in osteoarthritis of the knee

Background: Osteoarthritis (OA) of the knee is a very common musculoskeletal disorder. Although total knee replacement is a suitable option in the treatment of severe OA, it has some limitations when performed in the early stage and early age. Bone marrow aspirate concentrate (BMAC), which is rich in mesenchymal stem cells, is promising due to its potentially regenerative and symptomatic effects in many disorders of the musculoskeletal system. This study aims to investigate the efficacy of BMAC in terms of functional recovery in OA of the knee joint.Methods: Total of 52 patients with unilateral symptomatic knee OA but no inflammatory disease, advanced malalignment or instability were enrolled in this study. Bone marrow aspirate was collected from the iliac crest in one session, prepared using a manufactured kit and the patients received intra-articular injections of this BMAC. The mean age of the patients was 59.2±7.4 and the mean follow-up period was 22.1±3.6 months. Functional outcomes of the patients were evaluated using Modified Cincinnati and Tegner Lysholm scoring systems.Results: It was observed that both Lysholm and Cincinnati scores of the patients were statistically significantly higher throughout the follow-up period as compared to the period before the procedure (p=0.0001). There was no statistically significant difference in Lysholm and Cincinnati ratings between gender, side and body mass index groups throughout the follow-up period (p >0.05). It was found that the results of the patients with Kellgren-Lawrence Grade 4 severe joint arthrosis were statistically significantly lower (p <0.05).Conclusions: Considering the functional outcomes of the patients up to two years, it was observed that the application of concentrated bone marrow aspirate provided functional recovery in arthrosis of the knee joint.

The morphologic relationship of the lesser trochanter with the femoral neck and greater trochanter

Background: The anatomy of the proximal femur comprises important landmarks for many orthopedic surgical procedures. However, this area exhibits morphological differences depending on race, gender and age. Besides being the insertion area of the hip flexor muscles, the lesser trochanter is also used as an angular reference in many orthopedic surgical procedures. The aim of this study is to investigate the morphologic relationship of the lesser trochanter with the femoral neck and greater trochanter.Methods: Around 67 dry femur bones (32 left, 35 right) belonging to humans of unknown gender that belong to the Ankara University Medical Faculty, Department of Anatomy were used in this study. The morphologic relationship of the lesser trochanter (TRMI) with the femoral neck (FN) and greater trochanter (TRMJ) was studied and the results were provided in a table.Results: The measured mean lesser trochanter and greater trochanter tip distance was 67.5±4.9mm (60mm-75mm). The angle between the tip of the lesser trochanter and the center of the femoral neck was measured as 35.050±5.060 (290-420) degrees. The distance between the tip of the lesser trochanter and the center of the femoral neck was measured as 15±2.8mm (10mm-20mm).Conclusions: In addition to the angular relationship of the lesser trochanter with the femoral neck, its relationship in terms of distance with the greater trochanter and femoral neck are the anatomic relationships that are noteworthy for the lesser trochanter, which is used as a landmark during orthopedic surgical procedures.

Micro or Nano Does not affect the Functional Outcomes in the Midterm Follow-up

Introduction: Bone marrow stimulation techniques are themost commonly preferred options in the treatment of articularcartilage damage due to many features. Although nanofracturemethod that was developed in order to improve this techniquehas proven efficacy in animal models and in vitro studies,functional outcomes of nanofracture have not been shown inactual patients. In this study, our purpose was to compare theclinical outcomes of nanofracture technique and traditionalmicrofracture technique in the knee joint.Material and Methods: Patients operated using themicrofracture technique as group 1 (n=22) and patientsoperated using the Nanofx (Arthrosurface Inc., Franklin,Massachusetts) technique as group 2 (n=20) were prospectivelyevaluated. Demographic characteristics of the patients, defectsize and localization were recorded. Patients with isolatedcartilage damage who had ICRS Grade 3-4 cartilage lesionand no concomitant pathologies were included in the study.Each surgical procedure was performed by the same surgeonby following the same surgical protocol. Clinical outcomesin the patients were assessed using Modified Cincinnati andTegner-Lysholm scoring systems at months 6, 12, 24, 36 and48.Results: Calculated mean follow-up periods were 50.8±3.1and 51.2±3.2 in groups 1 and 2, respectively. There was nostatistically significant difference between the groups in termsof the defect and demographic characteristics of the patients.In the follow-up of patients using functional scoring, there wasno statistically significant difference in Lysholm (p=0.294)and Cincinnati (p=0.234) scores between the two groups.Conclusion: There was no difference in the mid-term betweenthe functional outcomes of microfracture and nanofracturetechniques in the treatment of cartilage lesions.

