Proprioception After Primary Repair of the Anterior Cruciate Ligament.

BACKGROUND: Primary repair of the anterior cruciate ligament (ACL) has some potential advantages over the reconstruction technique, which include but are not limited to better knee sensation due to preservation of the natural ACL tissue in patients compared with tendon graft. Proprioception is impaired after ACL injuries and the sense of the joint position is lost. PURPOSE/HYPOTHESIS: The purpose of this study was to compare arthroscopic ACL primary repair and ACL reconstruction techniques clinically and functionally and analyze the differences in proprioception. It was hypothesized that primary repair would restore knee joint proprioception more successfully because the original tissue of the ACL is preserved. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 63 patients (34 underwent reconstruction and 29 underwent primary repair between 2017 and 2020) and 33 healthy controls, as well as the healthy knees of the operated groups, were evaluated between 24 and 48 months (mean, 29 months) postoperatively. Patients with proximal femoral avulsion tears and stump quality suitable for repair underwent primary repair, and those with tears outside these criteria underwent reconstruction using hamstring tendon autograft. Proprioception was evaluated using the active joint position sensation method during weightbearing, with a digital inclinometer used to measure differences between the target and achieved flexion angles of 15°, 30°, and 60°. RESULTS: At 15° of knee flexion, the deviation angles for the healthy knee of the reconstruction and primary repair groups were significantly smaller than those of the control group (P < .001), but there was no statistically significant difference between the groups in terms of deviation angle at 30° and 60° of flexion. The deviation angle of the operated knees was statistically significantly larger in the reconstruction group than in the primary repair group at all angles. The deviation angles at 15°, 30°, and 60° were 2.83°, 2.66°, and 2.66° in the reconstruction group and 1.00°, 1.00°, and 1.33° in the primary repair group, respectively (P < .001). There was no statistically significant difference between the reconstruction and primary repair groups in terms of clinical scores. CONCLUSION: Primary ACL repair can preserve proprioception in a well-selected patient group. In short-term follow-up, primary repair of the ACL in patients with proximal femoral avulsion tears and stump quality suitable for repair appears to be proprioceptively protective. Future studies are needed to clarify the long-term consequences of primary repair on proprioception in a larger population.

Can coracoacromial ligament degeneration be evaluated with preoperative MRI?

BACKGROUND: Subacromial impingement syndrome is one of the most common causes of painful shoulder in the middle-aged and elderly population. Coracoacromial ligament (CAL) degeneration is a well-known indicator for subacromial impingement. PURPOSE: To examine the relationship between CAL thickness on preoperative magnetic resonance imaging (MRI), arthroscopic CAL degeneration and types of rotator cuff tears. MATERIAL AND METHODS: Video records of patients who underwent arthroscopic shoulder surgery between 2015 and 2021 were retrospectively scanned through the hospital information record system. In total, 560 patients were included in this study. Video records of the surgery were used to evaluate the grade of coracoacromial ligament degeneration and the type of cuff tear. Preoperative MRI was used to measure CAL thickness, acromiohumeral distance, critical shoulder angle, acromial index, and acromion angulation. RESULTS: Significant differences were observed between grades of CAL degeneration in terms of CAL thickness (P < 0.001). As CAL degeneration increases, the mean of CAL thickness decreases. According to the results of post-hoc analysis, the mean CAL thickness of normal patients was significantly higher than those of patients with full-thickness tears (P = 0.024) and massive tears (P <0.001). Patients with articular-side, bursal-side, and full-thickness tears had significantly higher CAL thickness averages than patients with massive tears. CONCLUSION: This study showed that the CAL thickness decreases on MRI as arthroscopic CAL degeneration increases. High-grade CAL degeneration and therefore subacromial impingement syndrome can be predicted by looking at the CAL thickness in MRI, which is a non-invasive method.

PCA-pump for analgesia following pediatric scoliosis surgery: bolus administration with/without basal infusion.

