Gökhun Arıcan

Purpose: The aim of this study was to evaluate how the pie‐crusting technique affects clinical and radiological outcomes in patients undergoing arthroscopic partial meniscectomy.Methods: A total of 68 patients with Kellgren–Lawrence (K‐L) grade 2 who underwent arthroscopic partial meniscectomy between 2015 and 2021 were evaluated and divided into two groups as arthroscopic partial meniscectomy (36 patients) and arthroscopic partial meniscectomy with pie‐crusting (32 patients) according to whether the pie‐crusting technique was applied or not. All patients were evaluated at a minimum 2‐year follow‐up in terms of Lysholm score, Tegner activity score, International Knee Documentation Committee (IKDC) score and Visual Analogue Scale (VAS) score. To assess the impact of the pie‐crusting technique, radiological measurements were conducted using radiographs taken before and after pie‐crusting, as well as postoperative radiographs.Results: Lysholm, Tegner, IKDC and VAS scores exhibited statistically significant differences after surgery compared to preoperative evaluations in both groups (p < 0.05). Furthermore, these scores were significantly superior in the arthroscopic partial meniscectomy with pie‐crusting group compared to the arthroscopic partial meniscectomy group at 24 months postoperatively (p < 0.05). While the radiological measurements in the arthroscopic partial meniscectomy with pie‐crusting group showed statistically significant differences before and after pie‐crusting (p < 0.05), no significant difference was observed between before pie‐crusting and 12 and 24 months postoperatively (n.s.).Conclusion: The current study is the first to demonstrate the true effectiveness of the pie‐crusting technique. The application of the pie‐crusting technique when necessary results in a statistically significant improvement in clinical scores without affecting radiological measurements for patients undergoing arthroscopic partial meniscectomy compared to not utilising it.Level of Evidence: Level III.

AIM The aim of this study was to evaluate the outcomes of the patients who underwent OCF fixation and simultaneous MPFL reconstruction after patellar dislocation in children. MATERIAL AND METHOD A total of 12 patients who underwent OCF fixation and simultaneous MPFL reconstruction between 2018 and 2021 were retrospectively evaluated. Demographic information, surgical specifics, and clinical follow-up data were gathered. Postoperative clinical assessments were conducted utilizing Kujala and Lysholm scores. RESULTS The mean age at surgery was 10.4 years (range, 7-15 years). The mean period of follow-up was 36.5 months(range, 24-58). One (8%) patient required a second surgery on the ipsilateral knee. The mean surface area of the fragments was 2.5 cm² (SD: 1.4). Preoperatively, the Kujala score and the Lysholm score were 38.2 (SD: 13.3) and 44.1 (SD: 10.4), respectively. These scores exhibited significant improvement postoperatively, reaching 87.6 (SD: 11) and 88.2 (SD: 10.3) at the latest follow-up. Radiological examinations, including X-ray and MRI, indicated favorable healing of the OCFs. CONCLUSION Osteochondral fracture fixation in children with patellofemoral instability can be effectively managed through fixation combined with simultaneous medial patellofemoral ligament reconstruction. The mid-term results have demonstrated satisfactory outcomes.

Although there are many studies evaluating optimal inlet and outlet angles required for the correct placement of S1 iliosacral screws, there is no study evaluating reliability and feasibility of these angles for all individuals on three‐dimensional (3D) anatomical models. A total of 100 women and 100 men were selected randomly. A vertical line was created according to long axis of the tomography device on which patient was lying in supine position. The automatized best‐fit planes were created on superior and inferior endplates, anterior cortex including notch region and posterior cortex of first sacral vertebrae using 3D imaging software to measure mean inlet and outlet angles. We observed no statistically significant difference between gender groups in terms of inlet and outlet angles. Mean inlet view is obtained for anterior cortex of S1 in 22.5 ± 9.5° and for posterior cortex in 46.5 ± 9.3°. Mean fluoroscopic view angle of S1 for superior outlet is 40.3 ± 7.6 and for inferior outlet is 46.9 ± 8.8. Mean anterior and posterior S1 inlet view angles do not accurately visualize anterior cortex of 74 (37%) and posterior cortex of 66 (33%) individuals. Mean superior and inferior S1 outlet view angles do not accurately visualize superior endplate of 74 (37%) and inferior endplate of 56 (28%) individuals. Due to individual alterations of spatial position of sacrum, mean inlet and outlet view angles of S1 are not sufficient to visualize the iliosacral screws under fluoroscopy in many individuals.

