Acta orthopaedica et traumatologica turcica最新文献

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 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: 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: 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: 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: 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.