The effect of platelet-rich plasma on fracture healing in long-bone pseudoarthrosis.

PURPOSE: The aim of this study was to investigate the effects of platelet-rich plasma (PRP) on fracture union rate and fracture union time in pseudoarthrosis surgery and to evaluate the clinical and functional results of the patients. METHODS: The patients who were undergone pseudoarthrosis surgery between 2011 and 2014 were evaluated retrospectively. Twenty-four patients were included in the study. Patients were divided into two groups with used PRP and not used PRP during surgery. There were 14 patients in the PRP group and 10 patients in the control group. The two groups were compared in terms of demographic characteristics, fracture union time, and functional scores of the Lower Extremity Functional Scale and Upper Extremity Functional Index. RESULTS: Fractures were healed in both groups, and no complications were encountered. A statistically significant difference was found between the two groups in terms of fracture union time. The mean time of union was 5.3 months in the PRP group and 11.3 months in the control group (p: 0.000). There was no statistically significant difference between the two groups in terms of functional scores (p: 0.250). CONCLUSION: As a result of our study, we concluded that PRP is an effective and safe method in pseudoarthrosis surgery that reduces fracture union time. Controlled studies with more patient numbers are needed.

Outcomes of isokinetic tests and functional assessment of anterior cruciate ligament reconstruction: Transtibial versus single anatomic femoral tunnel technique.

OBJECTIVE: The aim of the study was to compare the outcomes of the transtibial and anatomical femoral single tunnel surgical techniques in ACL reconstruction. METHODS: A total of 30 patients, with 16 patients (15 males and 1 female; mean age: 27.2 ± 7.04) with anatomical femoral single-tunnel technique (AFT) and 14 (12 males and 2 females; mean age: 29.4 ± 8.82) with transtibial technique (TT) were included into the study. All patients were evaluated with isokinetic tests at an angular velocity of 60°/s and 180°/s and the IKDC and Lysholm tests were performed preoperatively and in third, sixth, and 12th months postoperatively. The results were compared between the groups. The mean follow-up time was 17.1 ± 6.48 months. RESULTS: Postoperative third month changes in extension parameters of peak torque (AFT: -93.286, TT: -61.500), peak work (AFT: -77.071, TT: -47.500), peak torque ext/kg (AFT: -1.182, TT: -0.773), peak work ext/kg (AFT: -0.982, TT: -0.604), peak work (AFT: -55.143 TT: -33.063) at an angular velocity of 60°/s and postoperative third month change in extension parameter of peak power (AFT: -86.786 TT: -54.875) at an angular velocity of 180°/s were found to be better in the transtibial group (p < 0.05) and postoperative sixth month peak torque (AFT: 1.429, TT: -5.688) value at an angular velocity of 60°/s was found to be less in the anatomical femoral single-tunnel group (p < 0.05). The IKDC (AFT: 94.671, TT: 90.025) (p < 0.05) and Lysholm (AFT: 96.714, TT: 92.375) (p < 0.05) scores of the anatomical femoral single-tunnel group were better than the transtibial group regarding to the postoperative final follow-up. There are positive intermediate correlations between preoperative IKDC and Lysholm scores with preoperative and postoperative some isokinetic test ratio (r = 0.539; p = 0.031), and preoperative peak power extension (r = 0.541; p = 0.030) at the both angular velocity of 60°/s and 180°/s in the transtibial group. There was no significant difference between the two groups with regards to the Lachman, anterior drawer and pivot shift tests (p < 0.05). CONCLUSION: There were differences in terms of isokinetic parameters in early outcomes but there was no statistical difference between isokinetic parameters at the end of 1st year between two groups. There were some correlations between IKDC and Lysholm scores with some isokinetic parameters. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

The BstUI and DpnII Variants of the COL5A1 Gene Are Associated With Tennis Elbow.

BACKGROUND: Tennis elbow entails pain and tenderness over the lateral epicondyle. The exact cause of the condition is not fully understood. Type V collagen is a minor fibrillar collagen that intercalates with type I collagen and forms collagen fibrils. It is encoded by the COL5A1 gene. Sequence variants within COL5A1 3'-UTR have been implicated in musculoskeletal diseases. PURPOSE: To determine whether rs12722 (BstUI C414T polymorphism) and rs13946 (DpnII C230T polymorphism) of the COL5A1 gene are associated with an increased risk of tennis elbow. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 152 patients with tennis elbow and 195 healthy participants were enrolled in this study. The rs12722 (BstUI C414T) and rs13946 (DpnII C230T) polymorphisms were investigated with the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. RESULTS: There was a significant difference in both BstUI and DpnII genotype frequencies between patients with tennis elbow and healthy participants. The A2 allele of BstUI and the B1 allele of DpnII were significantly underrepresented in the patient group. CONCLUSION: Individuals with the BstUI A1 allele and DpnII B2 allele of the COL5A1 gene have a high likelihood of developing symptoms of the tennis elbow. This is the first study reporting that rs12722 and rs13946 SNPs (single nucleotide polymorphisms) are genetic risk factors for tennis elbow.