Background: Tibial slope measurements performed using only the proximal part of tibia ignore the native tibial anatomical axis. Our first aim is to measure the native medial, lateral and total tibial slope angles of gender groups using the whole tibial anatomical axis on computerized tomography-based three-dimensional anatomical models. The second aim is to determine the correlation between proximal and whole tibial anatomical axis for measurement of medial, lateral, and total tibial slope angles. Methods: We randomly selected 100 females and 100 males between 18-60 years of age. Three-dimensional anatomical models of right and left tibia were created. The gender-specific differences of medial, lateral, and total tibial slope angles according to proximal and whole tibial anatomical axis were measured. Correlation coefficients (r) of medial, lateral, and total tibial slope angles measured with proximal and whole tibial anatomical axis were calculated. Results: The mean age was 47.1 years. A statistically significant difference was observed between female (7.1 ± 3) and male (8.2 ± 2.5) groups in terms of mean lateral tibial slope angles according to the whole tibial anatomical axis (p=0.008). A strong correlation between proximal and whole tibial anatomical axis for all tibial slope angle measurements was detected. Conclusion: The method we determined for 3D measurement of medial, lateral and total tibial slope angles using proximal tibial anatomical axis has a strong correlation with slope angles measured in accordance with the whole tibial anatomical axis. Our 3D tibial slope angle measurement method on the proximal tibia has high reliability and could be used in the daily practice.

Background Knee arthroscopy is the most common surgery performed to treat meniscal injuries. The pie crust (PC) technique is applied during knee arthroscopy to increase joint vision of the medial femorotibial compartment and reduce the risk of iatrogenic damage. Medial collateral ligament (MCL) release is applied in the PC technique. Currently, there are no studies directly comparing the release of the superficial MCL (sMCL) or deep MCL (dMCL) when applied during the PC technique. In this study, we compared the clinical and functional results of the release of the deep and proximal tibial attachment of the superficial fibers of the MCL. Methodology We evaluated the results of 67 (27 women and 40 men) patients who underwent the PC technique during knee arthroscopy due to a medial meniscal tear. The patients who underwent the PC technique were divided into two groups according to the release of the deep and superficial fibers of the MCL. All patients were evaluated for pain, functional capacity, and laxity using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Oxford Knee scores. All patients were evaluated with radiographic examinations such as valgus laxity angle and medial tibiofemoral compartment opening height. Results The KOOS and Oxford Knee Scores in both groups showed a statistically significant increase at 12 months postoperatively compared with the preoperative values (p = 0.005, 0.002, 0.002, and 0.01, respectively). No statistically significant difference was found between the groups (p > 0.05). When the valgus laxity angle before the PC technique was compared with the 12-month result after the procedure, no statistically significant difference was noted (p > 0.05). There was no evidence of complications such as chondral injury and saphenous nerve or vein injury among patients in either group. Conclusions In this study, we did not observe laxity in the long-term follow-up of the groups in which the superficial or deep fibers of the MCL were released. In our view, the PC technique has similar effects on surgical outcomes regardless of sMCL and dMCL release techniques.

In the absence of effective long-term repair of meniscal injuries, damage to the knee may lead to the development of osteoarthritis. Recent reports have recommended meniscal repair to be undertaken in all cases of meniscal tears. However, the most common complication encountered during repair of the medial meniscus is iatrogenic cartilage and meniscal injury due to its unclear visualization. The aim of this study is to evaluate the long-term clinical and radiological results of the pie-crust (PC) technique performed during the repair of medial meniscal tears. This retrospective study included 86 patients who underwent arthroscopic medial meniscus repair. PC technique was performed if the medial joint width was less than 5 mm. The patient population was divided into two groups as who underwent meniscus repair with PC technique (PC + repair group) or not (repair group). All patients were evaluated clinically (Kujala score, International Knee Documentation Committee (IKDC) subjective score, Lysholm score, and Tegner activity score) and radiologically (medial joint width and valgus laxity angle). When the medial joint width measurements before the PC technique and at the postoperative first and sixth months were compared, it was found to be statistically significant (p < 0.05). However, there was no significant difference between the preoperative and 12-month postoperative joint width measurements (p > 0.05). At the 12-month follow-up, no statistically significant difference was determined for the valgus laxity angle in the PC group compared with preoperative values (p > 0.05). The follow-up Kujala score, IKDC subjective score, Lysholm score, and Tegner activity score were similar between the groups. The clinical scores in both groups were determined to have statistically significant increase at 12-month postoperatively compared with the preoperative values (p < 0.05). The results of this study showed that performing the PC technique prior to medial meniscal tear repair increase the medial joint visualization safely and effectively without permanent valgus laxity.

Dünya genelinde en önde gelen ölüm ve sakatlık sebepleri arasında yer alması sebebiyle halk sağlığını tehdit eden travma ile Ortopedi ve Travmatoloji ailesi olarak ön saflarda mücadele etmekteyiz. Bu alanda bugün ki mesleki uygulamalarımız ve yaklaşımlarımıza ulaşmamızda bizlere öncü olan büyüklerimizin tecrübelerine duyduğumuz minnet sonsuzdur. Tüm bu bilgi birikimine bir nebze katkıda bulunmuş olmak en büyük hedefimizdir. Ortopedi ve Travmatoloji uzmanlık eğitiminde yol gösterici olmasını istediğimiz bu eser; bilgilerimizin ve deneyimlerimizin güncel literatür ışığında bir derlemesidir.

