Treatment of knee osteochondritis dissecans with autologous tendon transplantation: Clinical and radiological results.

BACKGROUND: Defect treatment with tendon autograft in osteochondral lesions has been published in the literature with an experimental study in dogs. To demonstrate that it is possible to treat knee osteochondral lesions with the technique of autologous tendon transplantation. AIM: To evaluate the clinical and radiological results of patients with knee osteochondral lesions who were treated with autologous tendon transplantation. METHODS: Twenty patients (22 knees) with osteochondritis dissecans (OCD) lesions involving the knee were treated with autologous tendon transplantation between 2005-2018. All lesions were International Cartilage Repair Society grade IV. All patients were evaluated clinically at final follow-up with knee injury and osteoarthritis outcome score (KOOS); and radiologically with magnetic resonance observation and cartilage repair tissue (MOCART) and Kellgren-Lawrence (KL) classification. RESULTS: A total of 20 patients (22 knees) with a mean age of 25.5± 6.8 years were included. The average defect size was 4.2 ± 2.1 cm2, and the average defect depth was 0.9 ± 0.4 cm. Total KOOS score was preoperatively 29.4 ± 5.5 and was later found to be 81.5 ± 5.9 after an average of 68.7 ± 37.7 mo follow-up. The mean MOCART score was 56.2 ± 10.7. Preoperatively, all of the patients had KL grades of 0-1; during the follow-up period, 80% of the patients showed no radiological progress of osteoarthritis. Patients with less than 4 cm2 lesion had statistically significantly better overall KOOS than patients whose more than 4 cm2 lesion, particularly in sport and quality of life subscales. CONCLUSION: The autologous tendon transplantation is a single-step, safe, simple, cost-effective method for the treatment of knee OCD with satisfactory clinical and radiological outcomes, particularly in patients with less than 4 cm2 lesion.

Avascular Necrosis of Humeral Trochlea: A Case Report of the Rare Condition.

INTRODUCTION: Avascular necrosis of humeral trochlea is a very rare condition and was described by Hegemann in 1957. We reported two cases of avascular necrosis of humeral trochlea and also performed a literature review of the reported cases. We expect that this case report will assist clinicians in making a timely diagnosis when encountering similar clinical scenarios. MATERIALS AND METHODS: We presented cases of an 11-year-old and a 14-year-old with avascular necrosis of the humeral trochlea. The common etiology was idiopathic because there were no recent trauma history and sports activity. Also, there was no history of drug use. We discussed the clinical and radiological findings of these cases. RESULTS: These cases, two teenage boys, were diagnosed withHegemann's disease with clinical and radiological outcomes. We found that the etiology of both thecases is idiopathic;. The number of previously reported cases in the literature is limited to 64. In our study, there was a lateral crest in one of our two cases and a posteromedial involvement in another. The radiograph of trochleae of these two cases showed irregularity and granular appearance. In our case, heterogeneous signal changed and irregularities were accompanied by hypointensive changes on T1-weighted images. Also, hyperintensive changes on proton density sequences were detected. CONCLUSION: Radiological evaluation plays an important role in the diagnosis and evaluation of response to treatment in avascular necrosis of the humeral trochlea. Avascular necrosis should be one of the differential lesions involving the trochlea. Recognition of avascular necrosis in the trochlea may prevent the unnecessary biopsy.

Effectiveness and reliability of traditional open surgery in atypical localizations of osteoid osteoma.

OBJECTIVES: This study aims to evaluate traditional open surgery results of osteoid osteomas (OOs) in atypical localizations and explore whether open surgery can be a safe alternative in localizations where radiofrequency ablation (RFA) may not be suitable. PATIENTS AND METHODS: A total of 26 patients (20 males, 6 females; mean age 23.3±14.2 years; range, 4 to 65 years) having OO in atypical localizations between January 2008 and January 2017 were retrospectively evaluated. All patients underwent traditional open surgery under anesthesia. All patients were followed-up, and their clinical success and complications were evaluated. The pain intensity was assessed using the visual analog scale (VAS). RESULTS: The postoperative first year VAS score was 0.2±0.5 (range, 0-2) (p<0.005). None of the patients showed any complications. No recurrences were reported at the end of the first year. All patients were relieved from pain due to OO in atypical localizations. CONCLUSION: Although RFA has been accepted as the preferred treatment for OO, traditional open surgery may still be used for OO in atypical localizations yielding perfect clinical results with fewer complications. It is a safe alternative for localizations such as carpal bones, distal ulna, hand and foot where RFA complications can be seen more frequently. In these localizations, traditional open surgery can be recommended as the first treatment choice.

Metatarsal Head Restoration With Tendon Autograft in Freiberg's Disease: A Case Report.

Freiberg's disease is a form of osteochondrosis of a metatarsal head that often affects the second metatarsophalangeal joint, and that affects females more often than males. Repetitive microtrauma, osteonecrosis, and stress overload are the main factors in its pathophysiology. Surgical intervention is indicated in advanced cases wherein nonoperative treatment has failed. In this report, we describe the case of a young female who had Freiberg's disease localized to the third metatarsal head bilaterally and who was successfully treated with peroneus longus tendon transplantation.

