Acta orthopaedica et traumatologica turcica最新文献

Objective: This study aimed to investigate if there was a link between the biomechanical properties and the number of suture strands in repairing a rotator cuff (RC) tear in a bovine model using the transosseous technique.

Methods: Fifty-four fresh tendons from bovine (mean age: 7.1 ± 0.5 months; range 6.5-7.5 months) and 1 humeral head from porcine (8.5 months) were used in this study. All the specimens had no apparent abnormalities. Using the transosseous structure, the RC tendon was detached from the greater tuberosity and randomly assigned to 3-strand, 4-strand, 5-strand, and 6-strand groups, with the glenohumeral abducted at 0° and 90°. Biomechanical tests were conducted to compare the groups' differences in the failure mode, pull-toextension load in the 1-, 2-, and 3-mm formations, and the maximum load. The analysis of variance test was performed to compare the results. Statistical significance was set at P < .05.

Results: No significant difference was observed among the groups concerning the tendon characteristics (all P ≥ .05). At 90° shoulder abduction, a significant difference was detected in the load between 3- and 5-strand groups for 1-mm gap formation (P=.049). No statistical differences were noted in the load at the gap displacements in the 1-, 2-, and 3-mm formations at 0° and 90° shoulder abduction (all P > .05). The maximum failure load and extension in maximal tension increased with the number of sutures.

Conclusion: The maximum load and ultimate extension increase with the number of sutures at both positions. The number of sutures was not an influencing factor of gap formation. Regarding the tear size and tension of the RC, choosing the appropriate number of strands individually instead of excessively increasing the number of sutures is advocated for RC repair.

Objective: This study aimed to investigate the agreement of patient-assessed and researcher/physician-assessed measurements of the difference in range of motion between the unaffected and affected shoulders in 55 patients undergoing arthroscopic surgery for a unilateral shoulder condition.

Methods: The investigation included 55 patients (17 women and 38 men; median age=53 years; range=26-74) with a symptomatic unilateral shoulder condition and a surgically treatable diagnosis. Images of a model/researcher performing active shoulder abduction, flexion, external rotation, and internal rotation were created. Each image was paired with a degree diagram or a level system (for internal rotation) on the back for the patient to accurately self-evaluate and record. Each patient was instructed to attentively examine the figures and perform the movements with the same posture as depicted. On the day of surgery, prior to the procedure, 2 independent researchers who were not involved in the patient's care used a standard goniometer to assess the same active movements that the patient had previously self-assessed. For agreement analyses, the intraclass correlation coefficient and Bland-Altman plots were calculated for continuous data (abduction, flexion, and external rotation), and Cohen's weighted kappa was calculated for ordinal categorical data (internal rotation).

Results: The intraclass correlation coefficient for abduction, flexion, and external rotation was 0.93 (excellent) 95% CI (0.87, 0.96), 0.89 (good) 95% CI (0.81, 0.94), and 0.72 (moderate) 95% CI (0.52, 0.84), respectively. Cohen's kappa for internal rotation (measured as reaching levels on the back) was 0.63 (moderate).

Conclusion: We believe that patient-assessed measurements of abduction (intraclass correlation coefficient 0.93) and flexion (intraclass correlation coefficient 0.89) can be used as a valid substitute (for measurements by a clinician or researcher). Patient-assessed measurements for external rotation (intraclass correlation coefficient 0.72) and internal rotation (kappa 0.63) are in moderate agreement and should be used more cautiously as substitutes.

Level of evidence: Level II, Diagnostic Study.

Objective: This study aimed to introduce a new wound management method combining negative pressure wound therapy and polymethylmethacrylate sealant for Gustilo type III open tibia fractures and to evaluate its clinical outcomes.