OBJECTIVES: The aim of this study is to compare the use of two different opioid delivery systems (bolus PCA with/without basal infusion) to control postoperative pain and evaluate the side effect profile in pediatric patients undergoing scoliosis surgery. PATIENTS AND METHODS: 38 patients who underwent posterior spinal fusion for adolescent idiopathic scoliosis were included in the study. Patients were randomly divided into 2 groups by the computer. Patients who received only bolus PCA were named Group 1, and patients who received bolus PCA with basal infusion were named Group 2.Morphine consumption, postoperative pain assessmentduring rest, movement and coughing with numeric rating scale (NRS) and the Wong -Baker pain scale, heart rate and average blood pressure, sedation levels withRamsey sedation scale and side effects such as nausea, vomiting, itching, desaturation, and urinary retention were recorded. RESULTS: Total mean morphine consumption (mg) was 32.7 ± 9.7 in Group 1 and 43.4 ± 9.1 in Group 2. The mean morphine consumption (mg) at 12-24 hours and 0-48 hours in Group 1 was statistically lower than Group 2 (p = 0.001). There was no significant difference between the groups in terms of median NRS scores (p = 0.55). There was no statistically significant difference in the evaluation of the groups in terms of Wong-Baker pain scale. Wong-Baker pain scale is p:0.66 at the 2nd hour, p:0.951 at the 12th hour and p:0.467 at the 24th hour.There was no statistically significant difference in Ramsay Sedation Scale evaluation between groups during each follow-up time (p > 0.05). The Ramsay Sedation Scale was p: 0.94 at the 2nd hour, p:1.0 at the 12th hour, and p:1.0 at the 24th hour. The duration of vomiting between 0-2 h, 2-24 h and 0-48 h was higher in Group 2 (p = 0.001, p = 0.024, p = 0.001). CONCLUSION: The two administration settings of morphine sulphate by PCA pump have shown to be equally effective in the treatment of postoperative pain following PSF. In addition, PCA with basal infusion administration causes more opioid consumption and more systemic side effects. Therefore, the use of only bolus PCA in pediatric scoliosis surgery should be encouraged. LEVEL OF EVIDENCE: Level II, Randomized Controlled Trial.

A cross-cultural adaptation and validation of the Turkish version of American Orthopaedic Foot and Ankle Society Metatarsophalangeal-Interphalangeal Scale (AOFAS-MTP-IP) for the hallux.

OBJECTIVES: In this study, we aimed to translate and culturally adapt the American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal (MTP)-Interphalangeal (IP) scale, which is used for the clinical assessment of patients with hallux valgus (HV), into Turkish and to evaluate its validity and reliability. PATIENTS AND METHODS: Between February 2022 and October 2022, a total of 67 patients (18 males, 49 females; mean age: 51.5±15.9 years; range, 18 to 68 years) with HV deformity and able to communicate in Turkish were included. Following the translation of the AOFAS hallux MTP-IP scale into Turkish, its cultural appropriateness was confirmed. Intra-rater and inter-rater reliabilities were assessed by intraclass correlation coefficients (ICCs), using data collected by two orthopedists. Agreement among test-retest evaluations was conducted using the Bland-Altman analysis. The construct validity of the scale was determined by the Manchester-Oxford Foot Questionnaire (MOXFQ) and Short Form Health Survey (SF-36). Content validity was confirmed by the floor/ceiling effects. RESULTS: The Turkish AOFAS hallux MTP-IP had an excellent intra-rater reliability of 0.971. The intra-rater reliability of the pain, function, and alignment subscales ranged from 0.904 to 0.978. The inter-rater reliability was 0.913 for the total score, while ranging from 0.838 to 0.918 for the subscales. The total score of the AOFAS hallux MTP-IP had a high correlation with the physical domains of the MOXFQ and SF-36, while weaker correlations with mental domains were observed. No floor/ceiling effect was observed for the overall Turkish AOFAS hallux MTP-IP. CONCLUSION: The Turkish translated and culturally adapted AOFAS hallux MTP-IP scale is a valid and reliable measure, ensuring its use in assessing the clinical status of Turkish patients with HV deformity.

Capsular remnant in the rotator cuff footprint is a novel arthroscopic finding may indicate the etiology of the tear.

