Taner Güneş

Objective: This study aimed to evaluate the mid- to long-term clinical, functional, and radiological outcomes of osteochondral autograft transplantation (OAT) in patients with advanced-stage Freiberg disease. Methods: This retrospective study included 19 adult patients with Smillie stage III–IV Freiberg disease who underwent OAT between 2016 and 2022. The study included 11 female and 8 male patients, with a mean age of 36.7- 11.8 years and a mean follow-up of 61.6 - 24.1 months. Functional outcomes were assessed using the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society lesser metatarsophalangeal–interphalangeal (AOFAS-LMI) score, and metatarsophalangeal joint range of motion (ROM). Radiological evaluation included weight-bearing radiographs and magnetic resonance imaging to assess graft incorporation and joint morphology. Preoperative and postoperative outcomes were compared, and an anchor based receiver operating characteristic (ROC) analysis was performed to determine the minimal clinically important difference (MCID) for the AOFAS-LMI score. Results: The mean AOFAS-LMI score increased from 64.3- 5.0 preoperatively to 91.0 - 5.9 postoperatively, with a mean improvement of 25.5 points (95% CI, 21.9–29.0; P<0.001). The mean VAS score decreased from 7.1- 1.3 to 1.2 - 0.6, with a mean reduction of 5.6 points (95% CI, −6.4 to −4.8; P<0.001). Mean dorsiflexion increased from 9.4 - 3.6 to 34.7- 4.2 (mean improvement, 24.1; 95% CI, 21.1–27.1; P<0.001), and mean plantarflexion increased from 17.2 - 8.1 to 43.6 - 4.9 (mean improvement, 25.0; 95% CI, 20.3–29.7; P <0.001). ROC analysis demonstrated good discriminative performance (AUC=0.82) and identified an MCID threshold of 23 points for the AOFASLMI score. Complete graft incorporation was observed in all patients, with no evidence of arthritic progression or joint collapse. Four patients (21.1%) experienced transient donor-site knee pain that resolved spontaneously by 18 months, and two patients (10.5%) underwent debridement for superficial wound infection. No revision surgery was required. Conclusion: OAT was associated with clinically meaningful improvements in pain, function, and metatarsophalangeal joint mobility at mid- to long-term follow-up in patients with advanced-stage Freiberg disease. These findings suggest that OAT may provide a clinically relevant joint-preserving treatment option for appropriately selected patients with advanced-stage Freiberg disease; however, prospective comparative studies are required to confirm these findings. Cite this article as: Gedikbaş M, Aşci M, Eren MB, Güneş T. Osteochondral autograft transplantation in advanced Freiberg disease: durable joint-preserving outcomes with clinically meaningful functional improvement at mid-to-long-term follow-up. Acta Orthop Traumatol Turc., 2026; 60(5), 0827, doi: 10.5152/j. aott.2026.25827.

Aims: Several comorbidities have been reported to adversely affect outcomes following rotator cuff repair. This study aimed to evaluate the effect of comorbidities on postoperative tendon healing and functional outcomes in patients undergoing arthroscopic transosseous equivalent (TOE) double-row rotator cuff repair.Methods: In this retrospective cohort study, 44 shoulders in 44 patients who underwent arthroscopic TOE double-row repair between April 2006 and November 2011 were analyzed. All procedures were performed by a single surgeon using an identical surgical technique. Comorbidity burden was quantified using the Charlson Comorbidity Index (CCI). Patients were classified into two groups based on CCI scores (CCI=0 and CCI≥1). Additionally, an exploratory subgroup analysis using ordinal CCI categories (0, 1, and ≥2) was performed. Functional outcomes were assessed at final follow-up using the Rotator Cuff-Quality of Life (RC-QoL) Scale, American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, and University of California-Los Angeles (UCLA) score. Tendon integrity was evaluated with magnetic resonance imaging (MRI) at a mean of 21 months postoperatively.Results: No statistically significant differences were observed between the two groups in any functional outcome measure at final follow-up (all p>0.05). Similarly, postoperative MRI revealed no significant differences in tendon healing rates between the groups according to Sugaya’s classification.Conclusion: The presence of comorbidities, as quantified by the CCI, did not adversely affect tendon healing or functional outcomes following arthroscopic TOE double-row rotator cuff repair. The enhanced tendon footprint and compression achieved by this technique may mitigate the potential negative impact of systemic comorbidities on tendon-bone healing.

