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1.
Knee Surg Sports Traumatol Arthrosc ; 31(4): 1334-1346, 2023 Apr.
Article in English | MEDLINE | ID: mdl-35552475

ABSTRACT

PURPOSE: An anatomo-functional implant positioning (AFIP) technique in total knee arthroplasty (TKA) could restore physiological ligament balance (symmetric gap in extension, asymmetric gap in flexion). The purposes were to compare (1) ligament balancing in extension and flexion after TKA in the AFIP group, (2) TKA alignment, implant positioning and patellar tracking between AFIP and adjusted mechanical alignment (aMA) techniques, (3) clinical outcomes between both groups at 12 months. METHODS: All robotic-assisted TKA with an AFIP technique were included (n = 40). Exclusion criteria were genu valgum (HKA angle > 183°), extra-articular deformity more than 10°, and patellar maltracking (high-grade J-sign). One control patient with a TKA implanted by an aMA technique was matched for each case, based on age, body mass index, sex, and knee alignment. Ligament balancing (medial and lateral gaps in millimeters) in full extension and at 90° of flexion after TKA in the AFIP group was assessed with the robotic system. TKA alignment (HKA angle), implants positioning (femoral and tibial coronal axis, tibial slope, joint-line orientation), patellar tracking (patellar tilt and translation) and the Knee Society Score (KSS) at 6 and 12 months were compared between both groups. The ligament balancing was compared using a t test for paired samples in the AFIP group. The radiographic measurements and KSS scores were compared between groups using a t test for independent samples. RESULTS: In the AFIP group, there was no significant difference between the medial and lateral gap laxity in extension (NS). A significant opening of the lateral gap was observed in flexion compared to extension (mean: + 2.9 mm; p < 0.0001). The mean postoperative HKA angle was comparable between both groups (177.3° ± 2.1 in the AFIP group vs 176.8° ± 3.2; NS). In the AFIP group, the femoral anatomy was restored (90.9° ± 1.6) and the tibial varus was partially corrected (87.4° ± 1.8). The improvement of Knee and Function KSS at 6 months was better in the AFIP group (59.3 ± 11.9 and 51.7 ± 20, respectively, versus 49.3 ± 9.7 and 20.8 ± 13; p < 0.001). CONCLUSION: The AFIP concept allowed the restoration of the native knee alignment and a natural functional ligament pattern. With a more physiological target for ligament balancing, the AFIP technique had equivalent clinical outcomes at 12 months compared to aMA, with a faster recovery. LEVEL OF EVIDENCE: III retrospective therapeutic case control series.


Subject(s)
Arthroplasty, Replacement, Knee , Knee Prosthesis , Osteoarthritis, Knee , Robotic Surgical Procedures , Humans , Arthroplasty, Replacement, Knee/methods , Robotic Surgical Procedures/methods , Retrospective Studies , Osteoarthritis, Knee/surgery , Knee Joint/surgery , Ligaments/surgery , Range of Motion, Articular/physiology
2.
Am J Sports Med ; 50(5): 1399-1408, 2022 04.
Article in English | MEDLINE | ID: mdl-35354059

ABSTRACT

BACKGROUND: Various cell-free scaffolds are already in use for the treatment of osteochondral defects (OCDs); however, a gold standard material has not yet been defined. PURPOSE: This study compared the macroscopic, histological, and scanning electron microscopy (SEM) characteristics of Chondro-Gide (CG), MaioRegen (MA), and poly-d,l-lactide-co-caprolactone (PLCL) cell-free scaffolds enhanced with small-diameter microfractures (SDMs) for OCDs in a rabbit model. STUDY DESIGN: Controlled laboratory study. METHODS: In total, 54 knees from 27 rabbits were used in this study. Three rabbits were sacrificed at the beginning of the study to form an intact cartilage control group (group IC). An OCD model was created at the center of the trochlea, and SDMs were generated in 24 rabbits. Rabbits with OCDs were divided into 4 groups (n = 12 knees per group) according to the cell-free scaffold applied: CG (group CG), MA (group MA), PLCL (group PLCL), and a control group (group SDM). Half of the rabbits were sacrificed at 1 month after treatment, while the other half were sacrificed at 3 months after treatment. Healed cartilage was evaluated macroscopically (using International Cartilage Regeneration & Joint Preservation Society [ICRS] classification criteria) and histopathologically (using modified O'Driscoll scores and collagen staining). Additionally, cell-free scaffold morphologies were compared using SEM analysis. RESULTS: ICRS and modified O'Driscoll classification and staining with collagen type 1 and type 2 demonstrated significant differences among groups at both 1 and 3 months after treatment (P < .05). The histological characteristics of the group IC samples were superior to those of all other groups, except group PLCL, at 3 months after treatment (P < .05). In addition, the histological properties of group PLCL samples were superior to those of group SDM samples at both 1 and 3 months after treatment in terms of the modified O'Driscoll scores and type 1 collagen staining (P < .05). Concerning type 2 collagen staining intensity, the groups were ranked from highest to lowest at 3 months after treatment as follows: group PLCL (30.3 ± 2.6) > group MA (26.6 ± 1.2) > group CG (23.3 ± 2.3) > group SDM (18.9 ± 0.9). CONCLUSION: OCDs treated with enhanced SDM using cell-free PLCL scaffolds had superior histopathological and microenvironmental properties, more hyaline cartilage, and more type 2 collagen compared with those treated using CG or MA scaffolds. CLINICAL RELEVANCE: OCDs treated with PLCL cell-free scaffolds may have superior histopathological properties and contain more type 2 collagen than do OCDs treated with CG or MA cell-free scaffolds.


