Acta orthopaedica et traumatologica turcica最新文献

Objective: The microfracture technique is often considered the standard therapy for treating cartilage defects. The aim of the treatment is the migration of mesenchymal stem cells from the bone marrow into the defect area. However, this regeneration process often results in the formation of fibrocartilage instead of natural hyaline cartilage, due to cellular mechanisms whose causes are not well understood. Therefore, in this study, the differences in bioactivity and apoptosis of fibrocartilage tissue-derived chondrocytes (FCh) obtained by bone marrow stimulation and natural hyaline cartilage tissue-derived chondrocytes (HCh) in the knee joint of rats were compared.

Methods: A total of 24 Wistar albino rats were used in this study, and one hind leg of each animal was operated on, while the other served as a control. A 2-step surgical procedure was performed: First, a microfracture was generated at a 2 mm × 2 mm cartilage defect area in the medial condyle of the femur after a left knee arthrotomy. Second, 6 weeks later, after a double knee arthrotomy, fibrocartilage from the microfracture area of the left knee and 2 × 2 mm of hyaline cartilage from the medial femoral condyle of the right knee were harvested. Chondrocytes were isolated and grouped as HCh or FCh, and cell viability and apoptosis were determined by MTT (4,5-dimethylthiazol -2-yl)-2,5-diphenyltetrazolium bromide) and caspase-3 assays using enzyme-linked immunosorbent assay (ELISA) kits.

Results: Fibrocartilage tissue-derived chondrocytes showed similar bioactivity and apoptotic response as HCh under physiological conditions. However, low-dose H2O2 decreased viability (bioactivity) and increased apoptosis in FCh without affecting HCh. High-dose H2O2 reduced the bioactivity of both cell types and induced apoptosis, while the response of FCh to oxidative stress was more aggressive than that of HCh.

Conclusion: The different response patterns in oxidative stress may provide a basis for understanding the limited survival time of bone marrow-derived fibrocartilage tissue induced by microfractures.

Level of evidence: N/A.

Objective: Greater trochanteric pain syndrome (GTPS) is a prevalent condition that can significantly affect patient comfort and function. This study aims to compare the effectiveness of ultrasound (USG)-guided and anatomic landmark-guided corticosteroid injections in managing GTPS.

Methods: Patients diagnosed with GTPS received either USG or anatomic landmark-guided corticosteroid injections. Pain scores (Visual Analog Scale, VAS) and functional outcomes (modified Harris Hip Score, HHS) were assessed at baseline, 1 month, and 1 year postinjection. Cost-effectiveness was calculated using public and private payor pricing from June 2024.

Results: Both treatment groups exhibited significant improvements in pain and function. The USG group demonstrated greater initial improvements at the 1-month mark, particularly in VAS activity and HHS. However, these differences between the groups converged over time, with similar long-term outcomes observed in these parameters. The USG-guided injections showed more pronounced initial benefits, especially for patients with higher initial pain levels and lower functional scores. USG was found to be more cost-effective in terms of HHS, but not VAS measures.

Conclusion: While both USG and anatomic landmark-guided injections are effective for managing GTPS, USG-guided injections may provide greater initial relief in pain and function, particularly for patients with higher initial pain levels. USG does not demonstrate longterm superiority over anatomic injections. The study underscores the importance of evaluating long-term outcomes to comprehensively assess the sustained effectiveness of different treatment strategies for GTPS.

Level of evidence: Level III, Therapeutic study.

Objective: This study aimed to investigate the mechanical stability of a modified pedicle screw fixator and compare it with unilateral lumbopelvic fixation for treating sacroiliac joint disruption using finite element simulation technology.

Methods: The digital model of a normal spine-pelvis-femur containing the main pelvic and lumbar ligaments was established based on computed tomography images. A sacroiliac joint disruption model was built and validated, which was stabilized with the models of a modified pedicle screw fixator or unilateral lumbopelvic fixation. A 400 N follower loading was applied to the lumbar vertebrae for the 2 fixation models to analyze displacement and stress distribution. In addition, the construct stiffness was calculated.

