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Celikten M, Sahin H, Senturk GE, Bilsel K, Pulatkan A, Kapicioglu M, Sakul BU. The effect of platelet-rich fibrin, platelet-rich plasma, and concentrated growth factor in the repair of full thickness rotator cuff tears. J Shoulder Elbow Surg 2024; 33:e261-e277. [PMID: 37898418 DOI: 10.1016/j.jse.2023.09.028] [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: 01/31/2023] [Revised: 09/11/2023] [Accepted: 09/24/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Rotator cuff lesions rank among the prevalent causes of shoulder pain. Combining surgical interventions with growth factors, scaffolds, and stem cell therapies can effectively decrease the likelihood of rotator cuff repair recurrence. Platelet-rich plasma (PRP), platelet-rich fibrin (PRF), and concentrated growth factor (CGF), isolated from blood and rich in growth factors, have a critical role in cell migration, cell proliferation, and angiogenesis during the tissue regeneration process. Investigations have further substantiated the beneficial impact of PRP and PRF on the biomechanical and histologic attributes of the tendon-bone interface. We aimed to investigate the effectiveness of CGF compared with PRF and PRP in the repair of rotator cuff lesions as a new treatment strategy. METHODS Incision was performed on both shoulder regions of 21 adult rabbits. After 8 weeks, both shoulders of the rabbits were repaired by suturing. PRF and CGF were administered to 2 separate groups along with the repair. Tissues were collected for biomechanical measurements and histologic evaluations. RESULTS Histologically, CGF, PRF, and PRP showed similar results to the healthy control group. The level of improvement was significant in the PRF and PRP groups. In the PRF group, the distribution of Ki67 (+), CD31 (+), and CD34 (+) cells was determined intensely in the tendon-bone junction regions. Apoptotic cells increased significantly in the repair group compared with the healthy group, whereas fewer apoptotic cells were found in the PRF-, PRP-, and CGF-applied groups. In the biomechanical results, no statistical difference was recorded among the groups. CONCLUSION The use of PRF, PRP, and CGF in rotator cuff repair shows promise in shortening the treatment period and preventing the recurrence of rotator cuff lesions.
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Affiliation(s)
- Mert Celikten
- Department of Anatomy, Health Sciences Institute, Istanbul Medipol University, Istanbul, Turkey.
| | - Hakan Sahin
- Department of Histology and Embryology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Gozde Erkanli Senturk
- Department of Histology and Embryology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopaedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Faculty of Medicine, Istanbul, Turkey
| | - Anil Pulatkan
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mehmet Kapicioglu
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Bayram Ufuk Sakul
- Department of Anatomy, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
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Koukos C, Kotsapas M, Sidiropoulos K, Traverso A, Bilsel K, Montoya F, Arrigoni P. A Novel Surgical Treatment Management Algorithm for Elbow Posterolateral Rotatory Instability (PLRI) Based on the Common Extensor Origin Integrity. J Clin Med 2024; 13:2411. [PMID: 38673685 PMCID: PMC11051432 DOI: 10.3390/jcm13082411] [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: 03/11/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Here, we introduce a comprehensive treatment algorithm for posterolateral rotatory instability (PLRI) of the elbow, a condition affecting elbow mobility. We outline a diagnostic approach and a novel surgical management plan through the arthroscopic surgeon's point of view. Methods: The central focus of this management approach is the integrity of common extensor origin (CEO). High clinical suspicion must be evident to diagnose PLRI. Special clinical and imaging tests can confirm PLRI but sometimes the final confirmation is established during the arthroscopic treatment. The most appropriate treatment is determined by the degree of CEO integrity. Results: The treatment strategy varies with the CEO's condition: intact or minor tears require arthroscopic lateral collateral ligament imbrication, while extensive tears may need plication reinforced with imbrication or, in cases of retraction, a triceps tendon autograft reconstruction of the lateral ulnar collateral ligament alongside CEO repair. These approaches aim to manage residual instability and are complemented using a tailored rehabilitation protocol to optimize functional outcomes. Conclusion: PLRI is a unique clinical condition and should be treated likewise. This algorithm offers valuable insights for diagnosing and treating PLRI, enhancing therapeutic decision-making.
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Affiliation(s)
- Christos Koukos
- Medical Center Wuppertal, 42329 Wuppertal, Germany;
- Sports Trauma and Pain Ιnstitute, 54655 Thessaloniki, Greece
| | - Michail Kotsapas
- Orthopaedic Department, General Hospital of Naousa, 59200 Naousa, Greece
| | - Konstantinos Sidiropoulos
- Medical School of Patras, University of Patras, 26504 Patras, Greece
- Emergency Department, Papageorgiou General Hospital of Thessaloniki, 54635 Thessaloniki, Greece
| | - Aurélien Traverso
- Orthopaedic Department, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland
- ASST Pini-CTO, 20122 Milan, Italy
| | - Kerem Bilsel
- Faculty of Medicine, Acibadem Mehmet Ali Aydınlar University, 34752 Instanbul, Turkey;
- Orthopaedics and Traumatology Department, FulyaAcibadem Hospital, 34349 Instanbul, Turkey
| | - Fredy Montoya
- Sanatorio Aleman Clinic, Universidad de Concepcion, Concepcion 4070386, Chile;
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Keçeci T, Uçan V, Ertogrul R, Şahin K, Bilsel K, Kapıcıoğlu M. The effect of eccentric glenoid reaming in reverse shoulder artrhoplasty for glenohumeral osteoarthritis. J Orthop 2024; 50:111-115. [PMID: 38187370 PMCID: PMC10770422 DOI: 10.1016/j.jor.2023.11.073] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 01/09/2024] Open
Abstract
Background The objective of this study was to evaluate the abilitiy of eccentric reaming in reverse total shoulder arthroplasty (RSA), in patients with glenohumeral osteoarthritis (GHOA), to correct preoperative glenoid retroversion and to compare with cuff tear arthopaty (CTA) cases. Methods Fifty-nine patients who underwent RSA with GHOA or CTA diagnosis between 2013 and 2022 and who had pre- and postoperative computed tomography scans were included in the study. Preoperative glenoid version and postoperative glenoid component versions of 17 patients with GHOA and 40 patients with CTA were measured by Friedman method. Results The median preoperative glenoid versions in GHOA and CTA groups were measured as 16° and 4° retroverted respectively (p < 0.01). The median postoperative glenoid component versions in GHOA and CTA groups were 5° and 3° retroverted respectively (p = 0.09). The version change differences between the two groups varied significantly (p < 0.01). Conclusions GHOA is related with higher preoperative glenoid retroversion compared to CTA. However; with eccentric glenoid reaming, adequate version correction and similar postoperative glenoid version can be achieved in GHOA compared to CTA when performing a RSA. Level of evidence Level III. Retrospective study. Treatment study.
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Affiliation(s)
- Tolga Keçeci
- Ordu University, Department of Orthopedics and Traumatology, Cumhuriyet mah. 1242. Sk. No: 8A/1, Altınordu, Ordu, 52200, Turkey
| | - Vahdet Uçan
- T.C. Bezmialem Foundation University, Department of Orthopedics and Traumatology, Topkapı, Adnan Menderes Blv., 34093, Fatih, Istanbul, Turkey
| | - Rodi Ertogrul
- Istanbul Şişli Hamidiye Etfal Education and Research Hospital, Department of Orthopedics and Traumatology, Halaskargazi Cd., 34371, Şişli, Istanbul, Turkey
| | - Koray Şahin
- T.C. Bezmialem Foundation University, Department of Orthopedics and Traumatology, Topkapı, Adnan Menderes Blv., 34093, Fatih, Istanbul, Turkey
| | - Kerem Bilsel
- T.C. Bezmialem Foundation University, Department of Orthopedics and Traumatology, Topkapı, Adnan Menderes Blv., 34093, Fatih, Istanbul, Turkey
- Acıbadem Fulya Hospital Dikilitaş, Yeşilçimen Sokağı No:23, 34349, Beşiktaş, İstanbul, Turkey
| | - Mehmet Kapıcıoğlu
- T.C. Bezmialem Foundation University, Department of Orthopedics and Traumatology, Topkapı, Adnan Menderes Blv., 34093, Fatih, Istanbul, Turkey
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Şahin K, Sarıkaş M, Çeşme DH, Topal M, Kapıcıoğlu M, Bilsel K. Does previous arthroscopic Bankart repair influence coracoid graft osteolysis in Latarjet procedure? A case-control study with computed tomography scan data. J Shoulder Elbow Surg 2024; 33:e223-e230. [PMID: 37757904 DOI: 10.1016/j.jse.2023.08.011] [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: 06/13/2023] [Accepted: 08/14/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The Latarjet procedure is commonly performed in the treatment of recurrent shoulder instability and is also indicated as a salvage procedure for recurrence after failed arthroscopic Bankart repair. Although this procedure has shown success, there has been an increased awareness of complications in recent studies, especially graft osteolysis. Most relevant research has focused on the pathophysiology, incidence, or location of graft osteolysis or the risk factors for graft osteolysis; however, the data are limited to primary Latarjet procedures. This study aimed to investigate the effect of previous arthroscopic Bankart repair surgery on coracoid bone graft osteolysis in the Latarjet procedure. METHODS This retrospective case-control study analyzed data from patients who underwent primary Latarjet procedures or revision Latarjet procedures following failed arthroscopic Bankart repair. Clinical outcome measures included range of motion, the Subjective Shoulder Value, and the Rowe score. Volumetric analysis of each transferred coracoid graft was performed using early postoperative and late postoperative computed tomography scan data, and the amount of graft osteolysis was then calculated as the percentage of volume reduction of each graft. RESULTS A total of 32 patients who met the inclusion criteria were included in this study, with 24 patients in the primary Latarjet group (group I) and 8 patients in the revision Latarjet group (group II). The mean age of the patients was 32.5 ± 7.7 years, and the mean follow-up duration was 52.1 ± 8.9 months. Both study groups showed significant improvement in the Subjective Shoulder Value compared with baseline (P < .05). Comparison of postoperative clinical outcome measures showed no significant difference in any outcome parameter between the 2 study groups (P > .05). No recurrence was observed during the follow-up period. A positive apprehension sign was present in 6 patients (25%) in group I and 4 patients (50%) in group II (P > .05). Analysis of radiologic data revealed that all patients underwent some degree of graft osteolysis, with varying osteolysis ratios between 12% and 98%. The mean osteolysis ratio of the coracoid graft was 67.3% ± 22.6% in group I and 69.4% ± 25.6% in group II, with no significant difference between the 2 groups (P > .05). CONCLUSION The findings of this study suggest that a considerable amount of coracoid graft osteolysis is observed after both primary Latarjet procedures and revision Latarjet procedures following failed arthroscopic Bankart repair. Previous arthroscopic Bankart repair did not seem to have a significant influence on the amount of graft osteolysis, and both primary and revision Latarjet procedures showed satisfactory clinical outcomes.
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Affiliation(s)
- Koray Şahin
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Murat Sarıkaş
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Murat Topal
- Department of Orthopedics and Traumatology, Faculty of Medicine, Kastamonu University, Kastamonu, Turkey
| | - Mehmet Kapıcıoğlu
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey.
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Ali J, Pulatkan A, Kara D, Tezgel O, Misir A, Ucan V, Bozdag E, Yildirim AN, Yildiz F, Tuncay I, Kapicioglu M, Bilsel K. Fibroblast Growth Factor Soaked Collagen Membrane Shows No Biomechanical or Histological Advantages in the Treatment of Chronic Rotator Cuff Tears in a Rabbit Model. Arthroscopy 2024; 40:683-691. [PMID: 37394152 DOI: 10.1016/j.arthro.2023.06.030] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/04/2023] [Accepted: 06/16/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE To investigate the histological and biomechanical effects of a fibroblast growth factor (FGF-2)-soaked collagen membrane used to treat a full-thickness chronic rotator cuff (RC) rupture in a rabbit model. METHODS Forty-eight shoulders from 24 rabbits were used. At the beginning of the procedure, 8 rabbits were killed to assess the control group (Group IT) with intact tendons. To establish a chronic RC tear model, a full-thickness subscapularis tear was created on both shoulders of the remaining 16 rabbits and left for 3 months. The transosseous mattress suture technique was used to repair tears in the left shoulder (Group R). The tears in the right shoulder (Group CM) were treated using the same approach, with an FGF-soaked collagen membrane inserted and sutured over the repair site. Three months after the procedure, all rabbits were killed. Biomechanical testing was performed on the tendons to determine failure load, linear stiffness, elongation intervals, and displacement. Histologically, the modified Watkins score was used to evaluate tendon-bone healing. RESULTS There was no significant difference among the three groups in terms of failure load, displacement, linear stiffness, and elongation (P > .05). The total modified Watkins score was not affected by applying the FGF-soaked collagen membrane to the repair site (P > .05). Fibrocytes, parallel cells, large-diameter fibers, and the total modified Watkins score were significantly lower in both repair groups when compared to the intact tendon group (P < .05). CONCLUSIONS In addition to tendon repair, FGF-2 soaked collagen membrane -application at the repair site provides neither biomechanical nor histological advantages in the treatment of chronic RC tears. CLINICAL RELEVANCE FGF-soaked collagen membrane augmentation provides no impact on the chronic RC tear healing tissue. The need to investigate alternative methods that may have a positive effect on healing in chronic RC repairs continues.
