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Objectives: This study aims to compare the effects of mini-midvastus (MMV) versus medial parapatellar (MPP) approach on rapid recovery protocols during total knee arthroplasty (TKA)., Patients and methods: This prospective, randomized, single-blinded study was performed in 54 patients (4 males, 50 females; mean age 64.1 +/- 6.4 years) diagnosed as primary knee osteoarthritis and planned for unilateral TKA between May 2018 and March 2019. Patients were randomly assigned as MMV (1 male, 26 females; mean age 65 +/- 6.4 years) and MPP (3 males, 24 females; mean age 63.2 +/- 6.3 years) groups. Rapid recovery TKA protocol and discharge criteria were assembled and all patients were evaluated preoperatively, and at postoperative first and third months. Length of hospital stay (LOS) was recorded for all patients. Hemoglobin and hematocrit values, radiologic assessment of alignment, knee range of motion (ROM), quadriceps muscle strength, visual analog scale (VAS), 30-sec chair-stand test, stair-climb test, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Short Form-36 (SF-36) were used for evaluations by blinded observers., Results: There was no significant difference in demographic variables between two groups. Operative time in MMV Group (78.1 +/- 2.7 min) was significantly longer than the MPP Group (65.9 +/- 2.6 min) (p0.05). In terms of quadriceps muscle strength gain, we could not find any difference between groups in pre- and postoperative difference of changes (p>0.05)., Conclusion: With the use of contemporary rapid recovery protocols during TKA, MMV approach had no superiority over MPP approach when quadriceps muscle strength, LOS, pain, function, and quality of life were assessed. Longer operative time in the MMV approach compared to MPP approach may be considered as a disadvantage.

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Although adverse effects of smoking on bone health are all well known, data on how smoking interacts with cartilage structure in otherwise healthy individuals remains conflicting. Here, we ascertain the effects of cigarette smoking on sonoelastographic properties of distal femoral cartilage in asymptomatic adults. Demographic characteristics and smoking habits (packets/year) of healthy volunteers were recorded. Medial, intercondylar, and lateral distal femoral cartilage thicknesses and strain ratios on the dominant extremity were measured with ultrasonography (US) and real time US elastography. A total of 88 subjects (71 M, 17 F; aged 18–56 years, N = 43 smokers and N = 45 nonsmokers) were evaluated. Mean amount of cigarette smoking was 10.3 ± 8.9 (1–45) packets/year. Medial, intercondylar and lateral cartilage were thicker in smokers than nonsmokers (p = 0.002, p = 0.017, and p = 0.004, respectively). Medial distal femoral cartilage strain ratio was lower in smokers (p = 0.003). The amount of smoking was positively correlated with cartilage thicknesses and negatively correlated with medial cartilage strain ratios (p < 0.05). Femoral cartilage is thicker in smokers but has less strain ratio representing harder cartilage on the medial side. Future studies are needed to understand how these structural changes in the knee cartilage should be interpreted with regard to the development of knee osteoarthritis in smokers. © 2016 by the authors; licensee MDPI, Basel, Switzerland.

To the Editor,We read with interest the article entitled “Measurement of the knee joint line in Turkish population” by Gürbüz et al in Vol. 49, No 1 (2015) of your journal.1 We congratulate them for their inspiring work.The authors measured femoral width, the distance from the apex of the fibular head to joint line and the distance from the adductor tubercle to the joint line to determine the knee joint line level relative to these landmarks and correlation of relative distance of joint line level to the femoral width. However, the study itself has some methodological drawbacks;A total of 117 knees were included in the study, but the number of the patients was 108. That means 9 patients were recorded twice considering right and left knee measurements. This is not appropriate from the statistical point of view since joint line levels relative to specific landmarks for individual persons are not expected to be different in each knee. Therefore, to our knowledge, all the studies in the literature cover only one leg for this type of morphometric studies; otherwise, bilateral measurements should be evaluated in separate groups. 2-5To ensure images representative of normal anatomy, patients with preexisting radiologic evidence of arthritis in their knees should be excluded from the study.2-5 However, exclusion criteria of the authors did not cover knee osteoarthritis that definitely might alter joint level measurements due to erosions of subchondral bone as it is seen on Fig 1 in original article (knee with Kellgren-Lawrance grade 3 osteoarthritis and possible valgus deformity). In addition, the patella in the figure showing the knee joint is not centered that was supposed to be one of the criteria of the study.Statistical analysis results given in the article are very preliminary to understand relationship between variables in details. For instance, just by reporting R2 value for linear regression analysis, we could estimate what percentage of the variability in the dependent variable (adductor tubercle joint line level-AJD) is explained by the independent variable (femoral width-FW). DOI: 10.3944/AOTT.2015.15.0214This abstract belongs to the un-edited version of the article and is only for informative purposes. Published version may differ from the current version.