Background: It is known that meniscus root tears affect the biomechanics of the knee in a way that is equivalent to a total meniscectomy. Therefore, repair is increasingly favored for meniscal root tears. In our study, we aimed to investigate the clinical and radiological outcomes of meniscal root repairs with suture anchors. Materials and Methods: Patients who had undergone surgery for medial meniscus posterior root tear (MMPRT) using suture-anchors between 2018 and 2023 were retrospectively analyzed. Patients were excluded if they had a previous infection, a fracture and an operation on the same knee, or osteoarthritis and a follow-up period under one year. The MMPRTs were classified according to the LaPrade classification system. For the functional classification, the range of motion (ROM), the Visual Analog Scale (VAS), the Lysholm Knee Score (LKS), and the International Knee Documentation Committee (IKDC) Subjective Knee Form were used for the postoperative functional assessments. The radiological assessment was performed by measuring the medial meniscus extrusion (MME) and evaluating the signal changes in the magnetic resonance imaging (MRI) of the knee, which was recorded during the last follow-up examination. Results: Thirty-two patients (6M/26F) were included in the study. The mean age was 49.9 ± 5.4 years old, and the follow-up period was 29.6 ± 24.1 months. The LKS improved from 53.7 ± 6.9 to 83.6 ± 5.2 and the IKDC improved from 46.1 ± 6.9 to 83.0 ± 5.5 at the final follow-up control (p < 0.001 and p < 0.001). The VAS score decreased from 8.4 ± 0.5 to 2.5 ± 0.9 (p < 0.001). The MRI scan of the knee performed at the last follow-up examination showed no improvement in only one patient. While the MME before surgery was 5.0 ± 2.1 mm, it was 4.6 ± 2.1 mm at the last follow-up examination (p = 0.178). An increase in the Kellgren–Lawrence stage was observed in 4 of our patients (from stage 1 to stage 2 in one patient, from stage 0 to stage 1 in 3 patients). Conclusions: The results of this study suggest that repairing MMPRTs using suture-anchors is a valid solution for treatment and prevention in patients with poor prognoses in order to achieve positive results in reducing pain, restoring mobility, improving functional outcomes and avoiding a significant increase in progression to arthrosis.

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 radial head 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 two 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 improved 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: 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. Cite this article as: Gedikbas M, Ozturk T, Asci M, Erpala F, Sobay U, Güneş T. Comparison of autologous matrix-induced chondrogenesis and mosaicplasty in the treatment of osteochondral defects of the talus. Acta Orthop Traumatol Turc., 2024;58(5):301-307.

Aim: Unicondylar knee arthroplasty (UKA) is among the treatment options for patients with arthritis limited to one compartment of the knee. Fixed-bearing (FB) and mobile-bearing (MB) inserts are present. This study aimed to compare functional and clinical outcomes and revision rates of patients operated with FB-UKA and MB-UKA. Material and Methods: A total of 131 knees of 118 patients underwent cemented UKA, with a mean follow-up period of 80.58±31.31 months for FB-UKA and 97.66±29.24 months for MB-UKA. Clinical and functional evaluation was performed by the Knee Society Score (KSS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, at the last follow-up visit. The factors affecting the radiological and functional results, complication, and revision rates were examined under three main titles; i) surgeon-related, ii) patient-related, and iii) component alignment-related factors. Results: There was no significant difference between the groups in terms of age, gender, body mass index, and side. Regarding the KSS scores, 9 (6.87%) knees were within acceptable limits, 62 (47.32%) knees were found to be good, and 60 (45.80%) knees were found to be excellent. No statistically significant difference was found between groups (p=0.497). Regarding the WOMAC scores, the MB-UKA group had significantly lower pain (p=0.049) and stiffness (p=0.014), but similar functional (p=0.591) scores. There was no statistically significant difference regarding revision rates (p=0.931). Conclusion: Similar clinical, functional, and radiological results and low revision rates were found. In terms of pain and joint stiffness, a significant difference was found between groups, in favor of MB-UKA.