Novice Surgeon Portal Preference to Visualize the Femoral Anterior Cruciate Ligament Footprint: The Accessory Medial Portal Offers Improved Visualization.

PURPOSE: To evaluate participant opinions on the appropriateness of different viewing angles by asking 8 questions, using visual content techniques. METHODS: Survey information from participants was used in this study. We used images of a patient who was operated on for symptomatic knee instability. Participants were asked whether the visual angle could determine the femoral tunnel entry point or evaluate anterior cruciate ligament (ACL) integrity. RESULTS: Questionnaires were completed by 40 participants. When all responses were evaluated, participant opinions on the accessory medial portal (AMP) were more positive than opinions on images taken from the anterolateral portal (ALP). These observations were statistically significant (P < .005). Both ACL integrity assessments and femoral tunnel entry site questions were evaluated, we observed that participant opinions on the AMP for both types of evaluation were more positive than opinions on the ALP. This observation was statistically significant (P < .005). When evaluations with photos and video transcripts were compared, no significant differences in terms of participant opinions were observed (P < .005). CONCLUSIONS: AMP use may be a valuable tool for assistant and postgraduate education, as it offers a more suitable view angle for ACL reconstruction. LEVEL OF EVIDENCE: Level V, survey study.

A Practical Method for Obtaining True Lateral Elbow X-rays in a Paediatric Age Group: Lateral Elbow X-ray in the Standing Salute Position.

INTRODUCTION: Paediatric elbow fractures constitute 10% of all paediatric fractures. Radiological interpretation of the immature elbow is difficult due to its cartilaginous structure. We aimed to describe an X-ray technique in paediatric patients to obtain true lateral elbow X-rays and to prevent the repeat X-ray shots. MATERIALS AND METHODS: Radiographs of 39 children, with a mean age of 48.17 months (range; 7-84 months), with elbow trauma were included. All elbow lateral radiographs were taken in the 90º flexion position. In the first group, radiographs were taken using the standard technique(lateral radiographs in shoulder internal rotation). In the second group, lateral radiographs of the elbow were taken while the patient was standing and the forearm was elevated passively with 90° shoulder abduction and 90° elbow flexion (standing salute position). Three criteria were examined from the graphs to determine the true lateral elbow graphy. RESULTS: In group 1 (n = 20) and group 2 (n = 19), lateral elbow radiographs were evaluated. No statistically significant differences were found between the groups, in terms of mean age and distal humeral fractures. In group 2; the presence of humeroulnar joint space, partial coronoid superposition of the radius head and presence of the hourglass formation were significantly higher. DISCUSSION: It is clear that radiographs taken in appropriate positions decreases diagnostic errors. In our study, the ratio of correct lateral radiographs was significantly higher in the radiograph group in the standing salute position, suggesting this method was safe for accurate lateral radiographs, in accordance with our hypothesis.

A Retrospective Comparison of ACL Tear and Mucoid Degeneration MRI Findings and an Emphasis on Evaluating of ACL, Blumensaat, and PCL Angles.

OBJECTIVE: To determine MRI findings that can differentiate anterior cruciate ligament (ACL) tears from mucoid degeneration. MATERIAL AND METHODS: Thirty-seven patients with complete ACL tears and 43 with ACL mucoid degeneration were included in this study. Discontinuity, the abnormal signal intensity of the ACL on fat-saturated-PD weighted images, contusions, a deep lateral femoral notch, anterior tibial translation, uncovered posterior horn of the lateral meniscus, a celery stalk appearance, thickening, ganglion cysts, intraosseous cysts, the ACL, Blumensaat, and posterior cruciate ligament (PCL) angles were evaluated. Optimum threshold values, sensitivity, specificity, and 95% CIs for the angles were calculated to predict the tear. RESULTS: The prevalence of the significant findings in a tear versus mucoid degeneration, respectively, was as follows: discontinuity (97% vs. 0%, p < 0.001), contusions (65% vs. 2%, p < 0.001), the deep lateral femoral notch (22% vs. 0%, p = 0.001), anterior tibial translation (70% vs. 14%, p < 0.001), uncovered the lateral meniscus (46% vs. 7%, p < 0.001), a celery stalk appearance (0% vs. 66%, p < 0.001), thickening (19% vs. 100%, p < 0.001), ganglion cysts (14% vs. 70%, p < 0.001), and intraosseous cysts (8% vs. 63%, p < 0.001). Threshold values of ACL, Blumensaat, and PCL angles to predict the tear were ≤36° (78% sensitivity, 91% specificity), >11° (84%, 81%), and ≤96° (65%, 91%), respectively. CONCLUSION: A celery stalk appearance in the mucoid degeneration and discontinuity in an ACL tear are important in the differential diagnosis. ACL, Blumensaat, and PCL angles can be helpful in settings of diagnostic uncertainty.

