Ali Bülent Baz

Background: High-grade acromioclavicular (AC) joint separations are clinically relevant injuries in contact sports, yet data specific to recreational football players remain limited. This study evaluated clinical recovery, maintenance of vertical coracoclavicular reduction, and return-to-sport outcomes after minimally invasive acromioclavicular reconstruction (MINAR) in recreational players with acute Rockwood type IV-V AC joint separation. Methods: This single-center retrospective analysis included 49 male recreational football players who sustained acute, isolated, unilateral Rockwood type IV or V acromioclavicular (AC) joint separation during football participation between January 2015 and December 2023. All patients underwent surgery within 7 days of injury using the same MINAR construct and implant platform, and all procedures were performed by the same experienced surgical team. Postoperative rehabilitation was supervised by the institutional physiotherapy department, generally three times weekly, with progression individualized according to clinical recovery. The primary outcome was the change in Constant score from preoperative assessment to 24 months. Secondary outcomes included Taft, American Shoulder and Elbow Surgeons (ASES), and visual analog scale (VAS) pain scores; minimal clinically important difference (MCID) achievement; coracoclavicular (CC) distance; return to unrestricted match play; return to preinjury football level; and exploratory comparisons according to vertical reduction status. Coracoclavicular distance was measured independently by three blinded observers, and the mean of the three measurements was used for the radiographic analyses. Radiographic loss of vertical reduction was defined a priori as a 24-month injured-to-contralateral CCD ratio greater than 1.50. Because only five patients met this criterion, comparisons according to vertical reduction status were considered exploratory and descriptive. Results: The mean age was 35.1 ± 6.2 years, the mean body mass index was 27.9 ± 5.2 kg/m², and the mean follow-up was 48.6 ± 14.5 months. Forty-one patients had Rockwood type V injuries and eight had type IV injuries. All clinical scales improved over time (Friedman p < 0.001). The Constant score increased from 29.9 ± 6.0 preoperatively to 94.5 ± 3.8 at 24 months. Mean preoperative-to-24-month improvements were 64.6 points in Constant score, 6.11 points in Taft score, and 43.3 points in ASES score, while VAS pain decreased by 6.50 points. All 49 patients exceeded the prespecified Constant-score MCID threshold, and 47 of 49 patients (95.9%) exceeded the Taft-score MCID threshold. Return to unrestricted match play occurred in all patients at a mean of 239.9 ± 43.5 days, and 44 patients (89.8%) returned to their preinjury match level. Five patients met the radiographic criterion for loss of vertical reduction (10.2%; 95% CI, 4.4–21.8). In exploratory unadjusted comparisons, these five patients returned to unrestricted match play later than patients who maintained vertical reduction (332.4 ± 35.6 vs. 229.4 ± 29.8 days; unadjusted mean difference, 103.0 days; 95% CI, 59.5–146.5), and none returned to the preinjury football level (0/5 vs. 44/44). These sparse subgroup comparisons were interpreted descriptively. Conclusions: In this cohort of male recreational football players with acute Rockwood type IV-V acromioclavicular joint separation, MINAR reconstruction was followed by substantial improvement in shoulder function, minimal residual pain, and a high rate of return to football. Maintenance of vertical reduction and return-to-sport outcomes showed a clinically notable pattern in exploratory unadjusted analyses; however, the reduction-loss subgroup comprised only five patients, and patient-level chronology did not uniformly support a temporal pathway from reduction loss to delayed return. These findings should therefore be regarded as hypothesis-generating rather than predictive or causal.

Background: Adjacent segment disease (ASD) after spinal fusion is well described in degenerative cohorts, but its radiographic and clinical behavior after acute traumatic thoracolumbar fracture fusion remains incompletely defined. This study evaluated whether ASD after traumatic fusion represents an imaging finding alone or a clinically relevant recovery-limiting event. Methods: This retrospective study included 98 patients who underwent posterior instrumented thoracolumbar/lumbar fusion for acute traumatic vertebral fractures. Because urgent surgery precluded meaningful preoperative disability assessment, the 1-month postoperative Oswestry Disability Index (ODI) was used as an early post-treatment functional reference point. Radiographic ASD was defined by new or progressive adjacent-level disc degeneration, disc-space narrowing, translation, angular instability, or junctional kyphosis, whereas clinical ASD was defined strictly as revision-confirmed symptomatic adjacent pathology. Results: Radiographic ASD occurred in 54 patients (55.1%), whereas revision-confirmed clinical ASD occurred in 11 patients (11.2%). Proximal and distal involvement were observed in 39.8% and 36.7% of patients, respectively. ODI improved from 42.5 ± 15.4 at 1 month to 27.0 ± 10.9 at final follow-up. Radiographic ASD alone was not associated with worse functional recovery. In contrast, revision-confirmed clinical ASD identified patients with markedly reduced ODI improvement (4.4 ± 2.8 vs. 16.9 ± 17.0; p = 0.007), and no patient with revision-confirmed clinical ASD achieved the ODI minimum clinically important difference. Conclusions: ASD after traumatic fusion should be interpreted as a clinically stratified phenomenon: frequently radiographic, but clinically relevant primarily when revision-confirmed and associated with reduced ODI-based recovery.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Aim: The purpose of this study was to reveal mid-term outcomes by retrospectively investigating patients who underwent total knee arthroplasty with a posterior stabilized design. Material and methods: The study included a total of 68 knees of 52 patients with completed follow-up data who underwent PCL substituting (PS) total knee arthroplasty due to a diagnosis of primary or secondary osteoarthritis. The 52 patients comprised 45 (86.5%) females and 7 (13.5%) males with a mean age of 65.2±9.32 years (range, 30-82 years). The American Knee Society criteria were adopted for assessment of patient knee scores and functional knee scores. The Total Knee Prosthesis Radiological Evaluation criteria were applied for radiological evaluation of the patients. Results: The mean follow-up period of the patients was 32.1 ± 9.85 months (range: 18-60 months) and the Knee Society Scores (KSS) were 41.5 (range: 26 - 58) preoperatively, and 84.3 (range: 51 - 97) postoperatively. The mean preoperative and postoperative range of motion was 88.2º (range: 60º - 100º), and 106.7º (range: 90º - 120º), respectively. Two-stage revision surgery was applied to one patient due to deep infection. No cases of aseptic loosening were observed. Implant survivorship, and excellent and good results according to the functional knee score were reported as 98.8%, 41.1%, and 32.3%, respectively. Conclusion: Positive patient outcomes were obtained with the use of PS total knee arthroplasty in patients with severe osteoarthritis and there was no evidence of loss in mid-term follow-up.