Autologous Blood Injection Works for Recalcitrant Lateral Epicondylitis.

BACKGROUND: Recalcitrant lateral epicondylitis may be a disabling condition. Treatment of this condition is still controversial. AIMS: In the present prospective study, we evaluated the long-term results of autologous blood injection for the treatment of recalcitrant lateral epicondylitis. STUDY DESIGN: Prospective clinical study. METHODS: A total of 42 elbows of 40 consecutive patients (28 female, 12 male) were enrolled in this prospective study. Seven patients left the study (3 patients moved to another city, 1 patient died in the second week due to a heart condition, 1 patient quit the study because of the resolution of pain in the fourth week and 2 patients did not agree to the second injection). Thirteen patients were lost to third year follow-up. Therefore, a total of 21 elbows of 20 patients with 3 years of follow-up were included in this study. The mean age of the patients was 47.25 years (range, 20-68 years). RESULTS: Visual analogue scale (VAS), Nirschl score and grip strength were significantly improved after injections when compared to before treatment. The best improvement in terms of grip strength, Nirschl score and VAS score was detected at the one year follow-up. The improvement in Nirschl and VAS score sustained until the third year. CONCLUSION: We suggest that autologous blood injection for the treatment of recalcitrant lateral epicondylitis is an effective, safe and successful procedure in the long-term.

The effects of melatonin and caffeic acid phenethyl ester (CAPE) on fracture healing under ischemic conditions.

OBJECTIVE: The aim of this study was to investigate the effects of antioxidant molecules melatonin and caffeic acid phenethyl ester (CAPE) on fracture healing under ischemic conditions. METHODS: A right tibia fracture was created and fixed with an intramedullary pin in forty four male Wistar-albino rats. The rats were then randomly allocated to fracture, fracture-ischemia, fracture- ischemia-melatonin, and fracture-ischemia-CAPE groups. Ischemia was created by clamping femoral arteries four and a half hours. Animals were killed and radiographic, histological and biomechanical evaluation was performed sixth week after surgery. RESULTS: The radiological and histological scores of the fracture-ischemia-CAPE group were significantly better than the fracture- ischemia group at 6th week follow-up. Complete radiographical and histological healing of all fractures was detected in all groups. There was a significant difference between the maximum fracture force between the groups (fracture-ischemia

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.

Minimal invasive midvastus versus standard parapatellar approach in total knee arthroplasty.

OBJECTIVE: The aim of this study was to compare the short-term results of total knee arthroplasty (TKA) surgeries performed with minimally invasive mini-midvastus (MMV) incision and the standard medial parapatellar technique (ST). METHODS: Twenty patients (18 males, 2 females; mean age: 67.25±6.70) operated with the ST and 19 patients (4 males, 15 females; mean age: 64.53±7.53) operated with the MMV approach were retrospectively evaluated. The surgery time, blood loss, time to straight leg raise (SLR) postoperatively, range of motion (ROM) and Knee Society (KSS) score and Hospital for Special Surgery (HSS) score were compared between the groups. Radiological evaluation was made with standing orthoroentgenographs both pre- and postoperatively. Mean follow-up time was 29.4±8.2 months in the ST and 17.7±11.1 months in the MMV group. RESULTS: In the early postoperative period (10th day), the MMV group was significantly better than the ST group in terms of ROM. Time to SLR and blood loss values were also significantly better in the MMV group. However, there was no significant difference between the groups after the sixth month, for ROM, KSS and HSS values (p>0.05). Surgery time was significantly longer (with a mean difference of 22 minutes) in the MMV group. Radiological examination revealed ideal alignment in both groups. No deep or superficial infection was detected. Two patients in the MMV group had skin problems which healed after clinical follow-up. CONCLUSION: Our results suggested that functional results of TKAs performed via the MMV approach are better in the first six months when compared to those of the ST.

Antioxidant effects of propofol on tourniquet-induced ischemia-reperfusion injury: an experimental study.