Subject(s)
Cartilage, Articular , Animals , Cartilage, Articular/surgery , Collagen , Collagen Type I , Humans , Hyaline Cartilage , Rabbits , Tissue Scaffolds
3.
J Shoulder Elbow Surg ; 31(3): e85-e91, 2022 Mar.
Article in English | MEDLINE | ID: mdl-34474136

ABSTRACT

BACKGROUND: Although middle glenohumeral ligament (MGHL) variations have been shown in the literature, their clinical effect and relationship with intra-articular pathologies have yet to be revealed, except for the Buford complex. This study was designed to classify MGHL and to reveal its relationship with clinical pathologies. METHODS: A total of 843 consecutive shoulder arthroscopies were evaluated retrospectively, and a classification system was proposed for MGHL with regard to its structure and its relation to the anterior labrum. The associations of each MGHL type with superior labrum anterior-posterior (SLAP) lesions, subscapularis tears, and anterior instability were investigated. RESULTS: MGHL variations were grouped into 6 types according to the classification. A significant difference in favor of type 6 MGHL (Buford complex) was observed in the distribution of SLAP lesions (P < .001). There was no significant difference between MGHL types and the distribution of anterior instability history (P = .131) and subscapularis tears (P = .324). CONCLUSION: SLAP lesions accompany type 6 MGHLs (Buford complex) significantly more frequently than other types. There is also a negative relation between the anterior instability and thicker MGHL variants.


Subject(s)
Joint Instability , Shoulder Injuries , Shoulder Joint , Arthroscopy , Humans , Joint Instability/surgery , Ligaments, Articular/surgery , Retrospective Studies , Rotator Cuff , Shoulder Joint/surgery
4.
Int J Clin Pract ; 75(12): e14948, 2021 Dec.
Article in English | MEDLINE | ID: mdl-34614288

ABSTRACT

BACKGROUND/AIM: The aim of this study was to evaluate the effects of general anaesthesia and ultrasonography-guided interscalene block on pain and oxidative stress evaluated by thiol-disulphide balance and C-reactive protein levels in patients undergoing shoulder arthroscopy. MATERIALS AND METHODS: A total of 42 patients aged 18-75 years who were scheduled to undergo shoulder arthroscopy were randomised into interscalene block group (Group-IB, n = 20) and general anaesthesia group (Group-GA, n = 22). All patients received patient-controlled analgesia during the postoperative period. Additional analgesics were administered to patients with a visual analogue scale score of >4. Native-thiol, total-thiol, disulphide and C-reactive protein levels were measured. Patients' visual analogue scale scores, morphine and additional analgesic consumption were recorded. A shift in thiol-disulphide balance towards decreased thiol and increased disulphide levels was regarded as an indicator of oxidative stress. RESULTS: Pain level, morphine and additional analgesic consumption were higher in Group-GA. Native-thiol and total-thiol levels were higher in Group-IB postoperatively and also disulphide levels were lower at postoperative 18 hours. C-reactive protein levels were similar in both the groups. CONCLUSION: Interscalene block induced less oxidative stress during the postoperative period, as evaluated by thiol-disulphide balance. In shoulder arthroscopy, interscalene block provides more stable haemodynamics perioperatively and facilitates better postoperative pain control.


