Acta orthopaedica et traumatologica turcica最新文献

Objective: This study aimed to computationally evaluate the effects of lesions of varying sizes and locations on stress distribution and ankle stiffness across the nine-zone grid of the talar dome in three different ankle positions.

Methods: An adult ankle geometry was modeled with 1 mm of cartilage on both sides of the tibiotalar contact. Lesions with diameters of 4.5, 6.4, and 9 mm were created on the talar dome at each grid partition, ranging from section 1 (anteromedial) to 9 (posterolateral). The key innovation of the study was the use of tilted talar planes to account for the dome's curvature, enabling more accurate lesion model ing and biomechanical analysis. Percent changes in osteochondral von Mises stress distribution and ankle stiffness parameters were investigated using finite element analysis. Based on the designated design parameters, 81 different cases were modeled and simulated.

Results: Zones 7 (posteromedial, -33.2% change in stiffness for a 9 mm defect), 3 (anterolateral, -24.2% change in stiffness for a 9 mm defect), and 8 (mid-posterior, -48.8% change in stiffness for a 9 mm defect) were found to be the most critical zones, showing evidence of decreased ankle stiffness in neutral, dorsiflexion, and plantarflexion positions, respectively. Zone 9 (posterolateral; neutral -4.7%, dorsi flexion 5.4%, plantarflexion 0.17% stiffness change for a 9 mm defect) was found to be the least critical zone in terms of biomechanical stiffness.

Conclusion: From a clinical standpoint, since lesions in zones 8, 7, and 3 significantly impact joint biomechanics compared to other zones, more aggressive cartilage restoration or augmentation could be required while lesions in less problematic zones like zone 9 can be treated withmicrofracture surgery.   Cite this article as: Aslan L, Subasi O, Karaismailoglu B, et al. In silico assessment of talus osteochondral lesion size and location on biomechanical load distribution using tilted talar dome planes. Acta Orthop Traumatol Turc., 2025;59(6):361-367.

Cite this article as: Ashkani-Esfahani S, Aslan L. AOTT special issue Editorial. Acta Orthop Traumatol Turc., 2025;59(6):337-339.

Objective: This study aimed to evaluate the histopathological and biomechanical effects of intraperitoneal (systemic) and locally applied Papaverine on tendon healing in a rat rotator cuff model in which collagenase - induced tendinopathy was induced.

Methods: Twenty-four adult male Sprague-Dawley rats were randomly allocated into three groups: Group 1 (control), Group 2 (local papav erine application), and Group 3 (intraperitoneal papaverine application). Supraspinatus tendinopathy was induced by surgical injection of Type I collagenase. Group 2 received local papaverine at the surgical site, while Group 3 received systemic intraperitoneal papaverine. On day 30, the rats were sacrificed, and shoulder tissues were harvested for histopathological and biomechanical analysis.

Results: Histopathological evaluation revealed no significant differences among the groups regarding fiber structure, cellularity, or vascularity (P > .05). In contrast, biomechanical analysis demonstrated that the local papaverine group showed statistically significant superiority over the other groups in tendon breaking force, elongation, and durability (P < .0001).

Conclusion: Local application of papaverine improved the biomechanical durability of tendon tissue, although no significant histopatho logical differences were observed. These findings suggest that papaverine may contribute to regenerative processes and could serve as a supportive agent in the treatment of rotator cuff tendinopathy. However, further studies are required to confirm its clinical applicability.   Cite this article as: Çelebi ME, Meydaneri S, Çakmak O. Histopathological and biomechanical effects of papaverine application in rotator cuff tendinopathy treatment: An experimental rat model study. Acta Orthop Traumatol Turc., 2025;59(6):428-433.

Objective: To evaluate the accuracy and fluoroscopy shot count of a novel skin-matched, patient specific Instrument (PSI) for subtalar arthrodesis compared with the conventional freehand technique in a cadaveric setting.

