A new and simple method for patellar height measurement: Fibula-condyle-patella angle.

OBJECTIVES: This study aims to evaluate the inter-observer reliability of fibula-condyle-patella angle measurements and to compare it with other measurement techniques. PATIENTS AND METHODS: Between January 01, 2023 and January 31, 2023, a total of 108 patients (20 males, 88 females; mean age: 47.5±12.0 years; range, 18 to 72 years) who underwent X-rays using the fibula-condyle-patella angle, Insall-Salvati, Caton-Deschamps, Blackburne-Pell, and plateau-patella angle (PPA) methods were retrospectively analyzed. Knee lateral radiographs taken in at least 30 degrees of flexion and appropriate rotation were scanned. All measurements were made by two orthopedic surgeons who were blinded to measurement methods. RESULTS: Right knee patellar height measurements were conducted in 56 patients, while left knee patellar heights were assessed in 52 patients. The highest inter-observer concordance was found in the fibula-condyle-patella angle. The second highest concordance was found in the Insall-Salvati. The highest concordance correlation was found with PPA in the measurements of both researchers. CONCLUSION: The fibula-condyle-patella angle is a reliable technique with a good inter-observer reliability for measuring patellar height. We believe that this study will inspire future research to establish comprehensive reference values for clinical applications.

A comparative analysis of 3D bioprinted gelatin-hyaluronic acid-alginate scaffold and microfracture for the management of osteochondral defects in the rabbit knee joint.

OBJECTIVES: This study aims to compare the radiological, biomechanical, and histopathological results of microfracture treatment and osteochondral damage repair treatment with a new scaffold product produced by the three-dimensional (3D) bioprinting method containing gelatin-hyaluronic acid-alginate in rabbits with osteochondral damage. MATERIALS AND METHODS: A new 3D bioprinted scaffold consisting of gelatin, hyaluronic acid, and alginate designed by us was implanted into the osteochondral defect created in the femoral trochlea of 10 rabbits. By randomization, it was determined which side of 10 rabbits would be repaired with a 3D bioprinted scaffold, and microfracture treatment was applied to the other knees of the rabbits. After six months of follow-up, the rabbits were sacrificed. The results of both treatment groups were compared radiologically, biomechanically, and histopathologically. RESULTS: None of the rabbits experienced any complications. The magnetic resonance imaging evaluation showed that all osteochondral defect areas were integrated with healthy cartilage in both groups. There was no significant difference between the groups in the biomechanical load test (p=0.579). No statistically significant difference was detected in the histological examination using the modified Wakitani scores (p=0.731). CONCLUSION: Our study results showed that 3D bioprinted scaffolds exhibited comparable radiological, biomechanical, and histological properties to the conventional microfracture technique for osteochondral defect treatment.

The effect of biceps tenotomy on superior humeral migration in arthroscopic repaired full-thickness supraspinatus tears.

Background: Lesions of the long head of the biceps (LHB) tendon are a prevalent injury that frequently coexists with rotator cuff injuries. This study aimed to assess the effect of supraspinatus (SST) repair with concurrent LHB tenotomy on superior migration of the humeral head. The acromiohumeral distance (AHD) was determined via ultrasound to evaluate the superior migration of the humeral head. Methods: The study population was retrospectively recruited from patients who underwent unilateral arthroscopic repair of isolated degenerative full-thickness SST tears between January 2017 and December 2019. Patients were divided into 2 subgroups based on whether they underwent LHB tenotomies during arthroscopy. While 37 patients underwent arthroscopic single-row SST repair, the other 33 patients underwent arthroscopic single-row SST repair with LHB tenotomy. The subject group consisted of people who had undergone arthroscopic shoulder surgery. Contralateral shoulders without rotator cuff injuries were included in the control group. The AHD and SST thicknesses of patients were examined via the ultrasound in both groups and subgroups. Results: The mean age in the SST repair group was 55.52 ± 4.58 years (range, 46-63 years), whereas it was 58.24 ± 3.98 (range, 52-73 years) in the SST repair + LHB tenotomy group. In the SST repair group, 57.6% of patients were female and 42.4% were male, whereas 56.8% and 43.2% were in the SST repair + LHB tenotomy group, respectively. The mean body mass index was 28.06 ± 1.31 kg/m2 (range, 25.7-31.2 kg/m2) in the SST repair group and 28.95 ± 1.79 kg/m2 in the SST repair + LHB tenotomy group. Groups were not different for sex, surgery side, dominant side, tear size, and follow-up time; however, the SST repair + LHB tenotomy group had significantly higher mean age and body mass index than the SST repaired group. The mean AHD value and SST thickness were significantly less in both the rotator cuff repair group and the rotator cuff repair + LHB tenotomy group compared to the healthy shoulder. The mean AHD value was significantly lower in the SST repaired + LHB tenotomy group than in the SST repair group (P = .02). Conclusion: The AHD was narrowed in patients who underwent LHB tenotomy and radiologically demonstrated the depressor effect of the LHB tendon on the humeral head. As a secondary outcome, we demonstrated that regardless of tenotomy, AHD could not be restored in patients who underwent arthroscopic single-row SST repair.