PURPOSE: The aim of the study was that the capsule remnant is a common indicator of sub-acromial impingement syndrome and bursal side onset rotator cuff tears. METHODS: Sixty-three patients with capsule remnants in the rotator cuff footprint (Study group) were detected, while the 53 patients did not have any remnant on the tendon footprint (Control group) between 2015 and 2020 were included. Demographic data of patients, such as age, gender, and operated side information were obtained from the archive files. Acromion type, presence of osteophytes in the acromioclavicular joint, Acromiohumeral Distance (AHD), Acromial Index (AI), Critical Shoulder Angle (CSA), and Coracoacromial Ligament (CAL) degeneration values were evaluated from preoperative MRI, radiographic images, and arthroscopic video recordings. RESULTS: Severe stages of CAL degeneration were observed in 82.5% of the patients who had capsule remnant (p: 0.001). While type 2 acromion was found in 61.9%, and also acromioclavicular joint osteophyte was found in 58.7% of the patients in the study group. The mean AHD was 8.22 ± 1.56 mm in the study group and 9.2 ± 1.3 mm in the control group. The mean CSA was 43.3 ± 4.9 in the study group and 40.8 ± 4.2 in the control group. The AI was measured as 0.8 ± 0.1 in the study group and 0.8 ± 0.01 in the control group. As a result of these measurements, a statistical difference was found between the two groups in terms of type 2 acromion ratio (p < 0.001), presence of osteophytes in the acromioclavicular joint (p < 0.001), mean acromio-humeral distance (p < 0.001), critical shoulder angle (p = 0.004), and acromial index values (p < 0.001). CONCLUSION: The findings of sub-acromial impingement syndrome were found to be more prominent in patients with full-thickness degenerative tear and findings of capsular remnant in the footprint. If the presence of the current finding is detected during glenohumeral arthroscopy, sub-acromial impingement syndrome should be examined in more detail to reveal the underlying cause and prevent a recurrence.

Is it the subcoracoid impingement or the subacromial impingement that tears the subscapularis tendon? A comparison of the MRI findings of the operated and healthy shoulders of the patients.

BACKGROUND: : The purpose of this study is to investigate whether the etiological factors accepted as causes of idiopathic subscapularis tears are true or not when the comparison is made with the opposite side healthy shoulder of the patients who underwent arthroscopic repair for an isolated subscapularis tear. METHODS: Sixteen patients who underwent shoulder arthroscopy between February 2016 and January 2018 and were diagnosed with isolated subscapularis tear were evaluated. The coracohumeral distance (CHDax), coracoid overlap (CO), and tuberculum minus cysts (TMC) were evaluated on the axial images of the MRI studies while the acromiohumeral distance (AHDsag), CHDsag, and subscapularis tendon slip number (STSN) on the sagittal oblique images and the AHDcor and SLAP lesion on the coronal oblique images. Degeneration of the coracoacromial ligament was evaluated during arthroscopy. RESULTS: The mean CHDsag (11.26-10.08), CHDax (10.63-9.98), CO (14.2-15.43), AHDsag (8-7.66), and AHDcor (7.65-7.68) measurements (operated side-healthy side, respectively) were statistically similar (p > 0.05). No statistically significant difference was found between TMC and STSN in healthy and operated shoulders (p > 0.05). There was mild coracoacromial ligament fraying in 4 (25%) and obvious coracoacromial ligament fraying in 8 (50%) which indicated subacromial impingement in 75% of the patients. DISCUSSION: The parameters of the coracoid process did not reveal any significant difference between the operated (for an isolated subscapularis tear) and opposite-side healthy shoulders of the patients. However, coracoacromial ligament degeneration was present in 75% of the patients.

Investigating the magnetic resonance imaging cross-section area that best correlates with intraoperative hamstring autograft size.

OBJECTIVE: This study aimed to find out the level of the gracilis and semitendinosus tendons that would provide the closest information about the size of the quadruple-stranded hamstring autograft using magnetic resonance images before anterior cruciate ligament reconstruction. METHODS: Ninety-six patients (44 males, 52 females) who underwent anterior cruciate ligament reconstruction with quadruple hamstring tendon autografts between January 2015 and March 2020 were retrospectively analyzed. The cross-sectional areas of the gracilis and the semitendinosus tendons at 6 different levels (pes anserinus insertion site, tibial tuberosity, fibular head, tibial plateau, and the proximal insertion sites of the anterior cruciate ligament and the medial collateral ligament were measured on the magnetic resonance images. In addition, the harvested hamstring tendons were measured together (quadrupled) using a standardized graft-sizing block. RESULTS: There was no significant difference between genders in terms of the tendon sizes measured in all levels using magnetic resonance images. There was a strong correlation between the graft size and the measurements made at the tibial plateau level (P < .0001, r=0.590). CONCLUSION: Intraoperative quadruple hamstring tendon sizes were most correlated with the magnetic resonance image measurements at the tibial plateau level. To use a hamstring autograft with a diameter of at least 8 mm for anterior cruciate ligament reconstruction, the total area of the 2 tendons should be at least 18.11 mm2 in the magnetic resonance image measurements made at the tibial plateau level. LEVEL OF EVIDENCE: Level IV, Diagnostic Study.

