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Purpose: This study aimed to present the change in humeral retroversion (HR) angle (HRA) that occurs in childhood and young adulthood and the potential developmental difference that is observed in wrestlers. Methods: HRA of dominant and non-dominant shoulders (DSHRA and NDSHRA, respectively) were measured using ultrasonography in a group of 30 wrestlers who started wrestling before the age of 13 years (Group 1), a group of 30 young adults, aged between 16–20 years, who were not actively engaged in any branch of overhead sports (Group 2) and a group of children aged between 11–13 years and not actively engaged in any branch of overhead sports (Group 3). Range of motion (ROM) degrees of dominant and non-dominant shoulders in all groups were compared within each group and between the groups. Results: DSHRA (mean: 88.73°, 88.93° and 89.40°) values were significantly higher than NDSHRA (mean: 81.13°, 81.83° and 84.37°) values (p < 0.001, p < 0.001 and p < 0,05) in Groups I, II and III, respectively. Internal rotation and total ROM degrees of the dominant shoulder in Group 1 and 3 were higher than those in Group 2. Conclusion: There is no significant change in terms of HRA in people aged between 11–13 and 16–20 years because of natural development or wrestling. DSHRA values are higher than NDSHRA ones. In contrast to the shoulders of throwers, the shoulders of wrestlers are characterized by an increase in internal rotation, described as “Wrestler’s shoulder.” Level of Evidence: Level III.

Background The purpose of the study was to investigate the long-term outcomes of the all-inside arthroscopic medial reefing (AAMR) procedure for patellar instability and the factors that affect successful outcome. Methods In this retrospective study, AAMR with suture was performed in 16 knees of 15 patients who had at least one patellar dislocation and did not experience a decrease in pain and who did not have a major radiological bony abnormality. Preoperatively, Tegner and Lysholm scales were used; for the final evaluation Tegner, Lysholm, Kujala and Knee injury and Osteoarthritis Outcome Score (KOOS) were used. Results The average age of the patients at the time of operation was 18 years (range: 11–36 years). The average follow-up time was 118.3 months (range: 85–143 months). Six of the 16 knees (37.5%) exhibited re-dislocation. Preoperatively, the mean Lysholm and Tegner were 66.5 and 4.0, respectively; and postoperatively increased to 89.3 (P = .001) and 4.66, respectively. At the final follow-up, mean Kujala was 89.3 (good), and mean KOOS was 91.4. In all patients with re-dislocation, fewer than four knots were used, and none of the patients with four knots exhibited re-dislocation. Re-dislocations occurred in two, two, one and one patients at two, three, five and eight years, respectively. Conclusions The AAMR technique is associated with minimal incisional scarring and an increase in functional scores. It is also associated with a high risk of re-dislocation compared with other methods. If the technique still needs to be used, despite the high re-dislocation rate, at least four knots should be applied.

Background: Scapular kinesia is an important component of glenohumeral rhythm and shoulder stability. No studies have evaluated scapular dyskinesis and its relationship to shoulder proprioception in patients who have undergone arthroscopic Bankart repair (ABR). Purpose: To investigate scapular dyskinesis, proprioception, and functional level after ABR. Study Design: Cohort study; Level of evidence, 3. Methods: This study included 13 male patients who underwent ABR (ABR group; mean age, 30 years; range, 24-36 years) and 13 sex- and age-matched healthy individuals (control group). The age, height, weight, and dominant side of all participants were collected. Scapular dyskinesis was evaluated using the lateral scapular slide test and the scapular dyskinesis test; proprioception was measured by the active angle reproduction test using a smartphone goniometer application, and functional level was assessed using the upper-quarter Y-balance test for dynamic stability as well as the Rowe score and Walch-Duplay score for quality of life and return to activities of daily living. Results: The presence of static scapular dyskinesis in the neutral position, at 45° of abduction, and at 90° of abduction as well as the presence of dynamic scapular dyskinesis was higher in the ABR group compared with the control group ( P ≤ .04 for all). Shoulder joint position sense (absolute error) at 40° and 100° of shoulder elevation and shoulder functional level according to the Rowe score were worse in the ABR patients compared with the healthy controls ( P ≤ .02 for all). Dynamic scapular dyskinesis was negatively related to shoulder joint position sense at 40° of shoulder elevation ( r = –0.64; P = .01). Static scapular movement as measured on the lateral scapular slide test was moderately related to the Rowe score ( r = 0.58; P = .03). Conclusion: Scapular kinematics and proprioception should be evaluated after ABR. Treatment approaches to improve scapular control and proprioceptive sense should be included in the rehabilitation program for patients after ABR.

