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Aim: Videos related to avascular necrosis of the femoral head are no exception, and so the aim of this study is to evaluate the educational quality of YouTube videos on this topic. Material and Method: A standardized video search was performed on YouTube using the terms "avascular necrosis of the hip", "osteonecrosis of the hip" and "avascular necrosis of the femoral head". The top 50 videos were then analyzed, and the characteristics and content of the videos were recorded. The Journal of American Medical Association criteria, The DISCERN score, The Global Quality Score and the new YouTube 'Avascular Necrosis of the Femoral Head Score" were all used to assess the reliability and accuracy of the videos. Results: The median video duration of the 50 videos was 10.85±19.17 minutes. The median number of views was 10,866 (range 221 to 278,174). According to the video content, 60% of the videos contained information about the disease, 10% were about patient experience, and the remaining 30% related to surgical technique or approach. Physicians were the primary uploader on YouTube for this topic. The rate of low-quality videos was determined as following according to the different evaluative systems: 68% according to the newly defined YouTube Avascular Necrosis of the Femoral Head Score, 60% according to the DISCERN score, and 56% according to The Global Quality Score. The Journal of the American Medical Association, The Global Quality Score, and DISCERN score were significantly correlated with video duration, while the New YouTube Avascular Necrosis of the Femoral Head Score was significantly correlated with video duration, time since upload, number of views, and like rate. Conclusion: Most of the popular YouTube videos about avascular necrosis are of a low quality. [ABSTRACT FROM AUTHOR]

BACKROUND: Optimal postoperative management is controversial after arthroscopic rotator cuff repair (ARCR). OBJECTIVE: The aim of the study was to evaluate outcomes of patients with and without postoperative sling immobilization after undergoing arthroscopic RCR rotator cuff repair. METHOD: 369 arthroscopic full thickness superior rotator cuff tears (RCT) with a minimum follow-up of 6 months were included in this study. Propensity score matching was performed for age, sex, BMI, and tear size. Pain (VAS score), shoulder range of motion (ROM), functional outcome (ASES, Constant-Murley [CM] and Oxford shoulder score [OSS]), and health related quality of life (SF-36) scores were compared between patients with and without sling immobilization. RESULTS: According to the propensity match score, 92 patients (50 sling immobilization and 42 no sling immobilization) were matched to be almost identical in age (62.5 ± 8.0 vs. 61.8 ± 5.9), sex (female 78% vs. 76.2%), BMI (28.1 ± 2.8 vs. 27.8 ± 2.6), and tear size (2.7 ± 1.1 vs. 2.9 ± 0.8). The postoperative physical functioning domain of SF-36 scores was found to be significantly higher in the no sling group (p= 0.034). CONCLUSION: Early mobilization after arthroscopic small and medium sized full thickness superior rotator cuff repair is associated with improved ROM and quality of life scores. [ABSTRACT FROM AUTHOR]

Background: Although several factors are associated with anterior cruciate ligament (ACL) rerupture, the effect of anatomic factors associated with ACL rupture on ACL rerupture development has not been evaluated. Purpose: To determine individual anatomic parameters independently associated with ACL rerupture and the diagnostic values of these parameters. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 91 male patients with ACL rerupture and 182 age-, sex-, body mass index–, and side dominance–matched patients without rerupture who underwent ACL reconstruction with a 5-year follow-up were included. In all, 35 parameters that were previously defined as risk factors for primary ACL rupture were compared between the 2 groups. Uni- and multivariate logistic regression models were created to evaluate independently associated factors. Receiver operating characteristic curve analysis was performed for independently associated parameters to predict sensitivity, specificity, and cutoff values. Results: The mean ± standard deviation age of patients at the time of index surgery was 26.5 ± 6.7 years. Notch shape index (P =.014), tibial proximal anteroposterior (AP) distance (TPAPD) (P <.001), lateral femoral condylar AP distance (LCAPD)/TPAPD ratio (P <.001), medial meniscal cartilage bone height (P <.001), and lateral meniscal bone angle (P =.004) were found to be significantly different between the 2 groups. Only the LCAPD/TPAPD ratio (odds ratio, 2.713; 95% CI, 1.998-5.480; P <.001) was found to be independently associated with ACL rerupture development. The LCAPD/TPAPD ratio revealed 78.9% sensitivity and 75.5% specificity (area under the curve, 0.815; 95% CI, 0.760-0.870) for values above 1.52. Conclusion: The LCAPD/TPAPD ratio can be used to distinguish patients who are at risk of developing ACL rerupture from patients who are not. In the clinical practice, findings of this study may help to develop surgical and nonsurgical preventive strategies in ACL rerupture development. [ABSTRACT FROM AUTHOR]

