Utkan Sobay

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.

Background/Aims: Coxadini is a painful disease of the vertebral apex whose most common aetiological cause is direct-indirect trauma. While in acute cases cure is usually achieved with conservative treatment, in persistent cases interventional treatment methods come to the fore. Injections are often used when there is no response to conservative treatment. Injections can be given either directly into the posterior coccygeal region under fluoroscopic guidance or into the precoccygeal region. The most commonly favoured precoccygeal block is the impar ganglion block. In our study, we aimed to analyse the pain and sleep quality of patients who had undergone ganglion impar blockade at the end of the one-year follow-up. Material and Methods: Patients who presented with coxadinia between October 2019 and April 2021 were retrospectively analysed. Patients who did not respond to conservative treatment, were over 18 years of age at the time of the procedure, had symptoms that persisted for more than 6 months and agreed to participate in the study were included in the study. The VAS, SF-36 and Pittsburg Sleep Quality Index measurements recorded at the first examination of the patients were analysed. All patients were called in for a final follow-up 12 months after the injection and the VAS, SF-36 and Pittsburg Sleep Quality Index assessments were repeated. Results: 20 patients (17F / 3M) were included in our study. The mean age of my patients at the time of intervention was 41.05 ± 11.27. The mean time from symptom onset to intervention was 22.25 ± 17.06 weeks. There was a significant decrease in VAS scores, and significant improvement in SF-36 subcategories and Pittsburgh Sleep Quality Index scores. (p < 0.001) Conclusion: Ganglion impar injection is a treatment method that can help relieve pain, improve sleep quality and daily-life functions in cases that do not respond to medical treatment and lifestyle changes

Purpose: When infectious diseases are suspected, culture studies ensure the selection of the appropriate antimicrobial treatment and confirm the diagnosis. There are various differences in medium, sample collection technique, enrichment, and evaluation techniques. Culture sampling makes important contributions to the diagnosis and treatment of prosthetic joint infections, the frequency of which has increased in recent years as a result of the increased rate of arthroplasty. After evaluating the preoperative and intraoperative criteria together, prosthetic joint infections can be diagnosed in suspected cases without culture positivity. This study aims to evaluate different culture samplings efficiency for the diagnosis of prosthetic joint infection. Methods: This study retrospectively evaluated 946 patients who had been sampled in our department between January 2005 and May 2015. These patients were divided into two groups according to their final diagnoses: group one (prosthetic joint infection) and group two (suspected but non-infected prosthetic joint replacement). Considering patients' final diagnoses, this study aimed to compare the results of the blood culture bottle (BCB) method and the standard sterile fluid culture method. Results: When cultivated in a blood culture flask, the sensitivity of the culture test was 28.09%, specificity was 95.77%, and accuracy was 58.13%. When cultivated in a solid medium, sensitivity was 10.11%, specificity was 100%, and accuracy was 50%. Conclusions:When prosthetic joint infection is suspected, BCB usage is a preferable, safer method compared to the standard sterile fluid culture method because it has the power to isolate more bacteria with a higher diagnostic value.

In the present study, we aimed to determine the risk factors predicting femoral and/or tibial tunnel widening after single-bundle anatomical anterior cruciate ligament reconstruction using hamstring autograft and to investigate the effect of tunnel widening on clinical outcomes. Forty-two patients who underwent single-bundle anterior cruciate ligament reconstruction using hamstring autograft between the dates of November 2011 and June 2020 and met the inclusion criteria of the study were retrospectively reviewed. The amount of tunnel widening was obtained by finding the difference between the measurements made by examining the oblique-coronal and oblique-sagittal reconstruction sections in the computed tomography taken one year after the surgery and the diameter of the drill bit used in the surgery. The patients were divided into two groups as those with tunnel widening (>0.5 mm) and those without tunnel widening (≤ 0.5 mm). The factors that may cause tunnel widening were evaluated separately. International Knee Documentation Committee (IKDC) subjective knee form and Tegner activity scores were used in the clinical evaluation. According to the multivariate regression analysis performed, lateral posterior tibial slope was seen to be a good predictor of femoral and tibial tunnel widening. In the receiver operating characteristic (ROC) analysis, it was determined that lateral posterior tibial slope, especially above 6°, significantly affected both femoral and tibial tunnel widening after anterior cruciate ligament reconstruction. The present study showed that increased lateral posterior tibial slope was an independent factor predicting tibial and femoral tunnel widening following single-bundle anatomical anterior cruciate ligament reconstruction using hamstring autograft, but these tunnel widenings had no significant effect on clinical outcomes.

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.

Purpose: To determine the prevalence of enchondromas (EC) in adults as incidental findings in the long bones of the upper extremities and the bones of the hand on magnetic resonance imaging (MRI). Materials and Methods: A retrospective review of upper extremity MRI scans for the presence of incidental EC in patients older than 18 years was performed. EC location, size, and appearance were defined. Age, gender, MRI region, side, most common symptom, eccentric or central location in the bone, affected finger, presence of biopsy, presence of trauma history,and size of enchondroma were evaluated. Results: A total of 9713 upper extremity MRIs were evaluated. In our study, the prevalence of EC in the entire upper extremity was 1.2% with MRIs that performed for upper extremity bones only. EC was most commonly seen in MR imaging of the hand. The proximal phalanx was the most commonly affected bone. Often presentin the third and fourth decades of life and the ulnar side of long bones were affected. In our study, the overall prevalence of hand EC was 4.8%. While the incidence of hand enchondromas was 5.8% in females, it was 4.1% in males. The incidence of enchondromas in the hand was approximately 5.77 times higher than in the shoulder. Conclusion: This study suggests that with the prevalence of EC, as determined by MR imaging, the hand should continue to be considered the most common site for enchondromas.