... Yönden Deneysel Olarak Karşılaştırılması Prof. Dr. Ali Kemal US Op. ... lk adım 1914'de ... more ... Yönden Deneysel Olarak Karşılaştırılması Prof. Dr. Ali Kemal US Op. ... lk adım 1914'de Hibbs tarafından yapılan posterior füzyon ameliyatıyla atılmıştır (1,2). Skolyoz cerrahisindeki en büyük ilerleme ise Harrington tarafından geliştirilen enstrumentasyon olmuştur. ...
İnönü Üniversitesi Turgut Özal Tıp Merkezi dergisi, 2013
Aim: We aimed to show that successful results can be obtained by combining the fractured parts ov... more Aim: We aimed to show that successful results can be obtained by combining the fractured parts over the operating table and fixing them with an anatomic plate in Mason type 3 - 4 multi-fragmented and / or displaced radial head fractures. Materials and Methods: Eleven cases of the 29 patients, operated in Yildirim Beyazit University Ankara Ataturk Education and Research hospital with the diagnosis of Mason type 3-4 radius head fracture, between June 2005nOctober 2011, in which fracture reducted outside, than providing the head reconstruction and fixing with radius head plate; were evaluated retrospectively. Results: Eight patients were male, 3 were female. Patient's ages ranged from 24 to 47 years of age with a mean age of 35 years. Mean follow-up was 44,9 months. Patients were evaluated for elbow with disabilities of the arm, shoulder and hand outcome measures and Mayo elbow performance index with radiological examination of the fractures. Conclusion: Radial head is secondary stabilizer to the elbow and forearm. In the cases of undergoing resection and/or prostetic replacement after unsuccessful reduction of radius head fractures because of crash or deplacement such as Mason type 3 n 4, trying to combine the parts of the fracture at the surgery table, than reconstruction of the head following by fixation with anatomic plate, can be an operational alternative especially in younger patients. Key words: Radius Fractures; Fractures-Comminuted; Fracture Fixation-Internal; Arthroplasty-Replacement.
The medial patellofemoral ligament (MPFL) is the main medial stabilizer of the patella, while rec... more The medial patellofemoral ligament (MPFL) is the main medial stabilizer of the patella, while reconstruction of the ligament is a common surgery performed by orthopedic surgeons. Although several surgical methods have been described regarding MPFL reconstruction, the common goals of these surgeries are to imitate the anatomic features of the native MPFL. In the single-incision and single patellar tunnel and double-bundle MPFL reconstruction technique, we will present the anatomical footprint of the MPFL located in the medial aspect of the patella, which is filled with the graft. In this technique, graft fixation is performed in the femoral tunnel using only one bioabsorbable screw without the need for fixation in the patella.
Orthopaedic Journal of Sports Medicine, Sep 1, 2022
Background: Soft tissue interposition between a suspensory cortical button and the lateral femora... more Background: Soft tissue interposition between a suspensory cortical button and the lateral femoral condyle is the most common cause of postoperative suspensory cortical button migration in patients undergoing anterior cruciate ligament reconstruction (ACLR). Purpose: To investigate the effects of soft tissue interposition and suspensory cortical button migration after ACLR on functional outcomes and graft ligamentization. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 249 patients who underwent single-bundle ACLR with hamstring tendon autografts. To measure soft tissue imposition, the patients were divided into 2 groups: those in whom the suspensory cortical button was in contact with (group 1) or at least 1 mm away from (group 2) the lateral femoral condyle on 1-day postoperative radiographs. To measure suspensory cortical button migration, the patients in group 2 were further divided into 2 subgroups: those with button migration (group M) and those without migration (group non-M) as observed on 12-month postoperative radiographs. Ligamentization was evaluated according to Howell classification (grades 1-4) on 12-month follow-up magnetic resonance imaging scans. Also recorded were preoperative and 24-month postoperative Lysholm and Tegner scores and 24-month postoperative arthrometer measurements for anterior knee laxity. Results: There was no significant difference between groups 1 and 2 or between groups M and non-M in terms of demographic characteristics or additional intra-articular pathologies detected intraoperatively. Normal anterior laxity (<3 mm) was detected in 83.7% of the patients postoperatively, and all patients showed statistically significant pre- to postoperative improvement on the Tegner (from 4.1 to 4.3) and Lysholm (from 44.0 to 89.2) scores ( P < .05 for both). No significant difference in postoperative functional results or graft ligamentization was found between either the soft tissue interposition groups (groups 1 and 2) or the suspensory cortical button migration groups (groups M and non-M). Conclusion: Differences between patients in soft tissue interposition and suspensory cortical button migration did not significantly affect postoperative clinical or functional outcomes or graft ligamentization after single-bundle ACLR.