Extensor mechanism reconstruction with peroneus longus tendon autograft for neglected patellar fracture, report of 2 cases.

Extensor mechanism deficiency in the knee may occur due to neglected patellar and quadriceps tendons rupture or may be caused by chronic fractures of the patella. Older patients can tolerate nonunion with impaired function including extension limitation or persistent muscle weakness. In young patients, performing rigid internal fixation with reoperation should be considered when a nonunion occurs. However, delayed and neglected nonunion in patella fractures require performing different surgical procedures. We report two cases, operated for a patella fracture, in whom nonunion occurred and accompanied by patellar migration and retraction of quadriceps tendon because of a fixation failure. We reconstructed the extensor mechanism with peroneus longus tendon autograft and, owing to this method, we achieved excellent functional results during a 2-year follow-up period.

[Neglected ipsilateral simultaneous ruptures of patellar and quadriceps tendon]. / Ihmal edilmis ayni tarafli ayni anda olan patellar ve kuadriseps tendon yirtiklari.

Neglected patellar and quadriceps tendon rupture is a rare injury, but ipsilateral simultaneous patellar and quadriceps tendon rupture was not described in the literature to our knowledge. In this article, we report a 40-year-old healthy male patient with neglected ipsilateral patellar and quadriceps tendon ruptures treated by peroneus longus tendon autograft. Patient had received some conservative and surgical treatments for patellar fracture before applying to our clinic. After our treatment using peroneus longus autograft and interference nails, patient was immobilized for six weeks in cylindrical cast. Flexion exercises and full weight bearing were started after cast removal. Patient had no complaint at postoperative second year. Patient was a neglected case. Surgical repair and early rehabilitation enabled us to achieve a satisfactory outcome.

[Chondroblastoma in the anterior cruciate ligament origo: a case report]. / Ön çapraz bag yapisma yerinde kondroblastom: Olgu sunumu.

Chondroblastoma is a rarely seen cartilage originated tumor. It is mostly localized in the epiphysis of long bones. In this article, we present an 18-year-old male case in whom the tumor was located in the right distal femoral lateral condyle and destroyed anterior cruciate ligament origo. The tumor was curetted and the cavity was filled with cement. Anterior cruciate ligament resection was mandatory for this treatment. The patient had no complaint in the postoperative period.

Treatment of capitellar osteochondritis dissecans with a tendon graft: a case report.

A 14-year-old girl who was engaged in farming was admitted with the complaints of right elbow pain and limited range of motion in the elbow joint. Plain radiograph revealed capitellar osteochondritis dissecans. After the loose fragment was removed from the capitellum and the defect was curetted, a palmaris longus tendon graft harvested from the same hand was implanted into the capitellar defect. Elbow joint was immobilized for three weeks. Magnetic resonance imaging showed that tendon graft was successfully adapted into defect. The range of motion was preserved and she had no pain in the elbow joint. In conclusion, we suggest that tendon autograft can be used in the treatment of capitellar osteochondritis dissecans.

Magnetic resonance imagination of the peroneus longus tendon after anterior cruciate ligament reconstruction.

Several studies report that tendons can regenerate after harvesting. These studies have been performed especially in patellar and hamstring tendons. At our institution, 10 cm length of full thickness peroneus longus tendon has been harvested to reconstruct torn anterior cruciate ligament since 1997 as a different graft source. The aim of this study was to investigate whether the peroneus longus tendon used the anterior cruciate ligament reconstruction has a regeneration potential or not. Twelve patients, who had originally undergone harvesting of the peroneus longus tendon for the primary surgery of the anterior cruciate ligament reconstruction, underwent magnetic resonance imaging (MRI). Images of both legs were acquired simultaneously with the use of the scanner's extremity coil, as we aimed to compare harvested peroneus longus tendon with the other leg's peroneus longus tendon (healthy side) for evaluation of the regeneration potential. The average age of the patients was 31 years. There were eight right and four left legs. The average time interval was 52 months between ligament surgery and MRI. In all patients, a varying amount of the regeneration of the peroneus longus tendon was seen on the MRI images. Although the extent of PLT regeneration in proximal sections seemed better than in mid- and distal sections, there was no statistical difference between sections (P = 0.130). These data show that the peroneus longus tendon has a regeneration potential after harvesting for anterior cruciate ligament reconstruction.

[The effect of tibiofemoral angle changes on the results of dome osteotomy]. / Kubbe osteotomisinde tibiofemoral açi degisikliklerinin sonuçlar üzerine etkisi.

