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Avascular necrosis (AVN) of the femoral head is one of the most important complications after closed reduction and spica cast application in developmental dysplasia of the hip (DDH) treatment. This study aims to put forth the impact of closed reduction age and other factors which can cause AVN. Inclusion criteria of the study were: closed reduction and spica cast application before walking age (12 months) and minimum 2 years duration of follow-up. The presence of femoral head ossific nucleus, International Hip Dysplasia Institute (IHDI) score, acetabular indices and AVN were evaluated from radiographies. Hip abduction angles were evaluated on CT images. The absence of the ossific nucleus at the closed reduction time and preoperative IHDI grade were not significant risk factors for AVN (respectively OR = 2.83; 95% CI, 0.99-8.07; P = 0.052; OR = 2.5; 95% CI, 0.85-7.32; P = 0.094). For the patients older than 10 months, (1) the absence of the ossific nucleus was a significant risk factor for grade 2 or higher AVN according to the Bucholz Ogden criteria (P = 0.020) and (2) the higher preoperative IHDI grade (IHDI 3-4) was a significant risk factor for AVN (P = 0.032). AVN of the femoral head was a significant risk factor for fair or poor clinical outcome (P = 0.001). It is not reasonable to wait for radiological visibility of the ossific nucleus to prevent femoral head AVN before applying closed reduction and spica cast, irrespective of the age interval.

OBJECTIVE: The aim of this study was to evaluate the results of the arthroscopic repair in patients with partial and full thickness rotator cuff tears and less than 45 years of age. METHODS: Fifty patients (26 women and 24 men; mean age: 41.4±3.96 years; range: 31–45) with rotator cuff tear, and who were treated with the arthroscopic repair, were included in the study. Twenty patients had full thickness and 30 had partial-thickness tears. The final functional evaluation was conducted at a mean of 42.4 months (range, 24 to 95 months; SD:13.3). The American Shoulder and Elbow Surgeon (ASES) self-report score and the University of California at Los Angeles Shoulder Score (UCLA Shoulder Score) were used as validated scoring systems. RESULTS: At the final follow-up, the mean ASES and UCLA scores improved significantly to 72.3 and 26.5, respectively, in the full-thickness group (p0.06) and UCLA score (p

BACKGROUND: The aim of this study is to examine the effect of preoperative conservative treatment on the success of high-grade bursal/articular-sided partial rotator cuff repair. METHODS: Patients who had undergone shoulder arthroscopy in institution for Ellman Stage 3 bursal-side or articular-side partial tears between January 2008 and April 2018 were investigated retrospectively. This study assessed 201 patients diagnosed with isolated partial rotator cuff tears with a history of failed conservative management and persistent shoulder pain who underwent arthroscopic surgery. The demographic data of patients and pre- and postoperative The American Shoulder and Elbow Surgeons Shoulder Scores (ASES) that were recorded in the archive were evaluated. RESULTS: While 55 of the patients with Ellman grade 3 bursal-sided partial tears received preoperative conservative management for at least 6 months (Group 1), 62 of them could not tolerate conservative management and early arthroscopic repair was performed (Group 2). On the other hand, 42 of the patients with Ellman grade 3 articular-sided tears received preoperative conservative management (Group 3), 42 of them could not tolerate preoperative conservative management (Group 4). The mean ASES score improvement was 52.33 ± 8.55 for Group 1, 54.68 ± 11.29 for Group 2, 48.4 ± 7.77 for Group 3 and 49.33 ± 10.05 for Group 4. A statistically significant difference was found between the groups with one-way ANOVA test (p = 0.05). With the Tukey test, this difference was seen to be caused by Group 2. CONCLUSION: Although there are many factors affecting its success, conservative management should be the first option in the treatment of partial rotator cuff tears. However, we think that it should not be insisted especially in patients with bursal-sided tears (> 50% of the tendon thickness) that cannot tolerate conservative management due to severe pain since the results of early arthroscopic repair of bursal-sided tears were found to be better. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.