Orthopaedic Journal of Sports Medicine, Apr 1, 2022
Background: Ramp lesions are encountered in 16% to 24% of all anterior cruciate ligament (ACL) ru... more Background: Ramp lesions are encountered in 16% to 24% of all anterior cruciate ligament (ACL) ruptures. However, isolated ramp lesions without a ruptured ACL have also been reported. Purpose: To evaluate outcomes after type 3 hidden ramp lesions without ACL rupture were treated with all-inside sutures passed through the standard anterior portal. Study Design: Case series, Level of evidence, 4. Methods: Included were 41 patients (26 female; 63.4%) with isolated type 3 ramp lesions who underwent surgery between January 2017 and January 2019. Patients with concomitant lateral meniscal injuries and revision meniscal surgeries were excluded. We retrospectively recorded patient age, sex, and body mass index (BMI), as well as follow-up periods, comorbidities, and postoperative and early midterm complications. The Lysholm, visual analog scale (VAS) for pain, and International Knee Documentation Committee (IKDC) scores were compared preoperatively to final follow-up. In addition, patients were classified as having either a sedentary or active lifestyle according to Sedentary Behavior Research Network (SBRN) criteria. The Shapiro-Wilk test was used to evaluate the normality of the data, and the Wilcoxon and Mann-Whitney U tests were used to compare preoperative and postoperative outcome scores. The Spearman test was employed to evaluate the correlation between patient variables. Results: The mean follow-up period was at 37.6 (range, 25-49) months. A total of 17 patients (41.46%) had a sedentary lifestyle based on SBRN criteria. All scores improved significantly from preoperatively to final follow-up (VAS, from 8.43 ± 1.53 to 2.34 ± 2.9; Lysholm, from 47.73 ± 17.02 to 85.37 ± 14.01; and IKDC, from 27.12 ± 14.81 to 85.32 ± 8.78; P < .001 for all). Although no significant relationship was established between patient activity level and postoperative Lysholm and IKDC scores, an inverse correlation was observed between BMI and Lysholm ( r =–0.9906) and BMI and IKDC ( r =–0.9402). Conclusion: Satisfactory postoperative clinical results were obtained in patients with type 3 ramp lesions not accompanied by ACL rupture who were treated with all-inside suturing through standard anterior portals.
Revue de Chirurgie Orthopédique et Traumatologique, Jun 1, 2012
ABSTRACT Background Anterior knee pain is still a major problem in total knee arthroplasty (TKA).... more ABSTRACT Background Anterior knee pain is still a major problem in total knee arthroplasty (TKA). Although the most widely accepted opinion is that anterior knee pain is often associated with a patellofemoral etiology, there is no clear consensus as to etiology or treatment. Disabling pain receptors by electrocautery could theoretically achieve denervation of the anterior knee region. The present prospective randomized controlled study aimed to evaluate results after patellar denervation with electrocautery in TKA at a minimum follow-up of 2 years. Hypothesis Patellar denervation provides some benefit in terms of pain and clinical outcomes after TKA without patellar resurfacing. Patients and methods Clinical and radiological results for 35 patients with single-stage bilateral TKA (70 knees; 26 women, nine men; mean age, 68 years [range, 58 to 77 years]) were reviewed. In addition to removal of all osteophytes, patellar denervation by electrocautery was performed on one patella; and debridement alone, removing all osteophytes, was performed on the contralateral patella, as a control. KSS score and a visual analog scale (VAS) were used to assess pre- and postoperative anterior knee pain. Results Mean follow-up was 36 months (24 to 60 months). No revisions or re-operations were performed. There were no patellar fractures. On all parameters (KSS score, range of motion and VAS), there was a statistically significant pre- to postoperative difference in favor of the denervation group. Discussion Patellar denervation with electrocautery can reduce anterior knee pain, with satisfactory clinical and radiological outcome, in TKA without patellar resurfacing. Level of evidence Level II: low-powered prospective randomized trial.