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Affiliation(s)
- Jotyar Ali
- Department of Orthopedics and Traumatology, Yeni Yuzyil University School of Medicine, Zeytinburnu, Istanbul, Turkey
| | - Anil Pulatkan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey.
| | - Deniz Kara
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Okan Tezgel
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | | | - Vahdet Ucan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Ergun Bozdag
- Biomechanics Laboratory, Department of Mechanical Engineering, Istanbul Technical University, Taksim, Istanbul, Turkey
| | - Ayse Nur Yildirim
- Department of Pathology, Medeniyet University Goztepe Research and Training Hospital), Istanbul, Turkey
| | - Fatih Yildiz
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Ibrahim Tuncay
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Mehmet Kapicioglu
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
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Kahraman S, Karslioglu B, Imren Y, Keskin A, Bilsel K, Dedeoglu SS. Comparison of Functional Outcomes and Complications of Inlay and Onlay Reverse Shoulder Arthroplasty in Neer Type 4 Proximal Humerus Fractures and Cuff Tear Arthropathy: A Multicentric Study. Indian J Orthop 2024; 58:263-270. [PMID: 38425832 PMCID: PMC10899121 DOI: 10.1007/s43465-023-01084-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 12/10/2023] [Indexed: 03/02/2024]
Abstract
Background This multicenter retrospective study was conducted with the objective of comparing the outcomes and complications between inlay and onlay reverse shoulder arthroplasty (RSA) in patients presenting Neer Type 4 proximal humerus fractures and cuff tear arthropathy. The primary aim of this investigation was to assess and juxtapose the clinical as well as functional outcomes of individuals who underwent onlay reverse shoulder arthroplasty with those who underwent inlay reverse shoulder arthroplasty. Methods A retrospective cohort study was conducted, involving patients who had undergone reverse shoulder arthroplasty between the period of 2016 and 2022. The study divided the population into two groups: Group A received inlay humeral components, while Group B received onlay humeral components. Functional outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) and Constant scores. Range of motion, infection, periprosthetic fractures, and nerve injuries were also assessed. Results The study included 67 patients in Group A and 62 patients in Group B. Group A had significantly better functional outcomes, as indicated by higher ASES and Constant scores (p < 0.05). Group A also had greater shoulder joint motion (p < 0.05). Periprosthetic fractures were significantly more common in Group B (p < 0.05). However, complication rates, including infection and instability, did not significantly differ between the groups (p > 0.05). Nerve injuries occurred in both groups, with slightly higher occurrence in Group B. Conclusion Inlay humeral components in reverse shoulder arthroplasty for Neer Type 4 fractures and cuff tear arthropathy resulted in better functional outcomes, increased range of motion, and lower incidence of periprosthetic fractures compared to onlay components. Onlay components showed potential advantages in reducing instability rates. Further studies with larger samples and standardized protocols are needed to confirm these findings.
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Affiliation(s)
- Sinan Kahraman
- Department of Orthopedics and Traumatology, Demiroglu Bilim University, Buyukdere Cd. No: 120, Sisli, 34394 Istanbul, Turkey
| | - Bulent Karslioglu
- Department of Orthopedics and Traumatology, Prof. Cemil Tascioglu City Hospital, Health Sciences University, Istanbul, Turkey
| | - Yunus Imren
- Department of Orthopedics and Traumatology, Health Sciences University Baltalimani Metin Sabanci Bone Diseases Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Keskin
- Department of Orthopedics and Traumatology, Health Sciences University Baltalimani Metin Sabanci Bone Diseases Training and Research Hospital, Istanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Faculty of Medicine, Istanbul, Turkey
| | - Suleyman Semih Dedeoglu
- Department of Orthopedics and Traumatology, Health Sciences University Baltalimani Metin Sabanci Bone Diseases Training and Research Hospital, Istanbul, Turkey
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Ziroglu N, Balin H, Ucan V, Bozdag E, Kapicioglu M, Bilsel K. Three-Dimensional Finite Element Analysis of a Notched Insert Design for Reverse Total Shoulder Arthroplasty to Prevent Scapular Notching. Indian J Orthop 2023; 57:1874-1880. [PMID: 37881288 PMCID: PMC10593628 DOI: 10.1007/s43465-023-00975-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/06/2023] [Indexed: 10/27/2023]
Abstract
Purpose Reverse total shoulder arthroplasty (RSA) is an effective treatment option for rotator cuff arthropathy. Scapular notching following RSA remains a major complication and has a high incidence. This finite element analysis (FEA) study provides a future reference for the optimal design of the insert component of RSA. This study aims to clarify the effect of a new design RSA with a notched insert on the range of adduction, scapular notching, and stress variation of its insert component using three-dimensional (3D) FEA. Methods 3D nominal Grammont-type monobloc RSA implant components are modeled on the sawbones glenohumeral joint. The polyethylene insert is redesigned with notching of the inferior part. The comparison of standard and notched designs was performed by FEA for stress pressure of scapular notching and the degree of adduction. 3D mesh models are created for stress analysis to compare the results between standard and notched inserts for the adduction. Results The redesigned notched inserts had an additional ~ 11.2° on adduction and prevented scapular notching. The stress analysis results for the notched insert design were lower than the standard ones (4.7 vs 22.4 Kpa). Conclusions Notched insert design of Grammont-type RSA could provide additional adduction with lower stress on the glenoid, leading to less scapular notching. Further experimental and clinical studies on different RSA types are needed to verify this effect. Study Design Basic Science Study; Biomechanics and Computer Modeling.
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Affiliation(s)
- Nezih Ziroglu
- Department of Orthopedics and Traumatology, Acibadem University, Acibadem Atakent Hospital, Halkalı Merkez, Turgut Özal Bulvari No:16, 34303 Küçükçekmece/Istanbul, Turkey
| | - Hüseyin Balin
- Mechanical Engineer, Mechanical Engineering, Istanbul Technique University, Istanbul, Turkey
| | - Vahdet Ucan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Türkiye
| | - Ergun Bozdag
- Mechanical Engineer, Mechanical Engineering, Istanbul Technique University, Istanbul, Turkey
| | - Mehmet Kapicioglu
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Türkiye
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Türkiye
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Tiryaki P, Çelik D, Bilsel K, Erşen A. Effectiveness of Exercises With Electromyographic Biofeedback in Conservative Treatment of Massive Rotator Cuff Tears: A Randomized Controlled Study. Am J Phys Med Rehabil 2023; 102:419-426. [PMID: 36166658 DOI: 10.1097/phm.0000000000002111] [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: 11/26/2022]
Abstract
OBJECTIVE The aim of the study is to investigate the effectiveness of a rehabilitation program with electromyographic biofeedback compared with the control group on patients with massive rotator cuff tear. DESIGN Forty-six adults with massive rotator cuff tears, randomly assigned to 2 groups (23 electromyographic biofeedback group vs. 23 control group). The electromyographic biofeedback group (experimental group) performed the exercises under the guidance of electromyographic biofeedback, unlike the control group. All patients underwent a 45-minute training session a day, 3 times a week over a 6-wk duration, and followed up until 1-year. The outcome measures were American Shoulder and Elbow score, shoulder flexion strength, shoulder range of motion, Numeric Pain Rating Scale, and Global Rating of Change Scale. RESULTS Compared with the control group, the electromyographic biofeedback group demonstrated a significant change in shoulder flexion strength and patient satisfaction from baseline to 6 wks (posttraining) and from baseline to 12-mo follow-up ( F = 4.671, P = 0.005). There were significant improvements in within groups statistics for American Shoulder and Elbow score, shoulder flexion strength, shoulder range of motion, and Numeric Pain Rating Scale in both groups ( P < 0.05). CONCLUSIONS The results demonstrate that deltoid-focused structured rehabilitation program combined with electromyographic biofeedback can be used to increase shoulder flexion strength and patient satisfaction in conservative treatment of massive rotator cuff tear.
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Affiliation(s)
- Pelin Tiryaki
- From the Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Yalova University, Yalova, Turkey (PT); Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey (PT); Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey (DÇ); Department of Orthopaedics and Traumatology, Faculty of Medicine, Bezmialem University, Istanbul, Turkey (KB); and Department of Orthopaedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey (AE)
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Ertogrul R, Sahin K, Celik H, Kapicioglu M, Ersen A, Bilsel K. Is coracoclavicular ossification a complication or a good prognostic factor after surgical treatment of acromioclavicular joint injury? JSES Int 2022; 6:769-774. [PMID: 36081692 PMCID: PMC9445996 DOI: 10.1016/j.jseint.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The purpose of this study was to investigate whether heterotopic ossification (HO) in the coracoclavicular (CC) space after surgical treatment of acromioclavicular joint (ACJ) injury is a complication or a sign of good prognosis. Methods Fifty-nine consecutive patients who underwent CC reconstruction with or without augmentation of the ACJ for acute ACJ injuries were analyzed. Postoperative American Shoulder and Elbow Surgeons (ASES) score, Constant score (CS), subjective shoulder value (SSV), and visual analog scale (VAS) results were evaluated. For radiological evaluation, HO was evaluated, and CC distances were measured. Results Fifty-one patients (11 women and 40 men; mean age, 36 years [range, 17-68 years]) were evaluated after a mean follow-up of 3 years (range, 2-8 years). The mean ASES score at the follow-up was 82.73 (range, 51.6-100), mean CS was 85 (range, 50-100), mean SSV was 80 (range, 40-100), and mean VAS was 1.9 (range, 0-5). It was observed that the clinical outcomes (ASES, CS, SSV, VAS) of patients who developed ossification in the CC space were better than those who did not although it was not statistically significant. No statistically significant differences were found in the clinical outcomes (ASES, CS, SSV, VAS) between patients who underwent CC reconstruction without augmentation of the ACJ and those who were combined (P > .05). Conclusion HO in the CC space is a common finding following AC joint fixation injury. We suggest that HO is not a complication and might possibly have positive effects on clinical outcomes.
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Affiliation(s)
- Rodi Ertogrul
- Sisli Hamidiye Etfal Training and Research Hospital, Orthopaedics Department, Istanbul, Turkey
| | - Koray Sahin
- Mus State Hospital, Department of Orthopaedics and Traumatology, Muş, Turkey
| | - Haluk Celik
- Hisar Intercontinental Private Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Mehmet Kapicioglu
- Bezmialem Vakif University, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Ali Ersen
- Istanbul University, Istanbul Medical School, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Kerem Bilsel
- Bezmialem Vakif University, Department of Orthopaedics and Traumatology, Istanbul, Turkey
- Corresponding author: Kerem Bilsel, MD, Bezmialem Vakif Universitesi Tip Fakultesi Hastanesi, vatan street, Fatih, istanbul 34093, Turkey.
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Mohammad Sadeghi M, Kececi EF, Kapicioglu M, Aralasmak A, Tezgel O, Basaran MA, Yildiz F, Bilsel K. Three dimensional patient-specific guides for guide pin positioning in reverse shoulder arthroplasty: An experimental study on different glenoid types. J Orthop Surg (Hong Kong) 2022; 30:10225536221079432. [PMID: 35220811 DOI: 10.1177/10225536221079432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Incorrect positioning is one of the main factors for glenoid component loosening in reverse shoulder arthroplasty and component placement can be challenging. This study aimed to assess whether Patient-Specific Instrumentation (PSI) provides better guide pin positioning accuracy and is superior to standard guided and freehand instrumentation methods in cases of glenoid bone deformity. MATERIALS AND METHODS Based on the Walch classification, five different scapula types were acquired by computed tomography (CT). For each type, two different surgeons placed a guide pin into the scapula using three different methods: freehand method, conventional non-patient-specific guide, and PSI guide. Each method was repeated five times by both surgeons. In these experiments, a total of 150 samples of scapula models were used (5 × 2 × 3 × 5 = 150). Post-operative CT scans of the samples with the guide pin were digitally assessed and the accuracy of the pin placement was determined by comparison to the preoperative planning on a three-dimensional (3D) model. RESULTS The PSI method showed accuracies to the preoperative plan of 2.68 (SD 2.10) degrees for version angle (p < .05), 2.59 (SD 2.68) degrees for inclination angle (p < .05), and 1.55 (SD 1.26) mm for entry point offset (p < .05). The mean and standard deviation errors compared to planned values of version angle, inclination angle, and entry point offset were statistically significant for the PSI method for the type C defected glenoid and non-arthritic glenoid. CONCLUSION Using the PSI guide created by an image processing software tool for guide pin positioning showed advantages in glenoid component positioning over other methods, for defected and intact glenoid types, but correlation with clinical outcomes should be examined.
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Affiliation(s)
| | - Emin Faruk Kececi
- Department of Mechanical Engineering Kayseri, 346448Abdullah Gul University, Kayseri, Turkey
| | - Mehmet Kapicioglu
- Orthopaedics and Traumatology Department, 221265Bezmialem Vakif University, Istanbul, Turkey
| | - Ayse Aralasmak
- Radiology Department, 469683Istinye University, Istanbul, Turkey
| | - Okan Tezgel
- Radiology Department, 469683Istinye University, Istanbul, Turkey
| | - Murat Alper Basaran
- Department of Management Engineering, 450199Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Fatih Yildiz
- Orthopaedics and Traumatology Department, 221265Bezmialem Vakif University, Istanbul, Turkey
| | - Kerem Bilsel
- Orthopaedics and Traumatology Department, 221265Bezmialem Vakif University, Istanbul, Turkey
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Dedeoglu SS, Imren Y, Karslioglu B, Keskin A, Atar S, Bilsel K. Kinesiotaping therapy for midshaft clavicular fractures: a randomised trial study. Acta Orthop Belg 2022; 88:143-150. [PMID: 35512165 DOI: 10.52628/88.1.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Midshaft clavicle fractures with shortening by less than 2 cm or minimal displacement without neurovascular injury can be treated conservatively. We hypothesized that kinesiotaping reduces the disadvantages of conservative treatment, such as early-phase pain, high nonunion rates, and a prolonged time to return to work, and yields better clinical and functional outcomes. Forty patients were randomly divided into the arm slings only (group S) or arm sling with kinesiotaping therapy group (group K). The outcome measures included the visual analog scale (VAS) score, Constant score, American Shoulder and Elbow Surgeons (ASES) score, union time, magnitude of shortening, and time to return to work. The mean follow-up period of the study was 8.5 (6- 10) months. The ASES and Constant scores were significantly better in group K than in group S in the 3rd month. The mean union time was 8.60 (8-12) weeks in group S and 8.25 (6-12) weeks in group K. The mean time to return to work was 7.23 (4-12) weeks in group S and 5.37 (2-10) weeks in group K, and the difference was statistically significant (p <0.05). There was no significant difference in terms of shortening between the two groups. Compared with an arm sling only, an arm sling with kinesiotaping can yield better clinical functional results, higher union rates, and a shorter the time to return to work due to the early control of pain and edema.