Background: Accompanying injuries are frequently seen in middle aged patients with recurrent instability. The aim of this study was to elucidate the associated injuries, report patient outcomes of the following arthroscopic instability surgery regarding 40-60 years old patients with recurrent shoulder instability. Methods: Patients that underwent arthroscopic instability surgery due to recurrent shoulder instability between February 2008 and November 2015, and which were 40-60 years old were included and evaluated retrospectively. Minimum follow-up duration was 24 months. Anterior-inferior labral injuries and accompanying pathologies such as rotator cuff tears and SLAP lesions were documented. Postoperative patient-reported outcome evaluation was made using Oxford Shoulder Instability Score. Results: Among 355 patients that underwent arthroscopic instability surgery, 88 patients which had pathology of recurrent instability were in the range of 40-60 years old. Patients who had previous shoulder surgery or fracture (n = 8) epileptic seizure history (n = 3), neurologic deficit (n = 2) were excluded from the study. 75 patients were included with a mean follow-up 69 +/- 23 months (32-125). The percentage of middle-aged and elderly (40-60 years old) was 24.8% among recurrent shoulder instability patients. 44% had isolated Bankart lesion whereas 56% revealed multiple pathologies. Bankart + SLAP lesions were found in 32%, whereas Bankart + Rotator Cuff tears in 26.7% (13 isolated supraspinatus, 4 supraspinatus + subscapularis, 1 isolated subscapularis full-thickness and 2 partial thickness supraspinatus tears). The mean Oxford Shoulder Instability Score was 38.4 +/- 5.2 (26-48). The scores of patients which were treated with labrum and rotator cuff repair (median 42, range 30-48) were significantly better than the patients who were treated with isolated labrum repair (median 39, range 20-46) (p = 0.015). There was no difference regarding patients with or without SLAP repair (median 39 vs 39 and range 30-48 vs 20-48, respectively) (p = 0.702). Conclusions: Arthroscopic repair of capsulolabral lesions is a safe and successful technique in 40-60 years old patients. Furthermore, the presence of repaired rotator cuff tears led to even superior results. Accompanying SLAP lesions did not affect the results. Study design: Retrospective Case Series. Level of evidence: 4, Retrospective Case Series. (c) 2020 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

Aim: The aim of this study was to evaluate the clinical and radiological results of Ludloff medial open reduction surgery in patients with the developmental of hip dysplasia, younger than 18 months old.Methods: The radiological and clinical results of 35 patients (49 hips), younger than 18 months of age treated with Ludloff medial approach due to DDH between the years 2013 and 2020 were retrospectively evaluated. Preoperative, final control acetabular index angles and medial apertures were measured according to the McCay criteria, Tönnis classification, Kalamchi-MacEwen classification, IHDI classification and Severin classification were analysed.Results: At the last control, the youngest age was 27 months, the oldest was 88 months and the mean age was 43.90 ± 14.17 months. The follow-up period was performed at a minimum age of 12 months, a maximum age of 72 months, and the mean follow-up period was 24.81 ± 17.17 months. According to the Tönnis classification, 40 hips were Tönnis classification type 1 (81.63%), 4 hips were Type 2 (8.16%), 3 hips were Type 3 (6.12%) and 2 hips were Type 4 (4.08%) in the follow-up visit. According to McCay clinical evaluation criteria, 38 hips (79.59%) were grade 1 which equates to excellent results. Grade 0 (no necrosis) was detected in 38 (77.55%) of 49 hips according to the Kalamchi and MacEwen AVN clinical evaluation criteria. According to the Severin classification, type 1 results were observed in 32 (65.31%) of 49 hips, type 2 in 9 hips (18.37%), type 3 in 1 hip (2.04%) and type 4 in 7 hips (14.29%). The mean CE angle was found to be 18.56 ± 9.93. Additional surgical intervention was required in 8 hips of 6 patients.Conclusion: Clinically and radiologically satisfactory results were obtained in DDH patients with Ludloff medial open reduction technique, below the age of 18 months., Amaç: Bu çalışmanın amacı, 18 aylıktan küçük, gelişimsel kalça displazisi olan hastalarda Ludloff medial açık redüksiyon cerrahisinin klinik ve radyolojik sonuçlarını değerlendirmektir.Yöntem: 2013-2020 yılları arasında GKD nedeniyle Ludloff medial yaklaşımı ile tedavi edilen 18 aylıktan küçük 35 hastanın (49 kalça) radyolojik ve klinik sonuçları retrospektif olarak değerlendirildi. Ameliyat öncesi, son kontrol asetabular indeks açıları ve medial açıklıklar McCay kriterlerine göre ölçüldü, Tonnis sınıflaması, Kalamchi-MacEwen sınıflaması, IHDI sınıflaması ve Severin sınıflaması analiz edildi.Bulgular: Son kontrolde en genç 27 ay, en yaşlı 88 ay ve ortalama yaş 43.90 ± 14.17 ay idi. Takip süresi minimum 12 ay, maksimum yaş 72 ay ve ortalama takip süresi 24.81 ± 17.17 ay idi. Tönnis sınıflamasına göre 40 kalça Tönnis sınıflama tip 1 (%81,63), 4 kalça Tip 2 (%8,16), 3 kalça Tip 3 (%6,12) ve 2 kalça Tip 4 (%4,08) idi. McCay klinik değerlendirme kriterlerine göre 38 kalça (%79.59) derece 1 idi ve bu da mükemmel sonuçlara tekabül ediyordu. Kalamchi ve MacEwen AVN klinik değerlendirme kriterlerine göre 49 kalçanın 38'inde (%77,55) derece 0 (nekroz yok) saptandı. Severin sınıflamasına göre; 49 kalçanın 32'sinde (%65.31) tip 1, 9 kalçada tip 2 (%18.37), 1 kalçada tip 3 (%2.04) ve 7 kalçada tip 4 (%14.29) tespit edildi. Ortalama CE açısı 18,56 ± 9,93 olarak bulundu. 6 hastanın 8 kalçasına ek cerrahi müdahale gerekti.Sonuç: Ludloff medial açık redüksiyon tekniği ile 18 aydan küçük GKD hastalarında klinik ve radyolojik olarak tatmin edici sonuçlar elde edildi.