Purpose: The ideal treatment algorithm is still controversial for Superior Labral Anterior-Posterior (SLAP) tears. In this systematic review, we aimed to clarify and ascertain which treatment modality is effective and more usable in which conditions. Methods: In this systematic review, we used the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines established for systematic reviews and meta-analysis. “SLAP or Superior Labral Anterior-Posterior” and “biceps tenodesis” search terms were used in The Cochrane Library database and Pubmed from their inception to the 30th of September 2020. A total of 2326 titles were screened and 2069 articles were removed because of their ineligibility. Full texts of 14 studies were screened and finally, six were suitable for the present systematic review. Demographic details and study characteristics, patient satisfaction, functional outcomes, return to preinjury sports level, reoperation, stiffness, sling time and rehabilitation protocols were reviewed and compared between SLAP repair and biceps tenodesis groups. Results: A total of 2326 titles were screened and six studies were detected eligible. Results of 287 patients (SLAP repair: 160, Biceps Tenodesis: 127) were reviewed in included six studies. Biceps tenodesis was showed as more satisfied technique in four of the studies but the statistical comparing results of two groups were not significantly different in each study. Different functional scoring systems used in the studies were not statistically significantly different between the groups. The percentage of return to sport and preinjury level is higher in biceps tenodesis in the five studies. The total reoperation rate for SLAP repair was 19/160 (12%) and biceps tenodesis was 7/127 (6%). Conclusion: The biceps tenodesis has a higher return to preinjury sports level, higher patient satisfaction and lower reoperation rates but functional scores are similar between SLAP repair groups in patients with SLAP tear.

Proximal humerus fractures and acromioclavicular joint dislocation are the most common reasons for minimally invasive shoulder surgery. A fall (often low energy) is the most common mechanism. The rehabilitation approach that is used for patients following proximal humerus fractures and acromioclavicular joint dislocation differs depending on fracture type, pattern, and surgical approach. The postoperative management of the shoulder is as important as intraoperative care. Although each patient receives an individualized program, the basic goals are the same.

Recent studies have shown that adult human articular cartilage contains stem-like cells within the native structure. In this study, we aimed to determine the localization of putative stem cell markers such as CD90, STRO-1, OCT-3/4, CD105 and CD166 in adult human articular cartilage tissue sections and demonstrate the expression of these markers within the expanded surface zone colony-forming (CF) cells and evaluate their differentiation potential. Biopsy samples were either fixed immediately for immunohistochemical analyses or processed for in vitro cell culture. Immunohistochemical and flow cytometry analyses were performed by using CD90, STRO-1, OCT-3/4, CD105 and CD166 antibodies. Isolated colony-forming (CF) cells were further stimulated, by using the appropriate growth factors in their pellet culture, to obtain cartilage, bone and adipose lineages. We observed that the expression of the stem cell markers were in various zones of the human adult cartilage. Flow cytometry results showed that in CF cells the expression of CD90 and CD166 was high, while OCT-3/4 was low. We also determined that CF cells could be stimulated towards cartilage, bone and adipose lineages. The results of this research support the idea that the resident stem-like cells in adult human articular cartilage express these putative stem cell markers, but further experimental investigations are needed to determine the precise localization of these cells.