PURPOSE: This experimental study aimed to investigate the antioxidant effects of propofol anesthesia at induction doses in a rat skeletal muscle ischemia/reperfusion injury model. METHODS: Twenty-six rats were randomly divided into three groups to receive one of the following interventions: sham operation (n = 6), ischemia/reperfusion (I/R) injury (n = 10), or propofol administration in addition to I/R injury (n = 10). I/R injury was attained by 2-h clamping of femoral artery followed by 3-h perfusion. Then blood and tissue samples were collected for biochemical analysis and histopathologic examination. Glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) enzyme activities and nitric oxide (NO) and malondialdehyde (MDA) levels were measured in both plasma and muscle tissue. In addition, catalase (CAT) activity and protein carbonyl (PC) content were measured in muscle tissue. RESULTS: I/R group had significantly higher SOD activity (9.05 versus 5.63 and 6.18 U/mL, P < 0.05) and NO level (46.77 versus 30.62 and 33.90 µmol/L, P < 0.05) compared with sham-operated group and I/R plus propofol group. In addition, GSH-Px activity of the I/R group was significantly higher than sham-operated group (1.26 versus 1.05 U/mL, P < 0.05). I/R group had significantly higher tissue activities of CAT (0.11 versus 0.06 and 0.04 k/g protein, P < 0.05) and SOD (0.12 versus 0.08 and 0.07 U/mg protein, P < 0.05) compared with the sham and I/R plus propofol group. Histopathologic examination showed that I/R plus propofol group had significantly lower degeneration (P = 0.021) and inflammation (P = 0.028) scores compared with I/R group. CONCLUSION: Propofol anesthesia seems to enhance the antioxidant capacity against tourniquet induced ischemia-reperfusion injury.

Intraarticular Hyaluronic Acid Injection after Microfracture Technique for the Management of Full-Thickness Cartilage Defects Does Not Improve the Quality of Repair Tissue.

OBJECTIVE: Tissue repair that occurs after microfracture does not include hyaline-like cartilage. Therefore, other treatment modalities must be combined with microfracture to improve repair tissue quality. In this study, we combined exogenous hyaluronic acid with microfracture. DESIGN: Thirty mature New Zealand rabbits were randomly divided into 3 groups as control, microfracture (MF), and microfracture and hyaluronic acid (MFHA). Four-millimetre full-thickness cartilage defects were created in the medial femoral condyle of each rabbit. Microfracture was performed on defects in the MF and MFHA groups. At 1 week following surgery, 1 mL of saline was injected into the knees of the control and MF groups, whereas 1 mL (15 mg/mL) hyaluronic acid was injected into the knees of the MFHA group 3 times weekly. At 6 months postsurgery, defects were evaluated according to the ICRS (International Cartilage Repair Society) and Wakitani scales. RESULTS: According to the ICRS and Wakitani scales, the quality of repair tissue was improved in MF and MFHA groups as compared the control group (P = 0.001 and 0.001, respectively). No significant difference was observed between the MF and MFHA groups (P = 0.342). CONCLUSIONS: According to the model in this study, no beneficial effect was obtained when HA injection was combined with microfracture in the treatment of full-thickness cartilage defects.

Simvastatin improves spinal fusion in rats.

OBJECTIVE: Statins stimulate bone formation by inducing the expression of bone morphogenetic proteins (BMP-2). The aim of our study was to investigate the effects of orally administered simvastatin on spinal fusion in rats. METHODS: Twenty rats were randomized into a spinal fusion group (SF) (n=10) or a spinal fusion and oral simvastatin administered group (SFS) (n=10). A spinal fusion was performed between L4-L6 representing two levels. Simvastatin (120 mg/kg/day) was administered orally in the SFS group. The rats were killed at the end of the 12 week study period. RESULTS: Manual palpation revealed two moderate fusions in the SF group. The SFS group did not reveal any signs of pseudoarthrosis. An average three-point bending force causing failure of fusion revealed results of 148.80±39.403 Newtons and 123.80±28.479 Newtons in SFS and SF groups, respectively (p>0.05). Histological examination revealed better fusion grades in the SFS group (mean: 9.30±0.949) than in the SF group (mean: 6.80±2.044) (p=0.003). Radiographic examination revealed Grade C fusion in two levels and Grade A fusion in 18 levels in the SF group. In the SFS group, Grade C fusion was detected in one level and Grade A fusions in 19. CONCLUSION: Our results suggest that simvastatin can promote spinal fusion and can be used as an adjunct to spinal fusion procedures in an elderly population with high cholesterol levels.

