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Ozer AF, Akgun MY, Ucar EA, Hekimoglu M, Basak AT, Gunerbuyuk C, Toklu S, Oktenoglu T, Sasani M, Akgul T, Ates O. Can Dynamic Spinal Stabilization Be an Alternative to Fusion Surgery in Adult Spinal Deformity Cases? Int J Spine Surg 2024:8588. [PMID: 38561203 DOI: 10.14444/8588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Rigid stabilization and fusion surgery are widely used for the correction of spinal sagittal and coronal imbalance (SCI). However, instrument failure, pseudoarthrosis, and adjacent segment disease are frequent complications of rigid stabilization and fusion surgery in elderly patients. In this study, we present the results of dynamic stabilization and 2-stage dynamic stabilization surgery for the treatment of spinal SCI. The advantages and disadvantages are discussed, especially as an alternative to fusion surgery. METHODS In our study, spinal, sagittal, and coronal deformities were corrected with dynamic stabilization performed in a single session in patients with good bone quality (without osteopenia and osteoporosis), while 2-stage surgery was performed in patients with poor bone quality (first stage: percutaneous placement of screws; second stage: placement of dynamic rods and correction of spinal SCI 4-6 months after the first stage). One-stage dynamic spinal instrumentation was applied to 20 of 25 patients with spinal SCI, and 2-stage dynamic spinal instrumentation was applied to the remaining 5 patients. RESULTS Spinal SCI was corrected with these stabilization systems. At 2-year follow-up, no significant loss was observed in the instrumentation system, while no significant loss of correction was observed in sagittal and coronal deformities. CONCLUSION In adult patients with spinal SCI, single or 2-stage dynamic stabilization is a viable alternative to fusion surgery due to the very low rate of instrument failure. CLINICAL RELEVANCE This study questions the use of dynamic stabilization systems for the treatment of adult degenerative deformities. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Ali Fahir Ozer
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
- Spine Center, Koc University Hospital, Istanbul, Turkey
- Bioengineering and Orthopaedic Surgery Colleges of Engineering and Medicine, University of Toledo, Toledo, OH, USA
| | - Mehmet Yigit Akgun
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
- Spine Center, Koc University Hospital, Istanbul, Turkey
| | - Ege Anil Ucar
- Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Mehdi Hekimoglu
- Department of Neurosurgery, American Hospital, Istanbul, Turkey
| | | | | | - Sureyya Toklu
- Department of Neurosurgery, Erzurum Bolge Research and Education Hospital, Erzurum, Turkey
| | - Tunc Oktenoglu
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
- Spine Center, Koc University Hospital, Istanbul, Turkey
| | - Mehdi Sasani
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
- Spine Center, Koc University Hospital, Istanbul, Turkey
| | - Turgut Akgul
- Spine Center, Koc University Hospital, Istanbul, Turkey
| | - Ozkan Ates
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
- Spine Center, Koc University Hospital, Istanbul, Turkey
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Akgun MY, Ucar EA, Gedik CC, Gunerbuyuk C, Hekimoglu M, Cerezci O, Oktenoglu T, Sasani M, Ates O, Ozer AF. Use of Dynamic Spinal Instruments (Dynesys) in Adult Spinal Deformities According to Silva-Lenke and Berjano-Lamartina Classifications. Diagnostics (Basel) 2024; 14:549. [PMID: 38473021 DOI: 10.3390/diagnostics14050549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/19/2024] [Accepted: 02/01/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Adult spinal deformities (ASD) present complex challenges in spine surgery. The diverse nature of these deformities requires a comprehensive understanding of their classification and treatment options. Traditional approaches, such as fusion and rigid stabilization are associated with complications, including screw loosening, breakage, proximal junctional kyphosis (PJK), and pseudoarthrosis. Dynamic stabilization techniques have emerged as promising alternatives, to reduce these complications and preserve spinal motion. OBJECTIVE This study investigated the effectiveness of dynamic stabilization using the Dynesys system in the surgical treatment of adult degenerative spinal deformities, with a particular emphasis on their classification. METHODS ASDs were classified according to the Berjano-Lamartina (BL) and Silva-Lenke (SL) classifications. We analyzed the efficacy of the Dynesys system in enhancing sagittal balance, radiological parameters, and clinical outcomes in this context. RESULTS Dynamic stabilization of patients with ASDs using the Dynesys system significantly improved the visual analog scale and Oswestry Disability Index scores and decreased the complication rates. Patients with BL types 2, 3, and 4 experienced a significant improvement in sagittal balance followed by sagittal vertical axis measurements (p = 0.045, p = 0.015, and p < 0.0001, respectively). CONCLUSION The SL and BL classifications, which were originally developed for rigid spinal stabilization, can be applied in dynamic stabilization. Furthermore, dynamic stabilization using the Dynesys system can be used as an alternative to rigid stabilization in SL levels 2 and 3, and BL types 1, 2, and 3, and in some patients with type 4 ASDs.
