Joint diseases and related surgery最新文献

Objectives: This study aims to evaluate the effects of platelet-rich plasma (PRP), erythropoietin (EPO), and EPO-bevacizumab (EPO-BEVA) combination on tendon healing in a rat Achilles tenotomy model.

Materials and methods: Fifty-six male Wistar albino rats (14 to 16 weeks old) were randomly assigned to control, PRP, EPO, and EPO-BEVA groups including 14 rats in each group. Bilateral Achilles tenotomy was performed under anesthesia, followed by respective treatments. Platelet-rich plasma (0.1 mL/tendon) was prepared using a Ficoll-based extraction kit. The EPO (500 U/kg) and EPO-BEVA (175 U EPO + 1.25 mg BEVA) were administered locally. Biomechanical analysis assessed maximum force, stiffness, tensile stress, and Young's modulus. Histological evaluation included Bonar scoring, collagen organization, tenocyte morphology, and vascularity. Cross-sectional area (CSA) was measured.

Results: At Week 2, the EPO-BEVA group exhibited superior stiffness (14.79±6.9 N/mm) than PRP (8.64±1.5 N/mm, p=0.015) and greater tensile stress (8.2±1 MPa) than control (6.16±1.3 MPa, p=0.031). The CSA was reduced (4.79±0.8 mm²) compared to EPO (6.56±1.1 mm², p=0.038), indicating qualitative tendon improvements. Histological analysis showed enhanced matrix organization and reduced vascularity in the EPO-BEVA group, with lower Bonar scores (5.29±1.4 vs. 9.29±1.1 in control, p=0.002). By Week 4, maximum force remained higher in EPO-BEVA (46.67±5.8 N) than control (34.84±3 N, p=0.004), with sustained Young's modulus superiority compared to EPO (3.2±1.2 MPa vs. 1.78±0.5 MPa, p=0.014), although the stiffness differences were no longer significant.

Conclusion: Our study results showed that EPO-BEVA enhanced tendon healing via vascular and matrix modulation, although the lack of a BEVA-only group limits conclusions on synergy. Future studies with larger sample sizes, including BEVA monotherapy, optimized dosing strategies, and long-term evaluations are needed to better clarify these effects and refine treatment strategies in regenerative medicine.

Objectives: This study aims to compare patients undergoing total knee arthroplasty (TKA) with gap balancing (GB) versus measured resection (MR) techniques in terms of joint line (JL) using radiographic measurements from both femoral and tibial sides.

Patients and methods: Between August 2019 and May 2021, a total of 107 patients who underwent TKA were included in this randomized study. The patients were divided into two groups as the GB group (n=54; 9 males, 45 females; mean age: 66.6±7.4 years; range, 51 to 81 years) and the MR group (n=53; 10 males, 43 females; mean age: 64.0±6.8 years; range, 50 to 80 years). The adductor tubercle joint line (ATJL) and the tibial tubercle joint line (TTJL) were evaluated for JL measurement. Clinical and functional evaluation was made using the range of motion of the joint, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Knee Society Score (KSS)-Knee and Functional scores.

Results: The mean follow-up was 34.2±3.5 months in the GB group and 34.4±3.3 months in the MR group (p=0.80). The mean operation time was 119.1±14.9 min in the GB group and 118.6±17.5 min in the MR group (p=0.89). A total of 31 (57.4%) patients in the GB group had a degree of release of 3-4, while 21 (39.6%) patients in the MR group had a degree of release of 3-4 (p=0.26). The ATJL measurement was similar in the GB and MR groups, while the TTJL measurement was significantly different between the two groups (p=0.01). There was no significant correlation between the ATJL measurement and the degree of release, while there was a significant correlation between the TTJL and the degree of release (r=0.731, p<0.001).

Conclusion: While ATJL measurements in TKA showed similar results with GB and MR techniques, the amount of release may have caused the significantly higher JL elevation in the GB group in TTJL measurements. Based on these findings, we suggest that radiographic JL measurements on both the tibial and femoral sides in TKA may provide a more accurate assessment and we recommend to measure JL from the femoral side.

