[Arthroscopic rotator cuff repair: evaluation of outcomes and analysis of prognostic factors]. / Artroskopik rotator manset onarimi: Sonuçlar ve belirleyici faktörlerin analizi.

OBJECTIVES: The purpose of this study was to evaluate the results of arthroscopic rotator cuff repair of full-thickness tears and to determine prognostic factors. METHODS: Forty-one shoulders of 40 patients (16 males, 24 females; mean age 56 years; range 39 to 72 years) unresponsive to conservative treatment were evaluated. The mean symptom duration was 15 months (range 2 to 24 months). Involvement was on the right in 34 shoulders, on the left in seven shoulders, 80% being on the dominant side. The range of motion was measured with a goniometer, muscle strength was measured manually. Clinical and functional evaluations were based on physical and radiological examinations, and the UCLA scale. The mean follow-up was 37 months (range 12 to 61 months). Prognostic factors included age, symptom duration, range of motion, muscle strength, tear size, retraction and quality of tendon, and fatty degenerative changes. RESULTS: According to the UCLA scale, the results were satisfactory in 29 shoulders (70.7%), moderate in five (12.2%), and poor in seven (17.1%). Six shoulders (14.6%) required revision surgery. Postoperative improvements in forward flexion and muscle strength were significant (p<0.05), whereas change in external rotation was insignificant (p>0.05). Age, tear size, retraction and quality of tendon, and fatty degenerative changes were found to significantly affect unsatisfactory results (p<0.05). Preoperative symptom duration, range of motion, and muscle strength were not effective on the results (p>0.05). CONCLUSION: Our results are not as successful as those obtained from open procedures. The results may be more satisfactory through improving arthroscopic skills and taking prognostic factors into consideration in patient selection.

[Arthroscopic treatment of anterior-inferior shoulder instability]. / One-asagi omuz instabilitelerinin artroskopik tedavisi.

OBJECTIVES: We evaluated patients who underwent arthroscopic repair for posttraumatic, recurrent anterior-inferior glenohumeral instability with capsular laxity. METHODS: Seventeen patients (4 females, 13 males; mean age 27 years; range 18 to 40 years) were treated with arthroscopic Bankart repair and posterior capsular plication for posttraumatic, recurrent anterior-inferior glenohumeral instability with capsular laxity. Involvement was on the right side in 11 patients, and on the left in six patients. The mean duration from the first dislocation to surgery was 5.2 years (range 1 to 11 years). All the patients received conservative treatment before surgery. Range of motion was measured with a goniometer and muscle strength was measured manually. Apprehension test, Jobe apprehension-relocation test, and posterior apprehension test were used to assess instability. Preoperatively, all the patients were examined by anteroposterior and axillary radiographs and magnetic resonance imaging. Shoulder functions were assessed with the Rowe rating scale for Bankart repairs. The mean follow-up was 35.6 months (range 24 to 50 months). RESULTS: Instability recurred in three patients (17.7%). The Rowe score increased from a mean of 41 (range 15-45) to 78 (range 43-100) postoperatively. Functional results were excellent-good in 13 patients (76.5%), fair in one patient (5.9%), and poor in three patients (17.7%). One patient underwent arthroscopic revision following redislocation. Pre- and postoperative values for active forward flexion, external rotation, and internal rotation did not differ significantly (p>0.05). CONCLUSION: The results of arthroscopic Bankart repair and posterior capsular plication are satisfactory in the treatment of anterior glenohumeral instability with capsular laxity. However, the use of capsular plication with arthroscopic Bankart repair should be considered in selected cases.

[Early results of medial opening wedge osteotomy in varus gonarthrosis]. / Varus gonartrozunda medial açik kama osteotomisinin erken dönem sonuçlari.

OBJECTIVES: We evaluated the efficacy and short-term results of medial opening wedge high tibial osteotomy with the use of a Puddu plate in patients with medial compartment gonarthrosis. METHODS: The study included 15 knees of 12 female patients (mean age 50.6 years; range 45 to 63 years) who were treated with medial opening wedge high tibial osteotomy for varus knees with medial compartment gonarthrosis. The osteotomy sites were fixed with a Puddu plate followed by allograft application. The mean follow-up period was 30.7 months (range 19 to 40 months). RESULTS: The mean consolidation time was 7.1 weeks (range 6 to 9 weeks). The mean preoperative and postoperative Lysholm scores were 54.1 (range 30 to 60) and 82 (range 67 to 95), respectively. The mean preoperative femorotibial angle was 3.5 degrees in varus malalignment (range 3 degrees valgus to 9 degrees varus). It was 7.3 degrees valgus postoperatively. The mean correction of the mechanical axis was 10.7 degrees , with no loss of correction during the follow-up period. No adverse effects were observed associated with allograft use. The lateral cortex was broken in one patient (6.7%) who was then treated with an Ilizarov external fixator due to pseudoarthrosis. All but this patient were satisfied with the treatment. CONCLUSION: Compared with other osteotomy models, medial opening wedge osteotomy with the use of a Puddu plate offers advantages in terms of ease of application and maintenance of correction in the early follow-up period. With allograft application, consolidation is obtained without interfering with the rehabilitation period.

