A comparison of telephone interview versus on-site completion of Lysholm knee score in patients who underwent arthroscopic ACL reconstruction: are the results equivalent?

INTRODUCTION: The purpose of this study was to compare two different modes of administration (telephone versus face to face) for Lysholm knee score (LKS) to test their multi-mode equivalence and reliability. MATERIALS AND METHODS: Two LKSs were obtained in 100 patients who underwent ACL reconstruction surgery. First LKS was completed through telephone interview, and second LKS, which was at least 2 weeks later, was completed face-to-face interview at the hospital. To analyze the test-retest reliability, the relative level of agreement between the two modes of administration for LKS was calculated using interclass correlation coefficient (ICC) in 95 % confidence interval. RESULTS: The mean LKS was 93.01 ± 9.12 (range 59-100) at telephone interview and 93.56 ± 7.93 (range 59-100) at face-to-face interview (p = 0.130). Both the total point and the each item's point were statistically similar (p < 0.05 for each item). The total score was same in 66 (66 %) subjects. The mean difference between two scoring was only 1.83 ± 3.14 points (range 0-15). However, eight (8 %) patients were assigned to different grading groups (excellent, good, fair, and poor). The overall LKS and the each item of the LKS had acceptable test-retest reliability [ICC = 0.954 (95 % CI 0.931-0.969)]. CONCLUSIONS: LKS can be reliably completed through telephone interview, which would provide accurate data similar to face-to-face interview. Researchers can design studies using telephone interview as a mode of administration for LKS or use mix-mode designs.

Prevention of proximal junctional kyphosis after posterior surgery of Scheuermann kyphosis: an operative technique.

STUDY DESIGN: A prospective randomized study. OBJECTIVE: To introduce an operative technique that prevents proximal junctional kyphosis (PJK) in Scheuermann disease after a segmental posterior spinal instrumentation and fusion. SUMMARY OF BACKGROUND DATA: PJK is the progression of kyphotic deformity at the proximal end of a construct >10 degrees, and it can be seen up to 30% after posterior Scheuermann kyphosis surgery. After posterior fusion the biomechanics of the spine changes and the loss of motion at the fused levels is compensated by increased motion at other unfused segments. As a result significant amount of additional force is placed on the proximal junction. With our operative technique, we aimed to have a smooth passage from rigid to mobile segments and to decrease the stress on proximal junction during cantilever reduction to prevent PJK. METHODS: A total of 60 consecutive patients (mean age: 18.27±3.19, male/female: 28/32) who were surgically treated for Scheuermann kyphosis in our institution were recruited into this study and were prospectively evaluated. Patients were divided into 2 groups according to upper-most screw fixation technique. In group 1, a standard screw insertion technique was used (ST group). The technique was modified in group 2 (MT group), leaving 2 threads out of the posterior cortex. There were 29 patients in group 1 (ST) and 31 patients in group 2 (MT). Patients had an average follow-up time of 24.2 months (range, 19-48 mo). Evaluated radiographic parameters were preoperative and postoperative kyphosis angle, and proximal junctional angle (PJA) at last visit. PJA was defined as the angle between the caudal endplate of the upper instrumented vertebra and the cephalad endplate of 2 suprajacent vertebrae above the upper instrumented vertebra. PJA exceeding 10 degrees was accepted as PJK. Quality of life measurement was assessed preoperatively and postoperatively with SF-36 questionnaire. RESULTS: Correction amounts in ST group and MT group were 46.8% and 43.7%, respectively, which was statistically insignificant. The mean PJA was 8.08±2.96 degrees and 4.44±1.55 degrees in ST and MT groups, respectively, which demonstrated a statistically significant difference (P=0.001). Five patients in ST group had a PJA exceeding 10 degrees (PJK), whereas PJK was not seen in MT group (P=0.022). The improvement in physical component summary of SF-36 was significantly better in MT group; however, mental component summary was similar in both groups. CONCLUSIONS: This study introduces a new technique that may have an effect in preventing PJK. Our results seem to be satisfactory, but additional studies with more patients and longer follow-up times are needed to further delineate the feasibility of this technique.

Traction apophysitis of the fifth metatarsal base in a child: Iselin's disease.

Although Iselin's disease, apophysitis of the fifth metatarsal base, is not infrequent in clinical practice, it is accepted as a rare cause of lateral foot pain in young adolescents. Usually a simple clinical examination and radiographs are sufficient for diagnosis. We present a patient with Iselin's disease and discuss its clinical and radiographic characteristics, differential diagnosis, aetiopathogenesis and treatment.

Fatty degeneration and atrophy of the rotator cuff muscles after arthroscopic repair: does it improve, halt or deteriorate?