Methods: Among 186 patients who visited our institution for the treatment of open tibia fractures between January 2016 and December 2019, 20 male patients who sustained Gustilo type III open tibia fractures and were compelled to undergo delayed flap coverage using negative pressure wound therapy combined with polymethylmethacrylate sealant due to initial critical condition were enrolled in this study. We retrospectively investigated patients' demographics, interval between the injury and flap coverage, number of negative pressure wound therapy changes, flap survival, bone union time, and infection-induced complications.

Results: The mean interval from injury until flap coverage was 27.8 (range, 8-63) days. Most soft-tissue defects were reconstructed using free flaps (14/20, 70%); the anterolateral thigh flap was the most frequently used flap (12/20, 60%) in this study. Among 20 flaps trans- ferred, 16 flaps (80%) survived uneventfully, 1 flap (5%) developed partial necrosis, and 3 flaps (15%) failed. The mean follow-up period was 22.7 (range, 12- 43) months. A total of 17 patients (85%) achieved tibia fracture union. The mean bone union time was 31 (range, 12-81) weeks. With regard to infection-induced complications, 3 patients (15%) developed osteomyelitis and no patient showed superficial surgical site infection.

Conclusion: Combination therapy using negative pressure wound therapy and polymethylmethacrylate sealant serves as a useful and reliable therapeutic strategy for wound management of Gustilo type III open tibia fractures, especially when delayed soft-tissue recon- struction is unavoidable. Corresponding author: Yoo Joon Sur yoojoon@catholic.ac.kr Content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Level of evidence: Level IV, Therapeutic Study.

Objective: In this experimental animal study, a novel bilayered scaffold used in the treatment of osteochondral defects in rabbit knees was evaluated. This novel scaffold's upper (cartilage) layer consists of polyglycolic acid and hyaluronic acid, and the lower (bone) layer consists of β-tricalcium phosphate. The purpose of this study was to evaluate the efficacy of this novel scaffold, combined with or without mesenchymal stem cells (MSCs), in the treatment of osteochondral defects in rabbit knees.

Methods: Osteochondral defects were created in the left femoral trochlea of 30 rabbits. In group A, defects were treated with scaffold combined with MSCs; in group B, defects were treated with cell-free scaffolds; and group C was a control group with defects left untreated. In the 12th week, animals were sacrificed for macroscopic evaluation.

Results: The mean International Cartilage Repair Society (ICRS) macroscopic scores were 4.95 for group A, 6.16 for group B, and 8.25 for group C. The mean Oswestry Arthroscopic Scores (OAS) were 1.65 for group A, 3.39 for group B, and 6.05 for group C. The macroscopic scores were significantly higher in group C than group A for ICRS scores and group A and group B for OAS (P < .001, P < .000, P < .022).

Conclusion: In essence, our findings indicate that the newly developed osteochondral scaffold, when tested in a rabbit model, is not as effective as expected in repairing full-thickness osteochondral defects, with or without the supplementation of MSCs. Further investigation is required to enhance the effectiveness of this novel combination.

Objective: This study aimed to investigate the effect of adrenomedullin on the healing of the segmental bone defect in a rat model.

Methods: Thirty-six Wistar rats were randomly divided into 6 groups based on follow-up periods and administered a dose of adrenomedullin hormone. In each group, bilaterally, a 2-mm bone defect was created at the diaphysis of the radius. Sodium chloride solution was administered to sham groups 3 times a week for 4 and 8 weeks intraperitoneally. Adrenomedullin was administered to the study groups 3 times a week: 15 μg-4 weeks, 15 μg-8 weeks, 30 μg-4 weeks, and 30 μg-8 weeks, respectively. After euthanasia, the segmental defects were evaluated by histomorphometric [new bone area (NBA)] and microtomographic [bone volume (BV), bone surface (BS), and bone mineral density (BMD)] analyses.