Results: The peak amounts of sacral vertical displacement, horizontal displacement, posterior displacement, and overall displacement were 0.70 mm, 0.17 mm, 0.73 mm, and 0.88 mm, respectively, in the modified pedicle screw fixator model, which were less than those in the unilateral lumbopelvic fixation model (1.17 mm, 0.31 mm, 2.21 mm, and 2.29 mm, respectively). Compared with unilateral lumbopelvic fixation, the percentage decreases of the modified pedicle screw fixators were 40.2%, 45.2%, 67.0%, and 61.6%, respectively. The peak stress of the internal fixation and pelvis in the modified pedicle screw fixator model was 351.23 MPa and 39.91 MPa, which has 15.5% and 70.4% lower than in the unilateral lumbopelvic fixation model. The construct stiffness of the modified pedicle screw fixator (571 N/ mm) was 67% better than that of unilateral lumbopelvic fixation (342 N/mm).

Conclusion: The finite element simulation results showed that the modified pedicle screw fixator model demonstrated smaller sacral displacement, fewer stresses on the internal fixation and bone, and higher construct stiffness compared with the unilateral lumbopelvic fixation model. Thus, the modified pedicle screw fixator may provide biomechanical advantages over unilateral lumbopelvic fixation in the treatment of sacroiliac joint disruption.

Objective: This study aimed to investigate the association between acromial morphology and the incidence and extent of calcific tendonitis.

Methods: Ninety-two patients (33 male, 59 female; mean age: 47 ± 9.7) with calcific tendonitis were included in this retrospective study. Critical shoulder angle (CSA), slope angle, lateral acromial angle (LAA), acromion index (AI), acromial type according to Bigliani, and the morphology of the calcific deposits according to Gartner and Heyer were assessed on x-rays. The localization and volume of the calcific deposits were assessed using magnetic resonance imaging (MRI). Patients were divided into 2 groups: CSA < 33° (group 1) and CSA ≥ 33° (group 2).

Results: The median CSA was 33.5° (range=23°-51°), lateral acromial angle (LAA) was 83.6° (range=60°-106°), acromial index (AI) was 0.7 (range=0.4-0.9), and slope angle was 24.1° (range=3°-40°). Lateral acromial angle (P=.000) and AI (P=.000) were statistically different between the 2 groups. Critical shoulder angle was correlated with LAA (P=.000) and AI (P=.000); deposit volumes were correlated with slope angle (P=.001), Bigliani type of the acromion (P=.009), and deposit stage according to Gartner and Heyer (P=.004). There was a correlation between deposit localization and its volume; the size of the deposit increased anteriorly (P=.000).

Conclusion: This study has shown that CSA failed to quantify a patient's predisposition to calcific tendonitis. However, the findings demonstrate a relationship between the morphological parameters in the sagittal plane, such as acromial slope and deposit volume, which deserve further research.

Level of evidence: Level III, Prognostic Study.

Objective: This study aimed to compare the medium- to long-term results of mosaicplasty and autologous matrix-induced chondrogenesis (AMIC) in treating osteochondral defects of the talus (OCD).

Methods: Fifty patients treated for talus OCD were evaluated between 2010 and 2020. Patients were divided into 2 groups: patients who underwent mosaicplasty (Group I) and those who underwent AMIC (Group II). The OCD was graded according to the Berndt-Hardy and Hepple classification systems. The size of the OCD area, the number of osteochondral plugs, and the size of the collagen matrix were determined from the surgical data. The effects of patients aged below and above 45, defect areas smaller or larger than 1.5 cm2 , and gender on functional outcomes were analyzed in both groups. Range of motion (ROM), The American Orthopaedic Foot & Ankle Society score (AOFAS), the Freiburg ankle Index score (FAI), the Tegner activity scale, and the visual analog scale (VAS) were used for the functional evaluations.

Results: Group I included 28 patients, and group II included 22 patients. The mean age was 41.6 years; the mean follow-up period was 69.9 months. In the final examination of the patients, both methods could provide significant improvement in all functional scores (P < .001). Although it was not statistically significant, group II had better functional values. The size of the defect area independently negatively affected the preoperative AOFAS (P=.001 and P=.011, respectively) and FAI (P=.001 and P=.008, respectively) scores. Besides that, age and gender did not affect the results (P > .05).