Subject(s)
Arthroscopy , Shoulder , Anesthesia, General , Humans , Oxidative Stress , Pain, Postoperative/prevention & control , Shoulder/surgery , Ultrasonography
5.
J Shoulder Elbow Surg ; 30(7): 1561-1571, 2021 Jul.
Article in English | MEDLINE | ID: mdl-33675971

ABSTRACT

BACKGROUND: The treatment of massive, irreparable rotator cuff tears remains controversial today because there is no consensus on the ideal treatment option. This investigation aimed to prospectively evaluate and compare the outcomes of arthroscopy-assisted latissimus dorsi transfer and superior capsular reconstruction in the treatment of massive, irreparable rotator cuff tears. METHODS: Forty-two patients at an average age of 62.8 years with massive, irreparable rotator cuff tears were randomized into 2 treatment groups. Twenty-one patients underwent arthroscopy-assisted latissimus dorsi tendon transfer (LDT), and 21 patients underwent arthroscopy-assisted superior capsular reconstruction (SCR). The patients were followed up prospectively for 31 months on average. One patient in the SCR group was lost to follow-up. The outcomes were evaluated with American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Western Ontario Rotator Cuff Index (WORC), visual analog scale (VAS), and Constant scores clinically and with acromiohumeral distance (AHD) measurements radiologically. RESULTS: Both groups displayed improved results in ASES, WORC, Constant, and VAS scores in the final follow-up (P < .001). The LDT group had significantly better results in AHD (P = .006), whereas the SCR group yielded significantly higher improvements in ASES (P = .007) and Constant (P = .008) scores. The rate of successful pseudoparalysis treatment was 45% (5/11) in the LDT group and 92% (12/13) in the SCR group (P = .011). The graft failure rate was 5% (1 patient) in each group postoperatively; 1 patient in the SCR group had a traumatic graft rupture and 1 patient in the LDT group was complicated with septic arthritis, which required graft removal. CONCLUSION: Both SCR and LDT yielded promising short-term results in treatment of massive, irreparable rotator cuff tears in this study. The SCR group displayed better overall outcomes clinically, particularly in the pseudoparalytic shoulders, whereas the LDT group displayed better radiologic results.


Subject(s)
Rotator Cuff Injuries , Shoulder Joint , Superficial Back Muscles , Arthroscopy , Humans , Middle Aged , Ontario , Prospective Studies , Range of Motion, Articular , Rotator Cuff , Rotator Cuff Injuries/surgery , Shoulder Joint/surgery , Tendon Transfer , Treatment Outcome
6.
Orthop J Sports Med ; 7(6): 2325967119853507, 2019 Jun.
Article in English | MEDLINE | ID: mdl-31276003

ABSTRACT

BACKGROUND: Being able to predict recurrence after the treatment of shoulder instability would be helpful in planning the appropriate treatment. PURPOSE: To define the multiple subscapularis tendon sign (MSTS) as a novel anatomic variant and a possible risk factor for the recurrence of shoulder instability after anterior stabilization and to evaluate it, together with the other risk factors as described in the literature. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A total of 87 patients met the study criteria and underwent arthroscopic stabilization for anterior shoulder instability. The MSTS was evaluated in this study group. Age, sex, hand dominance, number of preoperative shoulder dislocations, history of overhead or contact sports participation, type of labral lesion, number of anchors used in surgery, presence of the drive-through sign, presence of the MSTS, Oxford Shoulder Score results, and the association of these parameters with recurrence were assessed. The mean follow-up time was 81.0 ± 27.9 months (range, 48-139 months). RESULTS: Nine (10.3%) patients experienced recurrent instability. The presence of the MSTS (P = .009), existence of an anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion (P = .04), and history of overhead or contact sports participation (P = .04) were significant risk factors for recurrence. The recurrence rates were as follows: 30.7% with the MSTS; 40% with the MSTS and an ALPSA lesion; and 75% with the MSTS, an ALPSA lesion, and a history of overhead or contact sports participation. CONCLUSION: The MSTS is a variation of the anterior shoulder joint capsule. It is a sign of capsular insufficiency or thinning, which may be a risk factor for recurrence after anterior stabilization. Considering the low success rates of anterior capsulolabral repair in patients participating in overhead or contact sports, especially when an ALPSA lesion is present, encountering the MSTS during surgery in this at-risk group may be an indicator for the surgeon to choose the surgical procedure more carefully.

7.
J Orthop Surg (Hong Kong) ; 27(2): 2309499019856389, 2019.
Article in English | MEDLINE | ID: mdl-31234725

ABSTRACT

OBJECTIVES: The aim of this study was to determine whether erythropoietin (EPO) can enhance rotator cuff healing in rats as measured by histological analysis and biomechanical testing. METHODS: A total of 72 rats were included in this study. In the control group (n = 24), repair was performed without EPO injection. In the local group (n = 24) EPO was injected in the repair site. In the systemic group (n = 24) EPO was administered as an intraperitoneal injection every day for 10 days after repair. Rats were euthanized on day 10 (n = 12 from each group) and day 28 (n = 12 from each group). Histopathological (n = 6) and biomechanical examinations (n = 6) were done. RESULTS: Biomechanical results reveal that the maximum load to failure values of the early control group were statistically lower than those of the early systemic group (p = 0.006). Comparing the the total Bonar values histopathologically reveal that the early systemic group was statistically higher than those of the early local group (p = 0.043). The late control group was statistically higher than those of the late local group (p = 0.003) and the late systemic group (p = 0.034). The late systemic group was statistically higher than those of the late local group (p = 0.003). CONCLUSIONS: EPO application had a positive effect biomechanically in the early euthanized group and histopathologically in the late euthanized group.


