Evaluation of the age and gender related changes in the Blumensaat line.

PURPOSE: The position of the patella according to the femur is very important in the evaluation of patella-femoral joint disorders. In 1938, Blumensaat (BS) described the BS line to evaluate the patella femoral congruence. This method is still valuable in clinical use. There is a limited number of studies demonstrating the accuracy of BS method as well as the affected variables. The aim of this study was to evaluate o the age and gender-related changes in the BS line. METHODS: Standard lateral knee radiography was performed to all patients at 30° flexion. The relationship between the BS line and the patella inferior pole was examined and the variability of the measurements according to gender and age groups was investigated by statistical methods. RESULTS: Ninety-five patients (43 men and 52 women) were enrolled in the study. Mean age of the patients were 43.7 ± 14.1 years (48.2 ± 11.7, 37.9 ± 14.8 in women and men, respectively). The BS line was passed through the inferior pole of the patella in only 2 (2.1%) of 95 patients. There was a statistically significant difference (p = 0.041) between BS measurement and gender which was found to be higher in females than males. There was no statistically significant correlation with this distance between the age groups (r = - 0.216, p = 0.427). CONCLUSION: In our study, it was concluded that BS measurement differs according to gender but did not have any difference between different age groups.

Biomechanical and histological effects of intra-articular hyaluronic acid on anterior cruciate ligament in rats.

BACKGROUND: The histologic and biomechanical effects of intra-articular hyaluronic acid on the anterior cruciate ligaments of rats were investigated. METHODS: Thirty rats were divided into three groups, i.e., the hyaluronic acid group, saline group, and control group. The hyaluronic acid and saline groups received a total of four intra-articular injections, whereas no injection was administered to the control group. The hyaluronic acid group was injected with 50 microg (0.05 cc) hyaluronic acid, and the saline group was injected with 50 microl (0.05 cc) of 0.9% sodium chloride solution. All of the rats were sacrificed on day 29 and the femur-anterior cruciate ligament-tibia complexes from the right knees were prepared, tested mechanically, and evaluated histologically. FINDINGS: The mode of failure involved the midsubstance of the anterior cruciate ligament in all the specimens. There were no statistically significant differences in the stiffness and ultimate load to failure values between the three groups (P>0.05). The energy to failure values were evaluated and there was no statistically significant difference between the groups (P=0.064, chi-square=3.43). In the histologic analyses, there was a significant difference in the hyalinization values between the hyaluronic acid and saline groups (P=0.029) and between the hyaluronic acid group and control groups (P=0.029). INTERPRETATION: The present study shows that intra-articularly delivered hyaluronic acid has no statistically significant effect on the tensile strength of the rat anterior cruciate ligament. Although hyalinization was increased, no difference was found on the other markers for degenerative changes. We conclude that intra-articular hyaluronic acid injections can be performed safely, although the use of a precise injection technique is recommended.

[The use of local anesthesia in endoscopic release of the carpal tunnel]. / Endoskopik karpal tünel cerrahisinde lokal anestezi teknigi.

OBJECTIVES: We evaluated the early results of endoscopic carpal tunnel release with the use of local anesthesia. METHODS: Endoscopic carpal tunnel release was performed in 14 hands of 10 patients (8 females, 2 males; mean age 43 years; range 35 to 58 years) using the two-portal Chow technique following local anesthesia described by Wood and Logan. Involvement was in the right hand in five patients, in the left in three, and in both hands in two patients. Electromyography showed moderate or severe compression of the median nerve in the carpal tunnel and the Tinel's and Phalen's signs were positive in all the patients. There was no previous history of metabolic diseases such as diabetes mellitus, gout, or hypothyroidism, nor a coexisting pregnancy. The decision for surgery was given at the end of an unsuccessful conservative treatment for a month. The mean follow-up period was 16 months (range 10 to 24 months). RESULTS: Two patients (14.3%) required further anesthesia with local anesthetic agents and sedation in the incision area. No complaints of paresthesia were seen during injections. Injection-associated problems such as increased thickness of the synovial layer or decreased endoscopic view did not occur. No instances of tendon or nerve injury, hematoma, or sympathetic dystrophy were seen. One patient developed neuropraxia in the third and forth fingers postoperatively. Early postoperative pain was observed in two wrists, appearing 10 days and two months after surgery, respectively. During the follow-up period, all the patients were free of preoperative complaints and no recurrences were encountered. CONCLUSION: Local anesthesia is a rapid and reliable technique in carpal tunnel surgery, enabling hospitalization confined to the same day.

[Avulsion fracture of the anterior superior iliac spine in a volleyball player]. / Amatör voleybol oyuncusunda anterior superior iliak spine avulsiyon kirigi.

Avulsion fractures of the apophyses of the pelvis rarely occur in adolescent athletes as a result of sudden and strong contraction of the muscles attached to the growth cartilage. We present a 16-year-old male patient who had an avulsion fracture of the left anterior superior iliac spine while he was playing volleyball. He presented with complaints of pain in the left hip and difficulty in walking. The diagnosis was made by means of pelvis x-rays, computed tomography, and three-phase radionuclide bone imaging. He underwent conservative treatment with a non-steroidal anti-inflammatory drug and bed rest. After two weeks, ambulation with crutches was allowed. At the end of four weeks, he was able to walk without crutches. He returned to his preinjury level of sports activities at the end of six weeks, without any complaint of pain.