Evaluation of the relationship between the anatomical characteristics of the vastus medialis obliquus muscle and the patella chondral lesion occurrence.

OBJECTIVES: The study aims to investigate the relationship between the vastus medialis obliquus (VMO) muscle distal insertion features and patellar chondral lesion presence. PATIENTS AND METHODS: This cross-sectional study included a total of 100 patients (18 males, 82 females, mean age 67.2±7.1 years; range, 50 to 86 years) who underwent total knee arthroplasty (TKA). Radiological assessments, including merchant view and standing orthoroentgenograms, were conducted. The current osteoarthritis stage, varus angle, quadriceps angle (Q angle), patella-patellar tendon angle (P-PT angle), congruence angle, and sulcus angle were calculated. The VMO tendon length, muscle fiber angle, tendon insertion width measurements, and patellar chondral lesion localization data were obtained intraoperatively. Grouping was done according to the distal insertion width of the VMO tendon to the medial edge of the patella. The medial rim of the patella was divided into three equal-sized sectors. The first group (Group 1, n=31) consisted of patients who had an insertion from the quadriceps tendon into the upper one-third of the patella. The second group (Group 1, n=48) consisted of patients with a distal insertion expanding into the middle one-third of the patella. The third group (Group 3, n=21) consisted of patients who had a distal insertion extending into the distal third region of the medial patella margin. The patella joint surface was divided into sectors, and the presence and location of cartilage lesions were noted in detail. RESULTS: The mean tendon insertion width rate was 45.99±16.886% (range, 16.7 to 83.3%). The mean muscle fiber insertion angle was 51.85±11.67º (range, 20º to 80º). The mean tendon length was 12.45±3.289 (range, 4 to 20) mm. There was no significant difference between the mean age, weight, height, body mass index, BMI, fiber angle, tendon length, varus angle, Q angle, sulcus angle, and congruence angle data among the groups. In terms of the P-PT angle, Groups 1 and 2 had a significant relationship (p=0.008). No relationship was found between the mean fiber insertion angle, mean tendon length, or the presence of chondral lesions. There was a statistically significant difference among the groups regarding the presence of chondral lesions. The highest percentage of chondral lesion frequency was observed in Group 3 (95.24%), followed by Group 1 (90.3%) and Group 2 (89.6%), respectively. Compared to the other two groups, Group 3 had a higher average ratio of lesion areas per patient. CONCLUSION: Our study results demonstrate that the formation and localization of the patellar chondral lesions are affected by the insertion width type of the VMO muscle into the patella. Group 2-type insertion is associated with a lower lesion frequency rate than Groups 1 and 3.

Immediate Effect of Kinesiology Tape on Functionality, Static and Dynamic Balance, Exercise Capacity, and Posture in Users of High-Heeled Shoes.

BACKGROUND: Using high-heeled shoes in daily life affects the stability of walking, body posture, and functionality. We aimed to determine the immediate effect of kinesiology taping (KT) on functionality, static and dynamic balance, exercise capacity, and posture in young women using high-heeled shoes. METHODS: Thirty-seven women who wore high-heeled shoes (mean ± SD age, 20.32 ± 1.37 years) were divided into control (n = 20) and study (n = 17) groups. Both limbs of study group participants were taped medially, laterally, and dorsally with KT; no application was made to the control group. Balance (TecnoBody postural line), functionality (vertical jump and functional reach tests), exercise capacity (6-Minute Walk Test), and human body posture (New York Posture Rating Chart) were assessed. RESULTS: Median use of high-heeled shoes was 8 hours daily, 5 days weekly, and 3 years in the study group versus 6 hours daily, 4 days weekly, and 4 years in the control group. Significance in functional reach distance was found within the control (P = .010) and study (P = .005) groups but not between the groups. Stabilometric monopedal right foot ellipse area (P = .016) and perimeter (P = .009); left foot ellipse area (P = .016), perimeter (P = .023), and front/back standard deviation (P = .018); and dynamic balance area gap percentage (P = .030) were significant within the study group. Posture, vertical jump distance, exercise capacity, stabilometric test results, and bipedal closed-eye and opened-eye results were similar within and between groups (P > .05). CONCLUSIONS: Kinesiology taping has no immediate effect on exercise capacity, vertical jump function, posture, and bipedal static balance but can modulate functional reach function, static monopedal leg balance, and dynamic equilibrium. Further studies are recommended to investigate the additive effect of KT with high-heeled shoes and after 45 min, 24 hours, and 72 hours.

Does Total Knee Arthroplasty Positively Affect Body Static-Dynamic Balance and Fall Risk Parameters in Patients With Satisfactory Functional Scores?