Results: Although the 4- and 8-week 15 μg administered study groups had higher NBA values than the other study and control groups, the histomorphometric analysis did not reveal any statistical difference between the control and study groups regarding NBA (P > .05). In microtomographic analysis, BV was higher in the 15 μg 4-week group than 30 μg 4-week group (296.9 vs. 208.5, P=.003), and BS was lower in the 30 μg 4-week group than in the 4-week control group (695.5 vs. 1334.7, P=.005), but overall, no significant difference was found between the control and study groups (P > .05). Despite these minor differences in histomorphometric and microtomographic criteria indicating new bone formation, the BMD values of the 15 μg 8-week study group showed a significant increase compared with the control group (P=.001, respectively).

Conclusion: Adrenomedullin positively affected BMD at 15 μg, but this study could not show healing in the segmental defect site at different dose regimens. Further studies are needed to assess its effects on bone tissue trauma.

Objective: This study aimed to investigate the effect of osteosarcopenia on second fracture development and mortality in patients aged above 60 years undergoing vertebroplasty because of osteoporotic vertebral compression fracture (OVCF).

Methods: A retrospective evaluation was conducted on 104 patients treated by vertebroplasty because of OVF between 2016 and 2021. The L3 vertebra Hounsfield unit values and the psoas muscle index (PMI) values measured at the L3 vertebra level were obtained from the patients' medical data and computed tomography images. Using these measurements, the patients were divided into 3 groups: only osteoporosis (OO group), only sarcopenia (OS group), and osteosarcopenia (OSP group). Differences between the groups were evaluated regarding second OVCF development and mortality.

Results: The study included 104 patients, comprising 30 males and 74 females aged 60-92 years. The OS group included 10 patients, the OO group included 54 patients, and the OSP group consisted of 40 patients. A single vertebral fracture occurred in 72 patients, and 2 vertebral fractures occurred in 32 patients. The chi-square test, Mann-Whitney U-test, Kruskal-Wallis test, and Kaplan-Meier survival analysis results showed no statistically significant difference between the 3 groups for the risk of second vertebral fracture. Sarcopenia, either alone or in combination with osteoporosis, was seen to have a negative effect on the survival of patients who underwent vertebro- plasty following a vertebral fracture.

Conclusion: This study has shown that osteosarcopenia did not increase the risk of developing a second vertebral fracture, but it increased mortality 2.8-fold for those who underwent vertebroplasty after vertebral fracture.

Level of evidence: Level III, Prognostic study.

Objective: This study aimed to examine the cellular-level adverse effects of tourniquet use on the infrapatellar fat pad (IPFP) in patients undergoing primary total knee arthroplasty (TKA).

Methods: Infrapatellar fat pad samples were collected in a prospective, randomized design to compare 2 groups of primary TKA patients with a tourniquet (T) and without a tourniquet (NT). The study included 80 knees of 58 patients with a mean age of 65.91 ± 9.04 years. The authors collected 3 samples from the T group (after exposure to the fat pad "t1," just before deflating the tourniquet "t2," just before fascia closure "t3") and 2 samples from the NT group (t1 and t3) for each patient. BAX, Bcl-2, and HIF-1α staining showed the extent of cellular hypoxia and apoptosis in IPFP cells, whereas the oxidative stress index (OSI) was determined using a biochemical method. The Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS), and Kujala score were used as clinical outcome measures.

Results: The mean HIF-1α, BAX/Bcl-2, and OSI scores across all time points were significantly higher in the T group than in the NT group (p<0.001) (d=1.16, 2.9, and 0.9, respectively). The mean BAX/Bcl-2 (P=.030) and HIF-1α (P < .001) scores significantly peaked at t2 in the T group (d=-1.2 and -3.9, respectively). The OSI had higher levels at t1 (P=.011) and t3 (P=.073) (d=0.2 and 0.1, respectively) than at t2 in the T group. The third-month postoperative follow-up revealed that the mean KOOS, KSS, and Kujala score improved significantly compared to the baseline preoperative values (P < .001); however, there was no difference between the T and NT groups regarding the maximum and total knee range of motion or clinical outcome scores.