Methods: Twelve cadaveric specimens were randomized into PSI-guided (n = 6) and freehand (n = 6) groups, with preoperative computed tomography scans used to design 3D-printed guides. Each PSI incorporated 2 pre-angled cannulated sleeves to allow optimal guidewire placement from the calcaneus into the talus. Outcomes included fluoroscopy usage, number of wire placement attempts, angular devia tion between planned and actual wire trajectories (assessed in sagittal, coronal, and axial planes), and linear deviations at entry (calcaneal) and distal (talar) points. Statistical analysis used the Mann-Whitney U and Wilcoxon signed-rank tests with significance set at P < .05.

Results: Fluoroscopy usage was significantly lower in the PSI group (median 3.0 [interquartile range, IQR 3.0-6.0]) compared with the free hand group (17.0 [15.3-18.8]; P = .009). Similarly, the number of attempts was reduced in the PSI group (2.0 [2.0-2.8]) versus the freehand group (6.0 [5.3-6.8]; P = .009). Angular deviation from the preoperative plan was low (median 3.0° [IQR 1.8°-4.7°]), indicating high trajec tory fidelity. Linear deviation at the calcaneal entry point was minimal (median 0.9 mm [IQR 0.4-1.2 mm]), whereas greater variability occurred distally at the talar point (median 3.6 mm [IQR 2.0-5.1 mm]), remaining within clinically acceptable limits.

Conclusion: The use of a skin-matched PSI for subtalar arthrodesis significantly reduced the number of fluoroscopy shots and wire place ment attempts while ensuring high accuracy of guidewire trajectory. These findings support the potential of 3D-printed PSIs to improve surgical precision, suggesting clinical applicability for subtalar arthrodesis and related hindfoot interventions.   Cite this article as: Karaismailoglu B, Subasi O, Tung W, et al. Improving subtalar arthrodesis with a skin-matched patient-specific surgical guide: a comparative cadaveric study. Acta Orthop Traumatol Turc., 2025;59(6):368-373.

Objective: To prospectively evaluate the safety and effectiveness of arthroscopic acellular dermal matrix (ADM) augmentation of large rotator cuff tear repairs (RCR) in a comparative study.

Methods: A prospective single-center series of 20 patients undergoing arthroscopic RCR. The patients were randomized to arthroscopic transosseous-equivalent rotator cuff patch augmentation repair with a decellularized dermis prepared in the tissue bank or a control group without augmentation. Preoperative and postoperative functional outcomes were assessed by The University of California- LosAngeles (UCLA) score. Magnetic resonance imaging (MRI) evaluation was obtained 1 year after surgery. All adverse events were recorded. Statistical analysis was performed in R 4.2 (Boston, USA), using non-parametric group tests for paired data to evaluate functional results. The mean age was 59 years in the ADM group and 56.7 years in the control group. The gender distribution was 60% male and 40% female in both groups.

Results: Each group consisted of 10 patients, with no statistically significant differences observed in age, body mass index, or preoperative UCLA assessment. In the ADM augmentation group, 2 patients required reoperation due to re-tear before the end of the follow-up period.No statistically significant differences were found in functional outcome measures at any of the evaluation points. Final MRI identified 5 reruptures in the matrix group and 6 in the control group, showing no statistical difference between groups. No adverse events attribut able to the presence of the grafts were detected.

Conclusion: These findings suggest that ADM augmentation may yield outcomes comparable to standard care, in terms of UCLA scores and re-tear rates. No adverse events related to ADM were observed.   Cite this article as: Sastre S, Pérez ML, Postnikov Y, et al. Prospective comparative study of arthroscopic rotator cuff repair with or without acellular dermal matrix augmentation: Clinical and radiological outcomes. Acta Orthop Traumatol Turc., 2025;59(6):446-451.

