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.

Effect of Boron on the Repair of Osteochondral Defect and Oxidative Stress in Rats: an Experimental Study.

The aim of this study was to investigate the effect of boron on the repair of osteochondral defect and also on some antioxidant and oxidant parameters of both cartilage tissue and blood. A total of 24 adult male Wistar rats weighing between 350 and 400 g were used in the study. Animals were randomly divided into control (n = 8), boron (n = 8) and hyaluronic acid (HA) groups (n = 8). Under general anesthesia, a cylindrical full-thickness osteochondral defect 1.5 mm in diameter and 2 mm in depth was formed using a drill on the anterior side of the articular surface of the femur condyle. Boron group received 0.1 ml (10 mg/kg) of boron and HA group received 0.1 ml of HA, whereas control group received 0.1 ml of physiological saline solution. All agents administered intraarticular route and once a week for four times. At the end of the third month, the animals were euthanized and blood and joint tissue malondialdehyde (MDA), glutathione (GSH), superoxide dismutase (SOD), and catalase levels were measured. Defected femoral condyles of the rats were removed for a histopathological examination. Histopathology revealed that the total cartilage repair score of the HA group was better than those detected in boron and control groups. Blood and articular cartilage GSH, SOD, and catalase levels were higher in the boron and HA groups as compared to the control group, while MDA level was lower compared to the control group. In conclusion, it was suggested that boron was not as effective as HA in the repair of osteochondral defect, but its antioxidant property was superior to HA.

Comparison of the effects of gabapentin and pregabalin on wound healing in rats.

Gabapentinoids are effective adjunct drugs for reducing postoperative pain. However, the effects of gabapentinoids on wound healing have not been evaluated yet. In this study we evaluated their effects on wound healing. A total of 17 male Wistar-Albino rats, 250-350 g, were divided into three groups randomly: control group (n = 5, 2 ml saline), gabapentin group (n = 6, 20 mg/kg gabapentin) and pregabalin group (n = 6, 20 mg/kg pregabalin). Until day 13 inflammation scores were significantly lower (P < 0·05) and wound healing was significantly better in the control group when compared with gabapentin and pregabalin groups (P < 0·001). Inflammation scores were significantly lower in pregabalin group when compared with gabapentin group until day 13. But wound healing was significantly better in gabapentin group than in pregabalin group between days 13 and 21. In conclusion when gabapentin and pregabalin were compared, although pregabalin decreases inflammation scores, gabapentin has better results in wound healing.

The determination of histopathological and biochemical effects of the rabbit knee joint injected dexketoprofen trometamol.

This study was conducted to investigate possible histopathological effects and biochemical reflections of intra-articular dexketoprofen trometamol. A total of 24 New Zealand rabbits were included in the study. Blood sampling was carried out from all animals on the first day, then they were randomly allocated either to the control group (Group C, n = 9) or the dexketoprofen trometamol group (Group D, n = 15). Group C underwent each two intra-articular injections of saline, 0.25 mL into right and 0.50 mL into left knee. Group D was injected 0.25 mL (6.25 mg) dexketoprofen trometamol into the right knee and 0.50 mL (12.5 mg) into the left. The groups were divided randomly into three. Tissue and blood samples were collected from Groups C1 and D1 on the first day, C2 and D2 on the second day and C3 and D3 on the 10th day of the study. Interleukin-1 (IL-1ß), interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-α) and C-reactive protein (CRP) levels were studied. The histopathological examination of C and D groups did not present any deterioration. IL-6 basal levels were significantly higher in Group D2 compared with C2 and C3 compared with D3. Basal TNF-α levels were higher compared with day 1 in Group C1, and IL-6 and CRP levels were higher in Group D3. Also, none of the increases in these values are supported by histopathological evaluation results. Consequently, we suppose that dexketoprofen trometamol does not cause histopathological deterioration in articular cartilage of rabbits, and the increases in biochemical parameters exclusively are not clinically significant.

Investigation of effects of levobupivacaine injection to rabbit knee joint on histopathologic changes of joint cartilage tissue and changes of serum biochemical parameters.