[Surgical treatment of isolated post-traumatic subscapularis tendon ruptures]. / Travma sonrasi olusan izole subskapularis tendon yirtiklarinin cerrahi tedavisi.

OBJECTIVES: We retrospectively evaluated the functional results of patients who were treated surgically for post-traumatic isolated subscapularis tendon ruptures. METHODS: The study included six patients (5 males, 1 female; mean age 63.3 years; range 53 to 70 years) who were operated on for isolated post-traumatic subscapularis ruptures. The mean interval between the development of symptoms due to trauma and operation was 4.3 months (range 1 to 9 months). Mechanism of injury, complaints, clinical findings, imaging methods, arthroscopic and surgical findings, repair techniques, and postoperative follow-up data were assessed. Evaluations were based on physical assessment, radiographic examination, and the UCLA (University of California at Los Angeles) score. The mean follow-up was 29.6 months (range 13 to 53 months). RESULTS: The mean UCLA score was 11.3 (range 9 to 14) preoperatively. It increased to 25.8 (range 12 to 31) postoperatively (p<0.05). The results were good in four patients, fair in one patient, and poor in one patient. Magnetic resonance images obtained in five patients at the final follow-up showed total rupture in the patient with poor outcome, partial rupture in the patient with fair outcome, and maintenance of tendon integrity in the remaining patients. CONCLUSION: A careful clinical examination may enable the diagnosis of subscapularis tendon ruptures. Magnetic resonance imaging may provide additional information. In most patients, the repair of the tendon is possible by proper protection of the axillary nerve and appropriate mobilization.

[Results of the surgical treatment for symptomatic mesoacromion]. / Semptomatik mezo-akromiyon cerrahi tedavisinin sonuçlari.

OBJECTIVES: Functional results of patients who were operated on for symptomatic meso os acromiale were retrospectively evaluated. METHODS: The study included six patients (5 females, 1 male; mean age 58.5 years; range 51 to 64 years) who underwent surgical treatment for symptomatic os acromiale following unsuccessful conservative treatment. Internal fixation and bone grafting were performed in all the patients. Evaluations were based on physical assessment, radiographic examination, and the UCLA (University of California at Los Angeles) score. All the patients had symptoms of subacromial impingement accompanied by various degrees of rotator cuff tears. Symptomatic os acromiale was diagnosed by imaging studies and tenderness over the acromion during palpation. In case of suspected stability of the acromion, arthroscopy was performed. Fixation was performed with cannulated screws (n=4) or K-wires (n=2) and a cerclage wire or nonabsorbable sutures. Bone graft was harvested locally. The mean follow-up period was 29 months (range 18 to 35 months). RESULTS: The mean UCLA score increased from a preoperative 11.8 to postoperative 28.2. Union was achieved in four patients in whom cannulated screws were used. Two patients who were fixed with K-wires remained ununited. CONCLUSION: It is possible to obtain satisfactory results with cannulated screws which probably enable a more rigid fixation in symptomatic os acromiale. Arthroscopic evaluation may be helpful in deciding whether or not os acromiale is symptomatic.

[Early results of treatment with expandable intramedullary nails in femur shaft fractures]. / Femur saft kiriklarinda genisleyebilir intramedüller çivilerle erken dönem tedavi sonuçlari.