Chondral delamination, characterized by separation between the articular cartilage and subchondral bone, commonly affects middle-aged adults and can evolve into cartilage defects. Management of extensive chondral delamination presents a significant challenge, particularly in preserving the delaminated yet structurally intact cartilage. Despite its clinical importance, there is no standardized treatment protocol for this condition, and there are few long-term follow-up studies of its surgical management. This case report presents the long-term clinical and radiological outcomes of a novel combined surgical approach for large chondral delamination in a neutrally aligned knee, and discuss the benefits and potential complications of this treatment strategy. In conclusion, autogenous osteochondral transplantation combined with medial opening-wedge high tibial osteotomy shows excellent long-term functional outcomes for large medial femoral condyle chondral delamination.

Objectives: The aim of this study was to investigate the long-term effects of computer-assisted Ci™ navigation on clinical, radiological, and functional results versus conventional total knee arthroplasty (TKA).

Patients and methods: Between January 2005 and July 2011, a total of 85 patients (36 males, 49 females; mean age: 66.2±5.2 years; range, 59 to 84 years) who underwent P.F.C. Sigma™ knee system implantation using computer-assisted Ci™ navigation system (BrainLAB®, DePuy International, Leeds, UK) and completed a minimum follow-up of eight years were included in the study. In the control group, a total of 100 patients (40 males, 60 females; mean age: 68.3±3.9 years; range, 60 to 79 years) who completed a minimum follow-up of eight years were randomly selected from a dataset of implanted P.F.C. Sigma™ knee systems in the same period using Specialist® 2 instrumentation without navigation. An implant survival analysis was used to compare implant survivorship between the groups throughout 12 years. The Knee Society Score (KSS) and range of motion (ROM) were assessed. Based on long-format X-ray images, the implant position in the frontal and sagittal planes was evaluated.

Results: The ratio for navigation to control group survival is approximately 1.01 at 12 years. The clinical outcomes showed no significant difference between the groups (knee scores, p=0.707 and functional scores, p=0.485). In the measured angles analysis, we observed a consistent pattern in both groups. In the control group, there was a trend toward implanting the tibial component with slight varus alignment (p=0.038) and a higher posterior slope (p<0.001). On average, the operation was prolonged by 13 min in the navigated group (p<0.001).

Conclusion: In conclusion, our study results demonstrate that while kinematic navigation in TKA improves the precision of implant alignment, it does not provide significant benefits in terms of long-term implant survival or functional outcomes compared to conventional TKA methods. The use of the computer-assisted Ci™ navigation system is associated with prolonged operation duration, although no technical complications related to the navigation device's software can be observed. Therefore, although navigation offers theoretical advantages in component positioning, its use may be more justifiable in cases with challenging alignment requirements rather than as a routine practice.

Objectives: This study aims to examine the diagnosis, treatment methods, and outcomes of Seymour fractures and to address diagnostic challenges in these fractures.

Patients and methods: Between January 2020 and November 2023, a total of 28 pediatric patients (18 males, 11 females; mean age: 6.8±4.5 years; range, 1 to 15 years) who presented with Seymour fractures within 24 h of injury were retrospectively analyzed. Patients were treated either conservatively in the emergency department or surgically in the operating room if closed reduction was unsuccessful. All patients received intravenous antibiotics within the first 24 h, followed by oral antibiotics after discharge. Infection rates, physeal arrest, and nail dystrophy were evaluated during follow-up.

Results: The mean follow-up was 16.6±6.6 (range, 12 to 32) months. There was no statistically significant difference in the affected side (right/left) and fingers (p=0.43 and p>0.05, respectively). The complication rate was significantly higher in surgically treated patients compared to those treated conservatively (p=0.02 and p<0.05, respectively). Evaluation of patients based on finger mobility showed no motion loss in the conservatively treated group at the final follow-up. In the surgically treated group, however, motion restrictions were noted in only two patients. Early antibiotic administration within 24 h significantly reduced infection rates, with only 3.5% (n=1) of patients developing osteomyelitis.

Conclusion: Stable Seymour fractures can be treated conservatively in the emergency setting, while complex cases may require surgical intervention in the operating room. Early antibiotic use is essential in minimizing infection risk. Antibiotherapy within the first 24 h after injury is an effective way to prevent infection.

Objectives: This study aims to investigate the effect of nerve graft orientation on nerve regeneration in a rat sciatic nerve defect model and to compare functional and histological outcomes of normal and reverse orientation grafts, focusing on sensory and motor recovery.