Background: No comparative studies have evaluated anatomic risk factors in a large cohort including both patients with anterior cruciate ligament (ACL) ruptures and healthy participants. Purpose: To determine which anatomic parameters are independently associated with an ACL rupture and the diagnostic values of the individual and combined anatomic parameters. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 352 male patients who underwent arthroscopic ACL reconstruction because of a primary ACL rupture and 350 age-, sex-, body mass index–, and side dominance–matched healthy participants were included. Measurements of 32 previously determined parameters and 7 calculations were performed. Between-group differences were calculated. Univariate and multivariate logistic regression models and receiver operating characteristic curve analysis were conducted for the individual and combined independently associated factors. Results: The mean age and body mass index of all participants were 29.9 ± 7.7 years and 27.2 ± 3.1, respectively. There were significant differences between the groups regarding the notch width (NW), notch shape index, anterior tibial slope, notch width index, NW–eminence width (NW:EW) ratio, notch height, axial lateral wall angle, medial intercondylar ridge thickness, alpha angle, medial tibial depth (MTD), lateral tibial slope (LTS), coronal tibial plateau width, eminence width index, tibial proximal anteroposterior distance (TPAP), lateral condylar anteroposterior distance (LCAP)/TPAP, ACL cross-sectional area, ACL volume, medial and lateral meniscal cartilage height, medial and lateral meniscal cartilage angle (MCA), and medial and lateral meniscal cartilage bone height. The NW:EW ratio (odds ratio [OR], 4.419; P =.017), MTD (OR, 8.617; P =.001), LTS (OR, 2.254; P =.011), LCAP/TPAP (OR, 2.782; P =.037), and medial MCA (OR, 1.318; P =.010) were independently associated with the development of an ACL rupture. Combining the independently associated factors revealed a sensitivity of 93% and a specificity of 94% (area under the curve, 0.968). Conclusion: Patients with ACL ruptures could be distinguished from uninjured controls with high sensitivity and specificity via the combined use of the NW:EW ratio, MTD, LTS, LCAP/TPAP, and medial MCA. In clinical practice, these findings may contribute to the development of preventive strategies for ACL ruptures. [ABSTRACT FROM AUTHOR]

Relatively larger size, displacement, the complexity of the bucket-handle meniscal tear (BHMT)s, and the fact that they can cause locking can be challenging for treatment. This study aimed to evaluate the effect of tear pattern and the number of preoperative locking episodes on the functional outcome and failure rate following arthroscopic BHMT repairs. 84 patients who underwent arthroscopic repair for BHMTs between 2013 and 2018 were included in the study. VAS, Lysholm, IKDC, Tegner, and overall satisfaction scale were used to assess functional and clinical outcomes. MRI was used for radiologic assessment method, and Barrett criteria were used for assessment clinical failure. The effects of BHMT pattern and the number of preoperative locking episodes were evaluated, and the effect of surgical and demographic features on failure was investigated following arthroscopic BHMT repair. The mean follow-up was 66.1 ± 16.2 months (range, 24-84 months). Improvement in VAS, Lyholm, IKDC scores, and patient satisfaction was significantly higher in patients with single locking history, and failure rate in this group was lower as well (p=0.036, p=0.000, p=0.001, p=0.000, p=0.015, respectively). Red--white (RW) zone tears, late repairs (>2 months), and smoking habits were found to be significantly higher in failed repairs (p=0.036, p=0.015, p=0.028, respectively). However, BHMT pattern did not affect clinical outcomes and failure rate (p<0.05). Recurrent preoperative locking episodes have a negative impact on clinical outcomes and meniscal healing. Especially, first time locking and peripheral BHMTs should be repaired in the early period regardless of tear pattern. [ABSTRACT FROM AUTHOR]