Anatomical Factors Which Influence the Formation of Peroneal Tendon Tears: A Retrospective Comparative Study.

This study aims to investigate the anatomical factors that are effective in the formation of peroneal tendon tears comparing with the control group. The patients with ankle magnetic resonance imaging (MRI) due to pain on the lateral side of the ankle were retrospectively analyzed using the clinical archive between July 2015 and January 2020. Peroneal tendon tears, peroneal tubercle type and size, presence of peroneal quartus, presence and type of retromalleolar groove, retromalleolar groove area, lateral malleolus type, presence of os peroneum, peroneus brevis-lateral malleolus distance (PBLMD), and accompanying pathologies in coronal, axial, and sagittal planes MRI were evaluated. PBLMD was measured as 27.1 ± 12.3 mm in Group 1. With PBLMD, it was measured as 39.6 ± 11.68 mm in Group 2. There was a significant relationship between low-lying peroneus brevis muscle and peroneal tear (p < .001). Peroneal tendon tear was more common in patients with peroneal quartus muscle (p < .001). There was a relationship between the retromalleolar groove type and the presence of peroneal tear (p = .004). More peroneal tears were observed in the concave retromalleolar groove type. The presence of concave type retromalleolar groove, peroneus quartus, and low-lying peroneus brevis muscle was found to be associated with peroneal tendon tears.

Does Preoperative Conservative Management Affect the Success of Arthroscopic Repair of Partial Rotator Cuff Tear?

BACKGROUND: The aim of this study is to examine the effect of preoperative conservative treatment on the success of high-grade bursal/articular-sided partial rotator cuff repair. METHODS: Patients who had undergone shoulder arthroscopy in institution for Ellman Stage 3 bursal-side or articular-side partial tears between January 2008 and April 2018 were investigated retrospectively. This study assessed 201 patients diagnosed with isolated partial rotator cuff tears with a history of failed conservative management and persistent shoulder pain who underwent arthroscopic surgery. The demographic data of patients and pre- and postoperative The American Shoulder and Elbow Surgeons Shoulder Scores (ASES) that were recorded in the archive were evaluated. RESULTS: While 55 of the patients with Ellman grade 3 bursal-sided partial tears received preoperative conservative management for at least 6 months (Group 1), 62 of them could not tolerate conservative management and early arthroscopic repair was performed (Group 2). On the other hand, 42 of the patients with Ellman grade 3 articular-sided tears received preoperative conservative management (Group 3), 42 of them could not tolerate preoperative conservative management (Group 4). The mean ASES score improvement was 52.33 ± 8.55 for Group 1, 54.68 ± 11.29 for Group 2, 48.4 ± 7.77 for Group 3 and 49.33 ± 10.05 for Group 4. A statistically significant difference was found between the groups with one-way ANOVA test (p = 0.05). With the Tukey test, this difference was seen to be caused by Group 2. CONCLUSION: Although there are many factors affecting its success, conservative management should be the first option in the treatment of partial rotator cuff tears. However, we think that it should not be insisted especially in patients with bursal-sided tears (> 50% of the tendon thickness) that cannot tolerate conservative management due to severe pain since the results of early arthroscopic repair of bursal-sided tears were found to be better. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.

The middle glenohumeral ligament: a classification based on arthroscopic evaluation.

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.

The Correlation of the SLAP II Lesion Findings Between Physical Examination, Magnetic Resonance Imaging, and Arthroscopic Surgery.