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Affiliation(s)
- Mehmet Yigit Akgun
- Department of Neurosurgery, Koc University Hospital, 34010 Istanbul, Turkey
- Spine Center, Koc University Hospital, 34010 Istanbul, Turkey
| | - Ege Anil Ucar
- Medical Faculty, Koc Univesity School of Medicine, 34010 Istanbul, Turkey
| | - Cemil Cihad Gedik
- Department of Orthopaedics and Traumatology, Koc University Hospital, 34010 Istanbul, Turkey
| | - Caner Gunerbuyuk
- Spine Center, Koc University Hospital, 34010 Istanbul, Turkey
- Department of Orthopaedics and Traumatology, Koc University Hospital, 34010 Istanbul, Turkey
| | - Mehdi Hekimoglu
- Department of Neurosurgery, American Hospital, 34010 Istanbul, Turkey
| | - Onder Cerezci
- Department of Physical Medicine and Rehabilitation, American Hospital, 34010 Istanbul, Turkey
| | - Tunc Oktenoglu
- Department of Neurosurgery, Koc University Hospital, 34010 Istanbul, Turkey
- Spine Center, Koc University Hospital, 34010 Istanbul, Turkey
| | - Mehdi Sasani
- Department of Neurosurgery, Koc University Hospital, 34010 Istanbul, Turkey
- Spine Center, Koc University Hospital, 34010 Istanbul, Turkey
| | - Ozkan Ates
- Department of Neurosurgery, Koc University Hospital, 34010 Istanbul, Turkey
- Spine Center, Koc University Hospital, 34010 Istanbul, Turkey
| | - Ali Fahir Ozer
- Department of Neurosurgery, Koc University Hospital, 34010 Istanbul, Turkey
- Spine Center, Koc University Hospital, 34010 Istanbul, Turkey
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Aslan L, Gunerbuyuk C, Gedik CC, Sarabi MR, Kilicoglu O. Comparison of Staple, Anchor, and Tenodesis Screw for Posterior Tibialis Tendon Fixation: A Biomechanical Analysis. J Foot Ankle Surg 2024; 63:194-198. [PMID: 37935326 DOI: 10.1053/j.jfas.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/09/2023] [Accepted: 10/28/2023] [Indexed: 11/09/2023]
Abstract
Various posterior tibialis tendon fixation techniques are described in literature. Suture anchor, staple and tenodesis screws are widely used for posterior tibialis tendon transfer, but their stiffness and the maximal ultimate failure load were not tested before. We aimed to compare the initial ultimate failure load and stiffnesses of suture anchor, staple and tenodesis screws on bovine tendon fixation to bovine metaphyseal bone. Thirty-five fresh bovine ankle joints and hooves were obtained from a local abattoir. Metatarsals bones with long extensor tendons were harvested. Staple group had 15, suture anchor group had 10, and tenodesis screw group had 10 samples. All fixations were tested with Instron® ElectroPuls® E10000 Test Instrument. Ultimate failure load and failure location were noted. Staple group's median ultimate failure load was 210.03 N (IQR: 133.43), suture anchor group's was 124.33 N (IQR: 63.67), and tenodesis screw group's was 394.46 N (IQR:115.09). Median stiffness of the staple group was 19.87 N/m (IQR: 15.29); the tenodesis screw group's was 20.28 N/m (IQR: 6.18), the anchor group's was 8.54 N/m (IQR: 4.35). Staples' failure occurred on tendon-staple interface, while suture anchors' occurred on anchor-suture interface and tenodesis screws' occurred on tendon-suture interface. Tenodesis screws' ultimate failure load was the highest (tenodesis vs anchor and staple p < .001 and p = .032, respectively). Staple fixation is less expensive than the other methods and can provide sufficient fixation strength but was weaker than the tenodesis screw fixation. Staples are still a good choice for tendon to bone fixation, whereas the suture anchors provide lower fixation strength at a higher cost.