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Altun G, Türkmen İ, Kara D, Çelik H, Sanem Dereli Bulut S, Bilsel K. The effect of sagittal orientation of the acromion relative to the scapular spine on the location of rotator cuff tears. Acta Orthop Traumatol Turc 2022; 56:116-119. [PMID: 35416163 PMCID: PMC9612654 DOI: 10.5152/j.aott.2022.21127] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: The aim of this study was to investigate the effect of the angle between the scapular spine and acromion in the sagittal plane on the location of chronic rotator cuff tears (RCTs). Methods: The magnetic resonance images of patients who had undergone an arthroscopic shoulder surgery were evaluated. The patients were divided into two groups: patients who had undergone RCT repair and those who had experienced different shoulder surgery as a control group. The RCT group (study group) was then subgrouped in terms of the location of the tear as posterior-superior RCT type 3, 4, 5 or combination (group A) and anterior-superior RCT type 1,2,3 or combination using the Patte sagittal classification (group B). A novel angle, scapular spine-acromion angle (SSAA), was described in the sagittal plane and compared between the groups and subgroups. Results : A total of 96 patients underwent an arthroscopic RCT repair with a mean age of 59.5 years (range, 36-65 years), and the control group was composed of 40 patients with a mean age of 52.5 (range, 41-63 years). Comparison the group B (mean value: 73.41°±5.98°, median: 73,8°, range: 60.6°-89.7°) has significantly higher degrees of SSAA than group A (mean value: 63.92°±6.82°, median: 64,8°, range: 52.3°-77.9°) (P < 0.001). Conclusion : This study demonstrated a higher incidence of posterior- superior RCTs in patients with lower SSAA and anterior-superior RCTs in patients with higher SSAA in the sagittal plane compared to the control group. So sagittal acromial orientation might influence the RCT location.
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Affiliation(s)
- Güray Altun
- Department of Orthopaedics and Traumatology, Ümraniye Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
- Corresponding Author: Güray Altun
| | - İsmail Türkmen
- Department of Orthopaedics and Traumatology, Göztepe Training and Research Hospital, İstanbul Medeniyet University, İstanbul, Turkey
| | - Deniz Kara
- Clinic of Orthopaedics and Traumatology, Suşehri Hospital, Sivas, Turkey
| | - Haluk Çelik
- Department of Orthopaedics and Traumatology, Ümraniye Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Safiye Sanem Dereli Bulut
- Department of Radiology, Ümraniye Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopaedics and Traumatology, Bezmialem Foundation University, School of Medicine, İstanbul, Turkey
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Bilgin E, Tezgel O, Ucan V, Kapıcıoğlu M, Turgut A, Bilsel K. Clinical Outcomes of Two-Stage Implantation in Reverse Shoulder Arthroplasty for Postinfectious End-Stage Glenohumeral Arthritis in Native Shoulders: A Single-Center Cohort Study with a Minimum 2-Year Follow-up. Clin Orthop Surg 2022; 15:272-280. [PMID: 37008966 PMCID: PMC10060767 DOI: 10.4055/cios21275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/01/2022] [Accepted: 04/16/2022] [Indexed: 11/06/2022] Open
Abstract
Background Septic arthritis of the shoulder is a rare but devastating condition that may lead to joint destruction. There are few studies and limited outcome data on shoulder arthroplasty for infected native shoulders with end-stage glenohumeral arthritis (GHA). Hence, this study aimed to demonstrate the clinical outcomes of two-stage implantation in reverse shoulder arthroplasty (RSA) using an antibiotic spacer in the first stage for this challenging condition. Methods We conducted a retrospective study on two-stage implantation in RSA in infected shoulders. Patients were diagnosed with end-stage GHA due to primary shoulder sepsis or infection following non-arthroplasty shoulder surgery. Laboratory data, range of motion (ROM), and functional scores including American Shoulder and Elbow Surgeons score, Constant score, and Disabilities of the Arm, Shoulder and Hand score were assessed prior to spacer placement and at the latest follow-up. Furthermore, intraoperative and postoperative complications were recorded. Results In this study, 10 patients with a mean age of 54.8 ± 15.8 years (range, 30-77 years) were included. The mean follow-up period was 37.3 ± 9.1 months (range, 25-56 months). All postoperative ROM measurements and functional scores were improved significantly. Although no reinfection was observed, a total of 5 complications including 2 hematomas, 1 intraoperative humeral fracture, 1 humeral stem loosening, and 1 anterior deltoid dysfunction were observed in 4 patients after a follow-up period of at least 2 years after RSA. Conclusions Two-stage implantation in RSA is an effective method for improving the function and controlling the infection in postinfectious end-stage GHA in native shoulders.
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Affiliation(s)
- Emre Bilgin
- Department of Orthopaedics and Traumatology, Health Science University Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Okan Tezgel
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Vahdet Ucan
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Kapıcıoğlu
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Ali Turgut
- Department of Orthopaedics and Traumatology, Health Science University Tepecik Training and Research Hospital, Izmir, Turkey
| | - Kerem Bilsel
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
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Akçal MA, Öztürk N, Erpala F, Bilsel K. The Most Cited Top 100 Articles in Shoulder Arthroscopy. Acta Chir Orthop Traumatol Cech 2022; 89:27-36. [PMID: 35247241] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE OF THE STUDY The purpose of this study was to identify and analyze the current most cited top-100 articles in shoulder arthroscopy literature. MATERIAL AND METHODS This retrospective analysis obtained bibliometric information from the Web of Science (WoS) database and analyzed the data via VOSviewer through software package. RESULTS The citation count of the most-cited articles varied from 122 to 923 on WoS. Altogether, the top 100 articles were cited 19,726 times; the average number of citations among the articles was 197.26. According to an abstract analysis, the most frequent terms were rotator cuff tear, tear, instability, and pain. A total of 73 of the top-100 cited articles were published between 2000-2014, while the oldest article was published in 1986. The most productive year was in 2007 (15 publications), and the most productive countries were the United States of America (63 publications) and France (15 publications). CONCLUSIONS Shoulder arthroscopy has been increasingly performed as an outpatient procedure in recent years. Our study may provide insights into trending topics in shoulder arthroscopy, the qualities which make an article relevant to global peers in the specialty, and may also serve to inspire relevant future articles. Clinical Relevance: The most cited top 100 articles in shoulder arthroscopy may give some insights on what qualities make an article relevant to global peers in the specialty and also inspire further relevant research in the future. Key words: arthroscopy, shoulder arthroscopy, bibliometric study, the most cited articles.
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Affiliation(s)
- M A Akçal
- Antalya Ataturk State Hospital Orthopaedics and Traumatology Clinic, Antalya,Turkey
| | - N Öztürk
- Antalya Province Directorate of Health, Antalya, Turkey
| | - F Erpala
- Çeşme State Hospital, Orthopaedics and Traumatology Clinic, Ankara,Turkey
| | - K Bilsel
- Bezmialem Vakif University, Orthopaedics and Traumatology Clinic, Istanbul,Turkey
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Uçan V, Pulatkan A, Sarıkaş M, Kapıcıoğlu M, Bilsel K. Does correction of reverse shoulder arthroplasty angle improve clinical outcomes in cuff tear arthropathy? Acta Orthop Traumatol Turc 2021; 55:466-472. [PMID: 34967733 DOI: 10.5152/j.aott.2021.21189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the impact of correction of the reverse shoulder arthroplasty (RSA) angle on clinical outcomes in patients with cuff tear arthropathy (CTA). METHODS This single-center retrospective study was conducted in patients with CTA treated with RSA between 2013 and 2018. A structured questionnaire collecting demographic data, postoperative follow-up time, pre- and postoperative range of motion (ROM), American Shoulder and Elbow Surgeons (ASES) and Constant functional scores as well as scapular notching according to the Sirveaux Classification and RSA angle were evaluated by independent observers. The association between functional outcomes and RSA angle was analyzed using a curve estimation approach. RESULTS Seventy-four patients with a mean age of 69.4 ± 8 years and mean follow-up period of 38.2 ± 10.8 months were included the study. The medialized inlay component was implanted in 35 patients, and the lateralized onlay component was used in 39 patients. The mean preoperative ASES and Constant scores improved from 28.4 ± 5.1 and 31.1 ± 5.9 to 73.4 ± 23.3 and 70.5 ± 16, respectively, at the last follow-up (both P < 0.001). The mean pre- and postoperative RSA angles were measured to be 21.3 ± 9.3° and 5.5 ± 10.1°, respectively, on X-ray. The postoperative RSA angle was 10.4 ± 10.3° in computerized tomography (CT) scans. There was an excellent correlation between X-ray and CT measurements (rs: 0.971, P < 0.001). It was found that patients with good postoperative functional scores tended to have an RSA angle of 0-10° postoperatively. The delta internal rotation of the medialized design group was greater than that of the lateralized design group (P = 0.029). CONCLUSION In patients undergoing RSA for CTA, satisfactory clinical outcomes can be obtained by achieving a postoperative RSA angle of 0-10° with an asymmetrical inferior reaming technique. LEVEL OF EVIDENCE Level III, Therapeutic Study.
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Affiliation(s)
- Vahdet Uçan
- Department of Orthopedics and Traumatology, Bezmialem Foundation University, İstanbul, Turkey
| | - Anıl Pulatkan
- Department of Orthopedics and Traumatology, Bezmialem Foundation University, İstanbul, Turkey
| | - Murat Sarıkaş
- Department of Orthopedics and Traumatology, Bezmialem Foundation University, İstanbul, Turkey
| | - Mehmet Kapıcıoğlu
- Department of Orthopedics and Traumatology, Bezmialem Foundation University, İstanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, Bezmialem Foundation University, İstanbul, Turkey
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Erden T, Kapicioglu M, Ersen A, Toker B, Sahin K, Bilsel K. Arthroscopic coracoclavicular button fixation versus anatomic locking plate fixation for unstable distal clavicular fractures. JSES Int 2021; 5:835-839. [PMID: 34505092 PMCID: PMC8411051 DOI: 10.1016/j.jseint.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Hypothesis Neer type II distal clavicle fractures are unstable and associated with high nonunion rates. The aim of this retrospective study was to compare the clinical and radiographic outcomes of anatomic locking plate fixation and arthroscopic coracoclavicular button fixation for unstable distal clavicle fractures. Methods Forty-seven patients with Neer type II distal clavicle fractures were treated surgically using either anatomic locking plate fixation (group 1, n = 20) or all arthroscopic coracoclavicular button fixation (group 2, n = 27) between 2012 and 2019 in 2 centers. Clinical and radiographic outcomes after an average follow-up period of 49 months for group 1 and 32 months for group 2 were assessed using the American Shoulder and Elbow Surgeons Shoulder score, Constant-Murley score, visual analog scale score and X-rays. Results At the final follow-up, the mean American Shoulder and Elbow Surgeons Shoulder score, Constant-Murley score, and visual analog scale score for group 1 and group 2 were 92.5 ± 3.9 (range 88.3-98.3), 93.6 ± 4.0 (range 90-100), and 0.6 ± 0.6 (range 0-2) and 95 ± 3.3 (range 86.6-100), 96.2 ± 3.0 (range 88-100), and 0.4 ± 0.5 (range 0-1), respectively (P = .32, P = .15, and P = .59, respectively). At the final follow-up, acceptable reduction and bone healing were achieved in all patients. All patients in both groups were able to resume work as well as sports activities. Postoperative complications included 1 case of acromioclavicular joint arthritis and 1 case of screw penetration in group 1 and 2 cases of coracoid process fracture that did not require additional surgery in group 2. Five patients underwent hardware removal owing to skin irritation and dissatisfaction with the cosmetic appearance in group 1. Conclusion Both distal anatomic locking plate fixation and arthroscopic coracoclavicular button fixation provide satisfactory functional and radiological outcomes. Both procedures can be used to treat distal clavicle fractures because they have a minimal risk of complications and present similar, high union rates.
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Affiliation(s)
- Tunay Erden
- Acıbadem Fulya Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Mehmet Kapicioglu
- Bezmialem Vakif University Medical School, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Ali Ersen
- Istanbul University Medical Faculty, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Berkin Toker
- Acıbadem Fulya Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Koray Sahin
- Istanbul University Medical Faculty, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Kerem Bilsel
- Bezmialem Vakif University Medical School, Department of Orthopaedics and Traumatology, Istanbul, Turkey
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Abstract
PURPOSE The ideal treatment algorithm is still controversial for Superior Labral Anterior-Posterior (SLAP) tears. In this systematic review, we aimed to clarify and ascertain which treatment modality is effective and more usable in which conditions. METHODS In this systematic review, we used the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines established for systematic reviews and meta-analysis. "SLAP or Superior Labral Anterior-Posterior" and "biceps tenodesis" search terms were used in The Cochrane Library database and Pubmed from their inception to the 30th of September 2020. A total of 2326 titles were screened and 2069 articles were removed because of their ineligibility. Full texts of 14 studies were screened and finally, six were suitable for the present systematic review. Demographic details and study characteristics, patient satisfaction, functional outcomes, return to preinjury sports level, reoperation, stiffness, sling time and rehabilitation protocols were reviewed and compared between SLAP repair and biceps tenodesis groups. RESULTS A total of 2326 titles were screened and six studies were detected eligible. Results of 287 patients (SLAP repair: 160, Biceps Tenodesis: 127) were reviewed in included six studies. Biceps tenodesis was showed as more satisfied technique in four of the studies but the statistical comparing results of two groups were not significantly different in each study. Different functional scoring systems used in the studies were not statistically significantly different between the groups. The percentage of return to sport and preinjury level is higher in biceps tenodesis in the five studies. The total reoperation rate for SLAP repair was 19/160 (12%) and biceps tenodesis was 7/127 (6%). CONCLUSION The biceps tenodesis has a higher return to preinjury sports level, higher patient satisfaction and lower reoperation rates but functional scores are similar between SLAP repair groups in patients with SLAP tear.