BACKGROUND Although middle glenohumeral ligament (MGHL) variations have been shown in the literature, their clinical effect and relationship with intra-articular pathologies have yet to be revealed, except for the Buford complex. This study was designed to classify MGHL and to reveal its relationship with clinical pathologies. METHODS A total of 843 consecutive shoulder arthroscopies were evaluated retrospectively, and a classification system was proposed for MGHL with regard to its structure and its relation to the anterior labrum. The associations of each MGHL type with superior labrum anterior-posterior (SLAP) lesions, subscapularis tears, and anterior instability were investigated. RESULTS MGHL variations were grouped into 6 types according to the classification. A significant difference in favor of type 6 MGHL (Buford complex) was observed in the distribution of SLAP lesions (P < .001). There was no significant difference between MGHL types and the distribution of anterior instability history (P = .131) and subscapularis tears (P = .324). CONCLUSION SLAP lesions accompany type 6 MGHLs (Buford complex) significantly more frequently than other types. There is also a negative relation between the anterior instability and thicker MGHL variants.

Background Long head of biceps tendon (LHBT) instability is an important source of pain and disability for the shoulder. Supraspinatus and subscapularis tendons contribute to the formation of the biceps pulley system, which maintains biceps stability during shoulder movements. The aim of this study is to evaluate the effect of morphology of bicipital groove on the stability of LHBT. Also, to evaluate the relationship between bicipital groove morphology and subscapularis rupture and supraspinatus rupture. Material and methods Surgical images and magnetic resonance images of 200 patients who underwent shoulder arthroscopy surgery in our clinic between January 2016 and December 2017 were retrospectively analyzed. The depth of groove, medial wall angle and opening angle values of 200 patients were measured on MRI. The stability of the biceps long head tendon, rotator cuff tear and SLAP lesions was recorded by monitoring the shoulder arthroscopy records in each groups. Results There were 200 patients, 131 male and 69 female, with an average age of 40.9 +/- 14.2 (range: 17.0-79.0) years. In 69 (34.5%) patients, long head of the biceps tendon (LHBT) instability was detected. The patients were divided into two groups according to LHBT instability.The subscapularis rupture was significantly more frequent in the group with LHBT instability (52.2%) than the group without LHBT instability (4.6%) (p < 0.001). The supraspinatus tear was observed in 72.5% in the group with instability and 56.5% in the non-instability group, which shows a statistical difference between the two groups (p = 0.027). The presence of SLAP was observed in similar rates in both groups (p = 0.053). Mean depth of groove, medial wall angle, and opening angle measurements were similar in both groups (p = 0.568, p = 0.393 and p = 0.598, respectively). Conclusion To conclude, the morphology of the bicipital groove is not related to the stability of LHBT, and the soft tissue factors above the bicipital groove rather than bone morphology are important in stability. In addition, subscapularis rupture is a pre-disposing factor for LHBT instability; therefore, we recommend a more careful examination of LHBT in patients with subscapularis rupture.