Purpose: The aim of the present study was to compare the diagnostic values of clinical tests and magnetic resonance imaging (MRI) which used for the diagnosis of subscapularis (SSc) tears in the patients who underwent arthroscopic rotator cuff surgery. Methods: Two‐hundred and nine consecutive patients who underwent arthroscopic rotator cuff surgery between 2015 and 2019 were analyzed. The lift‐off test, belly‐press test and bear‐hug test were performed preoperatively. 1.5 T MRI scans of all patients were evaluated for SSc integrity. The diagnostic values of both clinical tests and MRI were calculated. SSc tears were graded according to Fox and Romeo. Arthroscopic findings were used as the gold standard for diagnosis of SSc tears. Results: There were 54 SSc tears accounting for an prevalence of 29%. The BHT showed the greatest sensitivity for both type II–II–IV (73.3%) and all types of (68.5%) SSc tears. The sensitivity and specificity of the combined test and MRI were 91.1–87.2% and 93.3–90.8% in Type II–III–IV SSc tears, respectively, and 81.5–88.6% and 88.9–94.7% in all SSc tears, respectively. There were no statistically significant difference between combined test and MRI in terms of sensitivity and specificity (n.s.). Conclusion: The present study is the first that compared both clinical tests and MRI with arthroscopic findings in terms of sensitivity and specificity in the same patient group. A combination of clinical tests increases their diagnostic values and shows similar sensitivity and specificity as MRI. Level of evidence: I.

Aim: Hemiarthroplasty is an appropriate treatment option for hip fractures that provides early mobilization, and good functional results. In the available literature, there are few studies that particulary investigate the risk factors affecting the 30-day mortality after hemiarthroplasty in geriatric patients with hip fractures. This study aimed to determine patient-related factors and biochemical predictors, which were easily accessible, inexpensive, and routinely examined in the perioperative period of 30-day mortality in geriatric patients after hemiarthroplasty for femoral neck fractures. Methods: We enrolled 169 patients in our study, retrospectively. Age, body mass index, hospitalization time from admission to surgery, total hospitalization time, comorbidities, American Society of Anesthesiologists scores, blood transfusions, anticoagulant medications, albumin and plasma replacements, preoperative and postoperative hemogram, and biochemical tests were analyzed to determine the major predictors of 30-day mortality. Results: The 30-day mortality rate was 14.2%. Multivariate analysis indicated increased age (>80 years of age) (1.095 odds ratio, p = 0.029), American Society of Anesthesiologists score (3.584 odds ratio, p = 0.007), and postoperative creatinine level (2.845 odds ratio, p = 0.001) as the major predictors of 30-day mortality after hemiarthroplasty for femoral neck fractures in geriatric patients. Conclusion: Older age (>80 years of age), higher American Society of Anesthesiologists scores (ASA score 3 or 4) and increased postoperative creatinine levels were associated with an increased risk of 30-day mortality.

Introduction A recent histopathological and immunohistochemical study has proved that the addition of concentrated growth factors (CGF) to the Masquelet’s technique contributes to the quality of the membrane formed, in respect of inducing inflammation and proliferation, maintaining vascularization on large diaphyseal bone defects, and increasing the number of stem cells. The aim of the study is comparison of radiological results of this combination treatment by micro-CT. Materials and methods The study was planned on a critical bone defect model in rabbit radius. Group I and Group III were the control groups to which only the Masquelet’s technique is applied. Group II and Group IV were CGF groups in addition to the Masquelet’s technique. CGF was prepared by centrifugation of rabbit’s own blood. For early phase, Groups I and II were evaluated in the 8th week, while for late phase, Group III and Group IV were evaluated in the 12th week. Groups were compared in terms of bony union radiologically by micro-CT(μCT) (New Bone Volume (NBV), Total Bone Volume (TBV) and NBV/TBV) and histopathologically. Results The structural parameters, including NBV, TBV, NBV/TBV were higher in the early- (8th week) and late-phase (12th week) CGF group. There was no statistically significant difference between CGF and control groups in early phase, (p = 0.153), while in late phase, CGF group was significantly higher of new bone volume than the control group, 246.3 mm³ (196.1–258) and 169.6 mm³ (154.3–235.9), respectively (p = 0.028). For early phase, control group was significantly lower than late-phase control group, 121.8 mm³ (88.8–144.4) and 169.6 mm3 (154.3–235.9), respectively (p = 0.006). The ratio of New Bone Volume to Total Bone Volume (NBV/TBV ratio) in CGF groups was significantly higher compared to the control groups 27.3% (24.7–29.6), 35.3% (32.1–38.6) (p = 0.032) and 39.7% (36.7–41.6), 55.3% (52–57.5) (p = 0.002), respectively. Histopathologically, Microscopic New Bone Formation had no statistically significant difference between control and CGF groups in early phase (8th week) (p = 0.153), while in late phase (12th week), CGF group had significantly higher amount of new bone formation than the control group, 0.29 µm² (0.27–0.36), 0.51 µm² (0.42–0.59), respectively (p = 0.008). Conclusion The addition of CGF to the Masquelet’s technique is an important method for supporting new bone formation in large diaphyseal bone defects. Level evidence Level III, therapeutic/care management.