The "butterfly" suture technique for meniscal repair.

One of the important factors effecting meniscal healing is the strength of primary fixation obtained by repairing technique. From this perspective, it is important to choose the technique ensuring a higher primary fixation strength for meniscal repairs. We described a new technique for meniscal repair called "butterfly" technique using Viper device and hypothesized that high primary fixation strength can be obtained with this technique. The study was performed on calve knees. Full-thickness longitudinal tears 2 cm in length and 3 mm medial from the periphery were created in corpora of medial menisci of 14 calves. After creating tears, menisci were divided into two equal groups. In Group 1, two vertical loop sutures 1 cm apart were placed using a Viper device. Whereas in Group 2, tears were repaired using "butterfly" sutures. The mean load to failure was 156.3 ± 13.1 and 186 ± 15.8 N in Group 1 and 2, respectively (p = 0.002). The fixation strength in Group 2 was significantly higher than in Group 1. We suggest that, using Viper device and all-inside "butterfly" suturing techniques, meniscal ruptures with appropriate locations can be repaired with higher primary fixation strength.

[Overlooked primary hyperparathyroidism presented with fractures: case report]. / Kiriklarla gelen atlanmis primer hiperparatiroidi olgusu: Olgu Sunumu.

In the present paper, we report a female patient with multiple cystic lesions of bone arising from the primary hyperparathyroidism and pathological femur and contralateral tibia fractures at the level of these cystic lesions (osteitis fibrosa cystica). The patient's history revealed that she was admitted to a medical center with vague symptoms such as sudden onset of dyspepsia, loss of appetite, myalgia, arthralgia, fatigue, and weight loss six years ago but no disease was diagnosed. Loss of appetite and loss of weight continued. She had been walking only by assisted ambulation for the last year. However, primary hyperparathyroidism was overlooked until our examination. The fractures were managed by interlocking nailing and grafting after confirming with biopsy that the fractures were due to osteitis fibrosa cystica. The fractures healed uneventfully. In conclusion, it is essential to evaluate patients with these vague symptoms with full biochemical screening and radiological examination for the early detection of the disease.

[Protective effects of melatonin on ischemia-reperfusion injury of skeletal muscle]. / Melatoninin iskelet kasi iskemi-reperfüzyon yaralanmasi üzerine koruyucu etkisi.

OBJECTIVES: In this study, we investigated the antioxidant protective effects of melatonin on skeletal muscles of Wistar albino-type rats with acute ischemia/reperfusion (I/R) injury. MATERIALS AND METHODS: Twenty-eight Wistar albino-type male rats weighing between 334 to 422 g were included in this experimental study. The rats were randomly allocated into three groups including sham, I/R and I/R + melatonin groups, respectively. Limb ischemia was achieved by clamping femoral arteries. After a two-hour ischemia period followed by 1.5-hour reperfusion, muscle samples were collected for biochemical analysis and histopathological examination. RESULTS: Muscle tissues of I/R groups revealed significantly higher antioxidant enzyme (superoxide dismutase, glutathione peroxidase, catalase) activities, and increased levels of malondialdehyde, nitric oxide, and protein carbonyl content compared to the control group (p<0.001). Levels of these parameters in muscle revealed significant reductions in the I/R + melatonin group compared to the I/R group (p<0.001). Histopathological examination of ischemic muscles in the I/R group showed significant degeneration and inflammation compared to the control group whereas melatonin administered ischemic muscles showed significant reduction in degeneration and inflammation compared to the I/R group (p<0.001). CONCLUSION: In the present skeletal muscle acute I/R injury model, protective effects of melatonin against reperfusion injury have been revealed. We suggest that the protective effect of melatonin against I/R damage in cases of extremity injuries with acute vascular compromise, extremity surgery with prolonged tourniquet time and acute compartment syndrome should be investigated with clinical trials.