Evaluation of Isokinetic Knee Strengths after ACL Reconstruction with Quadrupled Semitendinosus Suspensory Femoral and Tibial Fixation versus Four-Strand Semitendinosus and Gracilis Suspensory Femoral and Tibial Screw Fixation.

INTRODUCTION: The purpose of this study was to demonstrate that patients undergoing ACL reconstruction with quadrupled semitendinosus suspensory femoral and tibial fixation have comparable results in muscle strength and knee function to those undergoing ACL reconstruction with four-strand semitendinosus-gracilis suspensory femoral fixation and a bioabsorbable tibial interference screw fixation. MATERIALS AND METHODS: Between 2017 and 2019, 64 patients who were operated on by the same surgeon were included. Patients underwent ACL reconstruction technique with quadrupled semitendinosus suspensory femoral and tibial button fixation in Group 1, and patients underwent ACL reconstruction with coupled four-strand semitendinosus-gracilis suspensory femoral fixation and a bioabsorbable tibial interference screw in Group 2. Evaluation of patients was performed with the Lysholm and Tegner activity scale preoperatively and at the 1st and 6th months postoperatively. At the 6-month visit, isokinetic testing of the operated and non-operated limbs was performed in both groups. RESULTS: There was no significant difference in the age, weight, and BMI values of the patients in Groups 1 and 2 (p < 0.05). According to the strength values of the operated sides of the patients in Group 1 and Group 2, there was no significant difference in the angular velocities of 60° s-1, 180° s-1, and 240° s-1 in both extension and flexion phases between the operated sides of Groups 1 and 2 (p < 0.05). CONCLUSIONS: Patients who have ACL reconstruction with quadrupled semitendinosus suspensory femoral and tibial fixation have comparable muscle strength and knee function to those who undergo ACL reconstruction with four-strand semitendinosus-gracilis suspensory femoral fixation and a bioabsorbable tibial interference screw.

Silver Nanoparticles Enhance the Antibacterial Effect of Antibiotic-Loaded Bone Cement.

Purpose The goal of this study was to determine the antibacterial activity of bone cement in polymethyl methacrylate (PMMA) structures with varying amounts of silver nanoparticles (AgNPs) included. Additionally, we aimed to evaluate whether AgNPs affect the biomechanical properties of PMMA cement in our study. Materials and methods Between April 2020 and June 2020, we conducted a series of experiments to demonstrate the antibacterial characteristics by adding silver nanoparticles to PMMA bone cement. PMMA bone cement (Cemex, Tecres Company, Verona, Italy) was used as the base material. Seven different samples were prepared in order to evaluate the amount and presence of AgNPs. Cement samples containing AgNPs and teicoplanin at different concentrations and empty cement (control, without teicoplanin and AgNPs) were placed on Petri plates. The agar diffusion method was used to determine the antibacterial effect (Kirby-Bauer). Results Kirby-Bauer assays demonstrated that AgNPs added to bone cement increased the antimicrobial activity compared to antibiotic-free or only teicoplanin-loaded cement. It was observed that increasing the AgNPs ratio further increased the antimicrobial activity. Conclusion AgNPs in various combinations enhance antimicrobial activity synergistically while maintaining the mechanical strength of bone cement. Increasing the amount of AgNPs results in a significant increase in antimicrobial activity.