OBJECTIVE: The purpose of this study was to evaluate the changes in fatty degeneration and atrophy of rotator cuff muscles after arthroscopic repair. We further assessed the factors affecting the functional outcomes and integrity of the rotator cuff. MATERIALS AND METHODS: One hundred and two prospectively followed patients who underwent single-row arthroscopic repair for full-thickness rotator cuff tears between 2008 and 2010 in our institution were included. All patients underwent shoulder MRI examination before the arthroscopic repair and at the final follow-up at least 2 years after the surgical repair. Supraspinatus muscle atrophy was measured and evaluated according to the Thomazeau classification. The fatty degeneration of the cuff muscles was graded according to the Goutallier classification. Functional outcomes were assessed with the Constant shoulder score. The changes in fatty degeneration and atrophy were analyzed during the treatment period. Correlation coefficients (Pearson r) and stepwise, multiple linear regression were used to determine the relationship between the outcome variables (final Constant score and integrity of the cuff), and the predictor variables, age, sex, follow-up duration, initial muscle atrophy, final muscle atrophy, initial fatty degeneration and final fatty degeneration. RESULTS: Of the 102 patients reviewed, 87 patients responded and concluded the final clinical follow-up and MRI examination (85.2 % follow-up rate). There were 67 females and 20 males with a mean age of 62.5 ± 8.3 years (range 40-80 years). Mean follow-up period was 30.1 ± 5.8 months (range 24-43 months). At the final follow-up, the mean Constant shoulder score was 94.2 ± 8.2 (range 70-100), and 66 (75.9 %) patients rated as excellent, 14 (16.1 %) as good, and 7 (8.0 %) as fair. No patient had poor results. There was re-rupture in 26 (29.9 %) patients on final MRI examination. No patient had improvement in muscle atrophy and fatty degeneration. The atrophic changes between intact tendon and re-rupture cases were statistically similar (p = 0.300). The deterioration of fatty degeneration was significantly higher in the re-rupture group (p = 0.0001). The Constant shoulder score was significantly lower in patients with re-rupture (97.4 ± 5.0 versus 86.6 ± 9.3, p = 0.001).Multiple stepwise regression analysis showed that the Constant score was dependent on the final integrity of the tendon and the size of the tear (R (2) 0.420, p 0.001). The final integrity of the tendon was dependent on the age of the patient, initial and final fatty degeneration of the cuff muscles and the size of the tear (R (2) 0.669, p 0.001). CONCLUSION: Initial muscle atrophy and fatty degeneration did not improve even after a successful rotator cuff repair where the tendon anatomic integrity was maintained for at least 2 years. It may continue to deteriorate, and the best possibility was preservation of the preoperative status. On the other hand, in cases of re-rupture, fatty degeneration and atrophy continued to worsen significantly. The factors affecting tendon integrity were found to be the age of the patient, the size of the tear and the severity of preoperative fatty degeneration in the rotator cuff.

Effect of untreated triangular fibrocartilage complex (TFCC) tears on the clinical outcome of conservatively treated distal radius fractures.

OBJECTIVE: The purpose of this study was to investigate the effect of untreated triangular fibrocartilage complex (TFCC) tear on the clinical outcome of conservatively treated distal radius fractures. MATERIALS AND METHODS: This prospective study comprised 47 consecutive patients who presented at our clinic between January 2009 and January 2010 with displaced radius distal fracture and were treated with closed reduction and casting. During the first 15 days of treatment, all patients underwent wrist MR imaging to detect traumatic TFCC tears. At the final follow-up, all patients were evaluated with Mayo wrist function score and wrist radiographs. Patients were divided into two groups according to presence of TFCC tear, and two groups were analyzed statistically. RESULTS: The mean follow-up period was 38.9 ± 3.5 months (range 36-48). TFCC tear was detected in 24 cases, and remaining 23 cases had no TFCC tear. Both groups were statistically similar regarding age (p = 0.574), gender (p = 0.108), dominant side involvement (p = 0.339), fracture type (p = 0.709) and immobilization period (p = 0.514). According to Mayo wrist score, excellent results were obtained in 21 (44.7%) cases, good in 16 (34.0%) and satisfactory in 10 (21.3%). No significant difference was observed between groups in wrist function scores (p = 0.451). Radiographic measurements were similar between groups (radial length p = 0.835, volar til p = 0.464, radial inclination p = 0.795). CONCLUSIONS: Traumatic TFCC tears which are frequently seen together with distal radius fractures do not affect the long-term functional results. Therefore, further diagnostic tests and treatment of TFCC tears in patients with stable distal radius fractures may be unnecessary. However, it should be borne in mind as a reason for continuing wrist pain and instability after distal radius fractures despite proper radiologic recovery.

Injection of autologous blood versus corticosteroid for lateral epicondylitis: a randomised controlled study.