OBJECTIVES: The aim of this study is to demonstrate the importance of clinical diagnosis by comparing with preoperative physical examination and magnetic resonance imaging (MRI) images in patients who were arthroscopically diagnosed as having Superior Labrum Anterior-Posterior (SLAP) II lesions. MATERIALS AND METHODS: 134 patients, arthroscopically diagnosed as SLAP II, established the study group, and 200 patients who underwent shoulder arthroscopy for the other pathologies established the control group. Preoperative clinical examination of the patients, MRI findings, and the arthroscopic findings of the patients were recorded. RESULTS: Out of the patients diagnosed with a SLAP II lesion, 107 (79.9) of those had an MRI finding while only 60 (30%) of the control group had it. The O'Brien test results of the patients diagnosed with SLAP were positive in 111 (82.8%) while those diagnosed with intact superior labrum were positive in 132 (66%). Of the 134 patients with a SLAP II lesion, 89 (66.4%) had both O'Brien test positiveness and MRI finding, and 129 (96%) had at least one positive result of the O'Brien test or MRI examination. CONCLUSION: The O'Brien test and MRI examination are not capable enough to indicate a SLAP lesion one by one, because of the low sensitivity and specificity. But, combining the test with MRI findings provides more trustable information about the superior labrum.

Excessive extremity shortness due to septic arthritis : Case report of treatment with two surgical procedures.

Septic arthritis is a common joint infection in neonates and young children. Since osteoarticular infections cause permanent disability in bones and joints, they should be treated appropriately as soon as possible. If there is a delay in starting treatment it can cause severe morbidity. It is most common in the hip and shoulder joints. In this article the surgical treatment process and postoperative clinical status of a 35-year-old patient with severe coxarthrosis and 12 cm femoral shortening due to septic arthritis are reported. To avoid damage to neurovascular structures an extremity lengthening procedure was performed first, followed by a total hip replacement. In order to complete the distraction and consolidation phase in one session and to reduce complications, a growing intramedullary nail was selected. As a result of the surgical interventions, the complaints of the patient in the hip joint and the limping due to shortness of the leg decreased and the performance of activities of daily living was improved.

The Buford complex: prevalence and relationship with labral pathologies.

BACKGROUND: This study aimed to determine the prevalence of the Buford complex and to investigate its association with labral pathologies (superior labrum anterior-posterior [SLAP] lesion and anterior, posterior, or multidirectional instability) using a very large patient database. Furthermore, the prevalence of the Buford complex in patients without any labral pathology was also determined. METHODS: A total of 3129 consecutive shoulder arthroscopy procedures were retrospectively evaluated for the presence of the Buford complex and coexisting labral pathologies. The relationships between the Buford complex and SLAP lesions, as well as instability, were evaluated statistically. RESULTS: The Buford complex was observed in 83 shoulders (2.65%). SLAP lesions were significantly more frequent in patients with the Buford complex than in those without it (81.9% vs. 33.1%, P < .001) Shoulders with the Buford complex presented a lower frequency of anterior instability (10.8% vs. 19.3%, P = .052) and a higher frequency of posterior instability (1.2% vs. 0.9%, P = .789). The prevalence of the Buford complex in patients with and without labral pathologies was 4.6% and 0.3%, respectively (P < .001). CONCLUSIONS: This study, to our knowledge, includes the largest cohort in the literature reporting the prevalence of the Buford complex (2.65%). In the 1461 patients without labral tears or multidirectional instability, the prevalence of the Buford complex was 0.3%. This result suggests that the real prevalence of the Buford complex might be lower than that reported previously. In addition to the aforementioned conclusions, the identification of the Buford complex should prompt a thorough evaluation for concomitant SLAP lesions.

Recurrent anterior shoulder instability in patients 40-60 years old. Accompanying injuries and patient outcomes of arthroscopic repair.