Determination of the safest level and screw length for the proximal locking screw in retrograde femoral nailing.

OBJECTIVES: This study aims to identify the most reliable level for the proximal locking screw in retrograde femoral nails and to investigate the preoperative detectability of the length of the proximal locking screw by radiological measurements. PATIENTS AND METHODS: Between April 2020 and June 2021, a total of 50 patients (42 males, 8 females; mean age: 38.1±14.3 years; range, 18 to 60 years) who were suspected of vascular injury after gunshot or stab wounds and underwent lower extremity computed tomography angiography (CTA) from the local institution's database were included in the study. The distances of the femoral neurovascular structures (FNVS) and sciatic nerve (SN) to the femur were measured in the sections determined in the anteroposterior and medial-lateral planes. The anteroposterior length of the femur was measured in selected sections to estimate the appropriate length of the proximal locking screw. RESULTS: The level at which FNVS and SN were closest to the femur in the medial-lateral plane was inferior to lesser trochanter (LT) 1 cm. The mean AP femur length at the level of the LT was 36.3±2.8 mm, at the level of inferior to LT 1 cm was 34.1±2.8 mm, at the level of superior to LT 1 cm was 38.6±3.7 mm. CONCLUSION: In retrograde femoral nailing, the safest level in terms of screw placement is 1 cm above the LT. Additionally, the optimal screw length is 40 mm at the level of the LT and 1 cm superior it, whereas it is 35 mm at the level of the LT and 1 cm inferior to it.

Comparative Results of Anterior Cruciate Ligament Reconstruction with Full Tibial Tunnel: Quadrupled Semitendinosus Suspensory Femoral and Tibial Fixation versus Quadrupled Semitendinosus and Gracilis Suspensory Femoral and Tibial Screw and Staple Fixation.

This study compared the clinical outcomes of patients treated with described "modified all-inside" anterior cruciate ligament reconstruction (ACLR) technique with those of patients treated with suspensory femoral fixation and a bioabsorbable tibial interference screw with the ACLR technique. From 2017 to 2019, 98 patients who underwent ACLR surgery by two surgeons using either of the techniques were included in this study. Patients in group 1 were treated with the "modified all-inside" ACLR technique. In this technique, only the semitendinosus tendon was harvested as a four-strand graft and fixed to the tibia and femur with suspensory buttons. Patients in group 2 were treated with suspensory femoral fixation and a bioabsorbable tibial interference screw ACL reconstruction technique. Patients' functional outcomes were evaluated by the Lysholm score, Tegner activity scale, and International Knee Documentation Committee (IKDC) subjective score. Postoperative knee stability of the patients was evaluated using the Lachman test and the pivot-shift test. The mean ages of the patients were 31.1 (16-55) and 28.7 (18-48) years in groups 1 and 2, respectively. The average follow-up durations were 26 (20-30) and 25.9 (22-30) months for both groups. There was no significant difference between the preoperative and postoperative Lysholm's score, Tegner's activity score, and IKDC subjective score in groups 1 and 2. There were no major complications or reruptures in either group. ACLR incorporating the "modified all-inside" ACLR technique obtained significant clinical outcomes compared to ACLR with a suspensory femoral fixation and a bioabsorbable tibial interference screw.

Supracondylar humerus fractures in children caused by monkey bar-related injuries: a comparative study.

We evaluated the functional and radiological outcomes of surgically treated supracondylar humerus fractures based on injury mechanisms, as well as the therapeutic and prognostic aspects of monkey bar-related injuries, in this study. Between December 2014 and December 2018, pediatric patients who had undergone surgical treatment for supracondylar humerus fractures were analyzed retrospectively. According to the mechanism of injury, patients were divided into two groups: monkey bar-related injuries and other injuries. Patients were evaluated functionally using the Mayo elbow performance score, while radiographically using the anterior humeral line, humero-capitellar angle, and Baumann angle. This study enrolled a total of 50 patients, 27 females and 23 males. Each patient was followed for a minimum of 24 months. There were no significant differences in age, sex or complications between the groups. The Mayo elbow performance score and fracture types were shown to be significantly associated with injury mechanisms ( P = 0.017, P < 0.001). Additionally, a significant correlation between the necessity for open reduction and the mechanism of injury was found ( P = 0.038). There were no significant differences in radiological evaluation between the groups. Supracondylar humerus fractures caused by falling from the monkey bar were more severe in children than supracondylar humerus fractures caused by other mechanisms of injury, and surgical treatment outcomes were worse for supracondylar humerus fractures caused by falling from the monkey bar.