Purpose To evaluate the clinical results of arthroscopic repair and open Ahlgren-Larsson method in patients with chronic lateral ankle instability. Methods We retrospectively evaluated 60 patients who were operated in our clinic between 2010 and 2018 with the diagnosis of chronic lateral ankle instability. Preoperative and postoperative clinical evaluations were performed with AOFAS ankle-hindfoot score, FAOS, and VAS scores. Results Sixty patients with chronic lateral ankle instability were evaluated. 28 patients were treated with Ahlgren-Larsson method, and 32 patients were treated with arthroscopic repair. Follow-up duration was 35 +/- 12 months for the open surgery group and 19 +/- 2 months for the arthroscopic surgery group. The mean age of the arthroscopy group was 44 +/- 9; the mean age of the open surgery group was 46 +/- 11. There was no significant difference between the groups in terms of demographic features (age, sex, BMI). Postoperative clinical improvement was observed in both groups. There was no statistically significant difference between the groups in terms of functionality. However, there was a statistically significant difference in VAS in terms of pain and patient satisfaction in favor of arthroscopy group. Conclusions Ahlgren-Larsson method and arthroscopic repair technique are safe and effective for chronic lateral ankle instability. Arthroscopic technique may be preferred for pain and patient satisfaction as it is less invasive and less morbid.

Purpose: The purpose of this study was to investigate the relationship between the superior capsule tear patterns and synovitis with subacromial pathologies, such as bursal-sided rotator cuff tear and subacromial impingement syndrome. Methods: Fifty patients who underwent arthroscopic treatment for isolated bursal-sided tear were included in the study. Fifty more patients who underwent arthroscopic treatment for isolated Superior Labrum Anterior Posterior (SLAP) 2 lesion without pathology in the rotator cuff were included in the control group. Firstly, superior capsule tear and common synovitis on the rotator cable were assessed during glenohumeral joint examination. Coracoacromial Ligament (CAL) degeneration grading was performed according to the Royal Berkshire Hospital classification. Bursal-sided partial tear grading was done using Ellman classification. Whether or not there was a relationship between synovitis, classic capsule tear, plus reverse flap capsule tear, and partial bursal-sided tear existence. Results: There were 21 patients with reverse flap capsule tear in the study group and 3 patients in the control group. In addition, there were 13 patients with synovitis in the study group and 4 in the control group. Compared to the control group, there was also a significant positive correlation in the presence of both synovitis and reverse flap capsule tear with the presence of bursal-sided tear in the study group ( p = 0.000). There was, however, no significant difference between the presence of classical capsule tear and the presence of bursal-sided tear ( p = 0.485). Conclusion: This study shows that the presence of reverse flap capsule tear and synovitis was associated with partial bursal-sided tears. Therefore, if the reverse flap capsule tear or synovitis is detected in the superior capsule, the rotator cuff should be evaluated in more detail during subacromial bursoscopy in order not to miss a bursal-sided partial cuff tear.