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Affiliation(s)
- Lercan Aslan
- Department of Orthopaedics and Traumatology, Koç University School of Medicine, Istanbul, Turkey
| | - Caner Gunerbuyuk
- Department of Orthopaedics and Traumatology, Koç University School of Medicine, Istanbul, Turkey
| | - Cemil Cihad Gedik
- Department of Orthopaedics and Traumatology, Koç University School of Medicine, Istanbul, Turkey.
| | | | - Onder Kilicoglu
- Department of Orthopaedics and Traumatology, Koç University School of Medicine, Istanbul, Turkey
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Gunerbuyuk C, Akgun MY, Ozer AF. Is The Modular Dynamic System as Effective as Classical Dynamic Systems in Long Segment Dynamic Thoracolumbar Stabilization? Turk Neurosurg 2024; 34:256-262. [PMID: 38497178 DOI: 10.5137/1019-5149.jtn.42746-22.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
AIM To evaluate the outcomes of dynamic stabilization in the multilevel degenerative spondylotic spine, and to compare the two dynamic systems (Dynesys® and Orthrus®) to reveal the increasing role of dynamic systems in the management of the degenerative spine. MATERIAL AND METHODS A total of 74 patients who received dynamic stabilization for degenerative pathologies were retrospectively analyzed. Demographic details: preoperative data including neurological status, pain scores, and radiology; and intraoperative data including blood loss, duration of surgery, complications, and postoperative data including the neurologic status, duration of hospital stay, and pain scores were examined. RESULTS Patients in both groups showed statistically significant improvements in their Visual Analog Scale and Oswestry Disability Index scores. Significant corrections of thoracic kyphosis (T2-T12), the sagittal vertical axis, and T10-L2 thoracolumbar kyphosis were obtained in our cohort (p < 0.05). A total of 4 patients received revision surgery due to screw loosening. Patients were discharged after 3-4 days and mobilized on the first postoperative day. CONCLUSION We did not experience any serious issues in terms of stabilization in the cases in which we employed both systems. Our patients' clinical results were satisfactory in both systems. Existing systems can be used safely even in long-segment stabilization surgeries.
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Affiliation(s)
- Caner Gunerbuyuk
- Koc University Hospital, Department of Orthopaedics and Traumatology, Istanbul, Türkiye
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Karadag MK, Akgun MY, Basak AT, Ates O, Tepebasili MA, Gunerbuyuk C, Oktenoglu T, Sasani M, Ozer AF. Clinical and radiological analysis of the effects of three different lumbar transpedicular dynamic stabilization system on disc degeneration and regeneration. Front Surg 2023; 10:1297790. [PMID: 38162089 PMCID: PMC10757836 DOI: 10.3389/fsurg.2023.1297790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024] Open
Abstract
Objective This study aims to assess the clinical outcomes of three transpedicular dynamic systems in treating degenerative disc disease and evaluate their impact on both clinical and radiological aspects of the operated and adjacent segments. Materials and methods A total of 111 patients who underwent posterior transpedicular short-segment dynamic system procedures for treatment of degenerative disc disease were included. The patients were categorized into three groups, namely, Group 1 (Dynesys system, n = 38), Group 2 (Safinaz screw + PEEK rod, n = 37), and Group 3 (Safinaz screw + titanium rod, n = 36). Disc regeneration in the operated segment and disc degeneration in the operated, upper, and lower adjacent segments were assessed using the Pfirrmann Classification. Results Postoperatively, a statistically significant difference was observed in visual analog scale and Oswestry Disability Index scores (p < 0.001). However, no statistically significant difference was seen in disc degeneration/regeneration and degeneration scores of the upper and lower adjacent segments between the preoperative and postoperative groups (p = 0.763, p = 0.518, p = 0.201). Notably, a positive effect on disc regeneration at the operated level (32.4%) was observed. No significant differences were found between the groups in terms of operation rates, screw loosening, and screw breakage after adjacent segment disease (p > 0.05). Conclusion In patients without advanced degeneration, all three dynamic systems demonstrated the ability to prevent degeneration in the adjacent and operated segments while promoting regeneration in the operated segment. Beyond inhibiting abnormal movement in painful segments, maintaining physiological motion and providing axial distraction in the operated segment emerged as key mechanisms supporting regeneration.