A new modified pararectus approach and visualization: an anatomical study.

INTRODUCTION: The aim of our study was to visualize all the windows used in the pararectus approach with detailed cadaver images to facilitate better understanding of orthopedic surgeons and, in addition, was to modify the incision used in the pararectus approach to a more cosmetic bikini incision. MATERIALS AND METHODS: In total, 20 cadavers fixed in 10% formalin were used in this study. Of these cadavers, 14 were male and six were female, with a mean age at death of 57 (42-82 years). The four windows were defined as follows in all the cadavers: pubic, quadrilateral, sacroiliac, and iliac windows. RESULTS: The most important structure at risk in the pubic window was the corona mortis, as it was observed in 12 (60%) cadavers. In men, the spermatic cord was an important structure at risk in the pubic window. The obturator vessels and nerves were the structures at most risk in the quadrilateral window due to their close location with the quadrilateral surface. The obturator nerve on the medial side and at the entrance of the pelvis through the linea terminalis and lumbosacral truncus were the structures at most risk close to the sacroiliac joint in the sacroiliac window. CONCLUSION: This anatomical study includes highly instructive visual shapes and cadaver images for the acetabulum and pelvis, whose anatomical structures are quite complex. We have found that this modified pararectus approach provides excellent access to the internal pelvic rim. CLINICAL RELEVANCE: The anatomical data regarding the modified pararectus approach in this study will assist orthopedic surgeons in the surgical management of acetabular and pelvic fractures.

Internal tibial torsion is associated with medial meniscus posterior horn tears.

PURPOSE: Risk factors for meniscal tears play a decisive role in deciding on treatment and rehabilitation. The purpose of this study was to investigate the effect of tibial rotation on medial meniscus posterior horn tears (MMPHTs). METHODS: This study is a retrospective case-control study. Fifty patients with meniscal tears and 57 knees with intact meniscus were compared. Tibial rotation, femoral version, tibial slope and knee varus were measured in each participant. Knee osteoarthritis was classified according to the Kellgren-Lawrence classification. Demographic characteristics were noted. RESULTS: There were significant differences in the mean tibial torsion angles and mean mechanical axes between the groups. The mean tibial rotation and mean mechanical axis were 26.3° ± 6.7 and 3.7° ± 2.7 in the MMPHT group and 30.3° ± 8.4 and 2.05° ± 2.7 in the control group, respectively (p = 0.008, p = 0.002). CONCLUSION: The current retrospective study has shown that tibial rotation is markedly reduced in patients with MMPHTs. Although the actual mechanism is not clear, the internal torsion of the tibia causes a decrease in the foot progression angle and increases the knee adduction moment, which in turn increases the medial tibial contact pressure. Internal torsion of the tibia, such as knee varus, may play a role in the aetiology of MMPHTs by this way. Whilst there was a significant difference in the mean varus and tibial torsion between the groups, there was no significant difference in the mean femoral version or tibial slope. LEVEL OF EVIDENCE: III.

Noninvasive Technique to Monitor the Pressure under a Cast: A Mobile Application-Friendly Bluetooth Pressure Sensor.

Aim: The purpose of this study was to design a sensor that could monitor the skin-cast contact surface pressure (SCCSP) of a limb under a cast and inform the user via a mobile application when the pressure increases. Methods: In this experimental study, an infant sphygmomanometer cuff was initially placed on the forearm of 10 volunteers. A pressure sensor with a Bluetooth chip was then placed on the volar aspect of the forearm. Short arm plaster was applied with synthetic cast material. The SCCSP under the plaster was measured by the sensor and the measured values were transmitted to a mobile application via a Bluetooth chip. The mobile application processed the data from the chip and converted it to mmHg. Results: Intracompartmental pressure (ICP) values were categorized as 0, 10, 20, 30, 40, 50, 60, and 75 mmHg. The highest SCCSP was 75 mmHg CP, while the lowest was 0 mmHg CP. The correlation coefficient of the mean pressure values was 0.993 (p ≤ 0.001) (SD 0.002, range 0.989-0.997), and there was a significant relationship between ICP and SCCSP values (p ≤ 0.05). Conclusion: We can monitor SCCSP, detect limb swelling, and notify the user via a mobile application by using Bluetooth pressure sensors.