Purpose Early detection and conservative treatment are essential for a successful outcome in developmental dysplasia of the hip (DDH). The aim of this study was to evaluate the efficacy of Tubingen hip flexion splint treatment on dislocated hips of type D, 3, and 4 according to the Graf classification. Methods A total of 104 dislocated hips in 92 patients were treated with Tubingen splints. Splint treatment was applied to patients with dislocated hips as diagnosed under ultrasonographic evaluation. After four to six weeks of treatment, the hips were re-evaluated according to the Graf classification under ultrasonography. The success of Tubingen splinting was determined as follows: hips initially diagnosed as Graf type 3 and 4 were upgraded to type 2c, 2b, or 1 after treatment, and hips initially diagnosed as Graf type D were upgraded to type 2b or 1 after treatment. Results The mean age at treatment initiation was 11.91 +/- 5.16 (range, 4-32) weeks. There were no statistically significant relationships between success rates and sex, bilateral hip involvement, or initial physical examination findings (p > 0.05). The age at the start of treatment was found to be statistically significant in terms of the success of the splint (p = 0.03). Conclusions For successful treatment with Tubingen splints, the cut-off point of starting initial treatment was defined as the 15th week, with sensitivity of 84.62% and specificity of 62.50%. The success rate was 75% with a successful outcome in 78 hips. In view of these results, Graf type D, 3, and 4 dislocated hips can be successfully treated with Tubingen splints.

A 68-year-old female patient admitted to our clinic with right anterior thigh pain ongoing for six months and which increased in last two months. The patient had no trauma history. The patient had been followed-up for 15 years because of osteoporosis and administrated alendronate and ibandronate treatment for 10 years. Patient had three shots of zoledronate once a year during the last three years. Her pain was increasing when she was walking. Physical examination revealed pain in her right thigh. Radiogram showed thickened lateral cortex of the subtrochanteric area. Magnetic resonance imaging also showed thickening and edema of the same area. These images were correlated with atypical fracture in right femoral subthrochanteric zone. Dual energy X-ray absorptiometry revealed that T score was -3.3 in lumbar region and -2.5 in femoral neck. Zoledronate treatment was ended. Prophylactic surgical fixation was performed with titanium elastic nails.

WOS:000475356700008, PubMed ID: 31291858, Objectives: This study aims to investigate the effect of simultaneous coracoplasty on postoperative clinical outcomes of patients undergoing shoulder arthroscopy due to the tear of the isolated subscapularis. Patients and methods: The study included 53 patients (16 males, 37 females; mean age 55.8 years; range, 44 to 70 years) who underwent arthroscopic repair for isolated subscapularis tear (type 2 and type 3) with anterior shoulder pain and tenderness. All patients had a coracohumeral distance of less than 7 mm on the preoperative magnetic resonance images and a minimum follow-up period of two years. Patients were divided into two groups as group 1 including patients who underwent coracoplasty and group 2 including those who did not undergo coracoplasty. Patients were evaluated pre- and postoperatively by the University of California Los Angeles (UCLA) shoulder score and the simple shoulder test (SST) score. Results: There were no significant differences between the groups in terms of age, gender and follow-up time (p0.05). The preoperative mean UCLA score was 19.65 for group 1 and 20.45 for group 2. The postoperative mean UCLA scores were 27.92 and 29.00, respectively. The preoperative mean SST score was 4.9 for group 1 and 5.1 for group 2. The postoperative mean SST scores were 10.0 and 9.5, respectively. Functional scores increased significantly in both groups postoperatively when compared to the preoperative values (p0.01). However, there was no statistically significant difference in terms of the increase in UCLA and SST scores between the two groups (p0.05). Conclusion: We believe that concomitant coracoplasty during arthroscopic repair may not be a necessary routine in the treatment of isolated subscapularis tears., Amaç: Bu çalışmada izole subskapularis yırtığı nedeniyle omuz artroskopisi uygulanan hastalarda eş zamanlı korakoplastinin ameliyat sonrası klinik sonuçlara etkisi araştırıldı.Hastalar ve yöntemler: Çalışmaya anterior omuz ağrısı ve hassasiyeti olan, izole subskapularis yırtığı (tip 2 ve tip 3) nedeniyle artroskopik tamir uygulanan 53 hasta (16 erkek, 37 kadın; ort. yaş 55.8 yıl; dağılım, 44-70 yıl) dahil edildi. Tüm hastaların ameliyat öncesi manyetik rezonans görüntülerinde korakohumeral mesafesi 7 mm’den azdı ve takip süreleri en az iki yıldı. Hastalar korakoplasti uygulanan hastaları içeren grup 1 ve korakoplasti uygulanmayanları içeren grup 2 olmak üzere iki gruba ayrıldı. Hastalar ameliyat öncesi ve sonrasında UCLA (University of California Los Angeles) omuz skoru ve basit omuz testi (BOT) skoru ile değerlendirildi. Bulgular: İki grup arasında yaş, cinsiyet ve takip süresi açısından anlamlı farklılık yoktu (p0.05). Ameliyat öncesi ortalama UCLA skoru grup 1’de 19.65, grup 2’de 20.45 idi. Ameliyat sonrası ortalama UCLA skoru sırasıyla 27.92 ve 29.00 idi. Ameliyat öncesi ortalama BOT skoru grup 1’de 4.9, grup 2’de 5.1 idi. Ameliyat sonrası BOT skoru sırasıyla 10.0 ve 9.5 idi. Ameliyat öncesi değerler ile karşılaştırıldığında, her iki grupta ameliyat sonrasında fonksiyonel skorlar anlamlı olarak arttı (p0.01). Ancak iki grup arasında UCLA ve BOT skorlarındaki artış açısından istatistiksel olarak anlamlı farklılık yoktu (p0.05). Sonuç: İzole subskapularis yırtıklarının tedavisinde artroskopik tamir sırasında eş zamanlı korakoplastinin gerekli bir rutin olmadığını düşünüyoruz.

