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Strain ratio measurements of tendons vary because of the reference tissue selection. The main purpose of this study is to highlight, in detail, the numeric variability attributable to the use of various reference materials on strain ratio measurements of patellar and Achilles tendons. Measurements were performed at the proximal, middle and distal thirds of the patellar and Achilles tendons on the dominant site of healthy volunteers. A total of 3 references were used: the Hoffa's fat pad for the patellar tendon, the Kager's fat pad for the Achilles tendon, subcutaneous tissue and Aquaflex gel pads (Parker Laboratories, Fairfield, NJ, USA) for both tendons. Although the same methods were used by the same physician for each tendon site on repeated measurements, strain ratio values had numeric variability with various reference materials in each measurement. Therefore, comparison of numeric strain ratio results of various studies with various reference materials could confuse the clinical interpretations of these numeric data, and, using a reference material with standard stiffness like Aquaflex ultrasound gel pads, should be considered by verifying these results with further studies. © 2019 World Federation for Ultrasound in Medicine & Biology

There is a tendency of orthopaedic surgeons to elevate joint line (JL) in revision total knee arthroplasty (RTKA). Here, we ascertain the use of the spacer block tool (SBT) to determine JL more accurately for less experienced RTKA surgeons. To perform more precise restoration of JL, an SBT with markers was developed and produced using computer software and three-dimensional printers. The study was planned prospectively to include patients who received either condylar constrained or rotating hinge RTKA between January 2016 and December 2019. To determine JL, distance from fibular head (FH), adductor tubercle (AT), and medial epicondyle (ME) were measured on contralateral knee preoperative radiographs and on operated knee postoperative radiographs. Patients were randomized and grouped according to the technique of JL reconstruction. In Group 1, conventional methods by evaluating aforementioned landmarks and preoperative contralateral knee measurements were used to determine JL, whereas in Group 2, the SBT was used. The main outcome measure was the JL change in revised knee postoperatively in contrast to contralateral knee to compare effective restoration of JL between the groups. Twenty-five patients in Group 1 (3 males, 22 females, 72 years, body mass index [BMI] 32.04 ± 4.45) and 20 patients (7 males, 13 females, 74 years, BMI 30.12 ± 5.02) in Group 2 were included in the study. JL measurements for the whole group were FH-JL = 18.3 ± 3.8 mm, AT-JL = 45.8 ± 4.6 mm, and ME-JL = 27.1 ± 2.8 mm preoperatively, and FH-JL = 20.7 ± 4.2 mm, AT-JL = 43.4 ± 5.2 mm, and ME-JL = 24.7 ± 3.1 mm postoperatively. JL level differences in reference to FH, AT, and ME in Group 1 were 3.6 ± 3.1, 3.6 ± 3.5, and 3.4 ± 3.1 mm, respectively, and in Group 2 were 1.0 ± .0.9, 1.3 ± 1.3, and 1.1 ± 1.3 mm, respectively. There were statistically significant differences between the two groups in JL changes referenced to all of the specific landmarks (p

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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Giriş:Tibia cisim kırıkları, ortopedi ve travmatoloji pratiğinde en sık görülen kırıktiplerinden biridir. Bu çalışmada tibia cisim kırıkları tedavisinde kilitliintramedüller çivi uygulanan hastaların klinik sonuçlarının ve fonksiyoneldurumlarının değerlendirilmesi ve yük verme ile kaynama zamanınınkarşılaştırılması amaçlanmıştır.Yöntem:Çalışmaya 18-73 yaş arası, tibia cisim kırığı nedeni ile intramedüllerfiksasyon uygulanmış olan 44 hasta dahil edildi. Çalışmamızda sonuçlar, Johnerve Wruhs Kriterlerine göre ve Karlstum-Olerud kriterlerine göre kaydedildi.Radyolojik olarak iyileşme, radyografilerde hastanın desteksiz olarak yükverebileceği düzeyde kallus formasyonu ve/veya kırık hattının kaybolması olarakdeğerlendirildi. Klinik iyileşme ise hastanın ağrısız tam yük verebilmesi vegünlük aktivitelerine dönebilmesi olarak değerlendirildi.Bulgular:Hastaların yaş ortalaması 38,7±14,9 (17-73) yıl idi. 44 hastadan Hastaların 16’sında ( %36,4) tibia 1/3 orta cisim kırığı, 25’ inde (%56,8) tibia 1/3 distalkırık, 3’ ünde ise ( %6,8) ise tibia 1/3 proksimal kırığı görüldü. Hastalarınortalama kaynama süresi 11,36±3,8 (6-20) hafta olarak gözlendi.Karlstrom-Olerud'un fiziksel fonksiyonel değerlendirme skalasına göre ; 21hasta (%47,7) mükemmel, 14 hasta (%31,8)iyi, 1 hasta (%2,3) tatmin edici, 8hasta ( %18,2 ) ise orta olarak kaydedildi ve hiç kötü sonuç yoktu. Johner-Wrushkriterlerine göre 32 hastada (%72,7) mükemmel, 12 hastada ise %27,3 iyi olarak değerlendirildi. Takipsürecinde bütün kırıkların kaynadığı gözlendi.Sonuç:Hastalar Johner-Wrush Kriterlerine göre mükemmel ve iyi skora sahiptiler. Karlstrom-Olerud'un fiziksel fonksiyoneldeğerlendirme skalasına göre ise hiçbir hasta kötü skora sahip değildi. Genç,erken ağırlık aktaran ve çivi korteks mesafesi 2mm’den az olan hastalardakaynama süresi kısalmaktadır., Introduction: Tibialdiaphyseal fractures are one of the most common types of fractures in practiseof the orthopedics and traumatology. In this study, clinical results of thepatients with diaphyseal fractures of the tibia which have been treated withlocking intramedullary nailing tecnique and the weight bearing time and uniontime has been evaluated. Method: Patients who appliedto our hospital with tibial diaphyseal fractures were evaluatedretrospectively. 43 patients wereincluded in the study. Karlstrom-Olerud, Johner and Wruhs score were used toevaluate clinical results. Radiologic improvement was assessed as loss ofcallus formation and / or fracture line at the level that the patient couldload without support on radiographs. Clinical improvement was assessed as thepatient was able to give full pain relief and return to daily activities.Results: Mean duration ofunion was 11.36 ± 3.8 (6-20) weeks. According to Karlstrom-Olerud 21 patients(47,7%) has received a full grade of 36, 14 patients (31,8%) have beenevaluated as good with a grade between 33 and 35, 1 patient (2,3%) wassatisfactory with a grade in the range 30-32 and 8 patients were in the range27-29 and they are evaluated as fair. Non of the patients were evaluated aspoor.Conclusion: Patients have anexcellent and good score according to the Johner-Wrush criteria. According toKarlstrom-Olerud's physical functional assessment scale, no patient had a badscar. Younger, early-weight-bearing patients with a nail cortex distance ofless than 2mm, the duration of union is shortening.