PURPOSE: To compare the efficacy of autologous blood injection versus corticosteroid injection for lateral epicondylitis. METHODS: 21 men and 59 women (mean age, 45.2 years) presenting with lateral epicondylitis were randomised to receive either autologous blood injection (2 ml of autologous venous blood mixed with 1 ml of 2% prilocaine hydrochloride) or corticosteroid injection (1 ml of 40 mg methylprednisolone acetate mixed with 1 ml of 2% prilocaine hydrochloride) given by a single physician. Patients were assessed before (day 0) and after (days 15, 30, and 90) treatment for elbow pain (using a visual analogue scale [VAS]), function (using the patient-rated tennis elbow evaluation [PRTEE] questionnaire), and grip strength (using a hydraulic hand dynamometer). Patients were followed up at 6 months by telephone to assess elbow pain using the VAS. RESULTS: No complications (infection, skin atrophy, neurovascular damage, or tendon rupture) were noted. 10 patients reported increased pain for up to 2 days after autologous blood injection. In both groups, the VAS score for elbow pain, PRTEE score, and grip strength improved significantly after treatment (p=0.0001), but the pattern of improvement differed. Compared with autologous blood injection, corticosteroid injection improved all 3 scores at a faster rate over the first 15 days (p=0.0001), and then started to decline slightly until day 90. After autologous blood injection, all 3 scores improved steadily and were eventually better (p=0.0001). If a 37% decrease in PRTEE is defined as complete recovery, 38 (95%) of patients with autologous blood injection and 25 (62.5%) of patients with corticosteroid injection achieved complete recovery (p=0.0001). CONCLUSION: Autologous blood injection was more effective over the follow-up period than corticosteroid injection in improving pain, function, and grip strength. It is recommended as a first-line injection treatment because it is simple, cheap, and effective.

[Long-term results of extensive surgical dissection in the treatment of congenital clubfoot]. / Dogustan çarpik ayak tedavisinde genis cerrahi diseksiyonun uzun dönem sonuçlari.

OBJECTIVES: We evaluated the long-term functional and radiographic results of patients who underwent extensive soft tissue dissection for the treatment of congenital clubfoot. METHODS: We retrospectively evaluated 47 feet of 30 patients (6 girls, 24 boys; mean age 9.8 months) who underwent extensive surgical dissection for congenital clubfoot. Involvement was bilateral in 17 patients. Surgical dissection included complete subtalar release (CSTR) in 35 feet, and posteromedial release (PMR) in 12 feet. The mean age was 9.6 months (range 6 to 23 months) in CSTR-, and 10.6 months (range 5 to 23 months) in PMR-treated patients. The patients were assessed with the Laaveg-Ponseti functional score, foot bimalleolar angle, and other radiographic measurements. The mean follow-up was 117.3 months (106.6 months in the CSTR, and 150.6 months in the PMR group). RESULTS: Functional results were excellent in 24 feet, good in 12 feet, fair in six feet, and poor in five feet. All the poor results were seen in the CSTR group. Of these five feet, two developed recurrences, two had both pes cavus and metatarsus adductus deformities, and one had pes cavus deformity. Considering the foot bimalleolar angle, 83.4% of PMR-treated feet, and 85.7% of CSTR-treated feet were rated as type 1 or 2. Functional scores were significantly correlated with the foot bimalleolar angle, talus-first metatarsus angle on anteroposterior and lateral radiographs, and with the talocalcaneal angle on anteroposterior radiographs (p<0.05). There were no significant differences between the two surgical procedures with respect to functional scores and radiographic measurements (p>0.05). CONCLUSION: Extensive surgical dissection enables simultaneous correction of all components of deformity and provides satisfactory results not only in the short-term but also in the long-term follow-up.

[The effect of surgical exposure on the clinic outcomes of supracondylar humerus fractures in children]. / Cocuk suprakondiler humerus kiriklarinda cerrahi yaklasimin sonuca etkisi.

BACKGROUND: The clinic outcomes of supracondylar humerus fractures in children treated with open reduction and internal fixation by using two different surgical exposures were studied. METHODS: The clinic outcomes of seventeen and ten patients to whom lateral (LA) and posterior (PA) approaches were used respectively, were evaluated according to the Flynn's criteria. All fractures were extension type and classified as type II and III according to Gartland's classification. Left arm was broken in nineteen children and right arm in eight. The mean age was 8.5 years (range 3-13 years) and mean follow up was 19.4 months (range 8-50). RESULTS: Four (23.52%) of the seventeen patients with LA and two (20%) of the ten patients with PA suffered from a loss in the range of motion (ROM) of the elbow more than 10 degrees (p>0.05). Mean operation time was 53.14+/-18.11 minutes in the patients used LA and 68.54+/-17.67 minutes in the patients with PA. Satisfactory results were obtained in thirteen of the seventeen patients (76.47%) in the group with LA and in eight of the ten patients (80%) in the group with PA. CONCLUSION: It is concluded that in the open reduction of childhood supracondylar fractures of the humerus, LA and PA approaches without dividing triceps muscle do equally affect the ROM of the elbow. Although PA decreases the risk of ulnar nerve injury with Kirschner wire, it prolongs the operation time.