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Affiliation(s)
| | - Mehmet Yigit Akgun
- Department of Neurosurgery, Koc University Hospital, Istanbul, Türkiye
- Spine Center, Koc University Hospital, Istanbul, Türkiye
| | | | - Ozkan Ates
- Department of Neurosurgery, Koc University Hospital, Istanbul, Türkiye
- Spine Center, Koc University Hospital, Istanbul, Türkiye
| | | | | | - Tunc Oktenoglu
- Department of Neurosurgery, Koc University Hospital, Istanbul, Türkiye
- Spine Center, Koc University Hospital, Istanbul, Türkiye
| | - Mehdi Sasani
- Department of Neurosurgery, Koc University Hospital, Istanbul, Türkiye
- Spine Center, Koc University Hospital, Istanbul, Türkiye
| | - Ali Fahir Ozer
- Department of Neurosurgery, Koc University Hospital, Istanbul, Türkiye
- Spine Center, Koc University Hospital, Istanbul, Türkiye
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Akgun MY, Ates O, Gunerbuyuk C, Baran O, Ozer AF. Can neurological recovery occur after late decompression of an intradural cement leakage? J Neurosci Rural Pract 2023; 14:744-746. [PMID: 38059241 PMCID: PMC10696329 DOI: 10.25259/jnrp_105_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/06/2023] [Indexed: 12/08/2023] Open
Abstract
Percutaneous vertebroplasty (PV) can be applied widely from osteoporotic to metastatic fractures. Pain, radiculopathy, spinal cord compression, pulmonary embolism, and infection are common complications of this procedure. However, rare complications such as intradural cement leakage have also been reported. There is little or no data on the results obtained after the late intervention. In addition, the midline total laminectomy method, which is the classical method, was predominantly used in intradural cement leaks after PV. We would like to report a 69-year-old female patient who underwent vertebroplasty for her L1 osteoporotic fracture about 3 months ago in an external center and subsequently developed paresis. The patient's surgery was successfully performed without the need for stabilization by hemilaminectomy. The improvement in the clinical findings of our case despite the late decompression shows that surgery is the most satisfactory option in such patients. As a surgical method, total excision can be achieved with the posterior hemilaminectomy approach.
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Affiliation(s)
| | - Ozkan Ates
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
| | - Caner Gunerbuyuk
- Department of Orthopaedics and Traumatology, Koc University Hospital, Istanbul, Turkey
| | - Oguz Baran
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
| | - Ali Fahir Ozer
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
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Akgun MY, Toklu S, Gunerbuyuk C, Ates O, Aydin AL, Baran O, Oktenoglu T, Sasani M, Ozer AF. Foraminoplasty with Partial Pediculectomy in Degenerative Spondylolisthesis Cases with Nerve Compression. World Neurosurg 2023; 172:e532-e539. [PMID: 36702240 DOI: 10.1016/j.wneu.2023.01.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND Degenerative spondylolisthesis refers to a forward displacement of a vertebra relative to the underlying vertebra. Patients with radicular pain and/or neurogenic claudication are considered suitable candidates for surgical intervention. The aim of this study was to present clinical results of dynamic stabilization applied after pediculectomy and neural foramen enlargement in patients with degenerative spondylolisthesis and normal spinal sagittal balance. MATERIALS AND METHODS All patients who underwent pediculectomy and dynamic stabilization for lumbar degenerative spondylolisthesis were retrospectively identified. Diagnosis was made with detailed neurological and radiological imaging examinations for the anatomical location of the pain. Demographic data, visual analog scale scores, and quality-of-life scores were obtained. RESULTS Patients included 3 (33.3%) men and 6 (66.7%) women with a mean age of 61.3 ± 13.0 years (range, 46-80 years) at initial symptom onset. Grade 1 degenerative spondylolisthesis was present in 5 (55.6%) patients, and grade 2 was present in 4 (44.4%) patients. Pathology was detected in L4-5 in 4 patients (44.4%) and L5-S1 in 5 patients (55.6%). In all patients, at the 3-month follow-up, statistically significant decrease in visual analog scale and Oswestry Disability Index scores was observed. At the last follow-up, no implant-related complications requiring revision were observed. CONCLUSIONS In patients without any pathology in the sagittal balance, the optimal physiological treatment modality can be created by applying posterior dynamic stabilization together with pediculectomy to support the posterior tension band.