Technicians often receive chronic magnetic exposures from magnetic resonance imaging (MRI) devices, mainly due to static magnetic fields (SMFs). Here, we ascertain the biological effects of chronic exposure to SMFs from MRI devices on the bone quality using rats exposed to SMFs in MRI examining rooms. Eighteen Wistar albino male rats were randomly assigned to SMF exposure (A), sham (B), and control (C) groups. Group A rats were positioned within 50 centimeters of the bore of the magnet of 1.5 T MRI machine during the nighttime for 8 weeks. We collected blood samples for biochemical analysis, and bone tissue samples for electron microscopic and histological analysis. The mean vitamin D level in Group A was lower than in the other groups (p = 0.002). The mean cortical thickness, the mean trabecular wall thickness, and number of trabeculae per 1 mm2 were significantly lower in Group A (p = 0.003). TUNEL assay revealed that apoptosis of osteocytes were significantly greater in Group A than the other groups (p = 0.005). The effect of SMFs in chronic exposure is related to movement within the magnetic field that induces low-frequency fields within the tissues. These fields can exceed the exposure limits necessary to deteriorate bone microstructure and vitamin D metabolism. © 2015 by the authors; licensee MDPI, Basel, Switzerland.

Following total knee arthroplasty (TKA), the most frequent cause of extension deficit and limitation of range of motion in early postoperative period is related to improper tensioning of soft tissues and failure to balance extension and flexion gaps. If a cruciate retaining (CR) prosthesis is the planned implant, then attention should be given to balancing the posterior cruciate ligament (PCL), and any factor that alters this balance may also cause deterioration of knee balance in postoperative period. Here, we report on an unusual case referred from another hospital because of continuous pain and restriction of knee motion in early postoperative period following CR-designed TKA that was initially thought to be due to flexion-extension imbalance. However, during the revision procedure, extruded cement to the intercondylar notch was found to be both mechanically blocking terminal extension and limiting flexion by possible mechanism of irritation of the synovial nerve endings around the stretched anterior fibers of PCL during flexion. This case was successfully treated by removal of extruded cement from intercondylar notch to decompress PCL, polyethylene exchange, and secondary patellar resurfacing.

Aims: We ascertained effects of hand dominance in both right and left-handed volunteers on the thickness and cross sectional area (CSA) of pronator quadratus (PQ) muscle as measured by the axial and sagittal views of ultrasound imaging. Secondly, we also aimed to document the extent of the relationship between the PQ measurements and handgrip. Materials and methods: Healthy adults from the volunteer medical staff were included in the study. Handedness was assessed via The Flinders Handedness survey. The sonographic appearance of the PQ was evaluated on sagittal and axial images for both hands. CSA of PQ muscle was digitally drawn and calculated on the axial plane. Handgrip was measured by using adjustable-handle dynamometer. Results: Eighty-nine healthy volunteers were included (54 right and 35 left-handed). Significant difference was detected between dominant and non-dominant hands in CSA and muscle thickness in both right and left-handed volunteers (p