Objective: The aim of this study was to assess the apoptotic effects of systemic corticosteroid application on the articular cartilage chondrocytes in vivo and to investigate the potential effects of zoledronic acid on corticosteroid-induced apoptosis.Methods: Twenty-four Wistar rats were randomly divided into 3 groups. In the control group, intramuscular isotonic salt solution was injected weekly. In the second group, a dose of 10 mg/kg intramuscular corticosteroid (methylprednisolone) injection was applied weekly for 8 weeks. In the third group, a dose of 10 mg/kg intramuscular corticosteroid (methylprednisolone) injection was applied weekly for 8 weeks and 0.1 mg/kg zoledronic acid was injected subcutaneously on days 0, 21 and 42. Femoral head specimens from each group were obtained at the end of the treatment and the TUNEL method was applied to detect apoptotic chondrocytes. Comparison analyses were performed using the ANOVA method and Tukey’s test.Results: There was a significant difference between the corticosteroid group and two other groups (control group: p=0.005; corticosteroid + zoledronic acid group: p=0.047). Zoledronic acid treatment significantly decreased the number of corticosteroid-induced apoptotic chondrocytes in the joint cartilage (p, Amaç: Bu çalışmamızda sistemik kortikosteroid uygulamasının in vivo eklem kıkırdağı kondrositleri üzerindeki apoptotik etkilerini ve zoledronik asidin kortikosteroide bağlı apoptoz üzerindeki olası etkileri olup olmadığını değerlendirmeyi amaçladık.Çalışma planı: Yirmi dört adet Wistar sıçanı rastgele 3 gruba ayrıldı. Kontrol grubunda, intramusküler izotonik tuz çözeltisi haftalık olarak enjekte edildi. İkinci grupta ise, kas içine 10 mg/kg dozunda kortikosteroid (metilprednizolon) enjeksiyonu 8 hafta boyunca haftada bir uygulandı. Üçüncü grupta, 10 mg/kg intramusküler kortikosteroid (metilprednizolon) enjeksiyonu 8 hafta boyunca haftada bir doz uygulanırken, ek olarak 0.1 mg/kg zoledronik asit 0, 21 ve 42. günde deri altına enjekte edildi. Tedavinin sonunda her gruptan femur başı örnekleri alındı ve apoptotik kondrositleri saptamak için TUNEL yöntemi kullanıldı. Karşılaştırmalı analizler için ANOVA yöntemi ve Tukey testinden yararlanıldı.Bulgular: Kortikosteroid grupla diğer iki grup (kontrol grubu için p=0.005 ve kortikosteroid + zoledronik asit grubu için p=0.047) arasında anlamlı bir fark vardı. Zoledronik asit tedavisi eklem kıkırdağında kortikosteroide bağlı gelişen apoptotik kondrosit sayısını anlamlı olarak azalttı (p

Introduction: Purpose of this study was to evaluate the results of arthroscopic medial reefing for patellar instability at long term. Materials-Methods: 15 patients (16 knees) with patellar instability were consecutively treated by arthroscopic medial reefing between 2005- 2010. At final follow-up 11 patients (12 knees) were available to evaluate. Average age was 18,6 (range, 12-37 years). Average follow-up was 90 months (range, 71-115). History of patellar dislocation episode was reported by all patients. Arthroscopic medial reefing was applied through three standard portals. At least 3 sutures were tied according to medial laxity. Post-operatively all patients were allowed to bear weight on the operated leg immediately and full knee flexion was allowed by the third week. At last follow-up patients were evaluated according to the Tegner and Lysholm scales. Paired t test was used to detect the statistical differences and pResults: Two patients reported re-dislocations after the operation. Re-dislocation rate was 16.6% (2 in 12 knees). In general, patients reported significant improvement in pain, swelling, crepitus, and physical activity. The most common complaint was the anterior knee pain. The average pre and post-operative Tegner scores were 3.66 and 4.0, respectively. The average preoperative Lysholm score was 72 and postoperatively improved to 87.8 (p=0. 017). Discussion: Arthroscopic medial reefing for patellar instability is a viable option for young patients with ligamentous insufficiency without major bony abnormalities. The most significant advantages are that the epiphyseal plates are protected in young patients, no skin incision applied, and no autografts are harvested.