Journal of the American Academy of Orthopaedic Surgeons, Jan 5, 2021
Osteochondral lesions in the talus are frequently seen disorders that can cause chronic ankle pai... more Osteochondral lesions in the talus are frequently seen disorders that can cause chronic ankle pain. Surgical treatment is determined by the size and location of the lesion. The microfracture procedure and additional application of scaffold technique have gained popularity for the treatment of small osteochondral defects. However, these techniques may be insufficient and have poor outcomes in deep lesions. Therefore, several different invasive surgical techniques that require the malleolar osteotomy have been described. Problems associated with the invasive surgical intervention may be seen such as reduction loss in the osteotomy site, delayed union or nonunion, permanent pain, and/or swelling. We describe a new all-arthroscopic technique for the treatment of deep talus osteochondral lesions using an autologous bone graft taken from the tibial plafond region together with a chitosan-based noncellular scaffold.
Archives of Orthopaedic and Trauma Surgery, Oct 29, 2013
No previous description has been made about an objective method to test the graft resistance in M... more No previous description has been made about an objective method to test the graft resistance in MPFL reconstruction intraoperatively. In our study, we aimed to obtain intraoperative objective data about the graft resistance using contact pressure-sensitive surfaces and measuring pressure formed under the graft. In 2012, double-layered contact pressure-sensitive Fuji Prescale Film bands were placed under MPFL in 15 fresh-frozen high above-knee amputates (Group 1) and under graft in 10 patients who underwent MPFL reconstruction (Group 2). Measured values at different flexion angles were compared between and in groups. Statistical analysis was performed by Student's t test. It has been found that the pressure under the graft was higher in patients having reconstruction as compared to the pressure under natural MPFL. Decreasing pressure values were observed with increasing flexion angles in both groups. Contact pressure-sensitive surfaces provided objective data when placed under the graft in natural MPFL and during surgery. Therefore, they may be used as an objective marker providing information about graft resistance.
... Yönden Deneysel Olarak Karşılaştırılması Prof. Dr. Ali Kemal US Op. ... lk adım 1914'de ... more ... Yönden Deneysel Olarak Karşılaştırılması Prof. Dr. Ali Kemal US Op. ... lk adım 1914'de Hibbs tarafından yapılan posterior füzyon ameliyatıyla atılmıştır (1,2). Skolyoz cerrahisindeki en büyük ilerleme ise Harrington tarafından geliştirilen enstrumentasyon olmuştur. ...
İnönü Üniversitesi Turgut Özal Tıp Merkezi dergisi, 2013
Aim: We aimed to show that successful results can be obtained by combining the fractured parts ov... more Aim: We aimed to show that successful results can be obtained by combining the fractured parts over the operating table and fixing them with an anatomic plate in Mason type 3 - 4 multi-fragmented and / or displaced radial head fractures. Materials and Methods: Eleven cases of the 29 patients, operated in Yildirim Beyazit University Ankara Ataturk Education and Research hospital with the diagnosis of Mason type 3-4 radius head fracture, between June 2005nOctober 2011, in which fracture reducted outside, than providing the head reconstruction and fixing with radius head plate; were evaluated retrospectively. Results: Eight patients were male, 3 were female. Patient's ages ranged from 24 to 47 years of age with a mean age of 35 years. Mean follow-up was 44,9 months. Patients were evaluated for elbow with disabilities of the arm, shoulder and hand outcome measures and Mayo elbow performance index with radiological examination of the fractures. Conclusion: Radial head is secondary stabilizer to the elbow and forearm. In the cases of undergoing resection and/or prostetic replacement after unsuccessful reduction of radius head fractures because of crash or deplacement such as Mason type 3 n 4, trying to combine the parts of the fracture at the surgery table, than reconstruction of the head following by fixation with anatomic plate, can be an operational alternative especially in younger patients. Key words: Radius Fractures; Fractures-Comminuted; Fracture Fixation-Internal; Arthroplasty-Replacement.