Dysplasia epiphysealis hemimelica of the lower limb.

Dysplasia epiphysealis hemimelica (DEH) is a rare developmental disorder characterized by osteocartilaginous overgrowth in one or more epiphyses. The disease usually involves a single limb or is hemimelic (lateral or medial compartment), and lower extremities are more frequently affected than upper extremities. Here we present clinical and radiological findings for a male DEH patient at 1.5 and 3.5 years of age. The radiographs obtained at first presentation showed minimal osseous overgrowth and irregularity at the epiphyses around the left knee and ankle joints, respectively. Radiographs obtained at the second presentation showed osteocartilaginous masses at most epiphyses of the left lower extremity. Two months after diagnosis (at 3.7 years old), the patient had surgery on his left knee to relieve increased joint restriction. The histopathological diagnosis was consistent with an osteocartilaginous lesion. This case report presents imaging features and age-related progression of DEH in this patient.

Ultrasonographic evaluation of the posterolateral radiohumeral plica in asymptomatic subjects and in patients with osteoarthritis.

AIMS: The aim of this study was to describe the morphological features of posterolateral radiohumeral (RH) plica in asymptomatic subjects and in patients with elbow osteoarthritis using ultrasonography (US). MATERIAL AND METHODS: The control group included a total of 100 healthy elbows (51 subjects) and the study group consisted of 22 elbows (22 patients) with osteoarthritis confirmed clinically and by imaging methods. The presence, length, height, thickness, cross sectional area, shape, and echogenicity of the posterolateral RH plica were evaluated in both groups. In addition, humeral and radial cartilage thicknesses were also measured. The clinical characteristics and radiographic findings of the study group were evaluated. RESULTS: The posterolateral RH plica was present in all elbows of the control group (100%) and in 15 (68%) of elbows in the study group (p<0.05). All sizes and cross sectional areas of the plica were statistically significantly lower in the elbows of the study group compared to the elbows of the control group (p<0.05 and p<0.001, respectively). The detected posterolateral RH plicae were triangularly shaped in both groups. The plica was hyperechoic in 95 elbows (95%) in the control group and 7 osteoarthritis elbows (46.7%) (p<0.001). The thicknesses of radial and humeral cartilage were also significantly higher in the control group (p<0.001). There were no statistically significant relationships between the radiographic scoring of the elbow osteoarthritis and US findings of the RH plica (all p>0.05). CONCLUSIONS: The posterolateral RH plica can be successfully evaluated using US. Based on these findings, it appears that osteoarthritis can result in a reduction of the RH plica and affect its morphological appearance.

Rotator cuff-quality of life scale: adaptation to Turkish.

PURPOSE: The adaptation of scales to the native language and cultural setting of the patient is essential for obtaining more reliable results in scientific studies. In this study, the rotator cuff-quality of life scale (RC-QoLS) was translated into Turkish, and validity and reliability testing was performed on the scale. METHODS: The scale was first translated into Turkish and then from Turkish to English by another language specialist. Subsequently, the two translations were evaluated by two orthopaedic surgeons who had comprehensive knowledge of English to create the final Turkish version of RC-QoLS. The scale was used for the assessment of 54 patients (average age 56 years) with rotator cuff tear scheduled for surgery. The scale was completed by each patient two times with 1-week interval. RESULTS: The Cronbach's alpha coefficients ranged between 0.895 and 0.980 and intraclass correlation coefficients ranged between 0.807 and 0.976, this rendered all domains reliable. The scale gave results very near to those obtained by the original questionnaire with respect to the constructed validity and internal consistency as well as domain relationships. CONCLUSIONS: In general, the Turkish version of the RC-QoLS is a valid and reliable test with high differentiating power that may be used in the evaluation the quality of life of patients with RC tear in patients who are native Turkish speaker. The use of the Turkish version of RC-QoLS may contribute to the making of a more reliable evaluation in the studies on RC problems in the Turkish society.