The effect of surgical technique on cognitive function in elderly patients with hip fractures: Proximal femoral nailing versus hemiarthroplasty.

OBJECTIVES: This study aims to compare the effects of hemiarthroplasty (HA) and proximal femoral nailing (PFN) on postoperative cognitive function in elderly adults with hip fractures. PATIENTS AND METHODS: Between August 2021 and January 2022, a total of 49 patients (28 males, 21 females; mean age: 78.1±9.4 years; range, 65 to 96 years) presented with a proximal femoral fracture were included. The patients were divided into two groups based on the type of surgical technique used. Group 1 consisted of 23 patients who underwent cemented HA, while Group 2 consisted of 26 patients who underwent osteosynthesis with a PFN. Preoperatively (24 h before surgery), within the first week (Days 4 to 7), and at one month following surgery, the MiniMental State Examination (MMSE) was applied. RESULTS: The surgery side and duration of surgery were not significantly different between the two groups (p>0.05); however, the length of hospital stay and estimated blood loss were significantly different (p<0.001) in favor of Group 2. When the decline in MMSE scores from preoperative to postoperative was assessed, it was shown that group 2 had a lesser decrease. CONCLUSION: Patients with hip fractures who underwent PFN surgery experienced less postoperative cognitive impairment than those who underwent HA surgery.

The Effects of Using K-Wire or Titanium Elastic Nails on Clinical and Radiological Outcomes in the Métaizeau Closed Reduction Technique.

Aim: The purpose of this study was to compare the effects of using Kirschner-wire (K-wire) or titanium elastic nails (TEN) on the functional results of patients treated with the Métaizeau closed reduction technique, which is a popular treatment modality for pediatric radial neck fractures (PRNF). Methods: Patients who underwent the Métaizeau closed reduction technique for PRNF between May 2017 and May 2019 were assessed retrospectively. The Judet classification was used for the PRNF classification. The study consisted of patients who underwent the Métaizeau technique for Judet Type IV PRNFs and had at least 12 months of follow-up. Results: This study enrolled a total of 43 patients, 22 females and 21 males. Their mean age was 8.69 ± 2.3 at the time of surgery. The mean MEPS of patients undergoing K-wire surgery was 89.50, while the mean MEPS of patients undergoing TEN surgery was 92.83. There was no statistically significant difference between the two groups in terms of MEPS. When the complication rates of the two groups were evaluated, there was no statistically significant difference between them. The cost per patient for TEN was $40. The cost per patient for the K-wire was $1. Conclusion: The effect of K-wire or TEN used in the Métaizeau closed reduction technique on clinical outcomes is similar, and K-wire is more cost-effective.

Métaizeau Closed Reduction Technique and Open Reduction Technique for the Surgical Treatment of Pediatric Radial Neck Fractures.

OBJECTIVE: To compare the functional outcomes of pediatric radial neck fractures treated with percutaneous reduction using Kirschner (K) wire with the Métaizeau technique, and that with open reduction plus internal fixation with K-wire. STUDY DESIGN: Comparative descriptive study. PLACE AND DURATION OF STUDY: Haseki Training and Research Hospital Orthopedics and Traumatology Department, from December 2007 to December 2018. METHODOLOGY: Children aged under 15 years, with radial neck fractures were inducted. The injury was classified according to Judet classification and the type IV was treated with either of the above technique. The inclusion criteria were a diagnosis of Judet type IV radial neck fracture and a minimum follow-up of 12 months. Exclusion criteria were patients with concomitant elbow fracture, follow-up for <12 months, failure to complete the Mayo Elbow Performance Score (MEPS) functional assessment, patients with missing data. Radiological results were evaluated in accordance with the Ursei Classification. MEPS was used to assess functional development. RESULTS: Forty-seven children (25 boys and 22 girls) aged (5-14 years with mean age of 8.57 ± 2.3 years were inducted. The surgical approach was the Métaizeau technique in 22 patients and open reduction technique in 25 patients. MEPS in the Métaizeau technique group was 95.2, with excellent results in 15 patients (68%), good results in 7 (31%), and fair or poor results in none of the patients. The mean MEPS in the open reduction / K-wire group was 88, with excellent, good, fair, and poor results in 9 (36%), 12 (48%), 4 (16%), and none of the patients, respectively. CONCLUSION: Closed reduction using the Métaizeau technique with the elastic stable intramedullary nailing method satisfies all the criteria for minimally invasive bone surgery. This approach was forward to be considerably efficient, with excellent functional and esthetic outcomes and a low rate of complications if the indications and biomechanical principles are considered. KEY WORDS: Radial neck, Métaizeau technique, Judet classification.