The presence of progenitor/stem cells in human articular cartilage remains controversial. Therefore, we attempted to isolate and culture progenitor/stem cells and to investigate their phenotypic characteristics. Biopsies were obtained (with consent) from patients undergoing arthroscopic surgery. Full depth explants were fixed and cryosectioned or enzymatically digested and the resulting cells cultured and plated on fibronectin-coated dishes. Chondrocytes were cultured until colonies of >32 cells were present. Colonies were trypsinized and expanded in monolayer for pellet culture. Immunolocalization of Notch and its ligands were detected in vivo and in vitro using immunocytochemistry. In vitro studies investigated differences in immunolocalization of Notch and its associated ligands in colony-forming cells and small clusters of non-colony-forming cells. The ultrastructure of the chondroprogenitors was examined by scanning and transmission electron microscopy. Results revealed that the immunolocalization of Notch-1 and its ligand Delta were concentrated in regions closest to the articular surface. Notch-1 was also densely localized in the deeper zone of articular cartilage. Notch-2 immunolabeling was densely localized in all zones of articular cartilage. Jagged-1 was concentrated in the deeper regions of articular cartilage. Notch-1, Delta and Jagged-1 were more abundant in colony-forming cells than non-colony-forming chondrocytes in vitro. Notch-3, Notch-4 and Jagged-2 were absent from all regions of the articular cartilage tissues and cultured cartilage cells in vitro. Ultrastructurally, chondrocytes cultured in monolayer dedifferentiated to fibroblast-like cells with cell surface processes of varying lengths, pellet cultured cells varied in morphology, as flattened and rounded. In conclusion, we propose that adult human articular cartilage may contain cells having progenitor cell features.

The aim of this study is to search if there is any proprioceptive difference between auto and allograft anterior cruciate ligament (ACL) reconstructions, and also to determine if there is any relationship between instrumented anterior knee laxity and proprioception after an ACL reconstruction. The following four groups were constituted for this purpose: group I, control group; group II, autograft reconstructions; group III, allograft reconstructions and group IV, people with injured ACLs. Each group consisted of 20 patients/volunteers. Two subgroups were constituted according to the findings of KT-1,000 laxity testing in group II and III; patients/volunteers found to have a laxity of 3 mm or less were enrolled in the normal subgroup and those with a laxity of more than 3 mm were enrolled in the lax subgroup. Two proprioceptive tests were used: threshold to detect passive motion (TDPM) and joint position sense (JPS) by using Cybex Norm dynamometer. Patients underwent ten tests and the discrepancy in degrees was averaged for ten trials. Comparisons were made to evaluate the proprioceptive differences between groups/subgroups; ANOVA and t test was used for comparisons where appropriate, and the significance was set at P0.05. There was a significant difference in degrees between patients with injured ACLs and the other three groups in TDPM evaluations (injured: 1.93 degrees vs. control: 1.03 degrees , autograft: 1.01 degrees , allograft: 0.96 degrees ; P0.001). Auto and allograft reconstructions were not different from each other and controls. Allo and autograft ACL reconstructions are not different from each other according to proprioceptive measurements. Also, proprioception is not correlated to postoperative anterior knee laxity; many variables involve joint proprioception and mostly the anterior knee laxity may not be the sole determining element, and a lax ACL still may fulfill some of its afferent arc functions as long as it bridges the femur and tibia.