Short-term clinical outcomes after first metatarsal head resurfacing hemiarthroplasty for late stage hallux rigidus.

The purpose of the present study was to evaluate the short-term results of metatarsal head resurfacing hemiarthroplasty in the treatment of advanced hallux rigidus. We reviewed 14 consecutive patients (5 males [35.71%], 9 females [64.29%]; mean age, 58.7 ± 7.4 years). These patients underwent first metatarsal head resurfacing hemiarthroplasty (HemiCAP(®)) for hallux rigidus from March 2010 to September 2012 at our institution. According to the Coughlin and Shurnas clinical and radiographic classification, 10 feet (71.43%) were classified as grade III and 4 (28.57%) as grade IV. We clinically rated all patients before surgery and at the final follow-up visit using the American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal scale, the visual analog scale for pain, and first metatarsophalangeal joint (MTPJ) range of motion. The mean follow-up duration was 24.2 ± 7.2 (range 12 to 36) months. The mean preoperative hallux metatarsophalangeal-interphalangeal scale score was 33.9 ± 9.8 (range 22 to 59), and it increased to 81.6 ± 10.1 (range 54 to 96; p < .05) postoperatively. The mean preoperative 10-cm visual analog scale for pain score was 8.4 ± 0.9 (range 7 to 10), which decreased to 1.21 ± 1.2 (range 0 to 5; p < .05) postoperatively. The mean preoperative MTPJ range of motion was 22.8° ± 7.7° (range 15° to 45°), which increased to 69.6° ± 11.8° (range 50° to 90°; p < .05) postoperatively. None of the 14 patients experienced component malalignment or loosening, infection, or neurovascular compromise during the follow-up period. One patient (7.14%) experienced postoperative pain and subsequently underwent first MTPJ arthrodesis. From the results of our investigation, first MTPJ arthroplasty is an effective treatment modality that can reduce pain and increase motion in the case of advanced hallux rigidus.

Is Sp1 binding site polymorphism within COL1A1 gene associated with tennis elbow?

Tennis elbow defines a condition of pain and tenderness over the lateral epicondyle of the humerus. The exact aetiology of the injury is not yet fully understood. The major constituent of tendons is type 1 collagen which is encoded by COL1A1 gene. The aim of the study was to determine whether Sp1 binding site polymorphism (SNP rs1800012; 1546G/T) within the intronic region of COL1A1 gene is associated with tennis elbow. One hundred and three tennis elbow patients and one hundred and three healthy subjects without any history of previous ligament or tendon injuries were recruited for this genetic association study. All participants were genotyped for the COL1A1 Sp1 binding site polymorphism by using PCR-RFLP method. There were no observed statistical differences in the genotype (p=0.17) or allele (p=0.11) distributions between the groups. G allele frequency in patients and controls was 82.5% and 76.21%, and T allele frequency was 17.5% and 23.79% respectively. This study has shown that there is no association between this polymorphism and tennis elbow within the population studied.

The complete type of suprapatellar plica and lipoma arborescens: a case report.

Lipoma arborescens is a rare intra-articular benign lesion. It is characterized by villous lipomatous proliferation of the synovial tissue and its etiology is not certain. Clinical presentation is usually long-standing, painless and slowly progressive swelling of the related joint. Magnetic resonance imaging plays an important role in diagnosis. Diagnosis can be determined by hypertrophied synovial tissue with synovial lining cells containing adipose tissue on examination using a light microscope. The synovial plica of the knee is formed during the embryogenic phase of development. This development is incomplete in many individuals. When the synovial plica of the knee persists, it is transformed into an embryonic relic that is located in either the suprapatellar or midpatellar region of the knee. We present a rare case with both a complete type of suprapatellar plica and a symptomatic lipoma arborescens in the suprapatellar recess.

Surgical practices in total knee arthroplasty in Turkey.