Evaluation of the patient satisfaction of using a 3D printed medical casting in fracture treatment.

OBJECTIVES: This study aims to assess, through a questionnaire, the functionality, and efficacy of using three-dimensional (3D) printed medical casts. PATIENTS AND METHODS: Between February 2017 and March 2019, a total of 24 patients (14 males, 10 females; mean age: 33.1±9.4 years, range, 12 to 62 years) with upper extremity fracture who were applied 3D printed medical cast were included. Patient satisfaction was evaluated using the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 (QUEST 2.0). Each item is scored on a five-point scale. RESULTS: The mean follow-up was 14 (range, 6 to 18) months. All fractures healed within four to six weeks without any complications. In all cases, there was no loss of reduction. The total mean QUEST 2.0 satisfaction score for the participants was 4.7. The ratings on each scale ranged from 4.5 to 4.9. CONCLUSION: Almost all patients with upper extremity fractures were satisfied with the 3D printed medical cast. The patients found the 3D printed medical cast to be comfortable, safe, easy-to-apply, lightweight, and effective.

The intra- and interobserver reliability of five commonly used intertrochanteric femur fracture classification systems.

OBJECTIVES: This study aims to evaluate the effect of surgical experience on reliability for Boyd-Griffin, Evans/Jensen, Evans, Orthopaedic Trauma Association (main and subgroups), and Tronzo classification systems. PATIENTS AND METHODS: Between January 2013 and December 2014, radiological images of a total of 60 patients (13 males, 47 females; mean age: 78.9±21.9 years; range, 61 to 96 years) with the diagnosis of intertrochanteric femur fracture were analyzed. Radiographs were evaluated and classified by five residents and five orthopedics and traumatology surgeons according to the Evans, Boyd-Griffin, Evans/Jensen, OTA, and Tronzo classification systems. Intra- and interobserver reliability were calculated using the kappa statistics. RESULTS: The worst intraobserver compatibility among the residents was the classification system with OTA subgroups (κ=0.516), while the classification system with the best intraobserver fit was found to be OTA main groups (κ=0.744). The worst agreement among surgeons was in the Evans classification system (κ=0.456). However, the best intraobserver agreement was in the OTA main groups (κ=0.741). The best interobserver agreement was observed regarding the OTA main groups (κ=0.699). CONCLUSION: The classification that has the best harmony both among residents and surgeons, and between residents and surgeons is the OTA main group classification.

Antibacterial Effects of Sodium Borate and Calcium Borate Based Polymeric Coatings for Orthopedic Implants.

Introduction Implants used in orthopedic surgery can be colonized by bacteria that form biofilm layers complicating treatment. We aimed to determine titanium implants' antibacterial and biofilm-degrading properties when coated with sodium borate (NaB) and calcium borate (CaB) minerals. Methods We analyzed twenty-four different implants. Three implants were not coated, three were coated with only a carrier polymer (alginate), and eighteen were coated with either CaB or NaB at different concentrations. The implants were incubated with Staphylococcus aureus, and then the bacterial colonies were enumerated. Results The highest microbial load was observed on the implant coated with alginate (1000 colony-forming units [CFU]/mL). The implant without coating contained a microbial load of 420 CFU/mL. The microbial loads of the implants coated with 0.75 mg/mL CaB or 0.25, 0.5, and 0.75 mg/mL NaB (100, 200, 0, and 0 CFU/mL, respectively) were lower than that of the implant without coating. No biofilm formation was observed on implant surfaces coated with 0.5 mg/mL NaB, 0.75 mg/mL NaB, or 0.75 mg/mL CaB; biofilm formation was observed on the implant without coating and alginate-coated implants surfaces. Conclusion At high concentrations, borate minerals (NaB and CaB) have a potent antibacterial effect on colonization and biofilm formation on the implant surface. These elements may be used in implant coating in the future because of their potential antibacterial effects.