Congenital dislocation of the patella is a rare and difficult pathology to treat. We present a case of bilateral congenital dislocation of the patella with synostosis of proximal tibiofibular and proximal radioulnar joints without genu valgum deformity of both knees in a 30-year-old man. To our knowledge, congenital dislocation of the patella associated with synostosis of proximal tibiofibular and proximal radioulnar joints has not been reported in the literature yet.

Congenital extremity anomalies are caused by pathological changes during the development process of the embryo. Exposure to toxins during 4-12 weeks of pregnancy may lead to extremity anomalies. In this article, we present a girl patient born as one of triplets at the 31st week and fifth day of pregnancy with meningomyelocele, Arnold-Chiari type 2 malformation, developmental dysplasia of the right hip, hypothyroidism, and lower extremity anomaly. Mother had a history of antenatal usage of sodium valproate. Radiographic examination of the lower extremity showed medial location of the fibula.

A 22-year-old male patient admitted to our clinic with mild pain in left knee. Pain had started 10 years ago and there was no history of trauma. Pain was increased with kneeling. No abnormality was detected on physical examination. Imaging results revealed proximal tibiofibular synostosis in left knee.

Purpose and Hypothesis: The subscapularis tendon is the major medial support of the long head of biceps tendon (LHBT). Thus, tears of subscapularis may cause biceps tendon subluxation or dislocation. A subluxated biceps tendon may cause a superior labrum injury because of the changed direction of the biceps tendon pulling vector. The purpose of this study is to express the frequency of superior labrum anterior posterior (SLAP) lesions accompanying subscapularis tears. Methods: The digital files of 2010 patients who underwent shoulder arthroscopy were reviewed retrospectively. 141 videos of 141 patients with subscapularis tear were examined in terms of superior labrum and biceps tendon injuries by one of the authors in this study. The results were compared with those of all the 2010 patients who underwent shoulder arthroscopy for any reason. The statistical analysis was made with a statistics programme by the Independent Samples T-Test. Results: There were 113 videos on which the superior labrum and LHBT could be examined precisely. Mean age was 57.8 and 66% of the patients were female. 96.4% of the 113 patients were having a SLAP lesion. 10.6% of those were SLAP I and 89.4% were SLAP II lesion. Out of 2010 patients, the SLAP lesion ratio was 32.2% of which 4.9% were SLAP I. That difference between the patients with and without subscapularis tear was statistically significant. Conclusions: Following the loss of medial support, the LHBT and its pulling vector subluxate anteriorly resulting in a tear of the superior labrum from anterior to posterior. In this study, SLAP lesions were strongly correlated with subscapularis tears as well. Furthermore, the synovial hypertrophy initiated after a superior labrum pathology at superior aspect of the glenoid spreads over the LHBT. An inflamed LHBT firstly degenerates, and then ruptures. According to this study, tears of subscapularis should be repaired when encountered in order to prevent the upcoming secondary intra-articular disorders. [Figure: see text]