COMBINED INSIDE-OUT AND ALL-INSIDE TECHNIQUE IN BUCKET-HANDLE MENISCUS TEARS

ABSTRACT Objective: To determine the outcomes after combined inside-out and all-inside repair technique of bucket-handle meniscus tears. Methods: A retrospective review was made of patients with bucket-handle meniscus tears repaired with combined techniques, using the all-inside technique in posterior meniscal tears and the inside-out technique in the middle part of the meniscal tears. Meniscal healing was assessed clinically using Barrett's criteria and MRI. Results: The study comprised 52 patients with a mean age of 28.4 years old (range, 19-52 years old). The mean follow-up period was 31.3 months (range, 24-59 months). Two patients had ACL re-rupture, and complete meniscal healing was achieved in all but one patient. Although improved from preoperative status, Tegner and Lysholm scores were lower in the ACL reconstructed patients than in the intact ACL patients. Conclusion: Combined inside-out and all-inside meniscal repair technique is a successful and cost-effective treatment method in bucket-handle meniscus tears. Level of Evidence IV, Therapeutic Study.

Retrograde Screw Fixation Results of Coronoid Fractures in Terrible Triad.

In this study, we aimed to evaluate the results of coronoid fracture fixation, in terrible triad of elbow injury with retrograde screws. Patients between 2008 and 2012 were reviewed. Six were men and 2 were women. Mean age was 44.5(21-62). Mean follow-up period was 25.25 months (8-50). According to Regan and Morrey classification, 6 of the fractures were Type 3 and 2 were Type 2. All cases were operated with single lateral incision. For coronoid fracture, reduction was maintained from anterior aspect and fixed with posterior percutaneous screws which were single 4.5 mm screw in 3 patients and double 3.5 mm screws in 5 patients. Mini and micro cannulated screws for 4 patients and anatomic radial head plates for 4 patients were used for radial head fractures. All lateral ligament complex repairs were performed with bone tunnel technique. The results of the treatment were evaluated with Mayo elbow performance scoring system. All the fractures were united and mean union time was 4 months (3-6). Mean active elbow flexion – extension range of motion at last visit was 108.2º (70º-130º). Mean Mayo elbow performance score of the patients was 87.5 (70-100). With retrograde screw fixation of coronoid fractures in terrible triad, we achieved a stable fixation.

A Comparison of the Essex-Lopresti Technique and Conservative Treatment for Displaced Tongue-Type Calcaneus Fractures.

Aims: This study aimed to evaluate the mid-term clinical and radiological results of conservative treatment and surgical treatment made with the Essex-Lopresti technique in tongue-type calcaneus fractures. Study Design: A comparison of two treatment options (the Essex-Lopresti Technique and conservatively). Radiological comparison, Functional comparison and isokinetic dynamometer were used to evaluate. Place and Duration of Study: 3 separate centers between November 2005 and April 2013 were examined. Methodology: A retrospective evaluation was made of 19 patients (Group 1) who were operated on with the Essex-Lopresti Technique and 27 patients (Group 2) who were treated conservatively. Radiological comparison was based on correction in Bohler’s angle. Functional comparison was made using the Maryland Foot Score (MFS). In the comparison of the gastrosoleus muscle complex strength, an isokinetic dynamometer was used. To determine the distribution of all the variables in the comparisons of the groups, the Kolmogorov-Smirnov test was used. For variables showing normal distribution, Student’s t-test (Independent Sample T Test) was applied. Results: The Maryland Foot Score was determined as 96.2 in Group 1 and 85.6 in Group 2 (p=0.002). While findings of subtalar arthrosis were determined in 2 (10.5%) patients of Group1, subtalar arthrosis was seen to have developed in 7 (25.9%) patients of Group 2 (p=0.014). In the isokinetic muscle strength measurements, the mean plantar flexion muscle strength was 106.2 (85- 122.4) Nm in Group 1 and 96.4 (73.3-124) Nm in Group 2 and this difference was statistically significant (p=0.034). Conclusion: The Essex-Lopresti Technique is an effective method in the treatment of tongue-type calcaneus fractures.