Conclusion: Both methods can provide successful results; however, the AMIC method can achieve better results than mosaicplasty in similarly sized defects without causing additional morbidity.

Objective: This study aimed to analyze the original articles published in Acta Orthopaedica et Traumatologica Turcica (AOTT) between 2013 and 2022 using bibliometric methods to identify their characteristics and examine the changing trends over the last 10 years.

Methods: The articles were analyzed in terms of publication year, authors, countries, affiliations, citations, study design, subspecialty of orthopedics, sample size, study outcome, presence of statistical methods, time elapsed from submission date to acceptance date, and presence of funding. Periods (2003-2012 and 2013-2022) were compared for trend analysis in the journal. Advanced bibliometric analysis was done using VOSviewer software (version 1.6.19).

Results: A total of 976 articles were included in the analysis. The journal's self-citation rate was 2.94%. Retrospective observational studies remained the most frequently published article design, as observed over 2003-2012 (n=411, 42.1%). No review articles were published in the previous period, while 35 review articles were published in this period. Publications from countries outside Türkiye exhibited a significantly higher number of case reports and reviews (P = .001), whereas articles from Türkiye had a significantly greater number of basic science and cross-sectional studies (P = .007, P=.017, respectively). Trauma (n=207), general orthopedics (n=144), and spine (n=105) were identified as the most prominent subspecialties. Spine surgery and adult reconstruction/arthroplasty publications significantly increased, while hand and microsurgery publications significantly decreased (P < .001). Article types were compared regarding citation counts, revealing that case reports and technical notes had significantly lower citation counts (P = .001). There was a significant increase observed in the number of author affiliations (n=2.57 ± 1.40) (P < .001). Management" (n=83), "fixation" (n=78), and "surgery" (n=65) were the most occurring keywords. There was a significant increase in articles with 1 or 2 authors in the latter 2017-2022 period compared to 2013-2016 (P=.001). A significant increase was observed in publications from private clinics and other clinical facilities (P < .001).

Conclusion: Acta Orthopaedica et Traumatologica Turcica (AOTT) has emerged as one of the leading journals in orthopedics, with a notable increase in international publications in the last decade. Being in the Science Citation Index Expanded (SCI-Expanded) database, increasing impact factor, and having low self-citation rates highlight its high standards and global impact. Acta Orthopaedica et Traumatologica Turcica (AOTT) is a valuable platform for researchers worldwide to share their work and advance orthopedic knowledge.

Level of evidence: N/A.

Objective: This study aims to investigate the preferences of orthopedics and traumatology specialists in evaluating the spinopelvic relationship in primary total hip arthroplasty (THA) in Türkiye.

Methods: Members of the Turkish Orthopedics and Traumatology Association (n=2485) were invited to fill out the questionnaire. The survey was created using Google Forms and distributed to participants via WhatsApp and Gmail by sharing the link. A total of 205 orthopedic surgeons responded and completed the questionnaire. The survey included 13 questions about the duration of their experience, the number of THA and spinal instrumentation procedures they performed, the dislocation rates they encountered after surgery, and the radiological assessments they performed for the spinopelvic relationship.

Results: Sixty-three percent of the participants evaluated spinopelvic parameters in patients undergoing THA. Forty-seven percent of surgeons state that in their daily practice, they determine the angle of the acetabular component according to whether the spinal deformity is rigid, flexible, balanced, or unstable. While 88% of the participants stated the rate of encountering dislocation after primary THA as less than 2%, 12% of the participants stated it as more than 2%. It was observed that 40% of the surgeons with a prosthetic dislocation rate of more than 2% evaluated the spinopelvic relationship, while 67% of the surgeons with a dislocation rate of less than 2% evaluated the spinopelvic relationship.

Conclusion: Approximately half of the orthopedic surgeons in Türkiye plan component placement in primary THA cases by considering the spinopelvic relationship. In order to increase awareness about the spinopelvic relationship, it would be beneficial to give more space to this subject in training programs and conferences.

Level of evidence: N/A.