OBJECTIVES: We evaluated the use of expandable intramedullary nails, their efficacy, and short-term results in the treatment of femur shaft fractures. METHODS: The study included 20 patients (10 females, 10 males; mean age 31 years; range 15 to 75 years) who were treated with expandable intramedullary nails (Fixion intramedullary femur nail) for femur shaft fractures. All the fractures were closed and were rated as type 32 A or B according to the AO classification. The mean duration from injury to surgery was three days (range 4 hours to 8 days). The results were evaluated using the Thoresen criteria. The mean follow-up was 26 months (range 9 to 38 months). RESULTS: The mean operation time was 79 minutes (range 45 to 120 min). Union was achieved in all the patients in a mean of 12.8 weeks (range 10 to 20 weeks). According to the Thoresen criteria, the results were excellent in 15 patients, good in one patient, fair in three patients, and poor in one patient. The results in all type A middle diaphyseal fractures were excellent. Of four patients with A2-3 distal metadiaphyseal fractures, one patient had a good result with a valgus of 5 degrees , and three patients had a fair result with a valgus ranging from 8 degrees to 10 degrees , one of which also had 8-mm shortening. Delayed union, early or late infections, compartment syndrome, or bone necrosis were not seen. Of six patients who completed a follow-up of two years, the nails were removed in five patients, whereas removal was not possible in one patient due to a break in the upper part. CONCLUSION: Expandable intramedullary nails offer advantages in terms of ease of application and are less invasive than static nails and reamed applications. However, they may not provide adequate stability in metadiaphyseal regions and in fractures with fragments greater than 50%.

[Arthroscopic treatment of type 2 superior labrum anterior posterior lesions]. / Tip 2 superior labrum anterior posterior lezyonlarinin artroskopik tedavisi.

OBJECTIVES: We retrospectively evaluated patients who underwent arthroscopic repair for isolated type 2 superior labrum anterior posterior (SLAP) lesions. METHODS: Isolated type 2 SLAP lesions were treated with arthroscopic repair with suture anchors in eight patients (5 males, 3 females; mean age 48.5 years; range 27 to 60 years) with shoulder pain unresponsive to conservative treatment. The mean duration of symptoms was 18.6 months (range 2 to 48 months). Initial diagnoses were based on patients' complaints and findings of physical examination and radiologic imaging, and were confirmed at diagnostic arthroscopy. Two suture anchors were used in six patients. Patients were evaluated with physical examination, radiographs, and the UCLA (University of California at Los Angeles) score. The mean follow-up was 30.8 months (range 14 to 48 months). RESULTS: The mean preoperative and postoperative UCLA scores were 13.3 (range 10 to 18) and 30.8 (range 24 to 33), respectively (p<0.05). The results were good in seven patients (87.5%), and fair in one patient (12.5%). The mean preoperative active forward elevation was 136.3 degrees (range 90 degrees to 170 degrees), adduction-external rotation was 42.5 degrees (range 40 degrees to 60 degrees), and adduction-internal rotation was at T7 in three patients, and at L1 in five patients. At final follow-ups, the mean active forward flexion increased to 164.3 degrees (range 150 degrees to 170 degrees), adduction-external rotation was 40 degrees (range 30 degrees to 60 degrees), and adduction-internal rotation was at T7 in four patients, and at T12 in four patients. CONCLUSION: The results of arthroscopic fixation of type 2 SLAP lesions with suture anchors are successful in the majority of patients, provided that an appropriate arthroscopic technique is performed to re-establish the stability of the biceps anchor.

[Arthroscopic treatment of symptomatic loose bodies in osteoarthritic elbows]. / Osteoartritli dirsekte eklem içi serbest cisimlerin artroskopik tedavisi.

OBJECTIVES: We evaluated functional and clinical results of patients who underwent arthroscopic surgery for symptomatic loose bodies in osteoarthritic elbow joint. METHODS: Arthroscopic surgery was performed in 10 patients (6 males, 4 females; mean age 47 years; range 30 to 59 years) for symptomatic loose bodies in osteoarthritic elbow joint. Eight patients had a history of trauma. Involvement was on the right in seven patients, and on the left in three patients. Preoperatively, six patients had limited joint movements and locking, and five patients had pain. The presence and the number of loose bodies were investigated by standard radiographs and computed tomography preoperatively, and by radiographs and magnetic resonance imaging postoperatively. The range of motion was measured with a goniometer. Functional assessment was made with the use of the Broberg and Morrey's scoring system, and pain was assessed with a visual analog scale. The mean follow-up was 31 months (range 7-59 months). RESULTS: The mean range of motion of the elbows increased from 100 degrees (range 55 degrees to 160 degrees) preoperatively to 115 degrees (range 70 degrees to 160 degrees) at the end of the follow-up (p=0.05). None of the patients developed valgus or varus instability. The mean preoperative and postoperative Broberg and Morrey's scores were 59 (range 45 to 80) and 86 (range 59 to 100), respectively (p<0.01). The results were excellent in five patients, good in three patients, and poor in two patients. The mean visual analog score decreased from 7 (range 5 to 10) preoperatively to 1 (range 0-4) postoperatively (p<0.01). Eight patients were satisfied with surgery and returned to normal activities after a mean of 16 days (range 1 to 60 days). CONCLUSION: Arthroscopic surgery is effective in reducing pain in selected patients with symptomatic loose bodies in osteoarthritic elbows, with the advantages of low morbidity and rapid functional recovery.