Materials and methods: A total of 30 Wistar Albino rats were divided into three equal groups: a control group, a normal graft orientation group (Group A), and a reverse graft orientation group (Group B). A 10-mm sciatic nerve defect was created in the surgical groups, and the graft was applied with epineural coaptation. Functional recovery was evaluated using extensor postural thrust (EPT), pinprick, and hot plate tests, while histological analysis involved axon counts, myelin sheath thickness measurements, and the axon count change ratio.

Results: No significant difference was observed between Group A and Group B in motor function recovery as evaluated by the EPT test (p>0.05). However, Group A showed improved sensory recovery compared to Group B in the pinprick test (p=0.028). Histologically, both groups demonstrated similar ratios of axon count and myelin sheath thickness between proximal and distal segments (p>0.05).

Conclusion: Normal autograft orientation demonstrated superior sensory recovery, while no significant differences were observed in motor function or histological results. These findings highlight the importance of graft orientation for sensory regeneration and underscore the need for future studies to explore the long-term effects of graft orientation and its implications for human nerve repair, particularly in larger defects and clinical scenarios.

Objectives: This study aims to investigate the effects of local irisin (IR) injections on closed femoral fractures in rats and to compare its efficacy to platelet-rich plasma (PRP) and hyaluronic acid (HA).

Materials and methods: A total of 64 male Wistar albino rats were divided into four equal groups: a control group that received no treatment and three experimental groups that received local injections of HA, PRP, or recombinant IR at the fracture site. All rats underwent a standard bilateral closed femoral shaft fracture and intramedullary fixation. Each group was further divided into two subgroups, sacrificed at Week 2 and Week 4. The right femurs were used for radiological examination with micro-computed tomography (micro-CT) and subsequent histological analysis, while the left femurs were reserved for biomechanical testing.

Results: By Week 2, the IR and PRP groups showed statistically significantly higher scores for the transformation of fibrous cartilage into bone tissue compared to the control group (7.88±0.6, p=0.0001, and 6±0.8, p=0.036, respectively). By Week 4, transformation scores in the IR group increased to 9.25±0.7, statistically significantly exceeding the control group (p=0.0001). Bone volume was also statistically significantly greater in the IR group (5.21±0.5 mm³ at Week 2; 5.94±0.8 mm³ at Week 4) compared to the control group (p=0.001) and the PRP group (p=0.003) at Week 2, and compared to the control group (p=0.001), the HA group (p=0.042), and the PRP group (p=0.014) at Week 4. Additionally, maximum strength in the IR group was statistically significantly higher than in the control group (p=0.0001) and the PRP group (p=0.048) at Week 2. By Week 4, the IR group was also statistically significantly higher compared to the control group (p=0.0001), the HA group (p=0.037) and the PRP group (p=0.009).

Conclusion: The present study is one of the first to demonstrate the potential of administering local IR via injection into the fracture hematoma to accelerate fracture healing. The superior efficacy of IR over HA and PRP may be explained by its ability to enhance osteoblast activity, promote vascularization, and reduce inflammation, creating an optimal environment for bone regeneration. Unlike PRP, which primarily delivers growth factors, and HA, which supports cell migration and proliferation, IR appears to directly influence the bone microenvironment, expediting callus transformation. These findings suggest that IR may play a significant role in improving outcomes for patients at risk of delayed union. However, further clinical trials in humans are necessary to confirm its efficacy and safety for clinical applications.

Objectives: This study aims to provide insight into the advantages and disadvantages of autograft and synthetic graft use in the surgical treatment of tibial plateau fractures with joint depression by comparing the clinical and radiological outcomes of both graft types.

Patients and methods: Between February 2019 and September 2022, a total of 51 patients (23 males, 28 females; mean age: 45.3±13.5 years; range, 20 to 69 years) who underwent surgical treatment for Schatzker type 2 and type 3 tibial plateau fractures in our clinic were retrospectively analyzed. The patients were divided into two groups; 30 patients received autografts and 21 received tricalcium phosphate synthetic grafts. Demographic data, graft type, fracture classification, preoperative joint depression, body mass index (BMI), and smoking status were recorded. Postoperative evaluations included Lysholm and Visual Analog Scale (VAS) scores at two years.