Subject(s)
Arthroscopy/methods , Erythropoietin/pharmacology , Rotator Cuff Injuries/surgery , Rotator Cuff/surgery , Wound Healing/drug effects , Animals , Biomechanical Phenomena , Disease Models, Animal , Female , Rats , Rats, Wistar , Rotator Cuff/physiopathology , Rotator Cuff Injuries/physiopathology
8.
Arthroscopy ; 33(5): 929-937, 2017 May.
Article in English | MEDLINE | ID: mdl-28024870

ABSTRACT

PURPOSE: To describe a modified technique for arthroscopic-assisted transfer of the latissimus dorsi tendon in a selected group of patients with irreparable rotator cuff tears and pseudoparalysis and to evaluate its short-term results. METHODS: Fifteen patients with irreparable rotator cuff tears and pseudoparalysis treated by arthroscopic-assisted latissimus dorsi tendon transfer were included. The mean patient age was 61.53 ± 6.24 years (range, 52-71 years). Patients were assessed with physical examination, University of California Los Angeles (UCLA) Score and Constant-Murley score, as well as visual analog scale score at a mean follow-up of 26.4 ± 2.58 months (range, 24-31 months). RESULTS: At final follow-up, mean UCLA score increased to 27.47 ± 6.31 compared with the preoperative UCLA score of 6.53 ± 2.1 (P < .001). Constant-Murley score was 21 ± 7.41 and 59.73 ± 13.62 (P < .001), visual analog scale pain score was 7.47 ± 1.06 and 2.47 ± 0.91 (P < .001), active forward flexion was 58° ± 21.11° and 130° ± 30.05° (P < .001), active abduction was 51° ± 21.64° and 129.67° ± 25.45° (P < .001), and active external rotation was 13.33° ± 21.68° and 32° ± 18.03° (P < .001) preoperatively and postoperatively, respectively. Mean acromiohumeral distance was 3.13 ± 1.40 mm preoperatively, whereas it was 5.67 ± 1.67 mm postoperatively (P < .001). No significant complications requiring a revision surgery was observed during the final follow-up. CONCLUSIONS: The modified technique of arthroscopic-assisted transfer of the latissimus dorsi tendon is a feasible, minimally invasive option for the surgical treatment of irreparable rotator cuff tears in a subset of patients with pseudoparalysis. LEVEL OF EVIDENCE: Level IV, therapeutic case series.


Subject(s)
Rotator Cuff Injuries/surgery , Rotator Cuff/surgery , Superficial Back Muscles/surgery , Tendon Transfer/methods , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Paralysis/surgery , Postoperative Period , Range of Motion, Articular , Rotation , Rotator Cuff Injuries/therapy , Severity of Illness Index , Treatment Outcome
9.
Acta Orthop Belg ; 81(2): 240-4, 2015 Jun.
Article in English | MEDLINE | ID: mdl-26280962

ABSTRACT

BACKGROUND: To evaluate the relationship of the intercondylar notch width with unilateral and bilateral ACL injury by using MR images. MATERIAL AND METHODS: The intercondylar notch width index was measured on the MR images of 18 patients with a bilateral ACL injury, 38 patients with a unilateral ACL injury and 53 healthy subjects with a normal ACL and the results of all groups were compared with each other. RESULTS: The mean NWI values were 0,227 (±0.008) in bilateral injured; 0,245 (±0.009) in unilateral injured and 0,272 (±0.01) in control groups and 0,251(±0.01) in unaffected side of the unilateral group. There were statistically significant differences in intercondylar notch width index (NWI) values between all groups and there was a significant difference between the affected and the unaffected sides in group with unilateral ACL injury. A cutoff value of 0.25 for NWI gave an odds ratio of 26.5 for bilateral and 3.23 for unilateral ACL injuries. CONCLUSIONS: The finding that NWI is significantly narrowed in patients with bilateral and unilateral ACL tears compared with the healthy controls suggest a relationship between a narrow NWI and an increased risk of ACL injury. The patients with a narrow NWI should also be screened contralaterally for assessment of ACL injury risk on the other knee. So, specialized training programmes for the people with narrow NWI can be prepared for preventing ACL injuries.