OBJECTIVE: The aim of this study was to determine the current practices in the total knee arthroplasty (TKA) and the differences of practice among the orthopedic surgeons in Turkey. METHODS: Data in this cross-sectional and descriptive study was collected through a questionnaire from 76 orthopaedic surgeons performing TKA. The questionnaire form contained 57 questions under four main headings, covering the professional properties of the surgeon, pre-surgery approach, surgical technique applied for TKA and the surgical details peculiar to the technique with solutions applied for complication scenarios, and finally the postoperative approach. RESULTS: It was determined that 39.7% of the TKA applications were performed in operating theatres without laminar airflow or HEPA filters. Nearly 1/5 of the surgeons used more than one antibiotic for prophylaxis, and more than 85% continued prophylaxis use over 3 days. Low-molecular-weight heparin was the most commonly used method for thromboprophylaxis. 94.67% of the surgeons used only the cemented technique in primary TKA. 44% indicated that they performed simultaneous bilateral arthroplasty, 89% did not use any scoring system and 72.37% preferred fixed-bearing and posterior-cruciate-retaining type prosthesis. CONCLUSION: Results showed no standardization in TKA surgery among surgeons in Turkey, and important educational deficiencies were noted.

[Parallelism of vibration sense with proprioception sense in patients with patellofemoral pain syndrome: a pilot study]. / Patellofemoral agri sendromu saptanan hastalarda, dizde vibrasyon duyusu, propriyosepsiyon duyusu ile paralel olarak algilanmaktadir: Pilot çalisma.

OBJECTIVES: The purpose of the study was to evaluate the utility of vibration sense as a proprioceptive test in patients with a clinical diagnosis of patellofemoral pain syndrome. PATIENTS AND METHODS: Nineteen patients with a clinical diagnosis of patellofemoral pain syndrome and 10 healthy volunteers were included in the study. Patients and volunteers underwent a joint position sense test and a vibration sense test. A digital goniometer and 128 Hz frequency tuning fork were used for the measurements. The results of the pathologic knees were compared with the results of both their contralateral knees and the normal knees of the volunteers. T-test, Mann Whitney U and Pearson correlation tests were used for statistical analysis. RESULTS: The amount of time to perceive the vibration was 7.2+/-1.3 sec for the symptomatic knees, whereas it was 9.1+/-1.5 sec for the contralateral knees (p<0.05), each in the extended position. Joint position sense testing also showed deterioration of proprioception in accordance with the vibration testing. Similar differences were obtained between the symptomatic knees and the normal knees of volunteers (p<0.05). No differences were found in vibration sense measurements done at a 90 degrees flexion position of the knee (p>0.05). CONCLUSION: The results of the study show that the amount of time a vibration could be perceived is diminished in the symptomatic knees of the patients as compared to symptomatic knees. It is possible to extrapolate from these findings that vibration perception may be used for proprioceptive measurement.

[Patellofemoral joint dynamics in patients with gonarthrosis]. / Gonartrozlu hastalarda patellofemoral eklem dinamigi.

OBJECTIVES: Although the tibiofemoral joint has been evaluated in most of the gonarthrosis studies, the relationships between gonarthrosis and the patellofemoral joint have usually been disregarded. In this study, the dynamics of the patellofemoral joint in gonarthrosis has been evaluated. PATIENTS AND METHODS: Dynamic and kinematic axial computed tomography scans were obtained in 33 knees of 22 patients (19 females, 3 males; mean age 67.0 +/-3.2; range 58 to 75 years) who were scheduled for total knee arthroplasty due to the gonarthrosis. The control group consisted of 28 knees of 14 normal volunteers (11 females, 3 males; mean age 25 +/- 4.6; range 10 to 46 years) without any knee complaints or disorders. Sulcus, congruence and patellar tilt angles were measured on axial images which were obtained in different flexion angles of the knee (0 degrees, 10 degrees, 20 degrees, 30 degrees, 40 degrees and 60 degrees), both with and without contraction of the quadriceps muscle. ANOVA and paired-t tests were used for statistical analysis. RESULTS: Patellar tilt increased significantly in gonarthrotic patients compared to the controls (p < 0.05). The congruence angle was significantly lower in patients at 0 degrees and 10 degrees of knee flexion, but higher at 20 degrees, 30 degrees, 40 degrees and 60 degrees than controls (p < 0.05). The congruence angle increased significantly with the contraction of the quadriceps in controls, but no significant changes were observed in patients. CONCLUSION: Dynamics of the patellofemoral joint is different in patients with gonarthrosis than normal volunteers. Patellofemoral complaints following knee arthroplasties may be related to these differences.

[Proprioception of the knee joint in patellofemoral pain syndrome]. / Patellofemoral agri sendromunda diz ekleminin propriyosepsiyonu.