OBJECTIVES: We investigated the effect of tibiofemoral angle changes on the results of dome osteotomy in patients with medial compartment osteoarthritis of the knee. METHODS: The study included 23 knees of 22 patients (15 women, 7 men; mean age 60 years; range 37 to 73 years) who underwent high tibial dome osteotomy for medial compartment osteoarthritis. A simple modified Charnley external fixator was used for stabilization of the osteotomy. Based on the Ahlback classification, 15 knees had grade I, six knees had grade II, and two knees had grade III osteoarthritis. The patients were evaluated in three groups based on the postoperative tibiofemoral angles obtained; hence, a valgus angle of less than 8 degrees (4 knees), 8 degrees to 12 degrees (10 knees), and greater than 12 degrees (9 knees). Clinical evaluations were made using the American Knee Society scoring system. The mean follow-up period was 5.4 years (range 1 to 10 years). RESULTS: The mean tibiofemoral angle was 4.4+/-2.9 degrees of varus (range 0 degrees to 10 degrees ) preoperatively, and 11+/-3.8 degrees of valgus (range 5 degrees to 18 degrees ) postoperatively. The mean correction loss at final evaluations was 2.7 degrees . The mean preoperative and postoperative knee scores were 37.7+/-15.8 (range 19 to 77) and 80.2+/-9.2 (range 51 to 93), respectively (p<0.001). The mean functional score increased from 52.3+/-18.8 (range 10 to 80) to 75.6+/-18.5 (range 35 to 100) at final analysis (p<0.001). The knee and functional scores did not differ significantly between three groups of patients having a different range of postoperative tibiofemoral angle (p>0.05). CONCLUSION: Our results show that the alignment obtained after high tibial osteotomy does not influence knee and functional scores provided that it is within an acceptable range.

[Anterior cruciate ligament reconstruction with the peroneus longus tendon]. / Peroneus longus tendonu ile ön çapraz bag rekonstrüksiyonu.

OBJECTIVES: The aim of the study was to evaluate the results of anterior cruciate ligament (ACL) reconstruction using a peroneus longus tendon (PLT) autograft. METHODS: The study included 29 patients (27 males, 2 females; mean age 30 years; range 21 to 39 years) who underwent ACL reconstruction using a PLT autograft and interference nail fixation. Fourteen patients (48.3%) also had partial meniscectomy during surgery. The results were assessed according to the Lysholm scores and the International Knee Documentation Committee (IKDC) scale at the end of at least five years of follow-up. RESULTS: According to the IKDC scale, 17 patients (58.6%) were rated as normal or nearly normal, and 12 patients (41.4%) were rated as abnormal or severely abnormal. The mean Lysholm score was 83.7 (range 45 to 100), with excellent or good results in 23 patients (79.3%). Radiographic examination showed mild (n=10) or moderate (n=1) degenerative changes in the knee joint. Compared with the normal side, no flexion or extension losses occurred in the affected knees. Stability of the ACL was assessed by the Lachman test, which showed normal findings in 12 patients (41.4%), while nine patients had 1+, five patients had 2+, and three patients had 3+ anteroposterior laxity. Pivot-shift test was negative in 13 patients (44.8%); ten patients had 1+ pivot glide, and six patients had 2+ pivot shift. Two patients (6.9%) complained of mild to moderate pressure pain, paresthesia and dysesthesia at the donor site of PLT. No patient experienced ankle joint dysfunction or difficulty in sports activities due to PLT graft transfer. CONCLUSION: Our data show that PLT can be an appropriate autograft source for ACL reconstruction, avoiding potential complications of autografts obtained from the knee region.

Bucket-handle tear of medial plica.

Plicae are synovial folds, classified according to their anatomical relationship to the patella. The medial patellar plica is normally asymptomatic, but it may cause symptoms when it becomes thickened and fibrotic. We describe three cases of bucket-handle tear of the medial patellar plica. They all suffered from anterior knee pain and clicking. Our cases' symptoms began when they incurred twisting injuries to the knee; therefore, we think that they had an asymptomatic plica first. Pain and clicking began because of the bucket-handle portion rubbed over the medial femoral condyle with knee flexion, and they improved after resection of the bucket-handle portion. Consequently, we think that medial patellar plica can be symptomatic not only when it becomes thickened or fibrotic but also when a bucket handle tear occurs.

Tendon regeneration: an anatomical and histological study in sheep.

Utilization of the hamstring tendon in reconstruction of the anterior cruciate ligament (ACL) has become common in recent years. In MRI studies regeneration potential in harvested tendon has been observed. In the present study, 20 legs from ten sheep, which underwent 10 cm segment resection of tendon of musculus extensor digitalis lateralis (MEDL) were used. The sheep were killed 6 months after the operation and regenerated tendons were examined macroscopically and histologically. Dissection was performed in the tendon resection area and specimens were reharvested for histological examination. Regeneration of the tendon with normal anatomical topographies was found in all legs. Regeneration occurred on both sides of the resected tendon simultaneously. Regeneration was muscle-like in the proximal side but it was tendon-like in the distal side. The developed tendon was fused to the joint capsule and to the fascia at the joint line in all specimens. This study indicates that tendon has a potential for regeneration.