Subject(s)
Anterior Cruciate Ligament Injuries , Knee Injuries/diagnosis , Magnetic Resonance Imaging/methods , Adult , Anterior Cruciate Ligament/pathology , Female , Humans , Male , ROC Curve , Retrospective Studies , Rupture , Trauma Severity Indices
10.
Int J Shoulder Surg ; 8(4): 107-13, 2014 Oct.
Article in English | MEDLINE | ID: mdl-25538429

ABSTRACT

PURPOSE: The rotator cuff tears (RCT) are a well-known cause of shoulder pain and loss of upper extremity function. The purpose of this study was to evaluate the upper extremity function using two different methods in patients with RCT and to determine the parameters that influence the upper extremity function. MATERIALS AND METHODS: A sample of 38 patients (27-76 years; 10 men and 28 women) who were diagnosed with a chronic full-thickness RCT, confirmed by magnetic resonance imaging (MRI), was studied. Upper extremity function was determined using Western Ontario Rotator Cuff Index (WORC) and 9 Hole Peg Test (9PEG). Other assessments included active range of motion (ROM), muscle strength, shoulder pain, and scapular dyskinesis. RESULTS: There was a weak association between WORC scores and 9PEG. A statistically significant, negative relationship was found between 9PEG and ROM in supination, as well as muscle strength of shoulder extensors, adductors, internal and external rotators. CONCLUSIONS: In addition to the weak association between WORC and 9PEG, the difference between the parameters related to each method suggests that they should not be used interchangeably to determine the upper extremity function. We recommend the utilization of 9PEG instead of WORC in assessing the upper extremity function in the setting of loss of muscle strength. LEVEL OF EVIDENCE: Level IV, Therapeutic study.

11.
Eur J Orthop Surg Traumatol ; 24(5): 733-9, 2014 Jul.
Article in English | MEDLINE | ID: mdl-23748696

ABSTRACT

The objective of this study was to retrospectively evaluate the prevalence of the cystic changes at rotator cuff footprint on proximal humeral tuberosities and investigate their relationship with rotator cuff tears and patient age. Magnetic resonance (MR) images of 657 patients who underwent shoulder arthroscopy for treatment of rotator cuff disorders were reviewed to localize the cystic changes at anterior (supraspinatus insertion) and posterior (infraspinatus insertion) aspects of greater tuberosity (GT) and lesser tuberosity (subscapularis insertion). Preoperative MR reports as well as cyst size and locations on MR images were correlated with arthroscopic records of rotator cuff pathology (tear type, size, location and tendon involvement) and patient age. The prevalence of cystic changes was 9.1% (60 patients) in the study population. Anterior GT cysts were found in 56% of patients and were strongly associated with full-thickness (p<.001) and articular-sided partial-thickness rotator cuff tears (p=.02). Posterior GT and lesser tuberosity cysts were found in 27 and 17% of patients, respectively, and were not significantly related to rotator cuff tears, although there was an increased trend of posterior cysts in patients with infraspinatus tears (p=.09). A significant relation was found between patient age and the cyst size (p=.01), while none of the cyst localizations were statistically related to age. Anterior GT cysts were more common in this patient group and demonstrated a strong association with rotator cuff disorders regardless of age. Posterior GT and lesser tuberosity cysts were less common and showed no association with rotator cuff pathology or patient age.


Subject(s)
Arthroscopy , Bone Cysts/etiology , Humeral Head , Rotator Cuff Injuries , Adult , Aged , Bone Cysts/pathology , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Retrospective Studies , Rotator Cuff/surgery , Rupture/complications , Rupture/surgery , Tendon Injuries/complications , Tendon Injuries/pathology , Tendon Injuries/surgery
12.
Arthroscopy ; 29(12): 1922-31, 2013 Dec.
Article in English | MEDLINE | ID: mdl-24286794

ABSTRACT

PURPOSE: To prospectively evaluate the return-to-sports rates after arthroscopic anterior stabilization in patients aged younger than 25 years. METHODS: Fifty-eight patients underwent arthroscopic capsulolabral repair for isolated anterior instability. The mean age at the time of surgery was 19.5 years (range, 12 to 24 years). At a mean follow-up of 27 months (range, 20 to 32 months), 53 patients (42 male and 11 female patients) were assessed with American Shoulder and Elbow Surgeons, L'Insalata, and visual analog scale scores, as well as physical examination. The rate of return to sports and risk factors for postoperative recurrence were evaluated. RESULTS: The overall rate of return to sports at final follow-up was 87%. Forty patients returned to a preinjury level of sports activity after surgery. Six patients returned to less competitive activities. Seven patients who had a subsequent traumatic event resulting in dislocation or subluxation did not return to sports activities. Open revision repairs were performed in 5 patients with recurrent instability. The American Shoulder and Elbow Surgeons and L'Insalata scores improved from 66.9 to 83.2 and from 60.4 to 79.2, respectively (P < .001). The visual analog scale score improved from 3.1 to 1 (P < .001). No significant loss of external rotation was noted postoperatively (mean, 79°). Mattress repair was associated with a higher return-to-sports rate (P < .05). Multiple instability episodes (>5) and the presence of a Hill-Sachs lesion were associated with postoperative failure (P < .05). CONCLUSIONS: Arthroscopic stabilization is a feasible surgical option in the young, athletic population. Mattress labral repair was associated with a higher rate of return to sports, whereas patients who had ligamentous laxity, multiple instability episodes (>5), and Hill-Sachs lesions had the greatest risk of recurrence. These factors should be given consideration in planning the appropriate treatment for anterior instability in this age group. LEVEL OF EVIDENCE: Level IV, therapeutic case series.


