Surgical treatment of medial knee ligament injuries: current indications and techniques.

The medial collateral ligament (MCL) and the posterior oblique ligament (POL) are the main static valgus restraints of the knee.Most isolated medial injuries can be treated with bracing and early knee motion.Combined MCL and ACL (anterior cruciate ligament) injuries can be managed with bracing of the knee followed by a delayed reconstruction of the ACL.Residual medial laxity may be addressed at the time of ACL surgery.Bony avulsions, incarceration of the distal MCL under the meniscus or over the pes anserinus tendons, open injuries, MCL tears combined with PCL or bi-cruciate injuries should be treated surgically.Chronic symptomatic medial instability can be managed with the recently described reconstruction techniques using free tendon grafts located at anatomical insertion sites. Cite this article: Tandogan NR, Kayaalp A. Surgical treatment of medial knee ligament injuries: Current indications and techniques. EFORT Open Rev 2016;2:27-33. DOI: 10.1302/2058-5241.1.000007.

[Early results of kyphoplasty in osteoporotic vertebral compression fractures]. / Osteoporotik vertebra kompresyon kiriklarinda kifoplasti sonrasi erken dönem sonuçlar.

OBJECTIVES: We evaluated early results of kyphoplasty for osteoporotic vertebral compression fractures with regard to the level of pain, activity levels of patients, and radiographic restoration of the vertebra bodies. METHODS: Sixteen patients (4 males, 12 females; mean age 63 years; range 55 to 72 years) with osteoporotic vertebral compression fractures in the lumbar spine were treated with kyphoplasty. The procedure was performed at 21 levels, with a minimum of 3 ml (range 3 to 6 ml) of cement per level. The mean time from the onset of symptoms to the application was six days (range 2 to 16 days). The effectiveness of the procedure was evaluated by a visual analog scale (VAS: 0 no pain; 10 very severe pain) before kyphoplasty, and after the first day and one month of the procedure. In addition, restoration of the vertebra bodies was assessed on pre- and postoperative radiographs by measuring the anterior, middle, and posterior heights. The mean follow-up was 11 months (range 4 to 30 months). RESULTS: The mean VAS scores were 8.8 (range 7 to 10), 2.4 (range 1 to 5), and 1.6 (range 0 to 3) before kyphoplasty, and after the first day and one month of the procedure, respectively (p<0.0001). All the patients returned to preinjury levels of activity within the first month. No collapse or refracture occurred in the treated vertebrae. Changes in the anterior, middle, and posterior heights of the vertebra bodies after the procedure were not significant. The only complication was the development of an additional fracture in the nearby segment in two patients, for which kyphoplasty was performed. CONCLUSION: With proper patient selection, kyphoplasty is an effective and reliable option for osteoporotic vertebral compression fractures, yielding 80% to 95% success rates.

[Osteochondritis dissecans]. / Osteokondritis dissekans.

Osteochondritis dissecans (OCD) is a disease of unknown etiology, characterized by separation of necrotic bone from its bony bed. While the juvenile form seen in patients with open physes has a 60-90% rate of spontaneous resolution, the adult form has virtually no chance of spontaneous healing. Plain X-rays are sufficient for the diagnosis, and magnetic resonance imaging (MRI) is essential for evaluation of disease progression and/or healing. The clinical correlation of MRI criteria defined in recent years to determine stability of the lesion is high. Juvenile OCD can be treated conservatively if there are no signs of instability on magnetic resonance images. Adult patients or unstable lesions in children should be treated surgically. For stable lesions, arthroscopic antegrade perforation is indicated to increase vascularity and stimulate healing. Unstable or displaced lesions should be treated with debridement, internal fixation, and cancellous bone grafting. Although cannulated metal screws are the most widely used implants for internal fixation, biodegradable implants have also been utilized in recent years. Loose fragments that are too deformed to be internally fixed should be removed and cartilage reconstruction techniques should be employed for the remaining crater. Long-term results of loose body removal alone are unsatisfactory. Modern cartilage restoration techniques are technically demanding due to the large, deep, and unconfined nature of the defect in the femoral condyle.

[A case of pigmented villonodular synovitis of the elbow joint with bone invasion]. / Dirsek ekleminde kemik invazyonlu pigmente villonodüler sinovit.

Pigmented villonodular synovitis is a benign proliferative disorder of the joint and of the tendon sheath synovium. It has a predilection for the lower extremities, particularly the knee and the hip. The elbow joint is rarely affected. A 56-year-old woman had complaints of pain and swelling in the left elbow for three years. She had no history of trauma. On physical examination, she had swelling of the left elbow, varus deformity, and flexion contracture of 20 degrees. Active and passive joint movements were painful. Magnetic resonance imaging showed synovial thickening and signal changes. An incisional biopsy yielded a diagnosis of pigmented villonodular synovitis. She underwent subtotal synovectomy and excision of the radius head. No evidence of clinical or radiologic recurrence was detected within a follow-up of 16 months.

[Thermal assisted arthroscopic stabilization of unstable shoulder]. / Instabil omzun isi destekli artroskopik stabilizasyonu.

The use of nonablative thermal energy to shrink soft-tissue collagen results in ultrastructural and mechanical changes at temperatures 60 degrees C or above. Due to this effect, the fibrils undergo shortening and shrinkage. Arthroscopic thermal capsulorrhaphy has been used in the treatment of shoulder instabilities and posterior impingement syndrome; in particular, the presence of a Bankart lesion or a superior labral anterior posterior lesion requires a labral or capsulolabral repair. Despite ease of application, thermal techniques have higher complication rates, with no proven superiority over traditional suture techniques. Further studies are required to develop the most appropriate technique for tissue shrinkage without any associated tissue destruction. The mechanical properties and long-term durability of the newly produced collagen need to be analyzed, as well.

[Periarticular fractures of the knee in child and adolescent athletes]. / Cocukluk ve ergenlik dönemindeki sporcularda diz çevresi kiriklari.

Most of the sports-related lower limb injuries in children and adolescents involve the knee. Due to the physiological characteristics of the growing skeleton, fractures are more common than ligamentous injuries in this age group. The most frequent type of injury is distal femoral physeal fractures followed by proximal tibial physeal injuries. Tibial tubercle avulsions are rare. Reduction should be gently performed and fixation methods should ensure that no further damage to the physeal plate occurs. Even after proper treatment, there is a significant risk for subsequent leg length discrepancies and/or angular deformities, requiring that children be followed closely for at least two years. Arthroscopic techniques have become popular in recent years in the treatment of displaced tibial eminence fractures. Residual anterior laxity remains an important problem after the healing of these fractures.

Type 4 median nerve entrapment in a child after elbow dislocation.

UNLABELLED: CASE STUDIED: Median nerve entrapment is a rare, serious complication of elbow dislocation. We report a Type 4 median nerve entrapment after elbow dislocation in a 10-year-old boy. Radiologically Matev's sign and a new radiological finding-a sclerotic tunnel at the lateral side of the olecranon-were seen. TREATMENT: The patient was treated by excising the damaged segment and reanastomosing the nerve 13 months after the injury.