Tenosynovitis of the peroneal tendons associated with a hypertrophic peroneal tubercle: radiography and MRI findings.

An enlarged peroneal tubercle can cause a peroneal tendon tear and/or tenosynovitis due to chronic friction. We present the case of a 45-year-old man with tenosynovitis in the peroneus longus and brevis tendons associated with a hypertrophic peroneal tubercle. On admission to our facility, the patient presented with pain while walking and had a fixed mass on the lateral aspect of his right foot. In addition, an osseous prominence corresponding to a hypertrophic peroneal tubercle was seen on the lateral side of the right calcaneus on radiography. MRI confirmed the hypertrophic peroneal tubercle and revealed high-signal intensity within the peroneus longus and brevis tendons along with fluid in their sheaths.

Effect of radiofrequency microtenotomy on degeneration of tendons: an experimental study on rabbits.

INTRODUCTION: Radiofrequency microtenotomy is used to enhance healing by increasing vascularity in the degenerated tendon. In the present study, the effect of radiofrequency microtenotomy (Rf-mt) treatment on tendon degeneration was investigated. MATERIALS AND METHODS: A total of 32 New Zealand rabbits were enrolled in the current study. Experimental degeneration was performed by injecting prostaglandin E1 (PGE1) into the bilateral Achilles tendons of rabbits. After excluding 4 rabbits with an infection on the injection site, 4 other rabbits were sacrificed to define the histopathologic changes in the tendons. The remaining 24 rabbits were divided into 2 groups: the control group and the Rf-mt group. In the control group, the Rf-mt device was only applied to the Achilles tendon without running the device. In the Rf-mt group, the Rf-mt device was applied bilaterally at the fourth energy level for 500ms to an area within 2cm proximal to the insertion site at 0.5cm intervals in order to form a grid. Six rabbits from each group were sacrificed at 6 and 12 weeks. The Achilles tendons were evaluated histopathologically by a modified Movin scale and by immunohistopathologic staining for vascular endothelial growth factor and type 4 collagen. RESULTS: After the PGE1 injection, findings similar to chronic degenerative tendinopathy were observed. The Rf-mt group showed significant improvement in vascularity in the histopathological and immunohistochemical examination (P<0.05). However, there was no significant difference in healing between the control and Rf-mt groups (P>0.05). CONCLUSIONS: Rf-mt treatment increases vascularity in degenerated tendons but does not create difference to facilitate the healing process comparing control group.

Comparison of ultrasonography and radiography in assessment of the heel pad compressibility index of patients with plantar heel pain syndrome. Measurement of the fat pad in plantar heel pain syndrome.

AIMS: The shock absorption of the heel fat pad is assessed by heel-pad compressibility index measuring the thickness of the heel pad on the lateral radiographs unloaded and loaded by body-weight. Ultrasonography is an easily applicable method without radiation and magnification inherent in radiographs. There are no reports comparing these measurements by diagnostic ultrasonography and direct radiography in healthy individuals and in different clinical entities. The efficacy of ultrasonography in assessment of heel-pad compressibility index in patients with plantar heel pain syndrome was investigated comparing it with direct radiography. METHODS: The loaded and unloaded heel-pad thicknesses by ultrasonography and direct radiography were measured in 69 feet of 42 patients with plantar heel pain syndrome and their results were compared. RESULTS: In direct radiographs, the mean unloaded heel-pad thickness was 20+/-2 mm and ranged from 14 to 26 mm. Heel-pad compressibility index was 0.62+/-0.09. There was a strong positive correlation between the measurements of the unloaded thickness (r=0.84, P<0.001) and also between the measurements of the loaded thickness (r=0.88, P<0.001) done using ultrasonography and direct radiography. The difference between the results of measurements in two modalities did not exceed +/-1 mm in 50% and +/-2 mm in 81% in unloaded position and +/-1 mm in 62% and +/-2 mm in 82% in loaded position. CONCLUSION: Measuring unloaded and loaded heel pad thickness by ultrasonography is reliable in the adult feet with heel pain. The preference of ultrasonography is reasonable in the studies involving the heel fat pad.