Objective The aim of this study was to determine the balance problems and risk of falling by using digital or computerized methods in patients who underwent total knee arthroplasty (TKA) and have satisfactory functional scores in the early postoperative period. Methodology A total of 31 participants (24 women, seven men; mean age: 61.93 ±10.75 years; range: 49-82 years) who underwent unilateral TKA were included. The fall risk was evaluated using the time up-and-go (TUG) test and computerized platforms. Patient-reported pain, stiffness, and physical functional outcome measures [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford Knee Score (OKS)] and posture (New York Posture Rating Chart) were evaluated. Results Based on the WOMAC scores, there was a significant impact on self-reported pain (p˂0.001), function (p=0.001), and stiffness (p=0.001) between preoperative and postoperative results. The OKS (p=0.006) and the TUG score (p=0.004) improved significantly, but the posture scores remained the same after the surgery. There was a statistically significant difference between the preoperative and third-month postoperative test results of the stabilometric test, bipedal opened eye, bipedal closed eye, monopedal right, and monopedal left foot static balance tests (p˂0.05). However, the disequilibrium and equilibrium dynamic balance values ​​remained unchanged three months after TKA. Conclusions Satisfactory functional scores according to WOMAC or OKS were achieved in the early postoperative period. However, posture and dynamic balance problems related to falling risk continued to persist in the same period. Although the TUG test results were statistically significant, they also showed fall risk values. Fall risk and postural problems should be analyzed objectively using computerized methods. Early rehabilitation programs after TKA in elderly individuals should be designed accordingly and close attention must be paid to fall risks.

Endoscopy-assisted distal locking of an intramedullary nail: A new experimental technique to reduce radiation exposure during distal locking of the intramedullary nails.

OBJECTIVES: In this study, we aimed to introduce a new technique in which distal locking step was easier and safer for orthopedic trauma surgeons involving in the treatment of long bone fractures using an intranail endoscopic visualization and illumination method. MATERIALS AND METHODS: A total of 20 fresh bovine hind limbs derived from healthy adults and killed for sale were dissected to obtain tibial bones. Two equal groups including 10 samples in each were prepared. We applied a standard nailing process in both groups: the study group (n=10) was locked by the new technique, intranail endoscopic illumination guidance and intranail visualization assistance locking technique and the control group (n=10) was locked by the classical free-hand fluoroscopic guidance technique. We measured the surgical period time and the radiation exposure time required for the distal locking in both groups. RESULTS: The radiation exposure time was statistically significantly lower in the study group compared to the control group. Also, the time period required for distal locking in the study group were statistically significantly lower than the control group. With the use of the intranail endoscopic illumination guidance and visualization assistance technique, the median period time required for the distal locking procedure reduced from 477.5 to 223.5 sec (p<0.001). The median time for radiation exposure dramatically reduced from 13.5 to 2 sec (p<0.001). The median attempt number reduced from 6.5 to 2 times (p<0.001). CONCLUSION: This experimental study indicates that the endoscopic illumination and intranail visualization assistance technique can reduce the radiation exposure time and the period time required for distal locking compared to the free-hand fluoroscopic guidance.

Treatment of secondary hip arthritis from shell fragment and gunshot injury in the Syrian civil war.

BACKGROUND: In gunshot and shell fragment injuries to the hip joint, orthopedic intervention includes wound assessment and care, osteosynthesis of fractures, and avoiding of infection and osteoarthritis. Individuals injured in the Syrian civil war were frequently transferred to the authors' institution in neighboring city. Orthopedic trauma exposures were determined in approximately 30% of these patients. The aim of this study was to evaluate the outcomes of the patients with secondary hip arthritis due to prior gunshot and shell fragment (shrapnel) injuries who underwent primary total hip arthroplasty. METHODS: This retrospective study reviewed 26 patients (24 males, 2 females) who underwent hip arthroplasty due to prior gunshot and shell fragment injuries from November 2013 to January 2019. For all patients, the Harris Hip Score (HHS) was evaluated preoperatively and after surgery. RESULTS: Mean age was 31.5 (range, 19-48) years. The mean preoperative HHS was 52.95 points, and the mean postoperative HHS was 79.92 points at the final follow-up after surgery. Patients with shell fragment injuries to the hip joint had higher infection rates, but it is not statistically significant. CONCLUSIONS: An anatomic reduction of the fracture may not be possible in these cases as a result of significant bone and/or cartilage loss. Total hip arthroplasty can be done after gunshot- and shell fragment-related posttraumatic arthritis. It is an effective treatment choice to reduce pain and improve function, but the surgeon must be very careful because of high rate of infection.