OBJECTIVES: The importance of proprioception in the etiology, treatment, and prevention of sports injuries and joint diseases has become increasingly clear. The purpose of this study was to investigate knee proprioception in patients with patellofemoral pain syndrome (PFPS). METHODS: The study included 28 patients (18 females, 10 males; mean age 28 years; range 16 to 48 years) with a clinical diagnosis of unilateral PFPS and 27 normal volunteers (13 females, 14 males; mean age 26 years; range 19 to 32 years) without any complaint related to the knee. The mean duration of complaints was 35.8 weeks (range 2 weeks to 3 years). In both patient and control groups, proprioception of the knee was measured by means of active joint position sense at four different target angles (15 degrees , 30 degrees , 45 degrees , 60 degrees ) with the use of a digital goniometer and the results were compared. RESULTS: Proprioceptive errors were greater at all target angles in the affected knees compared to those measured in the contralateral knees and both knees of the controls. Differences between affected knees and contralateral knees ranged from 1.01+/-0.25 degrees to 1.65+/-0.43 degrees and were significant at three target angles (15 degrees , 30 degrees , 60 degrees ; p<0.05). Comparisons between the affected knees and both knees of the controls also showed significant differences at all target angles ranging from 2.48+/-0.92 degrees to 3.87+/-2.46 degrees (p<0.001). Errors obtained in the normal knees of the patients were also significantly greater compared to those seen in both knees of the controls, exceeding 2.7 degrees at some target angles (p<0.001). CONCLUSION: Our results show that patients with PFPS have impaired proprioception in the affected knee accompanied by significant losses in the proprioception of the contralateral normal knee. Based on these findings, proprioceptive rehabilitation techniques should be incorporated into the treatment of PFPS.

[Cartilage defects of the knee joint: evaluation, classification, and natural course]. / Diz ekleminin kikirdak defektlerinde degerlendirme, siniflama ve dogal seyir.

Cartilage defects of the knee joint may be either isolated or in conjunction with various disorders of the knee. There are no clinical complaints and physical findings specific for joint defects. In addition, except for some magnetic resonance imaging techniques, there are no specific imaging methods for diagnosis. Therefore, arthroscopic evaluation is the gold standard for the diagnosis. Although there are many studies on the treatment of cartilage defects, natural course of the defects has been evaluated in only a few studies. Furthermore, controversy exists as to how and in which direction different treatment methods affect the natural course of cartilage defects. This review addresses factors affecting the natural course of cartilage defects; yet, the exact indications, timing, and methods of treatment, and whether any treatment is necessary remain unclear. Prospective, randomized, and controlled studies are needed to evaluate the results of different treatment methods on the natural course of cartilage defects.

A new weight-bearing meniscal test and a comparison with McMurray's test and joint line tenderness.

PURPOSE: The purpose of this study was to describe a new weight-bearing McMurray's test (Ege's test) and to compare its diagnostic value with McMurray's test and joint line tenderness (JLT). We also aimed to determine if associated lesions had any effect on the diagnostic values of the 3 tests. TYPE OF STUDY: Prospective controlled trial, clinical study. METHODS: The study group consisted of 150 consecutive patients who had had symptoms related to intra-articular knee pathology, and arthroscopic diagnoses were used as the gold standard. RESULTS: There were a total of 211 diagnoses on arthroscopy. A meniscus tear was found in 127 of the 150 patients; 90 had medial, 28 had lateral, and 9 had tears of both menisci. There were no statistically significant differences between the 3 tests in detecting a meniscal tear ( P > .05). However, better accuracy, sensitivity, and specificity rates were obtained with Ege's test for medial meniscal lesions (71%, 67%, and 81%, respectively). JLT also gave superior accuracy rates (71%), but the specificity of Ege's test was apparently higher than JLT (81% v 44%). The highest positive predictive value was also obtained with Ege's test (86%), whereas a superior negative predictive value was obtained with JLT (67%) in medial meniscal tears. Lateral meniscal tears were diagnosed more accurately than medial meniscal tears, and Ege's test gave results superior to the others (84%, 64%, 90% for accuracy, sensitivity, and specificity, respectively). Higher positive predictive values were obtained with McMurray's and Ege's tests than with JLT, but similar negative predictive values were achieved in all. A torn anterior cruciate ligament did not decrease the diagnostic values of the 3 tests, whereas the number of associated lesions in the knee negatively affected the diagnostic capabilities of the tests. CONCLUSIONS: Accuracies of traditional clinical meniscus tests may be improved by including Ege's test in the clinical examination. LEVEL OF EVIDENCE: Level II, diagnostic.

The evaluation of the proximal tibiofibular joint for patients with lateral knee pain.