Does long-term ischemia affect the oxidant status during fracture healing?

INTRODUCTION: The influence of transient circulatory arrest on oxidant status during the healing of a tibial fracture was investigated in rats by the use of a hindlimb tourniquet technique. MATERIALS AND METHODS: One of the most reliable indicators for cytological damage is lipid peroxidation, which can be demonstrated by malondialdehyde (MDA) levels. Fifty-eight Wistar rats were used in this study. To determine the basal MDA levels of bone, 10 rats not exposed to ischemia were killed by an overdose of ether. The remaining 48 rats were randomly divided into two groups (control and ischemia). The control and ischemia groups were then randomly divided into 4 groups of 6 rats each. In 48 rats, the left tibia was fractured and fixed intramedullarly. In the ischemic group, complete acute transient ischemia for 4.5 h was imposed after the fracture. In the control group, no other intervention except the fracture was done. Rats from the control and ischemic groups were killed on days 3, 7, 14, and 28, and MDA levels were determined in tibial bone and callus tissue. The MDA levels of the control and ischemic groups were compared with basal MDA levels in the bone of 10 rats. RESULTS: There was an apparent difference between the basal and control group MDA levels on days 3 and 7 (p < 0.01), between the basal and ischemic group MDA levels on days 3, 7, and 14 (p < 0.01). In addition, the ischemic group showed a statistically significant increase in MDA levels on days 3, 7 and 14 compared with the control group (p < 0.01). CONCLUSION: We conclude that complete acute transient ischemia affects the oxidant status during fracture healing. This effect especially occurs during the ischemic period, inflammation, and callus formation of fracture healing.

Tuberculosis of the knee in a child.

The diagnosis for skeletal tuberculosis is often overlooked. We report a 9-year-old patient with a history of 2 years of swollen joint, with a diagnosis of tuberculosis of the knee with involvement of the proximal tibial epiphysis, and treated surgically and with anti-tuberculosis drug therapy.

Swan-neck deformity and paresthesia following giant orf.

Orf is a zoonotic infection caused by a parapoxvirus that primarily infects sheep and goats. Human orf infection can take place when abraded skin comes into contact with infected animals. It occurs most commonly on the index finger. The characteristic lesion resembles a tumor and resolves spontaneously, usually without any complications. However, rare complications such as lymphangitis, adenitis, erythema multiforme, erysipelas, papulovesicular eruption, Pseudomonas aeruginosa infection, and bullous pemphigoid have been reported. Herein, we report a case of giant orf causing swan-neck deformity and paresthesia. These complications have not been previously reported in the literature.

Intraosseous ganglion of the lunate: a case report.

An intraosseous ganglion of the lunate treated operatively, is reported. The patient suffered 2 years of pain in the left wrist and a cystic lesion in the lunate. Curettage and bone grafting resulted in complete relief of pain.

[A case of ball-and-socket deformity of the ankle joint]. / Ayak bileginin ball-and-socket deformitesi: Olgu sunumu.

Ball-and-socket deformity of the ankle joint is a rare entity that is usually associated with inequality of leg length, fibular hypoplasia, coalition of the tarsal bones, and ray deficiency. This deformity was encountered in a nine-year-old girl with a short right limb, cavovarus foot, partial fusion of the 4th and 5th metatarsals, and talocalcaneonavicular coalition. No surgical intervention was necessary; the patient was recommended to wear a high-heeled shoe of 2.5 cm thickness to compensate for the difference in the leg length.