[Treatment of recurrent post-traumatic anterior-inferior glenohumeral instabilities with the selective capsular shift technique]. / Travma sonrasi tekrarlayan anterior-inferior glenohumeral instabilitelerin selektif kapsül kaydirma teknigi ile tamiri.

OBJECTIVES: We evaluated the functional results of treatment with the selective capsular shift technique in patients with recurrent post-traumatic anterior-inferior glenohumeral instability. METHODS: The study included 16 patients (15 males, 1 female; mean age 30 years; range 25 to 38 years) who underwent selective capsular shift operation for recurrent post-traumatic anterior-inferior glenohumeral instability. Dislocations occurred following severe (n=14) or mild (n=2) trauma. Preoperatively, the mean number of dislocations was 14 (range 4 to 45) and magnetic resonance imaging showed a Bankart lesion in all the patients and a Hill-Sachs lesion in 20%. The patients were evaluated according to the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and Rowe's scoring for Bankart repair. Preoperative and postoperative anteroposterior and axillary x-rays were obtained from all the patients. Range of motion was measured with a goniometer and manual muscle strength tests were performed. The mean follow-up was 41 months (range 21 to 74 months). Statistical analysis was made using the t-test. RESULTS: The mean preoperative and postoperative ASES scores differed significantly (63.2 vs 95.8; p<0.05). The mean Rowe score was 92.5 (range 70 to 100). Strength of the infraspinatus, supraspinatus, and subscapularis muscles increased significantly (p<0.05). The results were excellent in 12 patients (75%), good in two patients (12.5%), and fair in two patients. Fifteen patients (93.8%) expressed satisfaction with the operation and results. CONCLUSION: Addition of the selective capsular shift technique to the Bankart repair procedure improves stability and preserves the range of motion of the glenohumeral joint in patients with anterior-inferior glenohumeral instability accompanied by a Bankart lesion and capsular injury or laxity.

[Arthroscopic selective capsular release in the treatment of frozen shoulder]. / Donuk omuz hastaliginin tedavisinde artroskopik selektif kapsül gevsetmesi.

OBJECTIVES: We evaluated the results of arthroscopic selective capsular release in patients with frozen shoulder. METHODS: Sixteen patients (5 males, 11 females; mean age 51 years; range 25 to 73 years) underwent arthroscopic capsular release for frozen shoulder. The syndrome was due to trauma in two patients; nine patients had diabetes mellitus; no etiologic cause was found in three patients. Two patients had rotator cuff tendinitis. The mean duration of complaints was 14 months (range 3 to 36 months). The patients were treated conservatively for a mean of 9.5 months (range 3 to 12 months). The range of motion of the shoulder was measured with a goniometer. Functional evaluations were made according to the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES). Under general anesthesia, all the patients underwent arthroscopic capsular release, subacromial bursoscopy, and manipulation. Acromioplasty was performed in two patients with subacromial impingement. The mean follow-up was 14 months (range 4 to 25 months). RESULTS: Compared to the healthy side, postoperative increments in flexion, adduction-external rotation, abduction-internal and external rotations were 38%, 47%, 43%, and 30%, respectively. The strength of the infraspinatus, supraspinatus, and subscapularis muscles significantly increased (p<0.05). The mean postoperative ASES score improved by 50 (p<0.05). The mean visual analog scale score decreased significantly with significant improvements in daily activities (p<0.05). Complaints of pain and limitation disappeared in a mean of 3.5 months (range 15 days-12 months) in 14 patients (87.5%) who were fully satisfied with the operation. CONCLUSION: Patients with frozen shoulder unresponsive to conservative treatment can be effectively treated with arthroscopic selective capsular release and manipulation.

[The results of arthroscopic repair of full-thickness tears of the rotator cuff]. / Rotator mansetin tam kat yirtiklarinda artroskopik tamir sonuçlari.