BACKGROUND: Accompanying injuries are frequently seen in middle aged patients with recurrent instability. The aim of this study was to elucidate the associated injuries, report patient outcomes of the following arthroscopic instability surgery regarding 40-60 years old patients with recurrent shoulder instability. METHODS: Patients that underwent arthroscopic instability surgery due to recurrent shoulder instability between February 2008 and November 2015, and which were 40-60 years old were included and evaluated retrospectively. Minimum follow-up duration was 24 months. Anterior-inferior labral injuries and accompanying pathologies such as rotator cuff tears and SLAP lesions were documented. Postoperative patient-reported outcome evaluation was made using Oxford Shoulder Instability Score. RESULTS: Among 355 patients that underwent arthroscopic instability surgery, 88 patients which had pathology of recurrent instability were in the range of 40-60 years old. Patients who had previous shoulder surgery or fracture (n = 8) epileptic seizure history (n = 3), neurologic deficit (n = 2) were excluded from the study. 75 patients were included with a mean follow-up 69 ± 23 months (32-125). The percentage of middle-aged and elderly (40-60 years old) was 24.8% among recurrent shoulder instability patients. 44% had isolated Bankart lesion whereas 56% revealed multiple pathologies. Bankart + SLAP lesions were found in 32%, whereas Bankart + Rotator Cuff tears in 26.7% (13 isolated supraspinatus, 4 supraspinatus + subscapularis, 1 isolated subscapularis full-thickness and 2 partial-thickness supraspinatus tears). The mean Oxford Shoulder Instability Score was 38.4 ± 5.2 (26-48). The scores of patients which were treated with labrum and rotator cuff repair (median 42, range 30-48) were significantly better than the patients who were treated with isolated labrum repair (median 39, range 20-46) (p = 0.015). There was no difference regarding patients with or without SLAP repair (median 39 vs 39 and range 30-48 vs 20-48, respectively) (p = 0.702). CONCLUSIONS: Arthroscopic repair of capsulolabral lesions is a safe and successful technique in 40-60 years old patients. Furthermore, the presence of repaired rotator cuff tears led to even superior results. Accompanying SLAP lesions did not affect the results. STUDY DESIGN: Retrospective Case Series. LEVEL OF EVIDENCE: 4, Retrospective Case Series.

Partial and full-thickness rotator cuff tears in patients younger than 45 years.

OBJECTIVE: The aim of this study was to evaluate the results of the arthroscopic repair in patients with partial and full thickness rotator cuff tears and less than 45 years of age. METHODS: Fifty patients (26 women and 24 men; mean age: 41.4±3.96 years; range: 31-45) with rotator cuff tear, and who were treated with the arthroscopic repair, were included in the study. Twenty patients had full thickness and 30 had partial-thickness tears. The final functional evaluation was conducted at a mean of 42.4 months (range, 24 to 95 months; SD:13.3). The American Shoulder and Elbow Surgeon (ASES) self-report score and the University of California at Los Angeles Shoulder Score (UCLA Shoulder Score) were used as validated scoring systems. RESULTS: At the final follow-up, the mean ASES and UCLA scores improved significantly to 72.3 and 26.5, respectively, in the full-thickness group (p<0.01). The mean ASES and UCLA scores improved significantly to 70.7 and 25.3, respectively, in the bursal-side group (p<0.01). The mean ASES and UCLA scores improved significantly to 75.3 and 27.1, respectively, in the joint-side group (p<0.01). There were no significant differences between the groups according to the postoperative ASES score (p>0.06) and UCLA score (p<0.37). CONCLUSION: The arthroscopic repair of the joint-sided tears and bursal-sided tears has good functional outcomes as full thickness rotator cuff tears, and the surgical option should be considered in younger population if the conservative treatment fails. LEVEL OF EVIDENCE: Level IV, Therapeutic study.

Effect of Metatarsal Head Shape on the Development of Hallux Valgus Deformity: 10 Years of Natural Follow-up.

BACKGROUND: We investigated the role of first metatarsal head shape in the etiology of hallux valgus. By pedobarographic analysis, we evaluated whether first metatarsal head shape causes an alteration in plantar pressure values that would result in metatarsalgia. METHODS: Referrals to our clinic for metatarsalgia, plantar fasciitis, and calcaneal spur were scanned retrospectively. Patients with severe hallux valgus, pes planus, gastrocnemius stiffness, generalized joint laxity, neuromuscular disease, or a history of lower-extremity orthopedic surgery were excluded. Sixty-two patients with plantar pressure assessment and radiographic evaluation were included. These patients were invited for reassessment after 10 years. Feet were divided into three groups by metatarsal head shape: round, square, and chevron. On anteroposterior radiographs, the hallux valgus and intermetatarsal angles, relative first metatarsal length, lateral sesamoid subluxation, and presence of bipartite sesamoid were noted. Plantar pressure was assessed with pedobarography. RESULTS: Feet with round-shaped first metatarsal heads had a statistically significantly greater progression in hallux valgus angle than the other shapes. Plantar pressures under the first, second and third, and fourth and fifth metatarsals increased with time. This can explain the mechanism of transfer metatarsalgia and painful callosities under the first metatarsal in hallux valgus. There was no correlation between hallux valgus angle, relative metatarsal length, and lateral sesamoid subluxation. CONCLUSIONS: We found a strong relation between round-shaped first metatarsal head and hallux valgus angle progression. No patients had a risk factor responsible for hallux valgus. In other words, this study gives approximately 10-year natural history results in nearly normal feet.

