Acta orthopaedica et traumatologica turcica最新文献

Objective: The aim of this study was to examine if tranexamic acid (TXA) can assist in improving outcomes of arthroscopic rotator cu! repair (RCR).

Methods: The databases of PubMed, Embase, Web of Science, CENTRAL, and Scopus were searched for all types of studies examining the e"cacy of TXA for arthroscopic RCR. Twelve studies, 10 randomized controlled trials (RCTs), and 2 retrospective studies were considered eligible.

Results: Meta-analysis of only 2 studies using a visual clarity grading system showed better visualization with the use of TXA. A similar di!erence was noted for studies using the visual analog scale. Operating time was not significantly di!erent between the groups, but subgroup analysis of RCTs demonstrated reduced operating time with TXA. Meta-analysis showed no di!erence in 24-hour pain scores between TXA and control groups. Qualitative assessment of studies for blood loss showed no significant e!ect of TXA. No major complications were reported in any of the studies.

Conclusion: This study has pooled evidence suggesting that TXA can improve visual clarity in arthroscopic RCR and may also result in a reduction in operating time. TXA does not seem to reduce blood loss or 24-hour postoperative pain scores.

Level of evidence: Level II, Therapeutic Study.

Objective: This study aimed to compare preoperative and postoperative measures in haemophiliacs who had simultaneous total hip and knee arthroplasties.

Methods: A retrospective database search identified five patients with severe factor 8 deficiencies who underwent simultaneous hip and knee joint replacement surgery between 2002-2018. Preoperative and postoperative evaluations included Harris Hip Score (HHS), Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score (KOOS), range of motion, flexion contracture (FC), Visual Analog Scale (VAS), hip-knee angle, and leg length discrepancy.

Results: The mean age of the patients was 50.8 years, with a mean follow-up duration of 60 months. Preoperative knee ROM was 55 degrees, improving to 73.8 degrees postoperatively. Preoperative knee FC was 13.7 degrees, improving to 10 degrees postoperatively. HHS increased from 45.6 to 75.7, KSS increased from 36 to 69.3, and KOOS total score increased from 34.4 to 82.7. VAS scores decreased from 6.3 to 1.3. One patient experienced prolonged bleeding and subsequent complications, while the others showed significant improvements.

Conclusion: Simultaneous hip and knee arthroplasties in hemophiliacs may provide benefits in terms of physical and functional gains. However, the increased risk of complications necessitates careful patient selection. For patients with comorbidities, staged surgeries may be advisable to avoid potential complications.

Level of evidence: Level IV, Therapeutic study.

Objective: The aim of this study was to evaluate disc metabolism after decreasing the axial load through surgery by assessing the glycosaminoglycan content through a non-invasive method-delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC).

Methods: Sixteen patients with mono-segmental disc degeneration (L4-L5 or L5-S1) who underwent posterior lumbar spine fixation with intervertebral distraction of 2 consecutive vertebrae using monoaxial transpedicular screws and lyophilized allograft to achieve segmental fusion, and who had a follow-up period of at least 2 years, were included in this study. The first lumbar disc was used as the control group. The dGEMRIC studies in degenerative and control discs, visual analogue scale (VAS), Oswestry disability index (ODI), lumbar lordosis, and disc thickness were reviewed before and after surgery.

Results: Visual analogue scale and ODI showed significant improvements (P=.003, P=.0004, respectively). The thickness of the operated discs was increased by an average of 2.41 mm (P=.0004) while maintaining lumbar lordosis (P=.35). In pre- and post-surgery dGEMRIC studies, the operated discs showed a significant di!erence (P=.0013), while the control groups remained approximately unchanged (P=.87).

Conclusion: We have demonstrated that by restoring the disc height and reducing the associated pressure, the glycosaminoglycan content can be increased in the discs, as indicated by a decrease in gadolinium binding. Our results suggest that eliminating pressure on intervertebral discs can prevent their degeneration and initiate the regeneration process.

Level of evidence: Level IV, Therapeutic study.

Objective: The aim of this study was to evaluate whether the locking femoral neck plate (LFNP) can be an alternative fixation method to the cannulated screws with a medial buttress plate. For this purpose, we compared biomechanically the LFNP and cannulated screws with or without a medial buttress plate in Pauwels type 3 femoral neck fractures.

Methods: A vertical fracture model was created at an 80-degree angle to the femoral neck in 28 synthetic bone models. The models were randomly divided into 4 groups, each containing 7 bones each. The bone fracture models were fixed with 3 parallel cannulated screws in group 1, 3 parallel cannulated screws combined with a medial buttress plate in group 2, LFNP in group 3, LFNP combined with a medial buttress plate in group 4. The stability of the specimens was tested biomechanically at a 7° valgus inclination to simulate normal 2-legged weight-bearing through an anatomical femur. The forces corresponding to 0.5 mm, 1 mm, 1.5 mm, and 2 mm displacement and failure loads were calculated in all groups.