Objective: Post-lumbar fusion surgery often restricts daily activities due to lumbar stiffness. The validity and reliability of the lumbar stiffness disability index (LSDI) in Türkiye, which measures the impact of lumbar stiffness on functional abilities, have not yet been confirmed. This study aims to test the validity and reliability of the Turkish version of LSDI (Tr-LSDI).

Methods: Sixty-six patients who underwent lumbar fusion surgery were included in this methodological study. The Tr-LSDI was developed using a forward-backward translation. Using the Davis technique and expert feedback, we confirmed the content validity (CV) of the Tr-LSDI. The construct validity of the Tr-LSDI was assessed with exploratory factor analysis (EFA) and convergent validity. Convergent validity was examined by correlation analysis between Tr-LSDI, the Oswestry disability index (ODI) scores, and the number of fusion levels. Internal consistency was determined using Cronbach's alpha coefficients, and test-retest reliability was assessed with the intraclass correlation coefficient (ICC).

Results: Expert evaluation yielded CV indexes > 0.8 for all items. Exploratory factor analysis revealed a one-factor structure for Tr-LSDI, comprising 10 items that accounted for 63.7% of the variance. Factor loadings spanned from 0.371 to 0.926. Notably, the Tr-LSDI score correlated with fusion levels (r=0.386, P=.001) and demonstrated a robust correlation with ODI (r=0.899, P < .001), affirming its convergent validity. The Tr-LSDI displayed excellent internal consistency with a Cronbach's alpha coefficient of 0.934. The ICC was 0.980.

Conclusion: The Tr-LSDI is a validated, reliable tool for measuring lumbar stiffness in Türkiye. Its consistency, validity, and alignment with the original LSDI make it suitable for clinical and research use.

Level of evidence: Level II, Diagnostic Study.

Objective: This study aimed to develop the Turkish version of the Brief Michigan Hand Outcomes Questionnaire (B-MHQ) and to demonstrate its reliability and validity for evaluating hand function in the Turkish population with hand/wrist disorders.

Methods: This study was conducted in accordance with Beaton et al.'s Guidelines for the Process of Cross-Cultural Adaptation of SelfReport Measures. A total of 54 patients with various hand and wrist problems were included in the study. The B-MHQ and Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) were used to evaluate hand function, and the visual analog scale (VAS) was used for the assessment of pain, which were completed by the subjects at baseline and 7 days later.

Results: The Turkish version of the B-MHQ showed good internal consistency, as evidenced by Cronbach alpha coefficients ranging from 0.895 to 0.876, and excellent test-retest reliability with an intraclass correlation coefficient of 0.968. In addition, B-MHQ was strongly correlated with Q-DASH (r=-0.878) and moderately correlated with VAS (r=-0.445).

Conclusion: The Turkish version of the B-MHQ seems to be a reliable and valid tool for assessing hand function in Turkish-speaking patients with hand disorders.

Level of evidence: Level III, Diagnostic Study.

Vertebral arterial injury (VAI) remains a fatal complication of C1-C2 posterior screw fixation. Herein, we report asymptomatic bilateral VAI that was caused by screws following C1-C2 posterior fixation. A 34-year-old woman with cerebral palsy experienced quadriplegia after a fall. Cervical computed tomography (CT) showed increased ADI, with os odontoideum, for which C1 pedicle screw and C2 pedicle-lamina screw fixation were performed. Cervical magnetic resonance imaging (MRI) conducted for postoperative weakness in shoulder elevation demonstrated a well-decompressed spinal cord. However, neck CT angiography revealed bilateral vertebral artery (VA) violations by the C1 pedicle screw that induced occlusion of the V2 and V3 segments of both VA, with intact V4 segments. Diffusionweighted imaging showed no evidence of infarction. Cerebral angiography showed reconstitution of posterior circulation via the left fetal posterior communicating artery. Steroid treatment-induced improvement in shoulder elevation to the preoperative level, and no neurological deterioration has been detected for 3 years postoperatively. Prevention of VAI is one of the most important objectives when performing posterior cervical screw fixation. The screw should be inserted considering the rotation of C1 and C2. Notably, variations in cerebral circulation, which enable collateral blood flow to the posterior circulation, can lead to different sequelae in patients with iatrogenic VAI.