[Opening focal dome osteotomy in the treatment of varus gonarthrosis associated with medial laxity]. / Medial gevsekligin eslik ettigi varus gonartroz tedavisinde açici fokal-kubbe osteotomisi.

OBJECTIVES: We evaluated the short-term results of opening focal dome osteotomy in the treatment of varus gonarthrosis associated with medial laxity. PATIENTS AND METHODS: Seventeen knees of 16 patients with varus gonarthrosis associated with medial laxity (15 females, 1 male; mean age 51.6 years; range 45 to 58 years) were managed with opening focal dome osteotomy in our clinic between September 2003 and July 2006. The patients were evaluated for alignment of the lower extremities and medial laxity before and after the operation and were also evaluated clinically by Knee Society (KS) knee scores and Hospital for Special Surgery (HSS) knee scores. RESULTS: Mean follow-up was 27 months (range 12 to 44 months). Postoperatively, an average 13.8+/-3.3 degrees mechanical femuro-tibial angle (mFTA) correction was achieved (p=0.001). Average preoperative mechanical varus was 9.9+/-3.1 degrees whereas the mean postoperative mechanical valgus was 3.9+/-0.8 degrees (p=0.001). An average 2.6+/-1.2 mm reduction in medial laxity was ensured. Preoperative joint line convergence angle with a mean of 6.2+/-1.7 degrees was reduced to 3.2+/-1.1 degrees postoperatively which was statistically significant (p=0.002). Preoperative KS knee scores and function scores were 49+/-9 and 44+/-11 respectively whereas postoperative these values were 89+/-6 and 84+/-8 respectively. These values represent an average of 40+/-12 improvement (p=0.001). Pre- and postoperative HSS scores were 61+/-8 and 88+/-7 respectively representing an average of 27+/-11 improvement (p=0.001). CONCLUSION: Medial laxity is observed in a majority of patients with varus gonarthrosis. Opening focal high tibia dome osteotomy can achieve a correction in the mechanical alignment and also decreases medial laxity effectively in knees with varus gonarthrosis.

Comparison of intra-articular hyaluronic acid injections and mud-pack therapy in the treatment of knee osteoarthritis.

OBJECTIVES: Conservative treatment should be tried prior to surgical treatment in knee osteoarthritis. This study was designed to evaluate the short-term effects of mud-pack therapy on pain relief and functional improvement in knee osteoarthritis in comparison with intra-articular hyaluronic acid injections. METHODS: The study included 23 patients who were diagnosed as having knee osteoarthritis according to the ACR (American College of Rheumatology) criteria, and had complaints lasting for more than three months. All the patients had stage 2 or 3 osteoarthritis radiographically according to the Kellgren-Lawrence criteria. Twelve patients (3 males, 9 females; mean age 54+/-6 years; range 46 to 67 years) received mud therapy bilaterally. Mud packs were heated to 45 degrees C and applied on both knees for 30 minutes daily for a total of 12 weekdays. Eleven patients (2 males, 9 females; mean age 53+/-9 years; range 40 to 66 years) received a total of three bilateral intra-articular hyaluronic acid injections, each interspersed by weekly intervals. The patients were evaluated before and after treatment in terms of pain and functionality using the pain subscale of the WOMAC (Western Ontario and McMaster Universities) osteoarthritis index, Hospital for Special Surgery (HSS) score, and Knee Society clinical rating system (knee and function scores). The patients were followed-up for a mean of 5.9+/-6.3 months (range 4 to 8 months) after mud-pack therapy, and 5.8+/-0.8 months (range 5 to 7 months) after intra-articular hyaluronic acid injections. RESULTS: No significant differences were found between the two groups with respect to pre-and posttreatment WOMAC, HSS, and knee and function scores (p>0.05). The scores of all instruments showed significant improvements following treatment in both groups (p<0.001). Posttreatment changes in relation to baseline scores did not differ significantly between the two groups (p>0.05). CONCLUSION: Treatment of knee osteoarthritis with intra-articular hyaluronic acid injections or mud-pack therapy yielded similar results in the short-term in terms of functional improvement and pain relief. Mud-pack therapy is a noninvasive, complication-free, and cost-effective alternative modality for the conservative treatment of knee osteoarthritis.