Subject(s)
Arthroscopy/statistics & numerical data , Athletic Injuries/rehabilitation , Athletic Injuries/surgery , Return to Work/statistics & numerical data , Shoulder Injuries , Shoulder Joint/surgery , Sports/statistics & numerical data , Adolescent , Child , Female , Follow-Up Studies , Humans , Joint Instability/diagnosis , Joint Instability/surgery , Male , Pain Measurement , Physical Examination , Postoperative Care , Prospective Studies , Range of Motion, Articular , Recurrence , Reoperation , Rotation , Rotator Cuff/surgery , Rotator Cuff Injuries , Shoulder Dislocation/diagnosis , Shoulder Dislocation/surgery , Treatment Outcome , Young Adult
13.
Eklem Hastalik Cerrahisi ; 24(2): 82-6, 2013.
Article in Turkish | MEDLINE | ID: mdl-23692194

ABSTRACT

OBJECTIVES: This study aims to compare the measurements using biochemical markers of bone turnover and bone mineral density (BMD) in the assessment of the efficiency of osteoporosis treatment. PATIENTS AND METHODS: Between March 2006 and December 2008, 166 patients with osteoporosis in our clinic were included. Patients who were out of contact due to death or other reasons during follow-up were excluded. We compared the measurements of urinary biochemical markers of bone turnover using cross-linked N-telopeptide (Ntx) values and BMD in 60 patients (49 females, 11 males; mean age: 65.7 years; range: 42 to 87 years) with osteoporosis who were treatment-naive and completed study. RESULTS: Twenty-nine (48.3%) of the patients received surgical treatment, while 31 (51.7%) received conservative therapy. Urine NTx values of the patients decreased 38.82% at three months; 51.99% at six months and 66.41% at 12 months. Lumbar vertebra BMD increased by 20.7% and femur neck BMD increased by 11.9% at the end of the first year. CONCLUSION: Urine NTx values respond to osteoporosis treatment faster than BMD measurements; thereby it may be suitable to use this parameter for the monitorization of the treatment efficiency.


Subject(s)
Bone and Bones/metabolism , Osteoporosis/physiopathology , Adult , Aged , Aged, 80 and over , Biomarkers/blood , Biomarkers/urine , Bone Density , Bone Density Conservation Agents/therapeutic use , Bone Resorption , Collagen Type I/urine , Female , Femur Neck/diagnostic imaging , Humans , Lumbar Vertebrae/diagnostic imaging , Male , Middle Aged , Osteoporosis/blood , Osteoporosis/therapy , Osteoporosis/urine , Peptides/urine , Predictive Value of Tests , Radiography , Treatment Outcome
14.
Eklem Hastalik Cerrahisi ; 24(2): 91-5, 2013.
Article in Turkish | MEDLINE | ID: mdl-23692196

ABSTRACT

OBJECTIVES: This study aims to investigate the mid-term clinical and radiological results of cementless hydroxyapatite coated total hip arthroplasty (THA) for hip osteoarthritis due to developmental dysplasia of the hip (DDH). PATIENTS AND METHODS: Between January 2004 and December 2010, 34 hips (12 Crowe type I, 12 Crowe type II, 4 Crowe type III, 6 Crowe type IV) of 30 patients (22 females, 8 males; mean age 53.4 years; range 30 to 75 years) with degenerative arthritis due to DDH were analyzed in terms of cementless hydroxyapatite coated acetabular component (EPF Plus(®)) over Zweymüller femoral component (Zweymüller SL-PLUS(®)) and porous coating. Clinical assessment was performed using Harris hip scores (HHS) preoperatively and at the last clinic visit, while radiological assessment was done according to the Callaghan and Engh's criteria. RESULTS: The mean follow-up was 48 months (range, 25-91 months). The mean HHS was 44.97 (28-55) preoperatively and 92.25 (69-100) at the last visit. All femoral components were graded as stable according to Callaghan and Engh's criteria. Radiolucency was mostly observed in Gruen zones 1 and zone 7 of the femur [zone 1; 20 hips zone 7; 19 hips zone 2; one hip, zone 3; one hip and zone 6 one hip]. Around acetabular component, radiolucency was detected in zone 2 in 12 hips, zone 3 in 10 hips and zone 1 in six hips. Heterotopic ossification developed in two hips, while neuropraxy was detected in two hips postoperatively. Femoral fissure in one hip, nonunion in the femoral osteotomy line in one hip, and femoral head autograft nonunion in one hip developed. CONCLUSION: Mid-term results of uncemented Zweymüller femoral stem and hydroxyapatite coated press-fit using acetabular components for THA femoral stem are excellent.