The medial patellofemoral ligament (MPFL) is the main medial stabilizer of the patella, while rec... more The medial patellofemoral ligament (MPFL) is the main medial stabilizer of the patella, while reconstruction of the ligament is a common surgery performed by orthopedic surgeons. Although several surgical methods have been described regarding MPFL reconstruction, the common goals of these surgeries are to imitate the anatomic features of the native MPFL. In the single-incision and single patellar tunnel and double-bundle MPFL reconstruction technique, we will present the anatomical footprint of the MPFL located in the medial aspect of the patella, which is filled with the graft. In this technique, graft fixation is performed in the femoral tunnel using only one bioabsorbable screw without the need for fixation in the patella.
Orthopaedic Journal of Sports Medicine, Sep 1, 2022
Background: Soft tissue interposition between a suspensory cortical button and the lateral femora... more Background: Soft tissue interposition between a suspensory cortical button and the lateral femoral condyle is the most common cause of postoperative suspensory cortical button migration in patients undergoing anterior cruciate ligament reconstruction (ACLR). Purpose: To investigate the effects of soft tissue interposition and suspensory cortical button migration after ACLR on functional outcomes and graft ligamentization. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 249 patients who underwent single-bundle ACLR with hamstring tendon autografts. To measure soft tissue imposition, the patients were divided into 2 groups: those in whom the suspensory cortical button was in contact with (group 1) or at least 1 mm away from (group 2) the lateral femoral condyle on 1-day postoperative radiographs. To measure suspensory cortical button migration, the patients in group 2 were further divided into 2 subgroups: those with button migration (group M) and those without migration (group non-M) as observed on 12-month postoperative radiographs. Ligamentization was evaluated according to Howell classification (grades 1-4) on 12-month follow-up magnetic resonance imaging scans. Also recorded were preoperative and 24-month postoperative Lysholm and Tegner scores and 24-month postoperative arthrometer measurements for anterior knee laxity. Results: There was no significant difference between groups 1 and 2 or between groups M and non-M in terms of demographic characteristics or additional intra-articular pathologies detected intraoperatively. Normal anterior laxity (<3 mm) was detected in 83.7% of the patients postoperatively, and all patients showed statistically significant pre- to postoperative improvement on the Tegner (from 4.1 to 4.3) and Lysholm (from 44.0 to 89.2) scores ( P < .05 for both). No significant difference in postoperative functional results or graft ligamentization was found between either the soft tissue interposition groups (groups 1 and 2) or the suspensory cortical button migration groups (groups M and non-M). Conclusion: Differences between patients in soft tissue interposition and suspensory cortical button migration did not significantly affect postoperative clinical or functional outcomes or graft ligamentization after single-bundle ACLR.
Orthopaedic Journal of Sports Medicine, Apr 1, 2022
Background: Ramp lesions are encountered in 16% to 24% of all anterior cruciate ligament (ACL) ru... more Background: Ramp lesions are encountered in 16% to 24% of all anterior cruciate ligament (ACL) ruptures. However, isolated ramp lesions without a ruptured ACL have also been reported. Purpose: To evaluate outcomes after type 3 hidden ramp lesions without ACL rupture were treated with all-inside sutures passed through the standard anterior portal. Study Design: Case series, Level of evidence, 4. Methods: Included were 41 patients (26 female; 63.4%) with isolated type 3 ramp lesions who underwent surgery between January 2017 and January 2019. Patients with concomitant lateral meniscal injuries and revision meniscal surgeries were excluded. We retrospectively recorded patient age, sex, and body mass index (BMI), as well as follow-up periods, comorbidities, and postoperative and early midterm complications. The Lysholm, visual analog scale (VAS) for pain, and International Knee Documentation Committee (IKDC) scores were compared preoperatively to final follow-up. In addition, patients were classified as having either a sedentary or active lifestyle according to Sedentary Behavior Research Network (SBRN) criteria. The Shapiro-Wilk test was used to evaluate the normality of the data, and the Wilcoxon and Mann-Whitney U tests were used to compare preoperative and postoperative outcome scores. The Spearman test was employed to evaluate the correlation between patient variables. Results: The mean follow-up period was at 37.6 (range, 25-49) months. A total of 17 patients (41.46%) had a sedentary lifestyle based on SBRN criteria. All scores improved significantly from preoperatively to final follow-up (VAS, from 8.43 ± 1.53 to 2.34 ± 2.9; Lysholm, from 47.73 ± 17.02 to 85.37 ± 14.01; and IKDC, from 27.12 ± 14.81 to 85.32 ± 8.78; P < .001 for all). Although no significant relationship was established between patient activity level and postoperative Lysholm and IKDC scores, an inverse correlation was observed between BMI and Lysholm ( r =–0.9906) and BMI and IKDC ( r =–0.9402). Conclusion: Satisfactory postoperative clinical results were obtained in patients with type 3 ramp lesions not accompanied by ACL rupture who were treated with all-inside suturing through standard anterior portals.
