The role of patellar tendon morphometry on anterior knee pain.

PURPOSE: To investigate the morphometry of patellar tendon with magnetic resonance imaging (MRI) and to reveal the relation between patellar tendon properties and anterior knee pain (AnKP). METHODS: Twenty-three patients with AnKP and nine healthy individuals were included in the study. Patients with knee anomaly that may cause AnKP were excluded from the study. The patellar tendon examination was performed on sagittal and coronal sections of MRI. Freehand technique was used to frame the area of tendon and calculations were done by generic software. RESULTS: There were 23 patients in AnKP (+) and 9 individuals in AnKP (-) group. The morphometric results were not different among groups (p = 0.2). Higher body mass index was correlated with increased patellar tendon surface area in women (R (2) = 0.37). CONCLUSION: Patellar tendon length, thickness and surface area do not seem as a significant parameter to explain the aetiology of AnKP. Given the well-defined role of patellar tendon to support knee kinetics, the clinical value of tendon morphometry is to be determined.

[Venous thromboembolism prophylaxis in major orthopaedic surgery: A multicenter, prospective, observational study]. / Majör ortopedik cerrahilerde venöz tromboemboli profilaksisi: Cokmerkezli, prospektif, gözlem çalismasi.

OBJECTIVES: We investigated risk factors for venous thromboembolism (VTE), prophylaxis measures employed, and incidence of symptomatic deep venous thrombosis (DVT) and pulmonary embolism (PE) in patients undergoing major orthopaedic surgery (MOS). METHODS: An open, multicenter, prospective, observational study was conducted in 21 medical centers, comprising 899 patients. Of these, 316 patients (35.2%) underwent total hip arthroplasty (THA), 328 patients (36.5%) underwent total knee arthroplasty (TKA), and 255 patients (28.4%) underwent surgery for hip fractures (HF). Pharmacologic prophylaxis was employed in all the patients. RESULTS: Risk factors for VTE were seen in 73.2% of the patients, the most common being obesity (72%) and prolonged immobilization (36.3%). Low-molecular-weight heparin (91.1%) and fondaparinux (8.9%) were used for prophylaxis, which was short-term in 273 patients (30.4%) and long-term in 626 patients (69.6%). Mechanical prophylaxis was performed with compression stockings in 610 patients (67.9%) and by intermittent pneumatic compression in 67 patients (7.5%). During three-months of follow-up, symptomatic DVT and PE were seen in eight (0.9%) and four patients (0.4%), respectively. Mortality occurred in 10 patients (1.1%). Complications of major and minor bleeding were seen in eight (0.9%) and 40 (4.5%) patients, respectively. CONCLUSION: Effective VTE prophylaxis is associated with low risk of clinically apparent DVT and PE in MOS.

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

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

An unusual rotational injury: Pantibial ligamentous injury.

Pantibial ligamentous injury including knee dislocation and tibiotalar joint subluxation is an uncommon severe rotational injury. A 21-year-old male injured his right knee falling from a motorcycle. Physical examination revealed effusion on the right knee and ankle, and posterior translation of the tibia as well. The MRI of the right knee and ankle demonstrated the following findings: a complete disruption of cruciate ligaments, the medial collateral ligament, posteromedial corner injury together with a peripheric tear in the medial meniscus, the ruptured deltoid ligament, ankle syndesmosis space widening (>5 mm) and lateral subluxation of talus. Deltoid ligament of the right ankle was repaired and ankle syndesmosis was fixed with a cortical screw. The PCL and ACL were reconstructed arthroscopically with autogeneous bone-patellar tendon-bone graft. The midsubstance tear of MCL, posteromedial corner and medial meniscus tear were primarily repaired with nonabsorbable sutures. 3 years after the surgery, the patient was called for the final examination. MRI and X-ray findings of the knee and ankle joint demonstrated the continuity of ACL, PCL, MCL, and deltoid ligament. The patient, who is a farmer, can go back to his job and perform his daily activities. We presented a previously unreported case that involves both simultaneous occurrence of knee dislocation and tibiotalar joint subluxation. We used the term "Pantibial ligamentous injury" for this case.

[Assessment of quality of life of patients after hemiarthroplasty for proximal femoral fractures]. / Femur üst uç kiriklari nedeniyle hemiartroplasti ile tedavi edilen hastalarda yasam kalitesinin degerlendirilmesi.