Subject(s)
Biocompatible Materials , Durapatite , Hip Dislocation, Congenital/surgery , Hip Prosthesis , Osteoarthritis, Hip/surgery , Adult , Aged , Arthroplasty, Replacement, Hip , Female , Follow-Up Studies , Hip Dislocation, Congenital/complications , Humans , Male , Middle Aged , Osteoarthritis, Hip/complications , Osteotomy , Postoperative Complications , Prosthesis Design , Treatment Outcome
15.
Arch Orthop Trauma Surg ; 133(7): 979-84, 2013 Jul.
Article in English | MEDLINE | ID: mdl-23632780

ABSTRACT

Heterotopic ossification (HO) is a well-known condition that usually occurs after head trauma, burns and open surgical procedures, most commonly around the hip and elbow joints. It is a well-documented complication occurring after open hip surgery; however, there exists limited information regarding its prevalence and clinical importance following hip arthroscopy. We report a case of symptomatic HO formation in portal sites following arthroscopic rim decompression, femoroplasty and labral debridement that was successfully treated with arthroscopic removal.


Subject(s)
Arthroscopy/adverse effects , Femoracetabular Impingement/surgery , Ossification, Heterotopic/etiology , Debridement , Decompression, Surgical , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Tomography, X-Ray Computed
16.
Eur J Orthop Surg Traumatol ; 23(7): 767-74, 2013 Oct.
Article in English | MEDLINE | ID: mdl-23412202

ABSTRACT

The aim of this study was to investigate the effectiveness of a novel hydroxyapatite containing gelatin scaffold--with and without local vascular endothelial growth factor (VEGF) administration--as the synthetic graft material in treatment of critical-sized bone defects. An experimental nonunion model was established by creating critical-sized (10 mm. in length) bone defects in the proximal tibiae of 30 skeletally mature New Zealand white rabbits. Following tibial intramedullary fixation, the rabbits were grouped into three: The defects were left empty in the first (control) group, the defects were grafted with synthetic scaffolds in the second group, and synthetic scaffolds loaded with VEGF were administered at bone defects in the third group. Five rabbits in each group were killed on 6th and 12th weeks, and new bone growth was assessed radiologically, histologically and with dual-energy X-ray absorptiometry (DEXA). At 6 weeks, VEGF-administered group had significantly better scores than the other two groups. The second group also had significantly better scores than the control group. At 12 weeks, while no significant difference was noted between the second and third groups, these two groups both had significantly better scores in all criteria compared with the control group. There were no signs of complete fracture healing in the control group. The administration of hydroxyapatite containing gelatin scaffold yielded favorable results in grafting the critical-sized bone defects in this experimental model. The local administration of VEGF on the graft had a positive effect in the early phase of fracture healing.


Subject(s)
Biocompatible Materials/pharmacology , Durapatite/pharmacology , Fractures, Ununited/physiopathology , Tibial Fractures/physiopathology , Vascular Endothelial Growth Factor A/pharmacology , Analysis of Variance , Animals , Bone Density/physiology , Bone Transplantation/methods , Cryogels/pharmacology , Disease Models, Animal , Fracture Fixation/methods , Fracture Healing/drug effects , Fractures, Ununited/pathology , Gelatin/pharmacology , Rabbits , Tibial Fractures/pathology , Tissue Scaffolds
17.
Eur J Orthop Surg Traumatol ; 23(3): 317-22, 2013 Apr.
Article in English | MEDLINE | ID: mdl-23412278

ABSTRACT

Subacromial impingement is one of the most common causes of painful shoulder in the middle aged and elderly population. Since Neer's first description of the process, many investigators have researched this condition in an effort to gain a better understanding of the disease etiology. The aim of this study was to investigate the relationship between the radiological subacromial distance measurements and the subacromial impingement syndrome in a series of patients from our institution. For this purpose, 44 patients scheduled for a unilateral shoulder arthroscopy were investigated prospectively. The acromio-glenoid angle, supraspinatus-glenoid angle (from coronal MR images) and acromial index (from true anterior-posterior shoulder X-ray images) were measured as the implications of the subacromial distance, and the degree of subacromial impingement was graded according to intraoperative findings. Statistical data analysis revealed no significant correlations between the radiological measurements and the severity of subacromial impingement (p > 0.05). On the other hand, there was a significant correlation (p = 0.0049) between the patient age and subacromial impingement. These results suggest that the radiological subacromial distance measurements do not have enough clinical significance as predictive markers in the subacromial impingement syndrome.