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Affiliation(s)
- Osman Civan
- 64032Akdeniz University, School of Medicine, Department of Orthopaedics and Traumatology, Antalya, Turkey
| | - Kerem Bilsel
- 221266Bezmialem Vakıf University, School of Medicine, Department of Orthopaedics and Traumatology, İstanbul, Turkey
| | - Mehmet Kapicioglu
- 221266Bezmialem Vakıf University, School of Medicine, Department of Orthopaedics and Traumatology, İstanbul, Turkey
| | - Alpay M Ozenci
- Private Medical Park Hospital, Department of Orthopaedics and Traumatology, Antalya, Turkey
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Kapicioglu M, Erden T, Bilgin E, Bilsel K. All arthroscopic coracoclavicular button fixation is efficient for Neer type II distal clavicle fractures. Knee Surg Sports Traumatol Arthrosc 2021; 29:2064-2069. [PMID: 32382804 DOI: 10.1007/s00167-020-06048-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 03/21/2020] [Accepted: 04/29/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Neer type II distal clavicle fractures are associated with a high rate of non-union or malunion due to impaired coracoclavicular ligament stability. The purpose of this study was to assess the clinical and radiological outcomes of arthroscopically assisted indirect osteosynthesis for type II distal clavicle fractures using a cortical suture button device. METHODS Seventeen patients Neer type II fractures of the distal clavicle were treated surgically using cortical suture button fixation between 2012 and 2017. The clinical and radiological results were assessed using the American Shoulder and Elbow Surgeons Shoulder Score (ASES), Constant-Murley score and visual analogue scale (VAS) score. RESULTS Anatomic reduction and bone healing were achieved in all patients at the final follow-up. The median age of the patients was 31 years (range 19-57). The mean follow-up was 25.9 months (range 14-64). The average delay before surgery was 2 days (range 1-4). At the final follow-up, the mean ASES, Constant-Murley score and VAS score were 92.6 ± 3.2 (range 84.9-96.6), 96.2 ± 2.4 (range 92-100) and 0.47 ± 0.51 (range 0-1), respectively. All patients were able to resume work as well as sport activities. The postoperative complications included two coracoid process fractures, and none of the patients required additional surgery related to the index procedure. CONCLUSION All arthroscopic coracoclavicular button fixation of Neer type II distal clavicle fractures would provide sufficient stability and union with satisfactory radiological and clinical outcomes. This arthroscopic fixation technique would be more efficient than other osteosynthesis methods because it is a minimally invasive surgery with a low complication rate. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mehmet Kapicioglu
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University Medical School, Istanbul, Turkey
| | - Tunay Erden
- Department of Orthopaedics and Traumatology, Acıbadem Fulya Hospital, Istanbul, Turkey.
| | - Emre Bilgin
- Department of Orthopaedics and Traumatology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Kerem Bilsel
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University Medical School, Istanbul, Turkey
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Pulatkan A, Kapicioglu M, Ucan V, Masai MN, Ozdemir B, Akpinar S, Bilsel K. Do Techniques for Hill-Sachs Remplissage Matter in Terms of Functional and Radiological Outcomes? Orthop J Sports Med 2021; 9:23259671211008152. [PMID: 34262976 PMCID: PMC8243109 DOI: 10.1177/23259671211008152] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Different techniques are used for the remplissage procedure, including the
double-pulley and mattress suture techniques. Both techniques have shown
good results; however, it is unclear if one technique is superior. Hypothesis: The remplissage procedure using the double-pulley technique with 2 anchors
would have superior functional and radiological outcomes compared with the
mattress suture technique with a single anchor. Study Design: Cohort study; Level of evidence, 3. Methods: This study included patients with anterior shoulder instability who were
treated using arthroscopic Bankart repair combined with remplissage between
2012 and 2017. A structured questionnaire was used to gather information on
the following metrics: Instability Severity Index Score, hyperlaxity, Sugaya
index, presence of a Hill-Sachs defect, number of dislocations before
surgery, sports participation, radiological measurement of the Hill-Sachs
lesion, postoperative range of motion in both shoulders, Rowe score,
Walch-Duplay score, American Shoulder and Elbow Surgeons score, and Filling
Index Score of Remplissage grade according to magnetic resonance imaging
scans at the last follow-up. Results: There were 41 patients included with a mean age of 30 ± 7 years who underwent
the Hill-Sachs remplissage procedure using the double-pulley technique with
2 anchors (n = 21; group DA) or the mattress suture technique with a single
anchor (n = 20; group SA). At the final follow-up, there were no significant
differences between the groups regarding the Instability Severity Index
Score (P = .134), the Sugaya index (P =
.538), sports participation (P = .41), the radiological
measurement of the Hill-Sachs lesion (P = .803), or the
Rowe score (P = .182). However, there were significant
differences between the groups in the Walch-Duplay score (P
= .012), American Shoulder and Elbow Surgeons score (P =
.005), and Filling Index Score of Remplissage grade (P =
.015), favoring group DA, as well as differences in external rotation in a
neutral position (external rotation loss: 9° ± 3° [group SA] vs 12° ± 3°
[group DA]; P = .003) and at 90° of abduction (external
rotation loss: 8° ± 3° [group SA] vs 11° ± 3° [group DA]; P
= .006), favoring group SA. Conclusion: In the remplissage procedure, the double-pulley technique provided better
filling of the lesion and improvement in functional scores, but external
rotation was limited compared with the mattress suture technique.
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Affiliation(s)
- Anil Pulatkan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Mehmet Kapicioglu
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Vahdet Ucan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
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Kapicioglu M, Aliyev O, Bilsel K. Letter to the editor "Middle trapezius transfer for treatment of irreparable supraspinatus tendon tears-anatomical feasibility study". J Exp Orthop 2021; 8:35. [PMID: 33914173 PMCID: PMC8085159 DOI: 10.1186/s40634-021-00355-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/21/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Mehmet Kapicioglu
- Department of Orthopaedics and Traumatology, Bezmialem Vakıf University, Istanbul, Turkey
| | - Orkhan Aliyev
- Department of Orthopaedics and Traumatology, Bezmialem Vakıf University, Istanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopaedics and Traumatology, Bezmialem Vakıf University, Istanbul, Turkey.
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Kapicioglu M, Bilgin E, Guven N, Pulatkan A, Bilsel K. The Role of Deadlifts in Distal Biceps Brachii Tendon Ruptures: An Alternative Mechanism Described With YouTube Videos. Orthop J Sports Med 2021; 9:2325967121991811. [PMID: 34250167 PMCID: PMC8237209 DOI: 10.1177/2325967121991811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/18/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The classic injury mechanism of a distal biceps brachii tendon rupture (DBBTR) is eccentric loading to the flexed elbow when the forearm is supinated. PURPOSE To determine alternative mechanisms of a DBBTR in powerlifting sports, particularly in deadlift competitions, with the use of YouTube videos. STUDY DESIGN Descriptive epidemiology study. METHODS A search on YouTube was performed using the search terms "distal biceps tendon rupture" and "distal biceps tendon injury" combined with "competition," "deadlift," and "powerlifting." The videos underwent an evaluation for accuracy by 3 surgeons according to predetermined criteria. Type of sports activity, participant sex, side of the injury, and arm positions at the time of the injury were recorded. RESULTS Among the videos reviewed, 35 injuries were found appropriate for an evaluation. All participants were male. The majority of the injuries (n = 25) were observed during the deadlift. Only in 1 deadlift injury were both forearms in supination. In the remaining deadlift injuries (n = 24), all elbows were in extension, with 1 forearm in supination and the other in pronation. Among the deadlift injuries in the mixed-grip position, all ruptures occurred in a supinated extremity: 25% (n = 6) of ruptures occurred on the right side, and 75% (n = 18) of ruptures occurred on the left side; this was a significant difference (P = .014). CONCLUSION We described an alternative mechanism for a DBBTR, namely, eccentric loading to an extended elbow when the forearm is supinated during the deadlift. As all the ruptures occurred in a supinated extremity, holding the bar with both forearms in pronation may prevent or decrease the risk of ruptures during the deadlift.
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Affiliation(s)
- Mehmet Kapicioglu
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Emre Bilgin
- Department of Orthopaedics and Traumatology, Tepecik Training and
Research Hospital, Izmir, Turkey
| | - Necip Guven
- Department of Orthopaedics and Traumatology, Van Yuzuncu Yil
University, Van, Turkey
| | - Anil Pulatkan
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
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Agir M, Pulatkan A, Kapicioglu M, Bilsel K. An unusual injury of pediatric both forearm fractures: Distraction epiphysiolysis: A case report. Int J Surg Case Rep 2021; 79:1-8. [PMID: 33418421 PMCID: PMC7804365 DOI: 10.1016/j.ijscr.2020.12.084] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/27/2020] [Accepted: 12/27/2020] [Indexed: 11/30/2022] Open
Abstract
IM K-wire implementation is first choice at pediatric both forearm fractures. The biggest concern about transphyseal transmission of the K-wire is physeal arrest. Physeal arrest could not be shown literature in transphyseal K-wire implementation. Distal of the physis line, a more suitable place for the entry point of the k-wire. Transphyseal application can prevent from distraction epiphysiolysis.
Introduction and importance Pediatric both forearm fractures are one of the common traumas we encounter in clinical practice. We aimed to show a complication not shown in the literature, its possible cause and management of this complication in the surgery of these fractures. Case presentation 9 years old girl applied to emergency orthopedics unit after fall. Both forearm fracture was appeared after X-ray. Due to reduction loss in the control X-ray of the first week, closed reduction and intramedullary K wire were planned. The prebent K-wire was tried to be sent as intramedullary. While attempting to advance the K-wire, loss of intramedullary resistance was felt. When controlled with fluoroscopy, type 1 epiphysiolysis was observed in the distal radius. Open anatomical reduction was performed on distal radius epiphysis. Two K wires were placed so that crossed the physis line. In 2-year follow-up, there was no length discrepancy or limitation of movement between the left and right radius. Clinical discussion Intramedullary fixation is first choice for surgery in pediatric both forearm fractures. There are 2 opinions for K-wire entering point: proximal and distal of physis. The biggest concern about transphyseal transmission of the K wire is that this conduction may cause physeal damage or arrest. However, physeal damage or arrest could not be shown in the literature. On the other hand, transphyseal application provides convenience in terms of surgical applicability. Conclusion In our opinion, it will be more appropriate and safe to send the K wire transphyseal over the styloid for pediatric population have both forearm fractures.
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Affiliation(s)
- Muzaffer Agir
- Bezmialem Vakif University, School of Medicine, Department of Orthopaedics and Traumatology, Vatan Cd, Fatih, 34093, İstanbul, Turkey
| | - Anil Pulatkan
- Bezmialem Vakif University, School of Medicine, Department of Orthopaedics and Traumatology, Vatan Cd, Fatih, 34093, İstanbul, Turkey
| | - Mehmet Kapicioglu
- Bezmialem Vakif University, School of Medicine, Department of Orthopaedics and Traumatology, Vatan Cd, Fatih, 34093, İstanbul, Turkey
| | - Kerem Bilsel
- Bezmialem Vakif University, School of Medicine, Department of Orthopaedics and Traumatology, Vatan Cd, Fatih, 34093, İstanbul, Turkey.
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Pulatkan A, Anwar W, Ayık O, Bozdag E, Yildirim AN, Kapicioglu M, Tuncay I, Bilsel K. Tear Completion Versus In Situ Repair for 50% Partial-Thickness Bursal-Side Rotator Cuff Tears: A Biomechanical and Histological Study in an Animal Model. Am J Sports Med 2020; 48:1818-1825. [PMID: 32298135 DOI: 10.1177/0363546520909854] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tear completion followed by repair (TCR) and in situ repair (ISR) have been widely used for bursal-side partial-thickness rotator cuff tears (PTRCTs). Both techniques have shown favorable results; however, controversy continues in terms of the best management. PURPOSE To compare the histological and biomechanical outcomes of these 2 techniques for 50% partial-thickness bursal-side rotator cuff tear repair in a rabbit model. STUDY DESIGN Controlled laboratory study. METHODS A total of 27 rabbits were used in this experimental study. Seven rabbits were sacrificed at the beginning of the study to form an intact tendon control group. A chronic 50% partial-thickness bursal-side tear model was created in 20 rabbits, and 5 rabbits were sacrificed for biomechanical testing of chronic partial-thickness tears (control group) without repair. In 15 rabbits, partial-thickness tears were repaired after 8 weeks. Partial-thickness tears in the right shoulders were completed to full thickness and repaired; in contrast, left shoulders were repaired in situ. All rabbits were euthanized 8 weeks after the repair. The tendons were tested biomechanically for ultimate failure, linear stiffness, and displacement. Histological evaluations of tendon-to-bone healing were performed via the modified Watkins score. RESULTS Macroscopically, all repaired tendons were attached to the greater tuberosity. The TCR group had a higher failure load than the ISR group, with mean values of 140.4 ± 13.8 N and 108.1 ± 16.6 N, respectively (P = .001). The modified Watkins score was significantly higher in the TCR group (23.5; range, 22-27) than in the ISR group (19.5; range, 16-22) (P = .009). CONCLUSION Both repair techniques are effective for 50% partial-thickness bursal-side rotator cuff tears; however, TCR yields significantly superior biomechanical and histological characteristics compared with ISR. CLINICAL RELEVANCE Tear completion and repair technique may increase tendon-to-bone healing and thereby reduce re-rupture rate in the partial thickness bursal side rotator cuff tears.
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Affiliation(s)
- Anil Pulatkan
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| | - Wasim Anwar
- FCPS Department of Orthopaedics, Medical Teaching Institute, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Omer Ayık
- Department of Orthopaedics and Traumatology, Fatih, Istanbul University Medical Faculty, School of Medicine, Istanbul, Turkey
| | - Ergun Bozdag
- Biomechanics Laboratory, Department of Mechanical Engineering, Istanbul Technical University, Taksim, Istanbul, Turkey
| | - Ayse Nur Yildirim
- Department of Pathology, Medeniyet University Goztepe Research and Training Hospital, Istanbul, Turkey
| | - Mehmet Kapicioglu
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| | - Ibrahim Tuncay
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey
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Ali J, Altintas B, Pulatkan A, Boykin RE, Aksoy DO, Bilsel K. Open Versus Arthroscopic Latarjet Procedure for the Treatment of Chronic Anterior Glenohumeral Instability With Glenoid Bone Loss. Arthroscopy 2020; 36:940-949. [PMID: 31870727 DOI: 10.1016/j.arthro.2019.09.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 09/18/2019] [Accepted: 09/25/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare the clinical, functional, and radiographic outcomes of open versus arthroscopic Latarjet procedures. METHODS Between December 2009 to January 2015, all patients older than 18 years of age who were treated with a Latarjet procedure for chronic osseous anterior instability by a single surgeon were included in this retrospective cohort study. Range of motion, strength, Rowe, Western Ontario Shoulder Instability Index (WOSI) scores, and pain level according to the Visual Analog Scale (VAS) were evaluated. In addition, postoperative computed tomography scans were used to evaluate the position of the transferred coracoid, screw orientation, and degree of graft resorption. RESULTS Forty-eight patients with a mean age of 29.5 years (range 19-59 years) who underwent open (n = 15; group OL) and arthroscopic (n = 33; group AL) Latarjet procedures were included in the study. The mean follow-up was 30.5 months (range 24-50 months). At final follow-up there were significant differences in the mean internal rotation loss (mean of 9° vs 14°, P = .044) favoring open surgery and WOSI (P = .017) scores favoring arthroscopic. No significant differences were detected in mean forward flexion loss (P = .918), external rotation loss (P = .883), Rowe (P = .429), and Visual Analog Scale (P = .208) scores. Mean superoinferior position of the coracoid bone graft was found between the 1:55 and 4:49 o'clock positions (2:05-4:55 for group OL; 1:51-4:47 for group AL) in en-face views. The grafts were placed laterally in 13% (group OL) and 9% (group AL) of patients. The mean α angles of the screws were 11° and 19.2°, respectively (P = .004). The mean graft resorption rates were 21% and 34% (P = .087), respectively. CONCLUSION Good functional results were obtained after both open and arthroscopic Latarjet procedures for the treatment of chronic osseous anterior shoulder instability. Comparative analysis showed small but statistically significant differences in internal rotation loss favoring open and in WOSI favoring arthroscopic techniques. All measured radiographic parameters were similar with the exception of a significant difference in alpha angle with improved screw position in open surgery. OL and AL techniques provide similar clinical and radiographic outcomes. LEVEL OF EVIDENCE III; Retrospective cohort study with comparison group.