In contrast to important functions of the proximal tibiofibular joint (PTFJ), there appear a few clinical and radiological studies concerning the PTFJ pathologies. Although almost all of the joints have been investigated in detail by MRI, review of the literature reveals none on the pathologies of PTFJ. Thirty-eight knees of 32 patients with lateral knee pain were evaluated clinically and radiologically. All had tenderness over the PTFJ and lateral hamstring tightness. MRI examination revealed effusion of the PTFJ in 22 knees and partial ruptures of anterior or posterior tibiofibular ligament, lateral collateral ligament or biceps femoris tendon in 25 knees. All patients were treated by manipulative physiotherapy of the PTFJ and strengthening and stretching exercises of the surrounding structures. All patients were followed-up 12-36 months (mean 28 months) after the treatment protocol, and complete relief of the symptoms was recorded in 28 of the 38 knees. Although spontaneous pain was not present in five patients, there was tenderness over the PTFJ by palpation. No change in the symptoms was recorded in five patients. These results suggest that PTFJ pathologies should be kept in mind in the evaluation of lateral knee pain and MRI examination provides useful information.

[The accuracy of the clinical diagnosis of meniscal tears with or without associated anterior cruciate ligament tears]. / Menisküs yirtiklarinin klinik tanisi ve eslik eden ön çapraz bag lezyonunun taniya etkisi.

OBJECTIVES: Meniscal tears and anterior cruciate ligament (ACL) tears commonly coexist in sports injuries. The purpose of this study was to analyze the influence of ACL deficiency on our ability to diagnose meniscal tears. METHODS: The study included patients with a clinical diagnosis of medial meniscal tears with (group A; 26 patients; 22 males, 4 females; mean age 26.6 years; range 18 to 67 years) or without (group B; 17 males; mean age 28.2 years; range 19 to 49 years) associated ACL tears. Patients with lesions other than meniscal or ACL tears were excluded. Clinical evaluations were made with the use of medial joint line tenderness, McMurray, and hyperextension tests. Preoperative diagnoses were compared with arthroscopic results and the accuracy of the tests used were calculated. The two patient groups were also compared with regard to the Lysholm scale parameters and total Lysholm scores. Fisher's exact test and Mann-Whitney U-test were used for statistical analysis. RESULTS: Medial joint line tenderness was present in 82% in group A, and 73% in group B. McMurray test was positive in 82% in group A, and 62% in group B; hyperextension test was positive in 73% in group A, and 61% in group B. The total Lysholm scores were significantly different, being 69 in group A, and 61 in group B (p<0.05). CONCLUSION: Our findings suggest that the accuracy of a clinical diagnosis of a meniscal tear is decreased by the presence of an ACL tear. The coexistence of meniscal and ACL tears requires a more careful clinical evaluation and a more frequent need for magnetic resonance imaging.

The anterior inferior tibiofibular ligament and talar impingement: a cadaveric study.

Impingement by the distal fascicle of the anterior inferior tibiofibular ligament (AITFL) is a relatively new entity among the known causes of anterolateral impingement syndromes of the ankle. This study investigated the anatomy of the anterior inferior tibiofibular ligament and its possible role in talar impingement in 47 ankles of 27 cadavers. The length, width, insertion point to the fibula and the interactions with talus were noted, as was the relationship of the fascicle and talus during different ankle movements before and after incision of the lateral ligaments. A distal fascicle of the AITFL was found in 39 of the 47 ankles (83%) and appeared as a single-complete ligament in the remaining 8 ankles (17%). The fascicle averaged 16.1+/-2.94 mm in length (range 10-21) and 4.2+/-1.00 mm in width (range, 3-7). The insertion point of the fascicle on the fibula averaged 10.3+/-2.27 mm (5-13) distal to the joint level. Contact between the ligament and the lateral dome of the talus was observed in 42 specimens (89.3%). Bending of the fascicle was observed in 8 of these 42 ankles with forced dorsiflexion. These 8 specimens were significantly wider and longer than the specimens without bending of the fascicle. Incision of the anterior talofibular ligament led to bending in dorsiflexion in additional 11 ankles. The total 19 fascicles with bending after incision of the anterior talofibular ligament were significantly longer and inserted more distally than the remaining 20 fascisles without bending. Manual traction simulating distraction during arthroscopic procedures relieved the contact. These findings show that the presence of the distal fascicle of the AITFL and its contact with the talus is a normal finding. However, it may become pathological due to anatomical variations and/or instability of the ankle resulting from torn lateral ligaments. When observed during an ankle arthroscopy, the surgeon should look for the criteria described in the present study to decide whether it is pathological and needs to be resected.