Post-Operative Results of ACL Reconstruction Techniques on Single-Leg Hop Tests in Athletes: Hamstring Autograft vs. Hamstring Grafts Fixed Using Adjustable Cortical Suspension in Both the Femur and Tibia.

Background and Objectives: Anterior cruciate ligament (ACL) tears are common injuries in the athletic population, and accordingly, ACL reconstruction (ACLR) is among the most common orthopedic surgical procedures performed in sports medicine. This study aims to compare the semitendinosus/gracilis (ST/G) and ACL hamstring grafts fixed using adjustable cortical suspension in both the femur and tibia (MAI) ACLR techniques. We aimed to compare the results of single-leg hop tests (SLHT) applied in different directions and limb symmetry indices (LSI) in athletes with a 6-month post-operative ACLR history. Materials and Methods: A retrospective cohort of 39 athletes from various sports branches who underwent MAI (n = 16) and ST/G (n = 23) ACLR techniques by the same surgeon were evaluated. The knee strength of the participants on the operated and non-operated sides was evaluated with five different SLHTs. The SLHT included the single hop for distance (SH), triple hop for distance (TH), crossover triple hop for distance (CH), medial side triple hop for distance (MSTH), and medial rotation (90°) hop for distance (MRH). Results: There was a significant improvement in the mean Lysholm, Tegner, and IKDC scores in the post-operative leg for both techniques (p < 0.05) compared to the pre-operative levels. When there was a difference between the SH of the operative and the non-operative legs in the ST/G technique (p < 0.05), there was no significant difference in the other hop distance for both ST/G and MAI (p > 0.05). There was no difference between the techniques regarding the LSI scores. Conclusions: The fact that our research revealed similar LSI rates of the SLHTs applied in different directions in the ST/G and MAI techniques assumes that the MAI technique can be an ACLR technique which can be functionally used in athletes.

Comparison of extension block pinning technique versus pin orthosis-extension block pinning technique for acute mallet fractures: a prospective randomized clinical trial.

INTRODUCTION: The extension block pinning technique (EBPT) is a popular surgical treatment for mallet fractures; however, it has several drawbacks. The purpose of this randomized clinical trial was to compare EBPT to the pin orthosis-extension block pinning method (PO-EBPT) in the treatment of mallet fractures involving more than one-third of the joint surface but without primary joint dislocation. MATERIALS AND METHODS: Sixty-five patients with mallet fractures were randomized into two groups between June 2017 and January 2020: Group I (33 patients) was treated with EBPT and group II (32 patients) was treated with PO-EBPT. Five patients were lost to follow up due to lack of follow-up and death. There were no significant differences in the clinical and demographic characteristics of both groups. Patients were evaluated according to fracture union, extension lag, distal interphalangeal (DIP) joint range of motion, Crawford's criteria, and complication rates. The patients were followed-up post-operatively at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and annually thereafter. RESULTS: A total of 60 patients were randomized into two groups: one (30 patients) was treated with EBPT and the second (30 patients) with PO-EBPT. There were no significant differences between the two groups in terms of fracture union and active DIP joint flexion (P = 0.743 and P = 0.059, respectively). The mean extension lag of the DIP joint in the EBPT group was significantly greater than the PO-EBPT group (10° ± 9.47° vs. 4.17° ± 7.2°, P = 0.009). According to the Crawford criteria, the PO-EBPT group showed significantly better outcomes (P = 0.005). The complication rates were similar between groups (P = 0.45). CONCLUSION: In comparison to the EBPT technique, the group of patients operated with PO-EBPT had superior clinical outcomes and less loss of extension at the DIP joint according to the Crawford's criteria.