Objective: This national database study of a large cohort aimed to investigate the mortality and complication rates of patients with a his tory of solid organ transplantation (SOT) who underwent total knee arthroplasty (TKA), total hip arthroplasty (THA), or hemiarthroplasty (HA). Additionally, this study aimed to identify predictive factors for medical and surgical complications as well as mortality in this patient population.

Methods: This cohort study utilized data from the Turkish Ministry of Health to assess SOT patients undergoing TKA, THA, and HA. Propensity score matching was applied to create a comparable control group. Primary endpoints included medical and surgical complica tions within 90 days and mortality rates (in-hospital, at 1 month, 3 months, 1 year, and overall).

Results: Kidney transplantation was the most common type of transplant (n = 666, 81.5%), followed by  liver transplantation (n = 101, 12.4%). Revision rates were 4.5% in the SOT group and 3.9% in the control group (P = 0.472). SOT patients exhibited higher rates of medical complications, including chronic renal failure, pneumonia, electrolyte imbalances, urinary complications, and transfusion needs (P < 0.001). Mechanical complications were less frequent in the SOT group (2.57%) compared to the control group (3.7%), but prosthetic joint infection (PJI) rates were higher (2.57% vs. 1.4%, P = 0.035). Fracture history (HR: 4.82, 95% CI: 1.66-13.97, P = 0.004), chronic obstruc tive pulmonary disease (HR: 1.7, 95% CI: 1.17 2.46, P = 0.005), and age (HR: 1.034, 95% CI: 1.01-1.05, P < 0.001) were identified as indepen dent predictors of 90-day mortality. Patients undergoing HA experienced significantly higher mortality compared to TKA and THA (17.5%, 1.1%, and 1.7%, respectively; P < 0.001).

Conclusion: SOT patients undergoing joint arthroplasty have elevated risks of complications and mortality, particularly in the presence of fractures. Multidisciplinary management, perioperative optimization of modifiable comorbidities, and close monitoring may help mitigate these risks and improve patient outcomes.   Cite this article as: Kürşat Yılmaz M, Serdar Hakyemez Ö, Birinci M, et al. Hip and knee arthroplasty in solid organ transplant patients: results from a Turkish government-based health registry. Acta Orthop Traumatol Turc., 2025;59(6):452-457.

Objective: This study aimed to determine the prevalence of neck pain in the Turkish population and its association with sociodemo graphic factors, work status, self-rated health, obesity, depression, physical activity, non-prescribed medications, and vitamin/nutritional supplements.

Methods: A cross-sectional study was conducted using data from the 2019 Türkiye Health Survey, which included 17 084 participants aged ≥15 years. Descriptive and multivariate binary logistic regression analyses were performed to investigate the prevalence of neck pain and its associated risk factors.

Results: Neck pain prevalence increased with age, peaking between 35 and 65 years old. Women were 3.2 times more likely to experience neck pain than men. Married and divorced individuals had higher risks than single individuals did. There was no significant relation ship between neck pain and educational level or physical activity. Self-rated health showed a strong inverse relationship with neck pain: "good" health increased risk 11 times, "fair" 64 times, "poor" 145 times, and "very bad" 387 times compared to "very good" health. House workers had a lower risk (0.8 times) compared to employees, while pre-obese and obese individuals had a 1.2 times higher risk. Neck pain was twice as common in those using non-prescribed drugs and 1.3 times more common in those using vitamins and supplements.

Conclusion: Neck pain is prevalent in Türkiye, with factors such as age, sex, marital status, employment, health status, obesity, and use of non-prescribed drugs and supplements as significant risk factors. This study provides a reference for understanding neck pain, its associ ated factors, and guiding future research.   Cite this article as: Aydın HZ, Karaboğa HA, Yıldız NG, et al. Prevalence and associated risk factors of neck pain in the turkishTurkish population: A population based study. Acta Orthop Traumatol Turc., 2025;59(6):463-469.