BACKGROUND: Impaired postural balance due to somatosensory data loss with mechanical instability has been shown in patients with ACL deficiency. OBJECTIVE: To assess postural balance in patients with ACL insufficiency prior to surgery and following reconstruction with serial evaluations. METHODS: Thirty patients (mean age of 27.7 ± 6.7 years) who underwent arthroscopic reconstruction of ACL with bonepatellar tendon-bone autograft were examined for clinical and functional variables at preoperative day and postoperative 12th week. Posturographic analysis were performed by using Tetrax Interactive Balance System (Sunlight Medical Ltd, Israel) at preoperative day, at 4th, 8th, and 12th weeks following reconstruction. Data computed by posturographic software by the considerations of the oscillation velocities of body sways is fall risk as a numeric value (0-100, lower values indicate better condition). RESULTS: All of the patients (mean age of 27.7 ± 6.7 years) had significant improvements for clinical, functional evaluations and fall risk (p < 0.05). Mean fall risk was within high-risk category (59.9 ± 22.8) preoperatively. The highest fall risk was detected at postoperative 4th week. Patients had high fall risk at 8th week similar to preoperative value. Mean fall risk decreased to low level risk at 12th week. Preoperative symptom duration had relationships with preoperative fall risk and postoperative improvement of fall risk (p = 0.001, r = -0.632, p = 0.001, r = -0.870, respectively). The improvement of fall risk was higher in patients with symptoms shorter than 6 months (p = 0.001). CONCLUSIONS: According to these results, mean fall risk of patients with ACL insufficiency was within high risk category preoperatively, and fall risk improves after surgical reconstruction, but as the duration of complaints lengthens especially longer than 6 months, the improvement of fall risk decreases following reconstruction. © 2016 - IOS Press and the authors. All rights reserved.

Objectives - The aim of this study was to explore the sonographic and elastographic properties of patellar and Achilles tendons in smoking and nonsmoking otherwise healthy adults. Methods - We conducted a level 3 case-control analytical study. Smoking and nonsmoking volunteers (>18 years) without musculoskeletal system disorders were included in the study. Demographic characteristics and smoking habits (pack-years) were recorded. Proximal, middle, and distal third thicknesses of the patellar and Achilles tendons were measured by B-mode sonography. Strain ratio measurements of the same regions were measured by real-time ultrasound elastography. Results - A total of 69 participants (57 male and 12 female; mean age ± SD, 35.5 ± 7.8 years) were evaluated in the study. Smoking (n = 35) and nonsmoking (n = 34) groups had no significant differences in terms of age, body mass index, sex, and activity level (all P > .05). Proximal, middle, and distal thirds of the patellar and Achilles tendons were significantly thinner in the smoking group (all P < .05). Furthermore, strain ratio measurements in the same regions were significantly lower in the smoking group (all P < .05). Patellar tendon thicknesses and strain ratios had negative correlations with the smoking amount (all P < .05). Conclusions - Thickness and strain ratio measurements of patellar and Achilles tendons were reduced (thinner and harder tendons) in smokers. Clinical implications of these morphologic and elastographic changes should be investigated in future studies. © 2016 by the American Institute of Ultrasound in Medicine.

We read with interest the article entitled “Prevalence of bone mineral density testing and osteoporosis management following low- and high-energy fractures” by Angthong et al. in Vol. 47, No 5 (2013) of your journal. [1] We congratulate them for their inspiring work. However, the study itself has some methodological drawbacks, and contains false interpretations of results that lead to misunderstanding: 1. Inclusion of both low- and high-energy fracture patients to test probability of DEXA examination renders the criteria inconsistent., Bu makale, yukarıda künyesi belirtilmiş olan makalenin yazarlar tarafından gönderilen çevirisidir. Sağlanan içeriğin, orijinal makale ile uyumluluğunun tüm sorumluluğu yazarlara aittir

Although femoroacetabular impingement (FAI) syndrome is included in the etiology of lesions involving the acetabular labrum and acetabular cartilage, it is one of many possible reasons behind osteochondral lesions in the femoral head. Herein, we present clinical findings and outcomes of two cases with osteochondral defects and cam type impingement of femoral head. Both cases underwent autologous osteochondral mosaicplasty along with femoral osteochondroplasty following controlled hip dislocation. Harris hip scores improved significantly postoperatively and magnetic resonance imaging showed an adequate graft union and formation of a healthy chondral surface at the final assessment. Autologous osteochondral mosaicplasty of parafoveal region defects and femoral neck osteochondroplasty combination may be an effective treatment method for young patients with FAI syndrome. In addition, we believe that cam type impingement may also have a role in the etiology of parafoveal osteochondral lesions.

Purpose: Orthopedic surgeons remove more bone from the posteromedial femoral condyle than the posterolateral condyle to achieve the desired femoral component rotation. Here, the correlation between the asymmetry of chamfer cuts and femoral component rotation in total knee arthroplasty was determined., Methods: A model was built to simulate anterior chamfer cuts performed during total knee arthroplasty to measure posterior condylar offset. Right knee axial magnetic resonance imaging slices were examined from 280 consecutive patients (142 men, 138 women; mean age 31.4 ± 6.6 years). The anatomic and surgical transepicondylar axes, as well as the posterior condylar joint line, were drawn. Differences in the posteromedial and posterolateral offsets and the femoral rotation angles relative to the posterior joint line were measured., Results: The mean surgical femoral rotation angle was 4.8° ± 1.2°, and the mean posterior condylar offset difference was 4.4 ± 1 mm, with a strong correlation (p, Conclusion: The accuracy of the applied technique intra-operatively can be verified by correlating the asymmetry of posterior chamfer cuts with the achieved femoral component rotation, as determined by measuring the thicknesses of posterior chamfer cuts with a caliper. Technical errors can also be minimized by confirming the association between the femoral component rotation—as predicted by the posterior condylar offset difference—and the preoperatively measured femoral rotation angle., Level of evidence: II. © 2014, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).