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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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Introduction: Patellar tendon donor site has been previously evaluated in patients with auto-graft bone–tendon–bone (BTB) anterior cruciate ligament (ACL) reconstruction using either magnetic resonance imaging or B mode ultrasound. However, donor site patellar tendon strain ratio—reflecting structural features—has not been studied with US elastography. Here, we ascertain real-time elastography properties of patellar tendon donor site and clinical relevance of these properties in patients with auto-graft BTB ACL reconstruction in the postoperative period. Methods: Patients who underwent ACL reconstruction using BTB autograft were evaluated. Demographic, operative and clinical data (severity of pain, Lysholm Knee score, sit to stand test, packages/year for smoking amount) were noted. Patellar tendons of the operated knees were evaluated by ultrasound (length and thickness) and sonoelastography (strain ratio). The healthy knees of the patients constituted the control group. Results: Eighteen patients (17 M, 1 F; mean age 30.9 ± 7 years) were evaluated. Mean postoperative follow-up period was 22.1 ± 2.6 (range 18–26) months. Patellar tendons were shorter and thicker on the operated side when compared with the contralateral side (both p = 0.001). Patellar tendon strain ratios of the operated side were lower than the contralateral side (harder tendon on operated side). While there was no correlation between strain ratios and clinical variables (age, BMI, postoperative time, severity of pain, Lysholm score, all p values > 0.05), significant negative correlations were detected between strain ratios of proximal, middle and distal thirds of operated side and amount of smoking (p = 0.008, r = −0.607, p = 0.009, r = −0.598, p = 0.023, r = −0.533, respectively). Conclusion: Patellar tendons on the operated sides seemed to thicken and shorten with decreased strain ratios at the donor side compared to the healthy side at an average of 2-year follow-up in patients with ACL reconstruction using BTB autograft, and amount of smoking had negative relationship with strain ratio of donor patellar tendon. © 2016, Springer-Verlag Berlin Heidelberg.

BACKGROUND: Although functional results of combined rehabilitation programs are reported, there have been no reports studying the effects of solo pendulum exercises on ultrasonographic measurements of acromiohumeral distance (AHD). OBJECTIVE: To investigate the effects of weighted and un-weighted pendulum exercises on ultrasonographic AHD and clinical symptoms in patients with subacromial impingement syndrome. METHODS: Patients with subacromial impingement syndrome were randomized to performing weighted (1.5 kilograms hand held dumbbell, N = 18) or un-weighted (free of weight, N = 16) pendulum exercises for 4 weeks, 3 sessions/day. Exercises were repeated for each direction of shoulder motion in each session (ten minutes). Clinical situation was evaluated by Constant score and Shoulder Pain Disability Index (SPADI). Ultrasonographic measurements of AHD at 0°, 30° and 60° shoulder abduction were performed. All clinical and ultrasonographic evaluations were performed at the beginning of the exercise program and at end of 4 weeks of exercise program. RESULTS: Thirty-four patients (23 females, 11 males; mean age 41.7 ± 8.9 years) were evaluated. Significant clinical improvements were detected in both exercise groups between pre and post-treatment evaluations (p < 0.05). There was no significant difference for pre and post-treatment AHD measurements at 0°, 30°, and 60° shoulder abduction between groups (p > 0.05). There was no significant difference for pre and post-treatment narrowing of AHD (narrowing of 0°'30°, and 0°'60°) between groups (p > 0.05). CONCLUSION: While significant clinical improvements were achieved with both weighted and un-weighted solo pendulum exercises, no significant difference was detected for ultrasonographic AHD measurements between exercise groups. © 2017 IOS Press and the authors. All rights reserved.

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.

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.

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.