Conclusion: Evidence from this study has shown that tourniquet use during primary TKA may be associated with significantly increased cellular hypoxia, oxidative stress, and apoptosis in the IPFP.

Level of evidence: Level I, Therapeutic study.

Objective: This study aimed to compare the effects of a medial buttress plate (MBP) or a trochanteric lag screw (TLS) to augment cannulated screws (CSs) in fixing Pauwels type III femoral neck fractures.

Methods: This retrospective study included 58 patients (21 female, 37 male; mean age=46 years; age=19-64 years) treated by CSs for Pauwels type III femoral neck fractures from 2014 to 2017. All the patients were divided into 2 groups based on the internal fixation patterns: the MBP-augmented group (group A, n=26) and the TLS group (group B, n=32). The mean age was 47 (range=24-57) years in group A and 45 (range=19-64) years in group B. The operation time, intraoperative blood loss, reduction quality, Harris score, and postoperative complications were recorded and compared between both groups.

Results: All patients were followed up for an average of 44.8 months in group A and 47.3 months in group B (P=.406). No significant difference was noted in reduction quality (P=1.000). However, group A had a longer operation time (100.2 vs. 64.3 minutes, P < .001) and greater intraoperative blood loss (153.1 vs. 30.0 mL, P < .001) than group B. At the final follow-up, the union rate was equal between group A (96.2%) and group B (90.6%) (P=.760). The mean bone union time was 21.6 weeks in group A and 23.6 weeks in group B (P=.431). The delayed union rate was lower in group A (0%) than in group B (15.6%) (P < .001). The incidence of postoperative complications in terms of implant failure (7.7% vs. 28.1%, P=.048) and femoral neck shortening (7.7% vs. 28.1%, P=.048) were lower in group A than in group B. No significant difference was noted in avascular femoral head necrosis (P=1.000) and the Harris score (P=.659) between the 2 groups.

Conclusion: In the surgical treatment of Pauwels type III femoral neck fractures, medial buttress plating can offer fewer complications but equal avascular femoral head necrosis rate and functional outcome compared to trochanteric screw application.

Level of evidence: Level III, Therapeutic study.

Objective: The optimal glycemic control marker before total hip or knee arthroplasty remains inconclusive. Hemoglobin A1c (HbA1c) is widely used, while fructosamine may be valuable for predicting periprosthetic joint infection (PJI). Fructosamine levels can be affected by serum albumin levels; albumin-corrected fructosamine (AlbF) can be calculated to overcome this issue. The objective of this study was to evaluate the predictive value of different markers for complications after primary total hip or knee arthroplasty.

Methods: This prospective cohort study included 304 patients (mean age: 65 years [range, 16-85), mean follow-up: 32 months (range, 12-49)] who underwent primary total hip or knee arthroplasty between 2018 and 2021. Of them, 156 patients had diabetes. Mean HbA1c was 6.5% (range, 4.8%-13%), fructosamine 244 µmol/L (range, 98-566 µmol/L), and AlbF 632 (range, 238-2308). Patients who did and did not have diabetes were matched 1 : 1. Hemoglobin A1c 7% and fructosamine 292 µmol/L were used as cutoff. Complications were documented. Glycemic markers were compared using logistic regression analyses, with a special focus on PJI.

Results: In the logistic regression analyses, HbA1c was strongly associated with total complications [adjusted odds ratio (OR): 3.61; 95% CI, 1.65-7.91, P = .001], while fructosamine was associated with PJI (adjusted OR: 13.68; 95% CI, 1.39-134.89, P = .025). Albumin-corrected fructosamine did not show any additional benefits.

Conclusion: Preoperative assessment before total hip or knee arthroplasty must not focus on a single marker; HbA1c is a good predictor of total complications, while fructosamine is a better predictor of PJI. To the best of our knowledge, in its first orthopedic study, AlbF did not show any advantages.

Level of evidence: Level II, Prognostic Study.