OBJECTIVES: This study was designed to evaluate the functional results of arthroscopic repair of full-thickness tears of the rotator cuff and to investigate the degree of fatty degeneration of the rotator cuff muscles and recurrent ruptures by magnetic resonance imaging (MRI). METHODS: Twenty-two patients (9 males, 13 females; mean age 56 years; range 38 to 71 years) underwent arthroscopic repair of full-thickness tears of the rotator cuff following conservative treatment for a mean of 15 months (range 45 days to 120 months). Involvement was in the right shoulder in 17 patients, being on the dominant side in 77%. The range of motion was measured with a goniometer, and muscle strength by manual examination. Clinical and functional evaluations were made by physical examination and according to the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and the UCLA scale. Fatty degeneration of the rotator cuff muscles and recurrence were analyzed by MRI. The mean follow-up was 24 months (range 12 to 36 months). RESULTS: The mean active forward flexion and external rotation increased from 105 degrees to 160 degrees (p<0.05) and from 41 degrees to 44 degrees (p>0.05), respectively. The strength of the supraspinatus and infraspinatus muscles significantly increased (p<0.05). The mean ASES and UCLA scores significantly increased from 25.4 to 86.7 and from 10.6 to 25.6, respectively (p<0.05). The mean healing time was three months (range 1 to 12 months). Twenty patients (90.9%) were satisfied with the result of the treatment. On MRI scans, recurrent ruptures were detected in seven patients (31.8%); the extent of fatty degeneration of the rotator cuff muscles did not differ pre- and postoperatively (p>0.05). CONCLUSION: Arthroscopic repair of full-thickness tears of the rotator cuff yields high clinical and functional success rates.

[Arthroscopic-assisted mini-open repair of rotator cuff tears]. / Rotator manset yirtiklarinin artroskopik yardimli mini-açik yöntemle tamiri.

OBJECTIVES: We retrospectively evaluated the results of patients who underwent arthroscopic-assisted mini-open repair of rotator cuff tears. METHODS: Twenty-three patients (7 males, 16 females; mean age 56 years; range 41 to 75 years) underwent arthroscopic-assisted mini-open repair for nonretracted rotator cuff tears. The right shoulder was involved in 15 patients and the left in eight patients; 83% being on the dominant side. The range of motion was measured with a goniometer, and muscle strength by manual examination. The patients were assessed by physical examination, the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the UCLA scale, and magnetic resonance imaging (MRI). The mean follow-up was 32 months (range 12 to 61 months). RESULTS: All the patients had medium-sized ruptures. Biceps tenotomy was performed in three patients for tears affecting more than 50% of the biceps tendon. The mean preoperative active forward flexion increased from 99 degrees to 161 degrees , and active external rotation from 28 degrees to 50 degrees postoperatively (p<0.05); the strength of the supraspinatus and infraspinatus muscles increased significantly (p<0.05). The mean UCLA score was found as 31.6, showing an excellent result in nine patients (39.1%), good in 12 patients (52.2%), moderate in one (4.4%), and poor in one patient. The mean preoperative ASES score increased from 23.7 to 92.4 (p<0.05). The mean healing time was 1.7 months (range 1.5 to 12 months). Twenty-one patients (91.3%) were satisfied with the outcome. Of 16 patients with postoperative MRI scans, three (18.8%) exhibited recurrent ruptures. CONCLUSION: In selective cases, the clinical and functional results are successful following arthroscopic-assisted mini-open repair for rotator cuff tears.

[Early treatment results with expandable intramedullary nails in lower extremity shaft fractures]. / Alt ekstremite saft kiriklarinda genisleyebilir intramedüller çivilerle erken dönem tedavi sonuçlari.

BACKGROUND: We investigated the use of expandable intramedullary nails, their efficacy, and short term results in the treatment of lower extremity shaft fractures. METHODS: The study included 23 patients (10 females, 13 males; mean age 33 years; range 17 to 60 years) who were treated with expandable intramedullary nails (the Fixion nail) for the lower extremity shaft fractures. Fourteen patients had femoral, nine patients had tibial fractures, all of which were closed. Eight patients had associated injuries. The mean duration from injury to surgery was 3.2 days (range 24 hours to 14 days). The results were evaluated using the Kalström-Olerud criteria. The mean follow-up was 15.3 months (range 10 to 20 months) for tibial fractures, and 13.1 months (range 10 to 19 months) for femoral fractures. RESULTS: Union was achieved in all the patients. In tibial fractures, the mean operation time was 50 minutes (range 25 to 90 min) and the mean time to union was 12 weeks (range 8 to 24 weeks). The results were excellent in six patients, and good in three patients. In femoral fractures, the mean operation time was 83.5 minutes (range 55 to 120 min) and the mean time to union was 13.2 weeks (range 10 to 20 weeks). The results were excellent in eight patients, good in three patients, fair in two patients, and poor in one patient. No complications were seen such as delayed union, early or late infections, compartment syndrome, or bone necrosis. CONCLUSION: Expandable intramedullary nails offer advantages in terms of ease of application and are less invasive than static nails and reamed applications. However, they may not provide adequate stability in metadiaphyseal regions and in fractures with fragments larger than 50 per cent.