OBJECTIVES: The quality of life of patients was assessed with the SF-36 Health Survey following hemiarthroplasty for hip fractures. METHODS: Forty patients were divided into two groups according to the type of hip fracture. Group 1 included femoral neck fractures (24 patients; 21 women, 3 men; mean age 76 years; range 64 to 94 years) treated with straight stem prostheses. Group 2 included intertrochanteric femoral fractures (16 patients; 13 women, 3 men; mean age 81 years; range 62 to 102 years) treated with calcar replacement prostheses (Leinbach). The SF-36 questionnaire was administered before and at least six months after surgery to assess changes in the quality of life. The effect of gender, fracture type, and the type of prosthesis on the SF-36 scores were examined. RESULTS: In group 1, the mean preoperative and postoperative physical health scores were 53.4 and 41.7, the mean mental health scores were 55.2 and 48.5, respectively. The mean corresponding scores were 52.8 and 35.1 for physical health, and 55.2 and 48.9 for mental health in group 2, respectively. Significant decreases were found in physical health and mental health scores postoperatively (p<0.05), with all the patients having decreased quality of life compared to the preoperative levels. The highest decrease was observed in physical role (56.8%), followed by physical function (42.8%) and mental role (42.9%) scores. The least affected were mental health (10.3%) scores. Gender, fracture type, and the type of prosthesis were not found to have a significant effect on the summary scores (p>0.05). CONCLUSION: Health related quality of life significantly decreases following hemiarthroplasty in elderly patients with hip fractures. Nonetheless, arthroplasty procedures enable these patients to maintain basic activities of daily living.

[Clinical results of lateral closing wedge high tibial osteotomy for osteoarthritis of the knee (Oblique osteotomy with tension band fixation)]. / Diz osteoartritinde lateral kapali kama yüksek tibial osteotominin klinik sonuçlari (Oblik osteotomi ve gergi bandi tespit teknigi).

OBJECTIVES: We evaluated the preliminary results of oblique and lateral closing-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee. METHODS: Thirty-nine patients (29 women, 10 men; mean age 53 years; range 34 to 64 years) underwent oblique and lateral closing-wedge high tibial osteotomy followed by tension band plate fixation. According to the Ahlback system, seven patients had grade II, 27 patients had grade III, and five patients had grade IV osteoarthritis. Fixation was completed with a blade plate and two cortical screws. The results were evaluated using the Knee Society Score at the end of a mean follow-up of 23 months (range 12 to 41 months). RESULTS: The mean pre- and postoperative Knee Society scores were 43 (range 18-72) and 80 (range 20-90), and the mean Knee Function scores were 57 (range 45-90) and 72 (range 35-90), respectively (p<0.05). The mean preoperative deviation from the mechanical axis of the leg was 8.9 degrees varus (range 3 to 15 degrees). A mean correction of 11.6 degrees valgus (range 7 to 18 degrees) was afforded in order to obtain a slight valgus alignment. The mean postoperative femorotibial angle was 171 degrees (range 162-183 degrees). Complications were seen in 11 patients, which included severe overcorrection, fixation failure, transient nerve palsy, or pain over the fibular osteotomy site. CONCLUSION: Oblique high tibial osteotomy combined with tension band fixation is an effective procedure providing secure and durable fixation to allow early motion. It should be recalled that a high complication rate is likely during the learning curve, which adversely influences the clinical results.

The incidence and location of corona mortis: a study on 75 cadavers.

We dissected 150 fresh cadaver halves by ilioinguinal exposure, and counted all vessels more than 2 mm in diameter, connecting the obturator system to the external iliac system. The distance between the symphysis pubis and the anastomotic vessels was measured. We found vascular anastomoses between the obturator and external iliac systems in 91 of 150 sides (61%), and anastomotic veins in 78 of 150 exposures (52%). Arterial connections were seen in 29 of the exposures (19%). The mean distance between the anastomotic arteries and the symphysis pubis was 64 (45-90) mm, and 56 (37-80) mm for the communicating veins. There seemed to be no significant difference between genders in the incidence of corona mortis and the distance between communicating vessels and the symphysis pubis.