Revue de Chirurgie Orthopédique et Traumatologique, Jun 1, 2012
ABSTRACT Background Anterior knee pain is still a major problem in total knee arthroplasty (TKA).... more ABSTRACT Background Anterior knee pain is still a major problem in total knee arthroplasty (TKA). Although the most widely accepted opinion is that anterior knee pain is often associated with a patellofemoral etiology, there is no clear consensus as to etiology or treatment. Disabling pain receptors by electrocautery could theoretically achieve denervation of the anterior knee region. The present prospective randomized controlled study aimed to evaluate results after patellar denervation with electrocautery in TKA at a minimum follow-up of 2 years. Hypothesis Patellar denervation provides some benefit in terms of pain and clinical outcomes after TKA without patellar resurfacing. Patients and methods Clinical and radiological results for 35 patients with single-stage bilateral TKA (70 knees; 26 women, nine men; mean age, 68 years [range, 58 to 77 years]) were reviewed. In addition to removal of all osteophytes, patellar denervation by electrocautery was performed on one patella; and debridement alone, removing all osteophytes, was performed on the contralateral patella, as a control. KSS score and a visual analog scale (VAS) were used to assess pre- and postoperative anterior knee pain. Results Mean follow-up was 36 months (24 to 60 months). No revisions or re-operations were performed. There were no patellar fractures. On all parameters (KSS score, range of motion and VAS), there was a statistically significant pre- to postoperative difference in favor of the denervation group. Discussion Patellar denervation with electrocautery can reduce anterior knee pain, with satisfactory clinical and radiological outcome, in TKA without patellar resurfacing. Level of evidence Level II: low-powered prospective randomized trial.
Journal of the American Academy of Orthopaedic Surgeons, Jan 5, 2021
Osteochondral lesions in the talus are frequently seen disorders that can cause chronic ankle pai... more Osteochondral lesions in the talus are frequently seen disorders that can cause chronic ankle pain. Surgical treatment is determined by the size and location of the lesion. The microfracture procedure and additional application of scaffold technique have gained popularity for the treatment of small osteochondral defects. However, these techniques may be insufficient and have poor outcomes in deep lesions. Therefore, several different invasive surgical techniques that require the malleolar osteotomy have been described. Problems associated with the invasive surgical intervention may be seen such as reduction loss in the osteotomy site, delayed union or nonunion, permanent pain, and/or swelling. We describe a new all-arthroscopic technique for the treatment of deep talus osteochondral lesions using an autologous bone graft taken from the tibial plafond region together with a chitosan-based noncellular scaffold.
Archives of Orthopaedic and Trauma Surgery, Oct 29, 2013
No previous description has been made about an objective method to test the graft resistance in M... more No previous description has been made about an objective method to test the graft resistance in MPFL reconstruction intraoperatively. In our study, we aimed to obtain intraoperative objective data about the graft resistance using contact pressure-sensitive surfaces and measuring pressure formed under the graft. In 2012, double-layered contact pressure-sensitive Fuji Prescale Film bands were placed under MPFL in 15 fresh-frozen high above-knee amputates (Group 1) and under graft in 10 patients who underwent MPFL reconstruction (Group 2). Measured values at different flexion angles were compared between and in groups. Statistical analysis was performed by Student's t test. It has been found that the pressure under the graft was higher in patients having reconstruction as compared to the pressure under natural MPFL. Decreasing pressure values were observed with increasing flexion angles in both groups. Contact pressure-sensitive surfaces provided objective data when placed under the graft in natural MPFL and during surgery. Therefore, they may be used as an objective marker providing information about graft resistance.
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