Is the preoperative neutrophil-to-lymphocyte ratio a predictive value for postoperative mortality in orthogeriatric patients who underwent proximal femoral nail surgery for pertrochanteric fractures?

BACKGROUND: Hip fractures in the orthogeriatric population are a health problem that causes mortality and morbidity, with an increasing frequency. The present study aims to investigate whether the preoperative neutrophil-to-lymphocyte ratio (NLR) is a predictive value for the postoperative mortality risk in patients who underwent only proximal femoral nail (PFN) surgery due to pertrochanteric fractures (PTF). To our knowledge, there is not any study conducted with a similar population in the litertaure. METHODS: Fifty-five patients who were operated on by two National Board-certified surgeons with the PFN method were included in our retrospective study. The patients were divided into two groups. Group A included the patients who lost their lives within the postoperative first year (n=13), while Group B included the survivors (n=42). Preoperative NLR data, demographic information, duration of hospitalization, postoperative intensive care requirements (ICU) and comorbid diseases of all patients were recorded. RESULTS: In our study with a maximum follow-up period of 27 months, no statistically significant difference was found between the groups concerning age, gender, body mass index, preoperative American Society of Anesthesiologists scores (ASA), types of fractures, ICU requirements, duration of hospitalization (p>0.05). However, the NLR was significantly higher in Group A (p<0.01), with a cut-off value of 5.25, sensitivity of 84.6% and specificity of 78.6%. CONCLUSION: We believe that the preoperative NLR is a predictive variable for orthopedic surgeons in assessing the postoperative mortality risk in orthogeriatric patients who presented to the emergency room due to PTF and were planned to undergo PFN surgery.

Midterm outcomes after arthroscopic repair of partial rotator cuff tears: A retrospective study of correlation between partial tear types and surgical technique.

OBJECTIVE: Patients who underwent arthroscopic repair for partial rotator cuff tears were evaluated retrospectively. This study purposed to assess the postoperative clinical results of arthroscopic treatment of intratendinous rotator cuff tears and to investigate the effect of the tear type on the postoperative clinical outcomes. METHODS: Overall, 60 patients [36 women and 24 men; mean age: 48.6±12.2 years (range 33-67 years)] who underwent arthroscopic repair of Ellman stage 3 partial rotator cuff tear were evaluated retrospectively. These patients were grouped into the following three groups: articular-sided tears, bursal-sided tears, and intratendinous tears, with 20 patients included in each group. Subacromial decompression, acromioplasty, and tear repair without transforming to full-thickness tear were applied to the bursal-sided tears. The same technique was performed for intratendinous ruptures, with the only technical difference was that the capsular tissue was preserved during debridement of intratendinous tears. The articular-sided tears were transformed to complete tears and repaired arthroscopically. The preoperative and postoperative ASES scores and range of motion improvements were evaluated in all patients. The mean follow-up time was 44±6.5 months (range: 36-62 months). RESULTS: No significant intergroup differences were observed concerning the age and the mean follow-up duration (p=0.524, p=0.665). A similar increase in ASES scores was observed for all three types of tears (bursal-sided tears: 31.09-82.65; articular-sided tears: 35.50--84.00; intratendinous tears: 34.01-83.49). Statistically, no significant intergroup difference was observed concerning ASES score improvement (p=0.585). An increase in mean forward flexion, abduction, and external rotation were observed, especially, a statistically significant increase in flexion (p=0.001) and abduction (p=0.001) in all three types of tears. No patient experienced any intraoperative or postoperative complications. CONCLUSION: The results of arthroscopic treatment of intratendinous tears were similar to the other types of partial tears, and the results of arthroscopic treatment of grade 3 partial rotator cuff tears revealed satisfactory outcomes, regardless of the type of the tear. LEVEL OF EVIDENCE: Level III, Therapeutic study.