Does preemptive gabapentin modulate cytokine response in total knee arthroplasty? A placebo controlled study.

BACKGROUND: Gabapentin, as a structural analogue of γ-aminobutyric acid, has been investigated to provide pain relief in the early postoperative period following various surgical interventions. OBJECTIVES: The objective of this study was to investigate whether preemptive oral administration of gabapentin 800 mg can reduce postoperative pain and modulate the inflammatory cytokine response in comparison to placebo in patients undergoing total knee arthroplasty under general anesthesia. MATERIAL AND METHODS: Fifty-two patients were randomly divided into 2 groups before surgery, either to receive peroral gabapentin 800 mg or placebo drug, 1 h before surgery. All patients had general anesthesia with endotracheal intubation, in a standardized fashion, by the same anesthetist. Thirty min before completion of surgery, intramuscular diclofenac sodium 75 mg was administered. Following extubation, visual analogue pain scale (VAS) scores and additional analgesic requirements were recorded at 15 min at post-anesthesia care unit (PACU), and at 4th and 24th h postoperatively. Plasma levels of interleukin 6 (IL-6), and tumor necrosis factor R (TNF-R) were measured at predetermined time points (T0 1 h before administration of gabapentin, T1 at postoperative the 4th h mark, and T2 at postoperative at the 24th h mark). RESULTS: The VAS scores at postoperative 4th h were significantly higher in placebo and gabapentin groups compared with VAS scores at PACU and at 24th h. The groups did not differ in terms of additional analgesic requirements. In gabapentin group, IL-6 levels at T1 and T2 were significantly lower in comparison to values measured in placebo group at the same time points. This difference was not significant in TNF-R levels between the groups. CONCLUSIONS: Though preemptive oral gabapentin administration did not reduce postoperative pain and analgesic requirements in total knee arthroplasty surgery, it attenuated IL-6 production on the first postoperative day.

Elastographic Findings of Achilles Tendons in Asymptomatic Professional Male Volleyball Players.

OBJECTIVES: Elastography is a new sonographic technique that evaluates the elasticity of different tissues such as the Achilles tendon. In this study, we aimed to investigate the elastographic findings of Achilles tendons in professional athletes in comparison with healthy volunteers. METHODS: Twenty-one professional male volleyball players with no history of Achilles trauma were included in this study. Twenty-one healthy male volunteers with similar ages and body mass indices were selected as control participants. All participants underwent sonographic and elastographic evaluations of the Achilles tendons to evaluate Achilles tendon thickness and stiffness. RESULTS: We observed thickening in many of the thirds of the Achilles tendons (right proximal, right middle, left middle, and left distal thirds) of athletes in comparison with healthy volunteers. We did not detect any abnormalities according to the sonographic evaluations in both athletes and healthy volunteers. In the elastographic evaluations, we observed softening in the middle thirds of the Achilles tendons of athletes according to the main types (P < .001) and subtypes (P < .001 for right; and P = .002 for left middle third). There was no difference observed in the elastographic evaluations of the proximal and distal thirds. CONCLUSIONS: On sonography and elastography, we observed thickening and softening in Achilles tendons of athletes in comparison with healthy volunteers who had similar ages and body mass indices. These changes could be associated with early tendon degeneration. Further longitudinal studies may support this consideration.

Significant associated MRI findings in patients with anterior cruciate ligament stump entrapment.

OBJECTIVE: Objective of this study was to determine the relationship between development of stump entrapment (SE) lesions and associated injuries in patients with knee extension deficits who underwent anterior cruciate ligament (ACL) reconstruction surgery. MATERIALS AND METHODS: This retrospective study included 79 patients who had an arthroscopy-proven ACL rupture causing knee extension loss. Presence and type of the SE lesions, injuries of collateral-cruciate ligaments and bones, and tears of the menisci were evaluated and recorded on magnetic resonance imaging. RESULTS: The SE lesions were significantly more common in patients who had compressive posterior lateral tibial plateau fractures, tibia medial plateau edema and medial collateral ligament (MCL) injuries compared to the patients without stump lesions (p < 0.05). Posterior cruciate ligament (PCL) partial tears or sprains were significantly more common in patients with SE 1 lesions compared to the patients with SE 2 lesions (OR = 6.72; 95 % CI: 1.56-28.93). CONCLUSION: SE is significantly more common in patients with compressive posterior lateral tibial plateau fractures, tibia medial plateau edemas and MCL injuries. PCL injury is more common in patients with type 1 SE.

Ultrasonographic evaluation of the shoulder in asymptomatic overhead athletes.

This study aimed to evaluate the efficiency of ultrasonography (US) in the examination of soft tissue anatomical structures of the shoulder in overhead athletes. The study evaluated the shoulders of overhead elite premier league athletes involved in basketball, handball, volleyball, body building, and water polo. US examination of both shoulders was performed prospectively in 45 asymptomatic overhead athletes and 43 asymptomatic volunteers matched for age. On US examination, subacromial-subdeltoid bursa effusion was observed in 16 of the dominant shoulders and in 2 of the non-dominant shoulders of 45 overhead athletes and in none of the asymptomatic volunteers. The mean thickness of the subacromial-subdeltoid bursa was significantly larger in the dominant and non-dominant shoulders of the overhead athletes than in the asymptomatic volunteers (p < 0.001, p < 0.05 respectively). Ultrasonography appeared as an effective, convenient and non-invasive tool for the early diagnosis of shoulder pathologies occurring in overhead athletes, even in the asymptomatic stage.