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Affiliation(s)
- Jotyar Ali
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Anil Pulatkan
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | | | | | - Kerem Bilsel
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey.
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Baktir S, Razak Ozdincler A, Kaya Mutlu E, Bilsel K. The short-term effectiveness of low-level laser, phonophoresis, and iontophoresis in patients with lateral epicondylosis. J Hand Ther 2020; 32:417-425. [PMID: 29452929 DOI: 10.1016/j.jht.2018.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 12/24/2017] [Accepted: 01/08/2018] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Randomized parallel group trial. INTRODUCTION Various treatment options for lateral epicondylosis have been reported in the literature. PURPOSE OF STUDY We aimed to compare the effectiveness of low-level laser therapy (LLLT), phonophoresis, and iontophoresis in terms of pain, function, and grip strength. METHODS This study that comprised 37 patients with lateral epicondylosis was planned as a prospective randomized parallel group trial. Twelve participants were randomized to the LLLT group, 12 to the phonophoresis group, and 13 to the iontophoresis group. The Visual Analog Scale (VAS), pressure algometer, the Patient-Rated Tennis Elbow Evaluation, and grip strength dynamometer were used to measure outcomes. The measurements were performed at baseline and at the end of 15 sessions. RESULTS Investigation of the pain scores revealed that all VAS scores were improved in both the laser and iontophoresis groups (VAS at rest: P = .015, effect size (ES) = 1.49 and P = .016, ES = 0.58, respectively; VAS during activity: P = .008, ES = 1.05 and P = .008, ES = 1.16, respectively; VAS at night: P = .013, ES = 1.01 and P = .016, ES = 0.72, respectively). Only advance in function and grip strength was associated with the iontophoresis group (Patient-Rated Tennis Elbow Evaluation P = .006, ES = 0.78; grip strength with elbow extension P = .011, ES = 1.03; with elbow flexion P = .003, ES = 0.52). DISCUSSION The most effective approach could not be highlighted among the existing studies in the literature as they were applied in combination with other therapies. CONCLUSION In our study, we observed that LLLT provides a benefit only for pain, whereas iontophoresis is beneficial for both pain and function. If the effect size is evaluated, LLLT is more influential than iontophoresis for decreasing pain. However, when we compared phonophoresis and iontophoresis in terms of effectiveness, we found that iontophoresis has better effects for pain, function, and grip strength.
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Affiliation(s)
- Seda Baktir
- Department of Physiotherapy and Rehabilitation, Istanbul University, Institute of Health Sciences, Istanbul, Turkey.
| | - Arzu Razak Ozdincler
- Division of Physiotherapy and Rehabilitation, Istanbul University, Faculty of Health Sciences, Istanbul, Turkey
| | - Ebru Kaya Mutlu
- Division of Physiotherapy and Rehabilitation, Istanbul University, Faculty of Health Sciences, Istanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, Bezmialem University, Istanbul, Turkey
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Batar S, Turkmen I, Celik H, Uzer G, Bilsel K. Improved Functional Outcomes with Reverse Shoulder Arthroplasty Compared to Hemiarthroplasty after Proximal Humeral Fractures in the Elderly. Acta Chir Orthop Traumatol Cech 2020; 87:278-284. [PMID: 32940224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE OF THE STUDY Unsatisfactory functional results following hemiarthroplasty (HA) are seen in the treatment of 3- and 4-part proximal humeral fractures due to tuberosity healing problems and rotator cuff tears. Reverse shoulder arthroplasty (RSA) has been popular for improving functional outcomes. This study compares the results of HA and RSA in the treatment of comminuted proximal humeral fractures in the elderly. MATERIAL AND METHODS Patients over 60 years of age with three- or four-part proximal humeral fractures were included in the study. Twenty-five patients were treated with HA and 33 patients with RSA. The patients were evaluated with/using the American Shoulder and Elbow Surgeons (ASES) and Constant scores, active and passive ranges of motions of the shoulders and muscle strength measurements of HA and RSA patients were compared. RESULTS The mean age of the patients was 66 (60-85) years in the HA group and 73 (60-83) years in the RSA group. The mean ASES and Constant scores were 44.6 and 70 (p=0.06), 24 and 49 (p=0.022), respectively. The mean active abduction was measured as 50° and 90° (p=0.001), flexions as 70° and 120° (p=0.02), and external rotation as 30° and 50° (p=0.210), respectively. CONCLUSIONS In the treatment of three- or four-part proximal humeral fractures of the elderly, RSA gives significantly better functional results compared to HA. Key words: proximal humeral fractures, hemiarthroplasty, reverse shoulder arthroplasty.
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Erden T, Kapicioglu M, Demirtas A, Bilsel K, Akpinar F, Kuduz H. Biomechanical comparison of humeral nails with different distal locking mechanisms: Insafelock nails versus conventional locking nails. Acta Orthop Traumatol Turc 2019; 53:490-496. [PMID: 31562026 PMCID: PMC6938903 DOI: 10.1016/j.aott.2019.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 05/23/2019] [Accepted: 08/22/2019] [Indexed: 11/25/2022]
Abstract
Objective The aim of this study was to compare the biomechanical resistance to rotational and axial forces of a conventional locking nail with a newly designed intramedullary humeral nail developed for humeral shaft fractures with a secure locking mechanism through the distal part of the nail. Methods InSafeLOCK humeral nail system (group 1, TST, Istanbul, Turkey) and Expert humeral nail system (group 2, DePuy Synthes, Bettlach, Switzerland) of the same size (9 × 300 mm) were examined. In total, 24 fourth-generation humerus sawbones were used in the experiment. Osteotomy was performed at the humerus shaft, and a defect was created by removing 1 cm of bone. After pre-loading 5000 cycles at a frequency of 2 Hz and a force of 50–250 N for axial loading and 5000 torsion torques between 0.5 Nm and 6.5 Nm at a 2 Hz frequency for torsional loading, the failure load values of each load were recorded. Distal interlocking was performed with an endopin in group 1, while a double cortex screw was used in group 2. Results All samples successfully passed the cyclic loading. The initial and final stiffness values were similar between the groups after axial loading (p = 0.873 and p = 0.522, respectively). The mean axial failure load values in groups 1 and 2 were 2627 ± 164 N and 7141 ± 1491 N, respectively. A significant difference was found in the axial failure load values (p = 0.004). Significant differences were observed between the initial and final torsional stiffness between the two groups (p = 0.004 and p = 0.004, respectively). No significant difference was found in the failure load values after torsional loading (11791 ± 2055 N.mm and 16997 ± 5440 N.mm) (p = 0.055). Conclusion These results provide a biomechanical demonstration of the adequate stability of both nails after axial and rotational loading. The reliability of the newly developed InSafeLOCK humeral nail system, which does not require fluoroscopic control and an additional incision for distal locking, supports its use in the clinic.
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Kapicioglu M, Cetin H, Bilsel K. Late diagnosis of subcoracoid type 6 AC dislocation: A case report. SICOT J 2019; 5:37. [PMID: 31651396 PMCID: PMC6813848 DOI: 10.1051/sicotj/2019036] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/05/2019] [Indexed: 11/14/2022] Open
Abstract
Acromioclavicular (AC) dislocation is a common type of shoulder injury. Although the incidence of acromioclavicular dislocation is frequent, there are different opinions regarding the treatment. Many different techniques have been proposed for the surgical treatment of AC dislocations, but all these methods have been questioned from different angles, and the gold standard in terms of treatment has not yet been determined. There are six types described by Rockwood et al. and type 6 has two types: subacromial and subcoracoid. Subcoracoid AC Type 6 dislocations are seen very rarely and difficult to diagnose in initial clinical findings or can be simply overlooked due to associated more serious injuries which take more attention. The mechanism of injury of a type 6 AC dislocation is hyperabduction and external rotation of the shoulder. A small number of type 6 subcoracoid AC dislocations have formerly been reported and apart from one case all of them were acutely diagnosed and treated with open reduction and internal fixation. In this paper, we report a case of late diagnosis of subcoracoid type 6 AC dislocation, along with its rare and previously unreported surgical management.
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Affiliation(s)
- Mehmet Kapicioglu
- Bezmialem Vakif University, School of Medicine, Department of Orthopaedics and Traumatology, Vatan Cd, Fatih 34093, İstanbul, Turkey
| | - Huzeyfe Cetin
- Bezmialem Vakif University, School of Medicine, Department of Orthopaedics and Traumatology, Vatan Cd, Fatih 34093, İstanbul, Turkey
| | - Kerem Bilsel
- Bezmialem Vakif University, School of Medicine, Department of Orthopaedics and Traumatology, Vatan Cd, Fatih 34093, İstanbul, Turkey
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Erden T, Aksoy DO, Ceylan HH, Kapıcioglu M, Bilsel K, Elmali N. Is femoral trochlear dysplasia related to global joint hypermobility? J Orthop Sci 2019; 24:458-462. [PMID: 30396703 DOI: 10.1016/j.jos.2018.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 09/05/2018] [Accepted: 10/11/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Hypermobility is a known risk factor for patellar instability. In this study, we hypothesized that a significant relationship exists between global joint hypermobility and trochlear dysplasia. METHODS Follow-up patients from the shoulder department of our institution with global joint hypermobility (Group 1, n = 42) and healthy volunteers (Group 2, n = 42) without known knee complaints were included in our study. All participants underwent knee magnetic resonance imaging (MRI) for the evaluation of possible trochlear dysplasia, and the measurements included lateral trochlear inclination; trochlear facet asymmetry; the depth of the trochlear groove; condylar asymmetry; lateralization of the patella; sulcus angle; and the lateral, medial and central trochlear height. The Dejour classification was also assessed. RESULTS The age and gender distributions of the groups were similar (p > 0.05). The radiological evaluations revealed that the lateral trochlear inclination (p < 0.001), trochlear facet asymmetry (p < 0.001), depth of the trochlear groove (p < 0.001), lateralization of the patella (p < 0.001), sulcus angle (p < 0.001), and central trochlear height (p < 0.001) were significantly different between the two groups. The condylar asymmetry and lateral and femoral condylar height parameters were similar between the groups (p = 0.297, p = 0.890 and p = 0.521, respectively). According to the Dejour classification, 39 patients had dysplasia in Group 1, whereas dysplasia was detected in only 4 of the participants in Group 2. CONCLUSIONS Our study revealed that most of the trochlear dysplasia criteria were met in patients with global joint hypermobility. In addition to a clinical patellofemoral examination, the precise radiological evaluation of the joint is beneficial in patellofemoral instability patients with concomitant hypermobility. Patient cohort of this study was consist of patients underwent shoulder surgery.
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Affiliation(s)
- Tunay Erden
- Bezmialem Vakif University Medical School, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
| | - Direnc Ozlem Aksoy
- Bezmialem Vakif University Medical School, Department of Radiology, Istanbul, Turkey.
| | - Hasan Huseyin Ceylan
- Lütfiye Nuri Burat Public Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
| | - Mehmet Kapıcioglu
- Bezmialem Vakif University Medical School, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
| | - Kerem Bilsel
- Bezmialem Vakif University Medical School, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
| | - Nurzat Elmali
- Bezmialem Vakif University Medical School, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
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Yildiz F, Bilsel K, Pulatkan A, Kapicioglu M, Uzer G, Çetindamar T, Sonmez C, Bozdag E, Sünbüloglu E. Comparison of two different superior capsule reconstruction methods in the treatment of chronic irreparable rotator cuff tears: a biomechanical and histologic study in rabbit models. J Shoulder Elbow Surg 2019; 28:530-538. [PMID: 30466819 DOI: 10.1016/j.jse.2018.08.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/16/2018] [Accepted: 08/19/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND In the treatment of irreparable rotary cuff (RC) tears, the superior capsule of the shoulder is reconstructed using tensor fascia lata (TFL) or several allografts to prevent progressive joint degeneration. This study compared the healing qualities of acellular human dermal graft (HDG) and the TFL autograft in superior capsule reconstruction (SCR) from biomechanical and histologic perspectives. METHODS Chronic retracted RC tear models were created bilaterally in 9 rabbits, and 7 rabbits with intact RC were used as a control group. SCR was performed 8 weeks after the tear using HDG in right shoulders and TFL in left shoulders. At 12 weeks after SCR, 2 shoulders from each experimental group were investigated for histologic healing, and 7 samples from the experimental and control groups were biomechanically tested. RESULTS Complete healing was observed macroscopically in the glenoid and humeral sides of both groups. No difference was observed in the enthesis maturation scores between the experimental groups. Collagen fiber density was higher and the orientation was better in TFL group. Inflammatory cell infiltration was not seen in the TFL group, but inflammatory cell infiltration was pronounced in the HDG group. The mean pullout strengths of the TFL group, HDG group, and intact RC group were 139.7 ± 40.5 N, 123.9 ± 47.9 N, and 105.1 ± 11.8 N (P = .187), respectively. The mean stiffness values (P = .711), yield forces (P = .404), and displacements (P = .135) were also statistically not different between the groups. CONCLUSION In SCR, the healing qualities of HDG and TFL were similar in rabbit models.
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Affiliation(s)
- Fatih Yildiz
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey.