Background. Radiofrequency treatment is increasingly used to treat shoulder instability. Patients are asked to restrain their physical activities after this treatment but there is no precise information concerning the necessity for the restrain. Methods. There were two groups of ten specimens each. Treatment group specimens were stretched to subfailure injury, treated by a radiofrequency probe, and then cyclically loaded. Control group specimens were stretched to the same subfailure injury, Sham treated, and then cyclically loaded. Between each step of the experiment in both groups there was a relaxation test to examine the ligament viscoelastic properties. At the end, each ligament was stretched to failure and the load–elongation curve obtained. Findings. Relaxation forces decreased after the subfailure injury in both groups (average 76% and 81% of intact state, in treatment and control groups, respectively). In the treatment group, the relaxation forces first increased after the radiofrequency treatment (average 99% of intact state), and then decreased after the cyclic loading (average 50% of intact state). The treated ligaments failed at lower loads and smaller deformations than the controls. Interpretation. The radiofrequency treatment restored viscoelastic properties of the injured ligaments, but cyclic loading degraded these. Protection of the treated ligament is advised during the immediate post-operative period. 2004 Published by Elsevier Ltd.

The purpose of this study was to identify a reliable reference point for measuring anterior intermeniscal ligament thickness and to investigate the morphological characteristics of the ligament at its attachment site to anterior horns of both menisci by MRI. MRI was performed in 98 knees of randomly chosen patients. The anterior intermeniscal ligament was detected in 61 knees (62.2%). The average ligament length was 29.8 mm. Men had significantly longer anterior intermeniscal ligament than women patients (32.5 vs. 27.8 mm). The thickness of anterior intermeniscal ligaments at their attachment sites to menisci was usually less than 3 mm; a thickness of 3 mm or more at the attachment site to anterior horns of the meniscus was defined as "cordlike." It is suggested that the "cordlike" pattern is a variation of the anterior intermeniscal ligament's attachment characteristics, and that this might have a significant role in meniscal translations during knee motion, and also that the "cordlike" pattern could be clinically important with respect to its relationship to the anterior horn of medial meniscus. The attachment site of the ligament is a reliable reference point for measuring its thickness.

A 16-year-old boy with a 4-month history of pain and a palpable mass in the right wrist was presented to our clinic. Preoperative diagnosis was a ganglion cyst according to symptoms and physical examination. The lesion was removed by marginal resection and histopathologic examination revealed a juxta-articular myxoma. No recurrence was detected at 1-year follow-up evaluation. We report a case of juxta-articular myxoma of the wrist joint.

radiation-free and non-invasive and can almost replace radiography as the preoperative screening tool for diagnosing shoulder injuries, although its diagnostic value for various pathologies has to be appreciated separately from radiography. Nonetheless, a comprehensive clinical evaluation should always be the first step of any diagnostic workup. MRI is useful in detecting muscle and tendon injuries, soft-tissue pathologies, and major cartilage defects. Uncommon injuries can be readily diagnosed. For example, a rare case of seatbelt injury causing rupture of the deltoid muscle has been diagnosed by MRI.1 A ganglion cyst in the suprascapular fossa is uncommon and can cause a nerve palsy; noncontrast MRI helps diagnosing this pathology and planning of the surgical procedure.2 Bony pathology can be associated with other structures; MRI helps assess the anatomic association of acromioclavicular joint degeneration with supraspinatus outlet Commentary: Non-contrast magnetic resonance imaging for diagnosing shoulder injuries

Congenital dislocation of the extensor tendon is extremely rare. We report a case of bilateral dislocations in an 8-year-old boy, which were treated successfully with reconstruction of the sagittal band. We describe the technique and 18 months' result.