Results: Similar clinical and radiological outcomes were observed in both graft groups in the short term (p>0.05). Smoking had a negative effect on graft stability, with a significantly higher postoperative depression rate in smokers (p=0.026). Patients with a BMI above 30 kg/m² also showed higher rates of postoperative depression (p=0.004). Clinical outcomes were worse in patients with joint depression compared to those without depression (p=0.003).

Conclusion: Autografts and synthetic grafts show similar efficacy in the mid-term treatment of tibial plateau fractures. High BMI and smoking may be associated with potential joint depression and worse clinical outcomes in the postoperative period.

Objectives: This study aims to evaluate whether adding internal fixation to grafting could improve radiological and functional outcomes compared to grafting alone in patients with aneurysmal bone cysts (ABCs) of the proximal femur and to investigate whether there was a significant difference between these two treatment methods in terms of the need for a second surgery.

Patients and methods: Between January 2012 and January 2022, a total of 30 patients (21 males, 9 females; mean age: 13.7±5.1 years; range, 5 to 23 years) with proximal femur ABCs who underwent surgical treatment were retrospectively analyzed. Twelve of them were treated by grafting alone (Group GA), while the remaining 18 were treated by grafting along with fixation using plates and screws (Group GF). The demographic data of these patients, the need for secondary surgery, radiological and functional scores were recorded. The modified Neer Classification was used for radiological evaluations, while the Musculoskeletal Tumor Society (MSTS) scores were utilized for functional assessments.

Results: Overall, the mean preoperative MSTS scores were lower than the postoperative MSTS scores in both GF and GA groups (p<0.001 and p=0.002). The postoperative radiological scores of the GF group were superior to the GA group (p=0.012). However, no significant difference was found in the postoperative MSTS scores between the groups (p=0.185). Secondary surgeries were performed in six patients in the GF group due to implant removal and in three patients in the GA group due to recurrence. No significant difference was observed between the GF group and the GA group in terms of secondary surgery (p=0.626). Comparisons of final radiological (p=0.325) and final MSTS (p=0.346) scores after secondary surgeries revealed no significant differences.

Conclusion: In proximal femoral ABCs, grafting with fixation may provide more favorable radiological outcomes with lower recurrence rates. While grafting with fixation seems to increase the risk for a secondary surgery due to implant removal, our study shows that recurrence in high-risk regions can also necessitate secondary surgeries with grafting alone. Notably, both approaches can achieve successful outcomes, even with recurrent surgeries.

Objectives: This study aims to evaluate whether changes in ankle radiological parameters following fibular head resection due to tumors lead to ankle instability and/or ankle arthritis and to assess the impact of resection on clinical outcomes using pedobarographic analysis and pain and function scales.

Patients and methods: Between January 2005 and January 2023, a total of 30 patients (10 males, 20 females; mean age: 33.9±13.8 years; range, 10 to 67 years) who underwent proximal fibula resection were retrospectively analyzed. We assessed fibular rotation using axial ankle magnetic resonance imaging (MRI), fibular length, talar tilt angle, and talotibial angle changes using X-ray, foot load distribution changes through pedobarographic measurements, and clinical outcomes using the Visual Analog Scale (VAS) and Musculoskeletal Tumor Society (MSTS) scores.

Results: Fibular length and rotation were significantly reduced, while talar tilt and talocrural angle were higher on the operated side. Additionally, load balance and maximum pressure in the second to fifth toes (T2-5 regions) were significantly lower on the operated side. The mean VAS score was 1.5±1.4 and the mean MSTS score was 26.8±2.9. The MSTS scores showed weak negative correlations with differences in fibular length, fibular rotation, talar tilt, and talocrural angle, none of which were statistically significant (r=-0.35, -0.3, -0.1, -0.1, p=0.06, 0.1, 0.62, 0.61). In contrast, the VAS score showed a significant positive correlation with fibular length difference (r=0.45, p=0.01), while correlations with other parameters were not significant. A positive correlation was observed between the percentage of resected fibula and differences in fibular rotation (r=0.67, p<0.001), fibular length (r=0.73, p<0.001), talocrural angle (r=0.49, p=0.003), and talar tilt angle (r=0.66, p<0.001); this correlation was more pronounced in patients with more than 30% resection.

Conclusion: Proximal fibula resection for tumors involving the fibular head leads to significant changes in ankle radiological measurements and load distribution. Despite these changes, clinical outcomes, as reflected by low VAS scores and high MSTS scores, indicate generally favorable patient-reported outcomes.