Osteoid osteoma of the trapezium: case report.

Osteoid osteoma is a benign bone tumor representing approximately 10% of all benign bone tumors. Although osteoid osteoma of the long bones and carpus is frequent, the location in the trapezium is extremely rare. We found only one other report in the literature regarding osteoid osteoma of the trapezium.

[Joint immobilization increases reactive oxygen species: an experimental study]. / Eklem immobilizasyonu reaktif oksijen ürünlerini artirmaktadir: Deneysel çalisma.

OBJECTIVES: It has been shown that reactive oxygen species (ROS) contribute to the onset and progression of osteoarthritis. We investigated cartilage destruction and oxidative stress parameters in the blood and synovial fluid of knee joints of rabbits exposed to varying periods of immobilization. METHODS: Twenty-eight mature New Zealand albino male rabbits were divided into four groups equal in number. In three groups, the knees were immobilized with a rigid cast for 3, 6 and 9 weeks, respectively. The cartilaginous tissue of the femoral condyles and tibial plateau were analyzed with respect to total count, total volume, and numerical density of chondrocytes using stereohistological methods. Antioxidant activities of superoxide dismutase (SOD), catalase (CAT), and glutathion peroxidase (GSH-Px), and oxidative stress parameters including nitric oxide (NO) and malondialdehyde (MDA) levels were measured in the plasma and synovial fluid. RESULTS: Compared to the control group, total count and total volume of chondrocytes in the femoral condyle and tibial plateau showed significant decreases, while numerical density showed a significant increase at 3 weeks of immobilization. Subsequent immobilization periods resulted in significant decreases in all these parameters, being most remarkable compared to the control group at the end of nine weeks (p<0.001). In plasma and knee joint synovial fluid, all antioxidant enzyme activities (SOD, CAT, and GSH-Px) and oxidative stress parameters (NO and MDA) showed consistent increases compared to the control group throughout the immobilization period (p<0.001). CONCLUSION: Increased levels of ROS in the blood and synovial fluid might result in cartilage destruction and ROS may be one of the potential factors involved in the etiopathogenesis of osteoarthritis. Prolonged joint immobilization should be avoided in the treatment of orthopedic diseases.

[A biomechanical comparison of polymethylmethacrylate-reinforced and expansive pedicle screws in pedicle-screw revisions].

OBJECTIVES: Different techniques and choices exist for revision of pedicle screws, two of which are pedicle screw combined with cement augmentation and expansive pedicle screw fixation. This biomechanical study was designed to compare the pullout strengths of two different revision techniques. METHODS: Fourteen lumbar vertebrae obtained from four calves (mean age 15 months) were divided into two groups equal in number. Monoaxial 6.0-mm pedicle screws were inserted into the right pedicles, and axial pullout testing was performed at a rate of 10 mm/min and failure strengths were recorded. Revision was performed with the same-sized pedicle screws reinforced with polymethylmethacrylate in group 1, and with 7.0-mm expansive pedicle screws in group 2, and pullout testing was repeated to record maximum revision pullout strengths. RESULTS: The mean pullout strengths recorded before and after revision were significantly different in both groups, being 2,162.9+/-718.5 N and 2,794.3+/-979.2 N in group 1 (p=0.041) and 2,605.0+/-487.6 N and 3,327.1+/-640.8 N in group 2 (p=0.012), respectively. However, the mean pullout strengths recorded before and after revision did not differ significantly between the two groups (p>0.05). CONCLUSION: Our results showed that expansive pedicle screws 1 mm larger in diameter provide similar pullout strengths to those of same-sized, polymethylmethacrylate-reinforced screws in revision of pedicle screw fixation, suggesting that they can be preferred with the additional advantages of ease of application and avoiding risks for pedicle fracture and cement leakage.

Biomechanical evaluation of arthroscopic all-inside meniscus repairs.