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Anil Pulatkan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Mehmet Kapicioglu
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Gokcer Uzer
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Tolga Çetindamar
- Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Cavide Sonmez
- Department of Pathology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Ergun Bozdag
- Biomechanics Laboratory, Department of Mechanical Engineering, Istanbul Technical University, Taksim, Istanbul, Turkey
| | - Emin Sünbüloglu
- Biomechanics Laboratory, Department of Mechanical Engineering, Istanbul Technical University, Taksim, Istanbul, Turkey
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Yildiz F, Sari A, Pulatkan A, Ucan V, Kochai A, Bilsel K. Effect of nonoperative concomitant intraarticular pathologies on the outcome of arthroscopic capsular release for adhesive capsulitis of the shoulder. Acta Orthop Traumatol Turc 2018; 52:245-248. [PMID: 29699862 PMCID: PMC6145969 DOI: 10.1016/j.aott.2018.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 01/30/2018] [Accepted: 04/11/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to investigate whether coexistent intraarticular lesions are negative prognostic factors for the results of arthroscopic capsular release in frozen shoulder patients. METHODS Seventy-two patients who met inclusion criteria and underwent arthroscopic capsular release between March 2011 and August 2015 for the frozen shoulder were retrospectively evaluated. The patients were divided into two groups according to existence of concomitant intraarticular pathologies detected during arthroscopy. Preoperative and postoperative functional results were assessed with Constant score and shoulder ranges of motion; and the amount of pain was evaluated using visual analog scale (VAS). RESULTS Group I consisted of 46 patients (mean age 47.2 years and mean follow-up 26 months) without concomitant shoulder pathologies and group II consisted of 26 patients (mean age 48.6 years and mean follow-up 15 months) with coexistent lesions (SLAP lesions, n = 8; SLAP and partial rupture of the RC, n = 4; SLAP, partial rupture of RC and impingement, n = 10; SLAP and impingement, n = 2; and AC arthritis and impingement, n = 2). Preoperatively, the mean ranges of forward flexion (p = 0.221), abduction (p = 0.065), internal rotation (p = 0.564), Constant (p = 0.148) and VAS (p = 0.365) scores were similar between the groups. After a minimum 12 months of follow-up, all patients significantly improved but no statistically significant difference was detected in the mean ranges of forward flexion (152 vs 150; p = 0.902), abduction (137 vs 129; p = 0.095), external rotation (45 vs 40; p = 0.866), internal rotation (5 vs 5 point; p = 0.474), Constant (82 vs 82.3; p = 0.685) and VAS (1.2 vs 1.2; p = 0.634) scores between the groups. CONCLUSION The presence of concomitant shoulder pathologies does not appear to affect the clinical outcomes in patients undergoing arthroscopic capsular release for frozen shoulder. LEVEL OF EVIDENCE Level III, Therapeutic study.
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Affiliation(s)
- Fatih Yildiz
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey.
| | - Abdulkadir Sari
- Department of Orthopedics and Traumatology, Namık Kemal University School of Medicine, Tekirdag, Turkey
| | - Anil Pulatkan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Vahdet Ucan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Alauddin Kochai
- Department of Orthopedics and Traumatology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
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Uzer G, Yildiz F, Batar S, Bozdag E, Kuduz H, Bilsel K. Biomechanical comparison of three different plate configurations for comminuted clavicle midshaft fracture fixation. J Shoulder Elbow Surg 2017; 26:2200-2205. [PMID: 29037534 DOI: 10.1016/j.jse.2017.06.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 06/16/2017] [Accepted: 06/19/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to compare the fixation rigidity of anterior, anterosuperior, and superior plates in the treatment of comminuted midshaft clavicle fractures. METHODS Six-hole titanium alloy plates were produced according to anatomic features of fourth-generation artificial clavicle models for anterior (group I; n = 14), anterosuperior (group II; n = 14), and superior (group III; n = 14) fixation. After plate fixation, 5-mm segments were resected from the middle third of each clavicle to create comminuted fracture models. Half the models from each group were tested under rotational forces; the other half were tested under 3-point bending forces. Failure modes, stiffness values, and failure loads were recorded. RESULTS All models fractured at the level of the distalmost screw during the failure torque, whereas several failure modes were observed in 3-point bending tests. The mean stiffness values of groups I to III were 636 ± 78, 767 ± 72, and 745 ± 214 N ∙ mm/deg (P = .171), respectively, for the torsional tests and 38 ± 5, 20 ± 3, and 13 ± 2 N/mm, respectively, for the bending tests (P < .001 for group I vs. groups II and III; P = .015 for group II vs. group III). The mean failure torque values of groups I to III were 8248 ± 2325, 12,638 ± 1749, and 10,643 ± 1838 N ∙ mm (P = .02 for group I vs. II), respectively, and the mean failure loads were 409 ± 81, 360 ± 122, and 271 ± 87 N, respectively (P = .108). CONCLUSIONS In the surgical treatment of comminuted midshaft clavicle fractures, the fixation strength of anterosuperior plating was greater than that of anterior plating under rotational forces and similar to that of superior plating.
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Affiliation(s)
- Gokcer Uzer
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Fatih Yildiz
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey.
| | - Suat Batar
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Ergun Bozdag
- Biomechanics Laboratory, Department of Mechanical Engineering, Istanbul Technical University, Istanbul, Turkey
| | - Hacer Kuduz
- Biomechanics Laboratory, Department of Mechanical Engineering, Istanbul Technical University, Istanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
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Bilsel K, Yildiz F, Kapicioglu M, Uzer G, Elmadag M, Pulatkan A, Esrefoglu M, Bozdag E, Milano G. Efficacy of bone marrow-stimulating technique in rotator cuff repair. J Shoulder Elbow Surg 2017; 26:1360-1366. [PMID: 28395947 DOI: 10.1016/j.jse.2017.02.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 01/20/2017] [Accepted: 02/07/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study used a chronic rotator cuff (RC) tear model to investigate the effect of microfracture as a bone marrow-stimulating (BMS) technique for RC healing. METHODS A chronic retracted RC tendon tear model was created bilaterally in the subscapularis tendons of 20 New Zealand rabbits. The tendons were repaired after 8 weeks using a single-row configuration. Tendons in the right shoulder were repaired in standard fashion (control group). Microfractures were performed in the left shoulders before repair (microfracture group). The animals were euthanized 8 and 16 weeks after repair. The repaired tendons were tested biomechanically for their ultimate failure load, linear stiffness, and elongation at failure. Gross and histologic evaluations of the tendon-to-bone healing were evaluated. RESULTS Macroscopically, subscapularis tendons were attached on the lesser tuberosity. In the microfracture group, collagen fibers were organized in relatively thicker bundles. The mean ultimate failure load of the microfracture group was significantly greater at 8 weeks (148.4 ± 31 N vs. 101.4 ± 26 N, respectively; P = .011) and 16 weeks (155 ± 30 N vs. 114.9 ± 25 N, respectively; P = .017) after repair. There were no significant differences between the groups for linear stiffness at 8 weeks (15.9 ± 2.7 N/mm vs. 15.8 ± 1.3 N/mm, respectively; P = .798) and 16 weeks (16.9 ± 4.3 N/mm vs. 17.1 ± 3.6 N/mm, respectively, P = .848) and elongation at failure at 8 weeks (4.7 ± 1.1 mm vs. 4.7 ± 1.3 mm, respectively; P = .848) and 16 weels (4.8 ± 1.5 mm vs. 4.9 ± 0.9 mm, respectively; P = .749). CONCLUSION The microfracture on the tuberosity of the repaired chronic rotator cuff tear promoted dynamic tendon healing with significantly increased ultimate force to failure and with thicker collagen bundles and more fibrocartilage histologically at 8 weeks.
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Affiliation(s)
- Kerem Bilsel
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey.
| | - Fatih Yildiz
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Mehmet Kapicioglu
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Gokcer Uzer
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Mehmet Elmadag
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Anil Pulatkan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Mukaddes Esrefoglu
- Department of Histology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Ergun Bozdag
- Biomechanics Laboratory, Department of Mechanical Engineering, Istanbul Technical University, Istanbul, Turkey
| | - Giuseppe Milano
- Department of Orthopedics and Traumatology, Catholic University, Rome, Italy
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Altintas B, Yildiz F, Uzer G, Kapicioglu M, Bilsel K. All-arthroscopic, Guideless Single Suture-button Fixation of Acute Acromioclavicular Joint Dislocation: A Description of the Technique and Early Treatment Results. Clin Shoulder Elb 2017. [DOI: 10.5397/cise.2017.20.2.59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Yıldız F, Bilsel K, Pulatkan A, Uzer G, Aralaşmak A, Atay M. Reliability of magnetic resonance imaging versus arthroscopy for the diagnosis and classification of superior glenoid labrum anterior to posterior lesions. Arch Orthop Trauma Surg 2017; 137:241-247. [PMID: 27904970 DOI: 10.1007/s00402-016-2605-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Indexed: 01/03/2023]
Abstract
PURPOSE The physical examination of the shoulder is usually not reliable for the true diagnosis of superior glenoid labrum anterior to posterior (SLAP) lesions. Magnetic resonance imaging (MRI) has been routinely used for the diagnosis. This prospective study investigates the radiological diagnosis of the SLAP lesions and compares accuracy of arthroscopic and MRI classifications. METHODS One hundred thirty-two patients with positive physical examination signs using O'Brien, Yergason, resistance supination external rotation and Krank tests and MRI findings are included in the study. Shoulder MRIs were obtained for all patients within three months prior to the surgeries. SLAP lesion is detected in 90 and 102 patients according to MRI and arthroscopy, respectively. Arthroscopic and MRI classifications of the patients were performed according to modified Snyder classification. RESULTS Sensitivity and specificity of the MRI were found as 70.59 and 40%, respectively. No difference was detected between MRI and arthroscopy classifications in 52 (39%) patients. Although the diagnosis was compatible with arthroscopy in 34 (25%) patients, the classification was incompatible. In 46 (34%) of patients the diagnosis was incompatible with the MRI. CONCLUSION Although MRI is a good diagnostic tool for SLAP lesions, its use for the classification is limited. Level of evidence Level III, Diagnostic study.
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Affiliation(s)
- Fatih Yıldız
- Department of Orthopaedics and Traumatology, School of Medicine, Bezmialem Vakif University, Vatan Cd, Fatih, 34093, Istanbul, Turkey.
| | - Kerem Bilsel
- Department of Orthopaedics and Traumatology, School of Medicine, Bezmialem Vakif University, Vatan Cd, Fatih, 34093, Istanbul, Turkey
| | - Anıl Pulatkan
- Department of Orthopaedics and Traumatology, School of Medicine, Bezmialem Vakif University, Vatan Cd, Fatih, 34093, Istanbul, Turkey
| | - Gökçer Uzer
- Department of Orthopaedics and Traumatology, School of Medicine, Bezmialem Vakif University, Vatan Cd, Fatih, 34093, Istanbul, Turkey
| | - Ayşe Aralaşmak
- Department of Radiology, School of Medicine, Bezmialem Vakif University, Vatan Cd, Fatih, 34093, Istanbul, Turkey
| | - Musa Atay
- Department of Radiology, School of Medicine, Bezmialem Vakif University, Vatan Cd, Fatih, 34093, Istanbul, Turkey
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Uzer G, Yildiz F, Batar S, Binlaksar R, Elmadag M, Kus G, Bilsel K. Does grafting of the tuberosities improve the functional outcomes of proximal humeral fractures treated with reverse shoulder arthroplasty? J Shoulder Elbow Surg 2017; 26:36-41. [PMID: 27496351 DOI: 10.1016/j.jse.2016.05.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 02/04/2016] [Revised: 04/26/2016] [Accepted: 05/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Functional outcomes of reverse total shoulder arthroplasty (rTSA) can be improved by fixation of the tuberosities. This study compares clinical and radiologic results of patients with comminuted proximal humeral fractures treated with rTSA, with and without autologous grafting. METHODS Thirty-three patients with proximal humeral fractures were treated with rTSA and tuberosity fixation. In 18 patients (group I; mean age, 75 years), tuberosity fixation was augmented with autografting; in 15 patients (group II; mean age, 71 years), graft augmentation was not used. The mean follow-up was 16.7 (range, 12-24) months in group I and 16.8 (range, 12-25) months in group II. RESULTS Radiologic tuberosity union was achieved in 14 of 18 (77.8%) patients who underwent autograft augmentation and in 6 of 15 (40.0%) patients treated without autografting. The mean American Shoulder and Elbow Surgeons (ASES) score was 69.6 ± 13.0 in group I and 51.0 ± 20.0 in group II. The mean Disabilities of the Arm, Shoulder, and Hand (DASH) score was 31.9 ± 24.0 in group I and 58.2 ± 24.6 in group II. A significant difference was detected between groups for ASES and DASH scores. Among shoulder range of motion measures, only forward flexion differed significantly between groups I and II (124° ± 23° vs. 98° ± 30°, respectively). External rotation muscle strength was significantly higher in group I (3.36 ± 1.46 kg) than in group II (2.39 ± 2.00 kg). CONCLUSION In the treatment of complex proximal humeral fractures in elderly patients by rTSA, cancellous block autograft augmentation can increase the rate of tuberosity union and improve functional outcomes.
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Affiliation(s)
- Gokcer Uzer
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Fatih Yildiz
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Suat Batar
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Ruwais Binlaksar
- Department of Orthopedics and Traumatology, Binzeela Modern Hospital, Sieyun, Hadramout, Yemen
| | - Mehmet Elmadag
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Gamze Kus
- Faculty of Health Science, Division of Physiotherapy and Rehabilitation, Istanbul University, Istanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey.
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Tuncay I, Yıldız F, Bilsel K, Uzer G, Elmadağ M, Erden T, Bozdağ E. Biomechanical Comparison of 2 Different Femoral Stems in the Shortening Osteotomy of the High-Riding Hip. J Arthroplasty 2016; 31:1346-1351. [PMID: 26795256 DOI: 10.1016/j.arth.2015.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 07/31/2015] [Revised: 12/02/2015] [Accepted: 12/03/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We hypothesized that a rectangular cross-sectional femoral stem may produce more initial stability of the transverse subtrochanteric femoral shortening osteotomy rather than a circular cross-sectional stem. METHODS Twenty, fourth-generation, synthetic femur models were inserted with either circular or rectangular cross-sectional femoral stems after 3 cm of transverse subtrochanteric shortening. Half of the models were tested with axial bending and the other half with torsional loads. After the femora underwent cyclic loading, they were loaded until failure. Outcome parameters were stiffness values before and after cyclical loading, failure loads/torques, and displacements at the osteotomy sites. RESULTS In axial bending tests, the results were not significantly different between the groups. Under rotational forces, the mean stiffness value before cyclical loading and failure torque of the cylindrical stems was significantly higher than that of rectangular cross-sectional stems (11.8 ± 1.2 vs 7.1 ± 2.8 Nm/degree; P = .009 and 136.9 ± 60.2 vs 27.1 ± 17.5 Nm; P = .027 Nm, respectively). The mean amounts of displacements at the osteotomy sites were not significantly different between the groups in any direction in both axial and rotational tests. CONCLUSIONS According to the results of the study, using straight, cylindrical femoral stems can increase rotational stability of the transverse osteotomy more than the rectangular cross-sectional stems although the latter one has the advantages of rectangular geometrical design.