An unusual cause of recurrent joint effusions: nonhemophilic hemosiderotic synovitis of the knee.

A 20-year-old female presented with a painful swelling in the right knee and snapping sensation on joint motion that appeared without trauma and recurred several times. She had no history of a bleeding disease or trauma. Physical examination showed no signs of rash or temperature change or systemic or local findings of an infection. The knee was tender and knee motion was painful, with 90 degrees of flexion and full extension. The ballottement test was positive. All laboratory tests including rheumatologic and bleeding parameters were normal. Joint effusion analysis was normal except for its rusty-brown color. Magnetic resonance imaging showed synovial hypertrophy and grade 2 degeneration in the medial meniscus. During diagnostic and surgical arthroscopy, rust-colored synovial hypertrophy was noted in the suprapatellar pouch accompanied by patchy villi and nodules and cystic changes. The gross appearance of the synovium mimicked that of pigmented villonodular synovitis. Biopsy specimens were obtained from different parts of the synovium and a subtotal synovectomy was performed. The histopathologic diagnosis was reported as hemosiderotic synovitis. During a three-year follow-up, she had no pain, snapping sensation, or limitation of motion. There were no recurrent effusions.

Long-Term Results of Modified Green Method in Sprengel's Deformity.

AIM: Congenital undescended scapula (Sprengel deformity) is a rare deformity that is reported in the literature mostly as small case series with short- or medium-term follow-up periods. Here, we aimed to present the long-term results of this deformity treated with modified Green procedure. METHOD: The modified Green procedure was performed in 24 patients (28 shoulders) with Sprengel deformity. Clavicular osteotomy accompanied in all, and omovertebral bone excision in 13 shoulders. The mean age of the patients at the time of surgery was 4.5 years (range 1.5-17 years). Mean follow-up period was 11 years 4 months (4.3-17 years). Preoperative cosmetic appearance was noted as Cavendish III in 17 shoulders and as IV in 11 shoulders. In addition to the Cavendish scale, shoulder abduction, shoulder asymmetry, and scapular elevation and medialization were evaluated. RESULTS: The decrease in scapular elevation and Cavendish scale, and the improvement in shoulder abduction and scapular medialization postoperatively were statistically significant (P < 0.001). Cosmetic improvement of at least one Cavendish grade were attained in 88.9% of shoulders. One patient (unilateral) who was Cavendish grade IV preoperatively died in the early postoperative period from unrelated causes. Of the remaining 10 preoperatively grade IV shoulders, 2 remained at the same grade, 1 improved to grade III, and 7 shoulders to grade I. Of the 17 preoperatively grade III shoulders, 1 shoulder stayed the at same grade, 7 shoulders improved to II, and 9 shoulders to grade I. Postoperative winging in 2 shoulders and hypertrophic scarring in 6 shoulders were noted. CONCLUSION: The modified Green procedure is a relatively safe and reliable method in the treatment of severe Sprengel deformity cases and provides highly constructive and aesthetic results in the long term.

Free coracoacromial ligament graft for augmentation of massive rotator cuff tears treated with mini-open repair.

OBJECTIVES: Repair of massive rotator cuff tears is a challenging and complex procedure. The tissue at the end of the torn tendons is often friable and weak, because ruptures are old and degenerated, and thus the ends must be sutured effectively and strongly to achieve a satisfactory outcome. We aimed to evaluate the effectiveness of free total or partial coracoacromial ligament (CAL) graft to protect and augment the repair of massive rotator cuff tears. METHODS: Forty six patients ((32 females, mean age 54.3 years (range 39-66 years)) operated for massive rotator cuff tears between January 2003 and June 2009 were included in the study. Twenty nine of these patients had right-sided tears, and 17 had left-sided tears. Fifteen of the tears were 3-4 cm wide (mean 3.5 cm); 27 were >4 cm wide (mean 4.5 cm), and 4 were >5 cm wide. The mean follow-up period was 26 months (range 16-52 months). Patients were operated with a mini-open technique, and reconstructed after primary repair with 18 total and 28 partial free transfer of the CAL. Patients were evaluated by Constant-Murley score, and the degree of active flexion and abduction. Tendon thickness was measured with ultrasonography during follow-up. RESULTS: Mean preoperative shoulder flexion was 27.5° (range 5-40°), and mean abduction was 22.5° (range 10-30°). Shoulder flexion was significantly greater postoperatively (mean 102.6°, range 70-150°), as was shoulder abduction (mean 96.5°, range 60-150°). Mean preoperative and postoperative Constant-Murley score was 45 and 80, respectively. Surgical complications, particularly recurrence, did not occur in any patient during the follow-up period. The integrity and tendon thickness of the repairs were similar to those of normal tendons at the end of follow-up. CONCLUSION: Augmentation with a free transfer of the coracoacromial ligament provides excellent and promising functional results in the operative treatment of massive rotator cuff tears with a mini-open technique.