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Affiliation(s)
- Mehmet Yigit Akgun
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey; Spine Center, Koc University Hospital, Istanbul, Turkey.
| | - Sureyya Toklu
- Department of Neurosurgery, Erzurum Bolge Research and Education Hospital, Erzurum, Turkey
| | | | - Ozkan Ates
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey; Spine Center, Koc University Hospital, Istanbul, Turkey
| | | | - Oguz Baran
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
| | - Tunc Oktenoglu
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey; Spine Center, Koc University Hospital, Istanbul, Turkey
| | - Mehdi Sasani
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey; Spine Center, Koc University Hospital, Istanbul, Turkey
| | - Ali Fahir Ozer
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey; Spine Center, Koc University Hospital, Istanbul, Turkey
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Eren I, Ozben H, Gunerbuyuk C, Koyuncu Ö, Aygün MS, Hatipoglu E, Aydingöz Ü, Demirhan M. Rotator cuff tear characteristics: how comparable are the pre-operative MRI findings with intra-operative measurements following debridement during arthroscopic repair? Int Orthop 2018; 43:1171-1177. [PMID: 30159803 DOI: 10.1007/s00264-018-4130-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 08/21/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE Magnetic resonance (MRI) is a valuable imaging method which can detect pre-operative rotator cuff tear characteristics accurately. However, tendon degeneration almost always necessitates a certain amount of debridement during arthroscopic repair, which alters tear size and shape. The aim of this study is to question the accuracy of the pre-operative tear size and classification in MRI and its relation to the tear size and type of the debrided tendon during arthroscopic repair. METHODS A retrospective survey was performed to identify shoulders that underwent arthroscopic rotator cuff repair. Rotator cuff tears with an adequate history, a standard pre-operative MRI, and available surgical video records with appropriate measurements were included. Traumatic tears, calcifying tendonitis, isolated subscapularis tears, and revisions were excluded. In total, 60 shoulders' (30 males, 27 females; age 55.2 [35-73]) preoperative MRIs and intra-operative measurements were analyzed by orthopaedic surgeons and radiologists. Tear width and type were recorded. Interdisciplinary and intradisciplinary consistency of measurements and classifications were analyzed. Tear width measured on pre-operative MRI and after debridement were compared. RESULTS Average measured tear width was 9 ± 5.3 mm on MRI. Surgeons (9.98 ± 4.6 mm) measured tears significantly wider than radiologists (7.71 ± 6.6 mm). Radiologists (ICC, 0.930; CI, 0.883-0.959) showed superior consistency on MRI than surgeons (CI, 0.502; CI, 0.105-0.726). Average tear width measured after debridement (29.3 ± 9.6 mm) was significantly higher than tear width measured on pre-operative MRI (p < 0.0001). None of the researchers assessing tear type on pre-operative MRI showed agreement with surgeons assessing intra-operative data. CONCLUSIONS There were significant differences between the pre-operative tear characteristics on MRI and the debrided tendon characteristics during surgery, which were extensive enough to classify the tear in a different category.
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Affiliation(s)
- Ilker Eren
- Department of Orthopaedics and Traumatology, School of Medicine, Koc University, Istanbul, Turkey. .,Koc Universitesi Hastanesi, Davutpasa Cd No:4, Topkapi Zeytinburnu, 34090, Istanbul, Turkey.
| | - Hakan Ozben
- Department of Orthopaedics and Traumatology, School of Medicine, Koc University, Istanbul, Turkey
| | - Caner Gunerbuyuk
- Department of Orthopaedics and Traumatology, School of Medicine, Koc University, Istanbul, Turkey
| | - Özgür Koyuncu
- Department of Orthopaedics and Traumatology, American Hospital, Istanbul, Turkey
| | - Murat Serhat Aygün
- Department of Radiology, School of Medicine, Koc University, Istanbul, Turkey
| | - Edip Hatipoglu
- Department of Radiology, School of Medicine, Koc University, Istanbul, Turkey
| | - Üstün Aydingöz
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Demirhan
- Department of Orthopaedics and Traumatology, School of Medicine, Koc University, Istanbul, Turkey
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