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Affiliation(s)
- Ibrahim Tuncay
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Fatih Yıldız
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Gökçer Uzer
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mehmet Elmadağ
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Tunay Erden
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ergun Bozdağ
- Department of Biomechanics, Faculty of Mechanical Engineering, İstanbul Technical University, İstanbul, Turkey
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Ceylan HH, Bilsel K, Buyukpinarbasili N, Ceylan H, Erdil M, Tuncay I, Sen C. Can chondral healing be improved following microfracture? The effect of adipocyte tissue derived stem cell therapy. Knee 2016; 23:442-9. [PMID: 27068292 DOI: 10.1016/j.knee.2015.11.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 09/13/2015] [Accepted: 11/26/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND We aimed to investigate the effect of adipose tissue-derived mesenchymal stem cells (ADSCs) on chondral healing using the microfracture (MF) technique. METHODS Thirty male rabbits were randomly divided into three groups. Standard cylindrical osteochondral defects (OCDs) were created in the weight-bearing areas of the medial condyles of all the right knees; the defects were four millimeters in diameter and two millimeters in depth. The control group (group A) was restricted to spontaneous healing. For group B, we performed MF with a 1.5-mm drill. For group C, we applied MF using the same method and then applied 3×10(6) ADSCs to the defect area. At eight weeks post-operation, the subjects were sacrificed, and the distal femoral joint surfaces were evaluated histopathologically for chondral healing. The samples were scored according to the International Cartilage Repair Society (ICRS) scale. RESULTS The results for group C were significantly better than those for group A in terms of the surface properties (p=0.003). The matrix evaluation was better for group A than for group C (p=0.01). The cell distribution, cell viability and subchondral bone parameters were similar between the groups (p=0.198, p=0.387 and p=0.699). The cartilage mineralization parameter was better for group C than for group A (p=0.001). The signs of healing were better for group C than for group B, but the differences were not significant (p=0.185). CONCLUSIONS Improvements with additional ADSC treatments were not statistically significant in cases in which ADSC treatment was compared with isolated MF treatment. CLINICAL RELEVANCE Additional ADSCs treatment may have positive effect on chondral healing but it doesn't seem significant.
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Affiliation(s)
- Hasan H Ceylan
- LNB State Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Kerem Bilsel
- Bezmialem Vakif University Medical School, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Nur Buyukpinarbasili
- Bezmialem Vakif University Medical School, Department of Medical Pathology, Istanbul, Turkey
| | - Hamid Ceylan
- Ataturk University Science Faculty, Department of Molecular Biology and Genetics, Erzurum, Turkey
| | - Mehmet Erdil
- Istanbul Medipol University, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
| | - Ibrahim Tuncay
- Bezmialem Vakif University Medical School, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Cengiz Sen
- Istanbul University Istanbul Medical School, Department of Orthopaedics and Traumatology, Istanbul, Turkey
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Uzer G, Elmadağ NM, Yıldız F, Bilsel K, Erden T, Toprak H. Comparison of two types of proximal femoral hails in the treatment of intertrochanteric femur fractures. ULUS TRAVMA ACIL CER 2016; 21:385-91. [PMID: 26388276 DOI: 10.5505/tjtes.2015.72173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Hip nailing is frequently used to treat unstable intertrochanteric femoral fractures (ITF) in elderly patients. In this retrospective study, we compared the functional and radiological results, and the complications, of patients treated using proximal femoral nails (PFN) with an integrated, interlocking, compression lag screw, or two separate lag screws, which allow linear compression at the fracture site. METHODS A total of one hundred and eighteen patients were operated on for AO/OTA 31-A2 ITF between May 2010 and April 2012, and eighty-two of these patients, for whom sufficient follow-up data and documentation were available, were included into the study. PFNs with interlocking, integrated lag screws (Group I) were used in forty-four patients, and PFNs with two separate lag screws (Group II) in thirty-eight. Outcome parameters were the extent of varus collapse and leg length discrepancy on radiographs, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Harris hip scores (HHS) as functional results. RESULTS Mean follow-up duration was 20 months (range, 12-36 months); fractures healed in all patients. Mean varus collapse values were 2.03±5.68° and 5.21±5.27° (p=0.01), Harris hip scores 73.2±11.65 and 74.72±11.15 (p=0.54), and WOMAC scores 70.78±11.41 and 71.78±11.19 (p=0.69) in Groups I and II, respectively. No difference was detected between the groups in terms of outcome parameters or complication rate. CONCLUSION In the treatment of ITF, PFNs with an integrated, interlocking, compression lag screw, or two separate lag screws did not differ in terms of functional and radiological results or complication rate.
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Affiliation(s)
- Gökçer Uzer
- Department of Orthopedics and Traumatology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Nuh Mehmet Elmadağ
- Department of Orthopedics and Traumatology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Fatih Yıldız
- Department of Orthopedics and Traumatology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Tunay Erden
- Department of Orthopedics and Traumatology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Hüseyin Toprak
- Department of Radiology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
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Tuncay İ, Bilsel K, Elmadağ M, Erkoçak ÖF, Aşçı M, Şen C. Evaluation of mobile bearing unicompartmental knee arthroplasty, opening wedge, and dome-type high tibial osteotomies for knee arthritis. Acta Orthop Traumatol Turc 2016. [PMID: 26200407 DOI: 10.3944/aott.2015.14.0320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Three methods of surgery used in the treatment of knee osteoarthritis (OA) are mobile bearing unicompartmental knee arthroplasty (Oxford UKA), opening wedge high tibial osteotomy (HTO), and dome-type HTO. This article aimed to retrospectively compare these three methods in terms of outcomes for health status, patient satisfaction, and function. METHODS Between 2003 and 2010, 255 knees of 235 patients underwent operations for medial knee OA. Three types of surgery were performed. Group 1 consisted of 109 knees of 94 patients who underwent Oxford UKA. Group 2 was made up of 36 knees of 36 patients who underwent HTO using circular external fixation, and Group 3 comprised 57 knees of 52 patients on whom opening wedge type HTO using locking plate fixation was performed. SF-36 and HSS knee scores were used to compare the functional outcomes among groups. RESULTS Statistically significant differences were found between the preoperative and postoperative measures in all 3 of the treatment groups for physical function, physical role, pain, general health, vitality, social function, emotional role, and mental health according to SF-36 and HSS scores. In the 2nd group, the average correction of the mechanical axis deviation (MAD) was 38 mm with 11.7º along the femorotibial axis and 6.2º along the medial proximal tibial angle (MPTA). In the 3rd group, the average correction in the MAD was 28 mm with 9.7º along the femorotibial axis and 5.6º along the MPTA. All 3 of the treatment alternatives were observed to be sufficient. Satisfactory postoperative results were achieved in the UKA group in terms of social function and mental health, and the patients were able to achieve early rehabilitation and return to their previous life activities. CONCLUSION UKA is the ideal option for patients who wish for the earliest possible return to social and recreational activities.
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Affiliation(s)
- İbrahim Tuncay
- Bezmialem Vakıf University Faculty of Medicine, Department of Orthopedics and Traumatology, İstanbul, Turkey
| | - Kerem Bilsel
- Bezmialem Vakıf University Faculty of Medicine, Department of Orthopedics and Traumatology, İstanbul, Turkey
| | - Mehmet Elmadağ
- Bezmialem Vakıf University Faculty of Medicine, Department of Orthopedics and Traumatology, İstanbul, Turkey
| | - Ömer Faruk Erkoçak
- Selçuk University Faculty of Medicine, Department of Orthopedics and Traumatology, Konya, Turkey
| | - Murat Aşçı
- Tokat State Hospital, Department of Orthopedics and Traumatology, Tokat, Turkey
| | - Cengiz Şen
- İstanbul University, İstanbul Faculty of Medicine, Department of Orthopedics and Traumatology, İstanbul, Turkey
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Güzel Y, Elmadag M, Uzer G, Yıldız F, Bilsel K, Tuncay İ. Cytotoxicity of a new antimicrobial coating for surgical screws: an in vivo study. Singapore Med J 2016; 58:46-49. [PMID: 26805670 DOI: 10.11622/smedj.2016021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/18/2022]
Abstract
INTRODUCTION The risk of surgery-related infection is a persistent problem in orthopaedics and infections involving implants are particularly difficult to treat. This study explored the responses of bone and soft tissue to antimicrobial-coated screws. We investigated whether such screws, which have never been used to fix bony tissues, would result in a cytotoxic effect. We hypothesised that the coated screws would not be toxic to the bone and that the likelihood of infection would be reduced since bacteria are not able to grow on these screws. METHODS Titanium screws were inserted into the left supracondylar femoral regions of 16 rabbits. The screws were either uncoated (control group, n = 8) or coated with a polyvinylpyrrolidone-polyurethane interpolymer with tertiary amine functional groups (experimental group, n = 8). At Week 6, histological samples were obtained and examined. The presence of necrosis, fibrosis and inflammation in the bony tissue and the tissue surrounding the screws was recorded. RESULTS Live, cellular bone marrow was present in all the rabbits from the experimental group, but was replaced with connective tissue in four rabbits from the control group. Eight rabbits from the control group and two rabbits from the experimental group had necrosis in fatty bone marrow. Inflammation was observed in one rabbit from the experimental group and five rabbits from the control group. CONCLUSION Titanium surgical screws coated with polyvinylpyrrolidone-polyurethane interpolymer were associated with less necrosis than standard uncoated screws. The coated screws were also not associated with any cytotoxic side effect.
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Affiliation(s)
- Yunus Güzel
- Department of Orthopaedics and Traumatology, School of Medicine, Ordu University, Campus of Cumhuriyet, İstanbul, Turkey
| | - Mehmet Elmadag
- Department of Orthopaedics and Traumatology, School of Medicine, Bezmialem Vakıf University, İstanbul, Turkey
| | - Gokcer Uzer
- Department of Orthopaedics and Traumatology, School of Medicine, Bezmialem Vakıf University, İstanbul, Turkey
| | - Fatih Yıldız
- Department of Orthopaedics and Traumatology, School of Medicine, Bezmialem Vakıf University, İstanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopaedics and Traumatology, School of Medicine, Bezmialem Vakıf University, İstanbul, Turkey
| | - İbrahim Tuncay
- Department of Orthopaedics and Traumatology, School of Medicine, Bezmialem Vakıf University, İstanbul, Turkey
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Elmadag M, Uzer G, Yildiz F, Erden T, Bilsel K, Büyükpinarbasili N, Üsümez A, Bozdag E, Sen C. Comparison of four different techniques for performing an osteotomy: a biomechanical, radiological and histological study on rabbits tibias. Bone Joint J 2015; 97-B:1628-33. [PMID: 26637676 DOI: 10.1302/0301-620x.97b12.36060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This animal study compares different methods of performing an osteotomy, including using an Erbium-doped Yttrium Aluminum Garnet laser, histologically, radiologically and biomechanically. A total of 24 New Zealand rabbits were divided into four groups (Group I: multihole-drilling; Group II: Gigli saw; Group III: electrical saw blade and Group IV: laser). A proximal transverse diaphyseal osteotomy was performed on the right tibias of the rabbits after the application of a circular external fixator. The rabbits were killed six weeks after the procedure, the operated tibias were resected and radiographs taken. The specimens were tested biomechanically using three-point bending forces, and four tibias from each group were examined histologically. Outcome parameters were the biomechanical stability of the tibias as assessed by the failure to load and radiographic and histological examination of the osteotomy site. The osteotomies healed in all specimens both radiographically and histologically. The differences in the mean radiographic (p = 0.568) and histological (p = 0.71) scores, and in the mean failure loads (p = 0.180) were not statistically significant between the groups. Different methods of performing an osteotomy give similar quality of union. The laser osteotomy, which is not widely used in orthopaedics is an alternative to the current methods.
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Affiliation(s)
- M Elmadag
- Bezmialem Vakıf University, Vatan Cd. Fatih 34093 Istanbul, Turkey
| | - G Uzer
- Bezmialem Vakıf University, Vatan Cd. Fatih 34093 Istanbul, Turkey
| | - F Yildiz
- Bezmialem Vakif University, Vatan Cd. Fatih 34093 Istanbul, Turkey
| | - T Erden
- Bezmialem Vakif University, Vatan Cd. Fatih 34093 Istanbul, Turkey
| | - K Bilsel
- Bezmialem Vakif University, Vatan Cd. Fatih 34093 Istanbul, Turkey
| | | | - A Üsümez
- Bezmialem Vakif University, Vatan Cd. Fatih 34093 Istanbul, Turkey
| | - E Bozdag
- Istanbul Technical University, Gümüşsuyu Cd, Taksim, Istanbul, Turkey
| | - C Sen
- Millet Cd, Fatih 34093, Istanbul, Turkey
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Abstract
A retrospective study was performed in 18 patients with achondroplasia, who underwent bilateral humeral lengthening between 2001 and 2013, using monorail external fixators. The mean age was ten years (six to 15) and the mean follow-up was 40 months (12 to 104). The mean disabilities of the arm, shoulder and hand (DASH) score fell from 32.3 (20 to 40) pre-operatively to 9.4 (6 to 14) post-operatively (p = 0.037). A mean lengthening of 60% (40% to 95%) was required to reach the goal of independent perineal hygiene. One patient developed early consolidation, and fractures occurred in the regenerate bone of four humeri in three patients. There were three transient radial nerve palsies. Humeral lengthening increases the independence of people with achondroplasia and is not just a cosmetic procedure. Cite this article: Bone Joint J 2015;97-B:1577–81.