Objectives: This study aims to evaluate sonoelastographic properties of the distal femoral cartilage in patients with anterior cruciate ligament (ACL) reconstruction. Patients and methods: Demographic characteristics and operative data of 28 patients (27 males, 1 female; mean age 31.7 +/- 7.1 years; range 22 to 48 years) with unilateral ACL reconstruction were evaluated. Reconstruction was performed with patellar tendon graft in 22 patients (78.6%) and hamstring tendon graft in six patients (21.4%). Lysholm knee score was used for functional evaluation and chair stand test was used for lower extremity strength. Medial, intercondylar, and lateral distal femoral cartilage thicknesses of operated knees and healthy knees were measured with B-mode ultrasound, while strain ratios were measured with real time sonoelastography. Results: Postoperative mean follow-up duration was 20.4 +/- 9.8 months. Mean Lysholm knee and patient satisfaction scores were 88.0 +/- 8.5 and 8.2 +/- 1.8, respectively. Cartilage thicknesses were similar between operated and healthy knees (all p>0.05). Sonoelastographic strain ratio of medial distal femoral cartilage in operated knees was significantly higher (softer cartilage) (p=0.026). There was a negative correlation between strain ratio difference of medial cartilage of operated knees and lower extremity muscle strength (p=0.009, r=-0.487). Conclusion: While there was no difference for cartilage thickness between operated and healthy knees in B-mode ultrasound evaluation, detection of sonoelastographic strain ratio changes in medial distal femoral cartilage on the operated sides may indicate early structural changes following ACL reconstruction. Further studies are required to highlight the clinical effects of this relationship between the changes in cartilage structure and sonoelastography features.

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.

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).

Objectives: In this study, we aimed to evaluate the effects of static magnetic field (SMF) from magnetic resonance imaging (MRI) devices on the bone health of MRI workers. Materials and methods: Fourteen volunteer MRI technicians working with 1.5 Tesla MRI units at least for two years were included in the study. An age and sex-matched control group from indoor working 14 volunteer paramedical staff who were not exposed to SMF and met the identical criteria was formed. Dual-energy X-ray absorptiometry (DXA) scanning was performed in all participants. Parathyroid hormone, calcium, phosphorus, alkaline phosphatase, 25-hydroxyvitamin D3, and 1.25-dihydroxyvitamin D3 levels were measured. Results: The mean vertebral and femoral neck bone mineral content (BMC) and bone mineral density (BMD) as well as the mean 25-hydroxyvitamin D3 level of MRI technicians was found to be lower than the control group (p

Objectives: This study aims to investigate the tendencies related to assessment and treatment modalities administered to patients with osteoporotic fractures by orthopedics and traumatology specialists for the prevention of secondary fractures in our country. Materials and methods: A survey composed of 10 questions was applied in electronic environment to actively practicing 144 orthopedics and traumatology specialists to detect their demographics, protocol they administer for the diagnosis and follow-up of primary osteoporosis, and assessment and treatment modalities they administer for the prevention of secondary fractures. Categorical variables were compared statistically based on duration of specialization, affiliated institution, and academic career along with the descriptive results. Results: Use of the Fracture Risk Assessment Tool (FRAXTM) developed by World Health Organization is limited among orthopedics and traumatology specialists in our country (11%). There was no statistical difference between the groups (p>0.05). The rate of starting the appropriate treatment after hip and vertebral fractures due to osteoporosis was 21%. In addition, 46% of the physicians preferred to wait for the dual-energy X-ray absorptiometry results. Only academic career was statistically significantly different between the groups (p=0.043). Conclusion: In our country, majority of patients who present with osteoporotic hip and vertebra fractures are assessed and treated insufficiently for the prevention of secondary fractures. Supporting our results with clinical studies can accelerate the development of sufficient research and treatment programs for patients with osteoporotic fractures.

Objectives: Pertaining to peculiar designs of current knee prostheses, more bone is removed from posteromedial femoral condyle than posterolateral condyle to obtain desired femoral component rotation. The aim of our study was to evaluate whether there is a correlation between the asymmetry of the cuts and the femoral component rotation in total knee arthroplasty. Methods: We built a model to simulate anterior chamfer cut (ACC) performed during total knee arthroplasty for measuring posterior condylar offset (PCO). Right knee axial MRI slices of a total 290 consecutive patients (142 male, 138 female, and mean age 31.39 ± 6.6) were examined. A parallel line to surgical transepiphyseal axis was drawn, and placed at the deepest part of trochlear groove. Posteromedial and posterolateral condylar offsets were measured by drawing perpendicular lines to ACC beginning from the intersection points of both anteromedial and anterolateral cortices to posterior joint line (PJL), respectively. Differences between posteromedial and posterolateral PCO were calculated, and femoral rotation angles (FRA) relative to PJL were measured. Results: The mean surgical FRA was 4.76 ± 1.16 degrees and the mean PCO differencesss- was 4.35 ± 1.04 mm for the whole group and there was no statistically significant difference between genders. There was a strong correlation between surgical FRA and PCO difference (pConclusion: Correlation between the asymmetry of posterior chamfer cuts and achieved femoral component rotation can verify the accuracy of desired rotation, intraoperatively. However, further clinical investigations should be planned to test the results of our morphometric study.