The aim of this study is to evaluate the effects of intra-articular levobupivacaine on rabbit knee articular cartilage and certain biochemical parameters in the blood. A total of 24 New Zealand rabbits were included to study. Blood sampling was carried out in all animals on the first day, then the subjects were randomly allocated either to the control group (Group C, n = 9) or to the levobupivacaine group (Group L, n = 15). Group C underwent each two intra-articular injections of saline, 0.25 mL into the right knee and 0.50 mL into the left one. Group L was injected 0.25 mL (1.25 mg) of levobupivacaine into the right knee and 0.50 mL (2.5 mg) into the left one. The groups were divided randomly into three. Tissue and blood samples for histologic and biochemical examination were collected from Groups C1 and L1 on the first, C2 and L2 on the second, and C3 and L3 on the tenth day of the study. Interleukin-1ß (IL-1 ß), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP) levels were analyzed. No statistically significant differences could be detected when comparing either left or right joints within the same groups and with Group C and L (P > 0.05). Significant elevations of biochemical parameters were found in Group C. It is concluded that levobupivacaine does not lead to significant histologic changes in rabbit articular cartilage. Significant elevations of biochemical parameters being generally found in the C Group, it is thought that such elevations are not linked to levobupivacaine. Intra-articular levobupivacaine may be a safe alternative for use in post-operative analgesia.

Glove perforation time and frequency in total hip arthroplasty procedures.

OBJECTIVE: The aim of the present study was to investigate glove perforation rate and time and evaluate the factors affecting glove perforation in total hip arthroplasty (THA). METHODS: Nine hundred seventy-nine gloves used in 57 THA procedures were assessed according to the perforation. Forty-four (77.2%) procedures were primary THA and 13 (22.8%) were revision THA. Gloves were changed when perforated, become dirty with blood or blood products, and before bone cementing. All gloves were filled with water at the end of the operation and controlled for perforation. Two hundred and one surgical gloves used during scrubbing and removed after draping the patient were examined as the control group. The location (which finger), number and time of the perforation, surgery type and duration, and distribution of the perforation location according to the surgical team were assessed. RESULTS: Patients' mean age was 62.9 ± 14.6 (range: 33 to 97) years and the mean surgery duration was 162.9 ± 32.0 minutes. Thirty-two glove perforations were noted in 19 of the operations. Of these perforations, 28 belonged to the surgeons and first assistants. There was no significant difference between the dominant or non-dominant hand according to the location of perforations. Perforations in the first and second fingers of the gloves accounted for 81.3% of all perforations. There was no significant difference in terms of number of gloves used, perforation numbers and operation duration between the primary and revision THA procedures. Two perforated gloves (0.99%) were found in the control group and the difference between the number of perforations in the control and study groups was significant (p=0.048). CONCLUSION: We recommend the use of two pairs of gloves to avoid the risk of contamination and protect the surgical team from infectious disease in major surgeries like THA. Surgical gloves should be changed when they are excessively contaminated with surgical fluids and the surgeon and first assistant should also change their outer gloves at an average of every 90 minutes.

[A comparison between three irrigation methods in the debridement of contaminated bovine cancellous bone and the effect of duration of irrigation on the efficiency of debridement]. / Kirletilmis dana spongiöz kemiginin debridmaninda üç yikama yönteminin karsilastirilmasi ve yikama süresinin debridman üzerine etkisi.

OBJECTIVES: Irrigation and debridement constitute an important part of treatment of open fractures. We investigated the efficiency of different irrigation methods and durations in cleansing contaminated bovine femur cancellous bone samples and the extent of tissue damage associated with irrigation. METHODS: A total of 72 samples of 4x4x1 cm size were obtained from fresh frozen bovine distal femoral cancellous bone. The top surface of the samples were sawed to a 2-mm depth to create four squares equal in size. All the samples were contaminated with construction sand using the same method and were then randomized to three irrigation groups (bulb syringe irrigation, high-pressure pulsatile lavage, and low-pressure pulsatile lavage), each consisting of 24 samples. The duration of irrigation was set as 3, 6, or 9 minutes for every eight samples of each group. After the irrigation procedure, the images were transferred to a computer screen with a video-microscope camera and the number of sand particles on the samples were counted and irrigation-related macroscopic bone damage was assessed. RESULTS: The lowest number of sand particles was found on the samples irrigated by high-pressure pulsatile lavage (p<0.001). The duration of irrigation did not affect the efficiency of cleansing in all the groups (p>0.05). The least irrigation-related bone damage was observed in samples irrigated by low-pressure pulsatile lavage for 3 minutes (p<0.01). The amount of bone damage was similar in all groups after irrigations beyond 3 minutes (p>0.05). CONCLUSION: Our findings showed that the most efficient method of cleansing contaminated bone samples was high-pressure pulsatile lavage and that prolonged irrigations did not enhance the efficiency of the irrigation method; however, high-pressure irrigation of 3 minute duration resulted in the greatest bone damage.