Objective: This study aimed to evaluate the long-term results of radial head arthroplasty (RHA) in treating comminuted radial head fractures (RHF).

Methods: Patients who underwent surgery for RHF using the RHA method between 2011 and 2018 were retrospectively analyzed. We included patients who received reconstruction with a radial head prosthesis in the acute or chronic phase due to a comminuted radialhead fracture. Patients were  excluded if they had a systemic concomitant disease, a previous infection, a fracture or surgery on the same elbow, osteoarthritis, or a follow-up period of less than 5 years. Fractures were classified according to the Mason classification system. For functional assessment, postoperative evaluations included range of motion (ROM), the Mayo Elbow Performance Score (MEPS), and the Quick Disabilities of the Arm, Shoulder, and Hand score (qDASH).

Results: Thirty-five patients (23 male, 12 female) were included in the study. Twenty-five had Mason Type III fractures, and 10 had Mason Type IV RHF. The mean age was 47.8 ± 15.6 years, and the mean follow-up period was 117.3 ± 9.3 months. The mean MEPS was 87.5 ± 10.3, and the mean qDASH score was 16.7 ± 10.8. Patients with Mason Type III RHF demonstrated greater flexion (140° vs. 112.5°) and a larger rotational arc of motion (155.5° vs. 144.9°) compared to those with Mason Type IV fractures. However, extension loss, MEPS, and qDASH scores were comparable between the  groups. Radiological outcomes and complication rates also showed no significant differences between fracture types.

Conclusion: The findings of this study indicate that RHA is an effective treatment option for nonreconstructable RHF, offering reliable pain relief, restoration of elbow mobility, and  quality of life. These outcomes highlight its value in managing patients with poor prognostic factors, where conventional reconstruction is not feasible, and in preventing long-term functional impairment.   Cite this article as: Gedikbaş M, Aşcı M, Eren MB, Güneş T. Radial head arthroplasty provides successful long-term results in patients treated for comminuted fractures of the radial head, minimum eight-year follow-up. Acta Orthop Traumatol Turc., 2025;59(6):439-445.

Objective: Arch support insoles are among the first-line conservative treatments for patients with metatarsalgia. This study aims to exam ine the clinical effect, along with the associated radiologic changes in foot alignment, among metatarsalgia patients with and without the use of arch support insoles.

Methods: In this clinical trial, 14 patients with metatarsalgia aged 18 to 65 years were recruited. Pain intensity was obtained at the first visit and after 4, 8, and 12 weeks. All participants underwent bilateral weight-bearing computed tomography (WBCT) and weight-bearing (WB) radiographs of their feet while standing barefoot and on non-custom-made insoles. Several linear and angular radiological measure ments were conducted and compared between the barefoot and insole conditions. Interobserver reliability was calculated (intraclass correlation coefficient [ICC]), and the groups were compared using P < .05 as the statistical significance threshold.

Results: A total of 14 patients, consisting of 6 females and 8 males, participated in the study. Patient Reported Outcomes Measurement Information System Pain Intensity scores showed significant improvement starting from the 8th week (P = .04). Weight-bearing radio graphic measurements showed significant decreases in the M2-M3 and M2-M5 tangent angles (P = .04 and .03, respectively). Similarly, the M4-M5 intermetatarsal angle decreased when wearing insoles (P = .01). There were no significant changes in the WBCT measurements.

Conclusion: Arch support insoles significantly improved pain in patients with metatarsalgia. This symptomatic relief coincides with immediate radiologic changes, mainly in the forefoot area. Future prospective studies with larger populations are suggested to investigate the effects of these insoles on metatarsalgia with various foot types.   Cite this article as: Taseh A, Ghandour S, Karaismailoglu B, Toy K, Ashkani-Esfahani S, Landsman A. The effect of arch supports on foot alignment in patients with metatarsalgia based on weight-bearing computed tomography and radiographic parameters. Acta Orthop Traumatol Turc., 2025;59(6):374-378.