Detailed evaluation for recurrence following arthroscopic Bankart repair (ABR)s is important to develop strategies to decrease recurrence rates. The aim of this study was to evaluate the outcomes following ABR and to investigate clinical, functional and demographic data by recurrence status in recreational athletes. A total of 67 consecutive ABRs (63 males, 4 females) with a minimum 5-year follow-up were included in the study. Pre- and post-operative clinical and functional outcomes were evaluated using VAS, shoulder ROM, ASES, UCLA, Constant-Murley, Oxford Instability and Rowe scores. Patient characteristics were evaluated to investigate the correlation with the outcomes. Factors associated with recurrence were also evaluated. The mean age was 30.8 ± 7.7 years and the mean follow-up was 87.7 ± 19.1 months. Good to excellent postoperative functional and clinical outcomes were obtained in the last follow-up compared with the baseline (p<0.001). Eleven shoulders (16.5%) experienced recurrent instability. Contact sports, glenoid bone loss, Hill-Sachs lesions and smoking habit were associated with recurrence status (p=0.007, p=0.043, p=0.023, p=0.017, respectively). Only postoperative abduction degree was significantly higher in recurrence (-) patients compared to recurrence (+) patients (p<0.001). No major complications were occurred in peri- or post-operative period. Forty-seven patients returned to their preoperative sports activity levels. Good to excellent mediumto long-term functional and clinical outcomes were achieved after ABR. Contact sports, glenoid bone loss, Hill-Sachs lesions and smoking habit were associated with recurrence after ABRs. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to evaluate the reliability of the radiographic union scale in tibial (RUST) fractures and modified RUST (mRUST) fractures in pediatric forearm fractures treated with elastic stable intramedullary nail (ESIN) and to investigate the effect of the experience of surgeon, thresholds for union, and delayed union decisions., Patients and Methods: In this retrospective study, radiographic images of 20 patients (10 males, 10 females; mean age 8.6±4.3; range, 4 to 11 years) with forearm fractures treated using ESIN between January 2013 and December 2018 were scored by 20 observers based on the RUST and mRUST scores. The observers scored the radiographs at immediate postoperative period, and at 4-, 8-, and 12-week follow-up. Intra- and interobserver agreement for each cortex, RUST, and mRUST were evaluated using intraclass correlation coefficient (ICC). The Fleiss' kappa (κ) coefficient was used in the agreement between evaluators regarding union decision. Receiver operating curves were created to determine the thresholds for radiographic union and delayed union., Results: Intra- and interobserver reliability of the mRUST score (ICC: 0.84 and 0.79) were slightly higher than that of the RUST score (ICC: 0.80 and 0.72). Pediatric orthopedic and trauma surgeons had slightly higher agreement than the residents and general orthopedists for the total mRUST and RUST scores of the eight-week radiographs. Mean RUST and mRUST scores at the union for all fractures were 10.2±3.4 and 13.0±2.1, respectively. Kappa value for union was moderate (0.74). The total mRUST score had a higher predictive value for union than the total RUST score (area under the curve: 0.986 vs. 0.889). A mRUST score of ≥12 and RUST score of ≥9 were considered as the predictors of union. In addition, a mRUST score of ≤7 and RUST score of <9 were considered as the predictors of delayed union., Conclusion: A moderate agreement for both RUST and mRUST scores was found. However, the agreement for mRUST was found to be slightly higher. Healing and union of forearm fractures treated with ESIN can be reliably assessed using RUST and mRUST.