Results: The axial load values corresponding to 4 di!erent fracture displacements and the failure load values of the groups were compared, group 1 was significantly weaker (P < .05 for each) while group 4 was significantly stronger (P < .05 for each) compared to the other groups. There was no statistically significant di!erence between group 2 and group 3 (P > .05 for each).

Conclusion: The results of this biomechanical study showed that the LFNP fixation system provided su"cient biomechanical stability for unstable Pauwels type 3 femoral neck fractures. The biomechanical performance of LFNP was similar to that of cannulated screws with medial buttress plate and better than that of cannulated screws alone. This suggests that LFNP can be a promising stable alternative fixation method to cannulated screws with a medial buttress plate in unstable femoral neck fractures.

Objective: This study aimed to investigate the e!ect of arthroscopic Bankart repair (ABR) alone and ABR with an additional remplissage procedure on joint range of motion and functional results in patients with anterior shoulder instability.

Methods: This retrospective study included patients treated 1 year ago with either ABR alone or the ABR additional remplissage procedure. The Bankart lesion was determined by magnetic resonance imaging, and the amount of glenoid bone loss was determined by computed tomography. Patients with glenoid bone loss <25% and on-track Hill-Sachs lesions (HSLs) were treated with ABR alone (22 females, 8 males; mean age=27.4 ± 6.4 years). Those with o!-track HSL were treated with both ABR and remplissage (20 females, 10 males; mean age=27.5 ± 5.3 years). One year after surgical treatment, the joint range of motion of the patients was determined by a universal goniometer, and functional status was evaluated using the Rowe score.

Results: Sixty shoulders of 60 patients were evaluated over an average period of 1 year. There was no di!erence between groups regarding age (P=.767) and gender (P=.779). There were 42 female and 18 male patients, with a mean age=27.5 ± 5.8 years. There was a significant di!erence between the groups in patients' external rotation with arm adduction (ER1) (P=.001), external rotation with arm abduction (ER2) (P=.001), forward flexion (P=.001), and abduction (P=.001) measurements between the groups (P < .05). No significant di!erence was found in internal rotation and Rowe scores between the groups (P=.057, P=.069). A greater improvement was seen in the Rowe score of the ABR+remplissage group (85.2 ± 8.8). No recurrence or complications were observed in any of the patients.

Conclusion: The combined procedure of ABR with remplissage may limit joint mobility in patients with anterior shoulder instability. However, it provides satisfactory functional results, with patients in the ABR+remplissage group showing better overall outcomes.

Level of evidence: Level III, Therapeutic study.

Objective: This study aimed to investigate the distribution of knee phenotypes based on the CPAK classification in healthy nonarthritic subjects and osteoarthritic patients in Türkiye.

Methods: Radiological EOS analysis of nonarthritic 1172 knees and osteoarthritic 571 knees was evaluated to clarify the distribution of CPAK classification. The knees were categorized into 9 subgroups according to the arithmetic hip-knee-ankle (aHKA) angle and joint-line obliquity (JLO). The medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA) were used to calculate aHKA and JLO. The Sectra workstation program was used for all radiological measurements.

Results: In the nonarthritic group, CPAK distribution was 20.9% type I (n=245), 2.5% type II (n=30), 0.08% type III (n=1), 46.67% type IV (n=545), 7.7% type V (n=91), 0.7% type VI (n=9), 18% type VII (n=211), 2.9% type VIII (n=35), 0.2% type IX (n=3). The mean JLO was 173.7 ± 4.38, and the mean aHKA was 0.15 ± 3.81 in nonarthritic group. Arthritic group CPAK type distribution was 20.7% type I (n=118), 3.1% type II (n=18), 0.17% type III (n=1), 57.1% type IV (n=326), 8.4% type V (n=48), 0.17% type VI (n=1), 7.8% type VII (n=45), 1.4% type VIII (n=8), and 0.8% type IX (n=5). The mean JLO was 174.2 ± 3.78, and the mean aHKA was !2.21 ± 4.48 in the osteoarthritic group.

Conclusion: CPAK type IV and CPAK type I were the most common subgroups in the nonarthritic and arthritic groups. CPAK type 5, which is the target of the mechanical alignment strategy, is only 7.8% in the nonarthritic group and 8.4% in the osteoarthritic group in the Turkish population.

Level of evidence: Level III, Diagnostic Study.

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.