Discoid lateral meniscus is a rare disorder and its association with other variations in the knee joint has been reported. The anterior intermeniscal ligament has also been described as connecting the anterior convex margin of the lateral meniscus to the anterior horn of the medial meniscus. In the normal population, it was observed at 53-94%. Although the functional properties of the anterior intermeniscal ligament are not yet clarified, two distinct types of the ligament have been described according to their morphological characteristics as cord-like and membranous types. The purpose of this study was to evaluate any possible association between morphologic types of anterior intermeniscal ligament and discoid lateral meniscus. A retrospective study was designed; 20 discoid lateral menisci were operated using routine arthroscopic examination. Upon arthroscopic examination the thickness of the ligament and associated morphological changes were recorded systematically. The cord-like anterior intermeniscal ligament was an associated structure in 15 of the 20 knees with discoid lateral meniscus (75%). Patients with discoid lateral meniscus apparently have cord-like type anterior intermeniscal ligament, thus we conclude that cord-like type of anterior intermeniscal ligament is a frequent accompanying structure to discoid lateral meniscus and may have a potential stabilizing effect on its anterior stability.

Summary We studied the immunolocalisation of the stem cell-specific markers Notch-1, Delta,CD105 and CD166 in rat articular cartilage and analysed the effect of systemiccorticosteroid treatment on the patterns of distribution of cells labelling for thesemarkers. Female Wistar rats were separated randomly into two groups: the controlgroup (n ¼ 8) was injected with isotonic salt solution and the corticosteroid group(n ¼ 8) was injected with 10mg/kg intramuscular corticosteroid (methylpredniso-lone) once a week for a period of 8 weeks. Femoral head specimens from each groupwere obtained at the end of the treatment and processed for routine histological andimmunohistochemical examinations. Quantitative data were obtained by H-SCOREand statistical evaluations were performed. The immunolocalisation of all markerswas more apparent in the superficial zone and decreased through the deeper zonesin all groups. However, the intensity of labelling was much less obvious in the grouptreated with corticosteroid compared to control. H-SCORE analysis confirmed that inthe group treated with corticosteroid, the intensity of Notch-1, Delta, CD105 andCD166 labelling had decreased significantly compared to control (po0.05). Inconclusion, based on the immunolocalisation of stem cell-specific markers Notch-1,Delta, CD105 and CD166, the data suggest that the stem cells may continue to existin adult rat articular cartilage. It was also observed that systemic corticosteroidtreatment may effect the immunolabelling intensity of these markers, suggestingthat corticosteroid treatment may reduce the function and the regenerativecapacity of these cells in articular cartilage.& 2009 Elsevier GmbH. All rights reserved.

This is a case report of two children with congenital dislocation of the knee. They have been treated surgically with Z-lengthening of the quadriceps tendon and additional reconstruction of the quadriceps tendon with Achilles tendon allograft to fill in the remaining average 6 cm gap of the tendon. The patients were two girls, 6 and 9 years old. One of them had an operative treatment previously with a tendon lengthening procedure and it was failed and the other patient was untreated before. Preoperatively, untreated case was unable to walk. The other patient was limping. None of them was able to flex their knees beyond the neutral extension position. Postoperatively, both patients were able to walk and the knees were reduced to a range of motion of 0 degrees -95 degrees of flexion. The mean follow-up time was 20 months.

Objective. To evaluate the radiofrequency treatment applied to an intact anterior cruciate ligament, and to quantify the mechanical effects of controlled cyclic loading (simulating activities of daily living) post-treatment. Design. An in vitro radiofrequency energy application to the rabbit anterior cruciate ligament and cyclic loading of the treated ligament. Background. Effect of cyclic loading on the radiofrequency treated ligament in a controlled environment is not known. Methods. In the treatment group radiofrequency treatment was applied to an intact ligament and then the ligament was cyclically loaded for 3000 cycles, and stretched-to-failure. Control group was similar to treatment, except that the radiofrequency treatment was not applied. The cyclic loading (approximately 6% tensile strain) was kept below the injury threshold of the rabbit anterior cruciate ligament and was designed to simulate loading post-treatment. A relaxation test (5% constant strain for 180 s) was used to compare the results at different steps in the experiment; within each group and between the two groups. Results. Relaxation force increased in the treatment group (average 108% of intact, P