Viper is a new device for arthroscopically all-inside meniscal repairing. In previous studies about Viper device, procedures were not applied arthroscopically despite this device has been designed for arthroscopic application. In this study, we evaluated primary fixation strength of arthroscopically applied meniscal repair using Viper device to obtain better clinical relevance. Two centimeter in length meniscal tear 2-3 mm far from periferic edge of medial meniscus of 50 calves were created arthroscopically. The menisci were divided into five groups including 10 menisci in each. In group 1, tears were repaired by outside-in vertical loop suture technique with No: 0 PDS. Tears were fixed by all-inside vertical suture by using Viper device with No: 0 PDS in group 2. In meniscal implant groups, RapidLoc, H-Fix, and Clearfix were applied in groups 3,4, and 5, respectively. Primary fixation strength of repairing techniques were evaluated with bio-mechanical testing machine. Fixation strengths determined in groups 1 and 2 were detected as 145 +/- 13 and 136 +/- 33 N, respectively. There was no difference in pull-out strength between groups 1 and 2. Fixation strengths in these two groups were significantly higher compared to groups 3, 4, and 5. There was no significant difference between group 3 (33 +/- 6 N) and 5 (28 +/- 6 N) in terms of fixation strengths whereas fixation strengths of these two groups were significantly higher compared to group 4 (20 +/- 3 N) (P = 0.005, P = 0.018, respectively). All-inside vertical suture technique using Viper device revealed comparable primary fixation strength with outside-in vertical suture technique for meniscal repair. We suggest that the Viper device is safe and reliable for meniscal repair.

[Total hip arthroplasty using the anterolateral minimally invasive approach]. / Minimal invaziv anterolateral teknikle total kalça protezi.

OBJECTIVES: We evaluated the clinical and radiographic results of total hip arthroplasties (THA) performed with the minimally invasive anterolateral (MIA) and standard anterolateral (SA) approaches. METHODS: We retrospectively reviewed 25 patients (17 women, 8 men; mean age 57.7+/-12.5 years) and 15 patients (11 women, 4 men; mean age 68.9+/-5.5 years) who underwent THA with the SA and MIA approaches, respectively. The mean body mass index was 32.5+/-5.8 kg/m2 in the SA group and 28.7+/-2.7 kg/m2 in the MIA group. The two groups were compared with respect to blood loss, operation time, blood transfusions, and length of hospital stay. Pain was assessed with a visual analog scale (VAS), and functional results were assessed with the Harris hip score (HHS). The SF-36 questionnaire was administered pre- and postoperatively. Radiographic evaluations included femoral and acetabular components and signs of loosening. The mean follow-up was 25.2+/-8.7 months in the SA group and 26.1+/-7.2 months in the MIA group. RESULTS: The amount of blood loss and blood transfusions were significantly reduced and length of hospital stay was significantly shorter in the MIA group (p<0.001). The mean operation time did not differ between the two groups (p>0.05). Improvements in the VAS and HHS scores were significantly better in the MIA group (p<0.001). Similarly, improvements in all the SF-36 subscales other than general health, mental health, and role-physical subscales were significantly greater in the MIA group. Radiographically, no signs of loosening and osteolysis were seen. Superficial or deep wound infections did not occur. CONCLUSION: Compared to the SA approach, the MIA approach in THA operations is associated with shorter hospital stay, reduced blood loss and blood transfusions, better postoperative pain control, and higher levels of improvements in HHS and SF-36 scores.

Quality of life in patients with varus gonarthrosis treated with high tibial osteotomy using the circular external fixator.

Generally, surgeon-driven musculoskeletal evaluation systems are used for evaluating outcomes of patients who are treated with high tibial osteotomy. In this study, we investigated the effects of high tibial osteotomy using circular external fixator on quality of life. Twenty-one high tibial osteotomy of 19 patients were evaluated. Quality of life assessment was made using Short Form -36 at preoperative, before fixator removal and 6 months after fixator removal. After applying fixator, the physical function and physical role scores of Short Form-36 decreased and emotional role score did not improve. In other categories, significant improvements were observed when fixator in place. At the sixth month after fixator removal, significant improvements were dedected in all categories of Short Form-36. Although there was a decrease in physical functions after fixator application in patients who were treated with high tibial osteotomy using circular external fixator, significant improvement occurred in quality of life after fixator removal.