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Affiliation(s)
- H. I. Balci
- Istanbul University Istanbul Medical Faculty, Capa/Fatih, 34690, Istanbul, Turkey
| | - M. Kocaoglu
- Istanbul Memorial Hospital, Piyalepasa
Bulvari Okmeydani 34385, Istanbul, Turkey
| | - C. Sen
- Istanbul University Istanbul Medical Faculty, Capa/Fatih, 34690, Istanbul, Turkey
| | - L. Eralp
- Istanbul University Istanbul Medical Faculty, Capa/Fatih, 34690, Istanbul, Turkey
| | - S. G. Batibay
- Istanbul University Istanbul Medical Faculty, Capa/Fatih, 34690, Istanbul, Turkey
| | - K. Bilsel
- Bezmialem University, Fatih, 34690
Istanbul, Turkey
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Bilsel K, Ceylan HH, Yıldız F, Erden T, Toprak A, Tuncay I. Acetabular dysplasia may be related to global joint hyperlaxity. Int Orthop 2015; 40:885-9. [PMID: 26419956 DOI: 10.1007/s00264-015-3004-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/15/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE Some patients with shoulder laxity complain of coxalgia without a history of trauma. We hypothesised that patients who have recurrent shoulder instability accompanied with generalised joint hyperlaxity tend to have acetabular dysplasia. METHODS Pelvic radiographs of 26 young patients with hyperlaxity who had shoulder instability complaints without any history of hip joint trauma were evaluated by measuring their centre-edge angle (CEA) and acetabular angle (AA). In addition, Beighton generalised joint laxity tests were performed. All of the patients had shoulder pain and instability accompanied with hyperlaxity. We performed magnetic resonance imaging examination to show SLAP-Bankart lesions and pelvis anteroposterior X-rays to detect acetabular dysplasia. RESULTS The average age of the study group was 26 ± 8.03 years (13-39). Six patients were female and 20 were male. When CEA (<22.6 degrees) was used as a criterion for acetabular dysplasia, the dysplasia rate of our patient group was 3.84 % for the right hip, 3.84 % for the left hip and 3.84 % overall. When AA (>42.2 degrees) was used as the dysplasia criterion, the dysplasia rate of patient group was 30.76 % for the right hip, 57.69 % for the left hip and 57.69 % overall. CONCLUSIONS CEA values were significantly lower (p = 0.009) and AA values were significantly higher (p < 0.001) in our study group than the previously-reported average values of the Turkish population. We think that acetabular dysplasia is more frequent in patients with hyperlaxity; further studies are needed to test this idea.
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Affiliation(s)
- Kerem Bilsel
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Vatan Cd. Fatih, 34093, İstanbul, Turkey
| | - Hasan Hüseyin Ceylan
- Department of Orthopaedics and Traumatology, LNB State Hospital, Istanbul, Turkey
| | - Fatih Yıldız
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Vatan Cd. Fatih, 34093, İstanbul, Turkey.
| | - Tunay Erden
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Vatan Cd. Fatih, 34093, İstanbul, Turkey
| | - Ali Toprak
- Department of Statistics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ibrahim Tuncay
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Vatan Cd. Fatih, 34093, İstanbul, Turkey
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Elmadağ M, Ceylan HH, Erdil M, Bilsel K. Apophyseal avulsion fracture of the anterior inferior iliac spine due to a simple bone cyst. Acta Orthop Traumatol Turc 2015; 49:213-6. [PMID: 26012945 DOI: 10.3944/aott.2015.2996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Apophyseal avulsion fractures of the anterior inferior iliac spine are rare; they are usually seen in adolescents as a result of sudden contraction of the rectus femoris muscle. Treatment is usually conservative, but surgical management may be necessary in certain circumstances. We present an unusual case of a 14-year-old male who was referred to our department for a suspicious pathological fracture of his right anterior inferior iliac spine; he was found to have an avulsion fracture of the anterior inferior iliac spine due to simple bone cyst. We discuss the treatment of this rare injury caused by a benign osseous tumour.
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Affiliation(s)
- Mehmet Elmadağ
- Bezmialem Vakif University Faculty of Medicine, Department of Orthopedics and Traumatology, İstanbul, Turkey
| | - Hasan H Ceylan
- Bezmialem Vakif University Faculty of Medicine, Department of Orthopedics and Traumatology, İstanbul, Turkey
| | - Mehmet Erdil
- Bezmialem Vakif University Faculty of Medicine, Department of Orthopedics and Traumatology, İstanbul, Turkey
| | - Kerem Bilsel
- Bezmialem Vakif University Faculty of Medicine, Department of Orthopedics and Traumatology, İstanbul, Turkey
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Imren Y, Gurkan V, Bilsel K, Desteli EE, Tuna M, Gurcan C, Tuncay I, Sen C. Biomechanical comparison of dynamic hip screw, proximal femoral nail, cannulated screw, and monoaxial external fixation in the treatment of basicervical femoral neck fractures. Acta Chir Orthop Traumatol Cech 2015; 82:140-144. [PMID: 26317185] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE OF THE STUDY The objective of this study was to establish relative fixation strengths of proximal femoral nail (PFN), dynamic hip screw (DHS), monolateral external fixator (EF), and cannulated screw (CS) in basicervical hip fracture model. MATERIAL AND METHODS The study involved four groups of implanted composite proximal femoral synthetic bones of eight specimens per group; nailing with PFN, DHS, fixation with three cannulated screws, and EF. 70˚ osteotomy was performed to simulate a Pauwels Type 3 basicervical fracture. Minimum preload of 100 N was applied before loading to failure. The constructs were subjected to cyclic loading with 16˚ to midline from 100 N to 1,000 N for 10,000 cycles at 3Hz. Axial loading was applied at 10 mm/min until failure. Failure load, failure mode, and displacement were documented. RESULTS Mean failure load was 2182.5 ± 377.9 N in PFN group, 2008.75 ± 278.4 N in DHS group, 1941.25 ± 171.6 N in EF group, and 1551.6 ± 236.2 N in CS group. Average displacement was 15.6 ± 4.5 mm, 15.5 ± 6.7 mm, 11.7 ± 1.9 mm, and 15 ± 1.7 mm, respectively. No significant difference was noted among groups for fixation strength except CS group. All CS constructs failed during cyclic loading. CONCLUSION Our findings suggest that PFN, DHS and EF achieved higher fixation strengths than CS in basicervical fracture. PFN has higher failure loads and possesses biomechanical benefits for fixation of unstable basicervical fractures compared with DHS and EF. Key words: basicervical fracture, internal fixation, biomechanics.
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Affiliation(s)
- Y Imren
- Orthopaedics & Traumatology Department, Üsküdar State Hospital, Istanbul, Turkey
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Atalar AC, Bilsel K, Eren I, Celik D, Cil H, Demirhan M. Modified Latarjet procedure for patients with glenoid bone defect accompanied with anterior shoulder instability. Acta Orthop Traumatol Turc 2014; 47:393-9. [PMID: 24509218 DOI: 10.3944/aott.2013.3130] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this study was to assess the effects of coracoid bone block (modified Latarjet) procedure on clinical and functional results in cases with glenoid bone defect accompanied with anterior shoulder instability. METHODS The study included 35 patients (average age: 35 years; range: 20 to 58 years) with glenoid bone defect and recurrent dislocations treated with the modified Latarjet procedure. There were 12 sports injuries, 5 post-epileptic cases and 18 recurrent anterior shoulder dislocation following non-sports-related injuries. Recurrence was reported in 7 patients formerly treated with the Bankart procedure. Average number of preoperative dislocations was 10.8 ± 6.5 and average time range between the first dislocation and surgery was 14.9 ± 13.2 months. All patients underwent preoperative diagnostic arthroscopy. Postoperative isometric exercises in braces were assigned for the first 6 weeks, followed by active strengthening exercises. Pre- and postoperative functional results were evaluated using the ASES (American Shoulder and Elbow Surgeons) and Rowe scores and pain using the VAS (Visual Analog Scale). RESULTS Osseous union of coracoid graft was achieved in all patients. Average follow-up was 24 ± 12.2 (range: 12 to 74) months. No degenerative arthritis or continuing instability was detected in any of the patients. Average forward flexion was 165° ± 20° and external rotation 59° ± 13°. Mean preoperative ASES and Rowe scores of 49.6 ± 10.6 and 47.9 ± 21.5 increased postoperatively to 91.3 ± 11 and 89.1 ± 9.2, respectively. Mean VAS scores decreased significantly from 6.2 ± 2.4 to 1.8 ± 0.6 postoperatively (p<0.05). CONCLUSION Shoulder functionality and former activity levels can be successfully achieved in terms of increased patient satisfaction through use of the modified Latarjet surgery in the treatment of glenoid bone defect and anterior shoulder instability.
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Bilsel K, Erdil M, Elmadag M, Ozden VE, Celik D, Tuncay I. The effect of infraspinatus hypotrophy and weakness on the arthroscopic treatment of spinoglenoid notch cyst associated with superior labrum anterior-to-posterior lesions. Knee Surg Sports Traumatol Arthrosc 2014; 22:2209-15. [PMID: 23462957 DOI: 10.1007/s00167-013-2469-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 02/25/2013] [Indexed: 01/02/2023]
Abstract
PURPOSE Patients with spinoglenoid notch cyst associated with superior labrum anterior-to-posterior (SLAP) lesions were evaluated. The patients were all treated by arthroscopic cyst decompression combined with SLAP repair. The hypothesis of the study was that the patients who underwent prolonged conservative treatment period prior to surgery would exhibit significant infraspinatus hypotrophy and weakness, and their postoperative clinical and functional outcomes would be less satisfactory. METHODS Sixteen patients exhibited positive MRI and EMG findings with clinical signs of weakness and pain. The median age was 40.5 years (range 32-52), and the study group consisted of 11 males and 5 females with a median follow-up period of 26 months (12-48). The median duration of symptoms and conservative treatment prior to the surgical intervention was 3.5 months (1-14). Seven patients in group A exhibited infraspinatus hypotrophy. Group B comprised 9 patients without infraspinatus hypotrophy. RESULTS The results of the pre- and postoperative Constant scores, visual analogue scale (VAS) scores, and external rotation strength test rates were compared between groups. They all improved in terms of pain, strength, and function (P < 0.05). Significant differences were observed between the pre- and postoperative external rotation strengths and Constant scores (P < 0.05). However, no significant difference was observed between the pre- and postoperative VAS scores (n.s.). A significant correlation was observed in group A between surgical timing, the preoperative external rotation strength ratio (P = 0.04) and the postoperative VAS scores (P = 0.013). CONCLUSION The arthroscopic treatment was satisfactory with good clinical outcomes. Infraspinatus hypotrophy occurred in cases of prolonged surgical duration and significantly affected external rotation strength and functional outcomes. LEVEL OF EVIDENCE Retrospective comparative study, Level III.
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Affiliation(s)
- Kerem Bilsel
- Orthopaedic and Traumatology Department, Bezmialem Vakif University, Istanbul, Turkey,
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Ozkanli S, Soylemez MS, Sahin A, Senol S, Bilsel K, Ceylan HH. Unusual implant-related soft tissue reaction presenting as a swollen leg: a case report. J Med Case Rep 2014; 8:187. [PMID: 24927814 PMCID: PMC4082173 DOI: 10.1186/1752-1947-8-187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 03/31/2014] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION There are several causes of peri-implant edema, pain, and swelling around implants after orthopedic fixation device application for fracture repair. The most common and well-known reason is infection, however, granulomas associated with foreign body reactions are rarely seen. In this report we present a case of a granulomatous reaction mimicking a hydatid cyst and sarcoma. We emphasize the importance of differential diagnosis in triggering appropriate management of the patient. Our case was unusual; to the best of our knowledge no similar clinical or pathological findings have been reported in current literature. CASE PRESENTATION A 56-year-old Turkish man who had been treated for a right femoral fracture via a plate fixation 10 years prior underwent an operation to treat pain and swelling around the plate. A hydatid cyst-like mass was observed during surgery, but subsequent examination revealed that no hydatid cyst was present; both malignancy and infection were also absent. CONCLUSIONS Although infection is generally the first possibility that should be considered in a patient complaining of pain and swelling in the vicinity of an implant, malignancies, hydatid cysts, and (finally) foreign body reactions should also be kept in mind as differential diagnoses. A soft-tissue reaction around a previously implanted plate should be managed carefully. Pre-operative radiological assessment, and biopsy to allow pathological and microbiological examination, should be considered in all suspected cases.
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Affiliation(s)
- Seyma Ozkanli
- Department of Pathology, Göztepe Training and Research Hospital, Fahrettin Kerim Gökay Street, 2346 Istanbul, Turkey
| | - Mehmet Salih Soylemez
- Department of Orthopedics and Traumatology, Göztepe Training and Research Hospital, Fahrettin Kerim Gökay Street, 2346 Istanbul, Turkey
- Göztepe E.A.H. floor 3. Orthopaedics ward, Fahrettin Kerim Gökay Street, 2346 Kadıköy/Istanbul, Turkey
| | - Adem Sahin
- Department of Orthopedics and Traumatology, Göztepe Training and Research Hospital, Fahrettin Kerim Gökay Street, 2346 Istanbul, Turkey
| | - Serkan Senol
- Department of Pathology, Göztepe Training and Research Hospital, Fahrettin Kerim Gökay Street, 2346 Istanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakıf University, Vatan Street, 34080 Istanbul, Turkey
| | - Hasan Hüseyin Ceylan
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakıf University, Vatan Street, 34080 Istanbul, Turkey
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Elmadag M, Imren Y, Erdil M, Bilsel K, Tuncay I. Excess retained cement in the posteromedial compartment after unicondylar knee arthroplasty. Acta Orthop Traumatol Turc 2014; 47:291-4. [PMID: 23999519 DOI: 10.3944/aott.2013.3043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Acute mechanical symptoms due to excess retained cement in the posterior compartment of the knee joint following unicondylar knee arthroplasty (UKA) are uncommon. Infection, aseptic loosening, polyethylene wear and progressive arthritis are well-documented complications of UKA procedure. We present a patient with acute pain and 'clicking' sensation in the knee joint due to cement extrusion in the posteromedial compartment after UKA. Full functional recovery was achieved after arthroscopic removal of the cement debris. Of retrospectively screened 43 UKA cases, asymptomatic cement extrusion was detected in 8 patients in the posteromedial compartment on direct X-rays. Careful inspection of components is essential to minimize the risk of cement extrusion into the posterior compartment and perioperative fluoroscopy may be helpful during UKA procedure.
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