Subject(s)
Acromion/diagnostic imaging , Shoulder Impingement Syndrome/diagnostic imaging , Acromion/pathology , Adult , Age Factors , Aged , Female , Glenoid Cavity/diagnostic imaging , Glenoid Cavity/pathology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Prospective Studies , Radiography , Shoulder Impingement Syndrome/pathology
18.
Arch Orthop Trauma Surg ; 131(8): 1107-13, 2011 Aug.
Article in English | MEDLINE | ID: mdl-21706304

ABSTRACT

BACKGROUND: Superior labrum anterior posterior (SLAP) lesions are a well-defined cause of shoulder pain and disability and may occur in conjunction with rotator cuff tears. This study was designed to prospectively evaluate the minimum 2 year results of arthroscopic repair of type II SLAP lesions in patients over the age of 45 years with and without rotator cuff tears. PATIENTS AND METHODS: Thirty-five patients with symptomatic type II SLAP lesions were enrolled in the study. All patients underwent arthroscopic SLAP repair and simultaneous repairs were carried out in 17 of these patients who had concomitant full-thickness rotator cuff tears. Patients were grouped into two with regard to the presence of rotator cuff tears. The outcome was assessed by University of California at Los Angeles (UCLA) score and clinical examination (forward flexion/internal rotation/external rotation). RESULTS: At an average follow-up of 2.5 years, both groups displayed significant improvements in UCLA score (31.2 vs. 11.8; p < 0.01) and range of motion. Compared with the group that had SLAP and concomitant rotator cuff tears, patients in isolated SLAP group had significantly better scores in function (9.4 vs. 8.6; p = 0.045) and patient satisfaction (4.9 vs. 4.5; p = 0.039). No significant difference was found between two groups with respect to range of motion. CONCLUSIONS: The arthroscopic repair of symptomatic type II SLAP lesions yields favorable outcomes in patients over 45 years of age and the presence of accompanying rotator cuff tears has a negative effect on the results.


Subject(s)
Arthroscopy/methods , Rotator Cuff Injuries , Shoulder Injuries , Shoulder Joint/surgery , Aged , Female , Humans , Male , Middle Aged , Prospective Studies , Range of Motion, Articular , Recovery of Function , Rotator Cuff/physiopathology , Rotator Cuff/surgery , Shoulder Joint/physiopathology , Treatment Outcome
19.
Knee Surg Sports Traumatol Arthrosc ; 19(9): 1576-81, 2011 Sep.
Article in English | MEDLINE | ID: mdl-21234537

ABSTRACT

PURPOSE: The long head of the biceps tendon (LHBT) generally runs free through its course in the glenohumeral joint. It can rarely be seen as attached to the joint capsule or the rotator cuff in different patterns. Although these variations are usually considered harmless in the literature, they may occur in conjunction with the labral pathologies. This study was designed to determine their prevalence and investigate their relationship with intra-articular pathologies encountered during arthroscopy. METHODS: Out of a patient population of 671 arthroscopies performed in one center, the data regarding the LHBT variations and labral pathologies were collected retrospectively. RESULTS: Fifty patients (7.4%) of this total population were included as possible LHBT variants. Categorized into seven groups ranging from the simple vinculum, cord, and pulley types to the synovial tunnel types partially or totally fused to the capsule and to more complex types adherent to the capsule or the rotator cuff, their association with the labral pathologies was analyzed. The labral pathology prevalence was significantly higher in this group of 50 patients with LHBT variants compared to the total population (32 vs. 13%; P < 0.001). In the pulley-type variant group, the labral pathologies were also encountered at a significantly higher rate than the total population (62.5%; P = 0.026). CONCLUSION: The prevalence of embryological variations of the biceps tendon may be higher than common presumptions, and a particular type of these variants displays an increased association with labral pathologies.


Subject(s)
Joint Instability/pathology , Muscle, Skeletal/abnormalities , Musculoskeletal Abnormalities/epidemiology , Shoulder Joint/pathology , Tendons/abnormalities , Adolescent , Adult , Age Distribution , Arthroscopy/methods , Cohort Studies , Female , Humans , Incidence , Intraoperative Complications/prevention & control , Joint Instability/surgery , Male , Middle Aged , Musculoskeletal Abnormalities/diagnosis , Prognosis , Retrospective Studies , Risk Assessment , Sex Distribution , Shoulder Joint/surgery , Tendons/surgery , Young Adult
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