[Bucket-handle tear of a discoid lateral meniscus in a 6-year-old girl]. / Alti yasindaki kiz hastada diskoid lateral menisküsün kova sapi yirtigi.

A six-year-old girl was examined upon development of pain, swelling, and locking in her right knee after a considerable period of discomfort and popping sensation. She had no history of trauma. Magnetic resonance imaging showed a discoid lateral meniscus, filling the entire lateral plateau and exhibiting signs of degeneration. On arthroscopic examination, a bucket-handle tear of the discoid lateral meniscus was noted and the patient was treated with arthroscopic subtotal meniscectomy. During the first month of follow-up, the patient had a full range of motion and normal gait. At three years, she maintained full range of motion without pain, locking, or popping. Due to the likelihood of joint degeneration, long-term follow-up was recommended.

[Total hip arthroplasty in patients with osteoarthritis secondary to developmental dysplasia of the hip: results after a mean of eight-year follow-up]. / Gelisimsel kalça displazisi zemininde gelisen osteoartritli hastalarda total kalça artroplastisinin ortalama sekiz yillik sonuçlari.

OBJECTIVES: We evaluated eight-year results of total hip arthroplasty in patients with osteoarthritis secondary to developmental dysplasia of the hip (DDH). METHODS: Total hip arthroplasty was performed in 31 hips of 29 patients (25 females, 4 males; mean age 54 years; range 35 to 78 years) with osteoarthritis secondary to DDH. According to the classification by Hartofilakidis et al., there were 13 type 1 hips, 13 type 2 hips, and five type 3 hips. The acetabular component was placed in the true acetabulum in all the hips. Hybrid and uncemented prostheses were used in six hips and 25 hips, respectively. Eight patients with severe acetabular deficiency required augmentation with an autogenous bone graft. Soft-tissue releases were performed in seven hips. Femoral shortening osteotomy was performed for high hip dislocations. All the patients were evaluated using the Merle d'Aubigne and Harris hip scores. The mean follow-up period was eight years (range 1 to 10 years). RESULTS: According to the postoperative Merle d'Aubigne and Harris hip scores, the results were excellent in eight hips (25.8%), good in 17 hips (54.8%), fair in five hips (16.1%), and poor in one hip (3.2%). The mean length discrepancy between the two extremities was 1.7 cm (range 0.5 to 2.5 cm). Complications included nonunion of the acetabular graft in one patient and superficial wound infection in two patients. Neurologic complications did not occur. Three patients required revision for loosening of the acetabular (n=2) or femoral (n=1) components. CONCLUSION: Successful results can be obtained with good planning and proper surgical procedures in the treatment of osteoarthritis secondary to DDH.

An unusual complication of familial Mediterranean fever: protracted arthritis with bilateral coxarthrosis and intraosseous amyloidosis of femoral head.

Protracted arthritis is uncommon in familial Mediterranean fever (FMF) and rarely may result in degenerative joint damage, a well-known complication of FMF, usually affecting kidneys. We present an unusual case of FMF involving severe bilateral coxarthrosis leading to residual incapacity that was treated by total hip arthroplasty, and an unusual presentation of amyloidosis - intraosseous amyloidosis of the femoral head.

[Surgical treatment of type III acromioclavicular joint dislocations by a modified Bosworth technique]. / Tip III akromiyoklaviküler eklem çikiklarinin modifiye Bosworth teknigi ile cerrahi tedavisi.

BACKGROUND: We evaluated the results of surgical treatment of type III acromioclavicular joint dislocations by a modified Bosworth technique. METHODS: Thirty-four patients (9 females, 25 males; mean age 35 years; range 20 to 53 years) were treated with a modified Bosworth technique for type III acromioclavicular joint dislocations. Dislocations were caused by falls (n=18), traffic accidents (n=8), and during contact sports (n=8). Involvement was on the right side in 23 patients, and on the left side in 11 patients. The mean time to operation was two days (range 1 to 4 days). Functional evaluations were made with the use of the Constant scores. The mean follow-up was 35 months (range 12 to 57 months). RESULTS: The mean postoperative Constant score was 93 (range 46 to 96). No complications were seen during operation. The results were excellent in 24 patients (70.6%), good in seven patients (20.6%), and poor in three patients (8.8%). None of the patients had to change their jobs or give up any previous sports activities. Radiographically, the distal clavicle appeared normal in 32 patients, atrophied in one patient, and enlarged in another. Functional results were good in 12 patients (35.3%) in whom calcifications were detected in the coracoclavicular ligament. Dislocations recurred in three patients (8.8%). Two patients developed superficial infections. CONCLUSION: Surgical treatment of acromioclavicular joint dislocations by the modified Bosworth technique is a convenient option with regard to short- and long-term results.