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Purpose: End-stage ankle arthrosis causes severe pain and limited movement. Tibiotalocalcaneal arthrodesis with arthroscopy-assisted hindfoot nailing can be used to achieve a high union rate and low complication rate. We aimed to examine the early- and mid-term results of patients treated with this technique from various perspectives and to evaluate them by comparing them with the current literature., Methods: Data were collected from 25 patients who met the established criteria and underwent TTCA with arthroscopic-assisted hindfoot nailing. In addition to the demographic data of the patients, their clinical and pain scores were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS). Additionally, the union time and complication data during the follow-up period were examined., Results: When the AOFAS and VAS scores of the 25 patients were examined, a significant improvement was observed in the preoperative period and early postoperative period comparisons ( p < .001). No significant change was observed between the comparison of the postoperative 12th month and last postoperative control clinical scores. While the union rate of the patients was observed to be 92%, the average union time was 13.1 ± 3.5 weeks. During follow-up, peri-implant fracture, deep infection, and non-union were observed in one patient each (12%)., Conclusion: The early- and mid-term postoperative results of patients treated with TTCA surgery with posterior approach arthroscopic-assisted hindfoot nailing show that this technique may be an option with low complication and high union rates for the appropriate group of patients planned for ankle arthrodesis., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Soft tissue interposition between a suspensory cortical button and the lateral femoral condyle is the most common cause of postoperative suspensory cortical button migration in patients undergoing anterior cruciate ligament reconstruction (ACLR)., Purpose: To investigate the effects of soft tissue interposition and suspensory cortical button migration after ACLR on functional outcomes and graft ligamentization., Study Design: Cohort study; Level of evidence, 3., Methods: Included were 249 patients who underwent single-bundle ACLR with hamstring tendon autografts. To measure soft tissue imposition, the patients were divided into 2 groups: those in whom the suspensory cortical button was in contact with (group 1) or at least 1 mm away from (group 2) the lateral femoral condyle on 1-day postoperative radiographs. To measure suspensory cortical button migration, the patients in group 2 were further divided into 2 subgroups: those with button migration (group M) and those without migration (group non-M) as observed on 12-month postoperative radiographs. Ligamentization was evaluated according to Howell classification (grades 1-4) on 12-month follow-up magnetic resonance imaging scans. Also recorded were preoperative and 24-month postoperative Lysholm and Tegner scores and 24-month postoperative arthrometer measurements for anterior knee laxity., Results: There was no significant difference between groups 1 and 2 or between groups M and non-M in terms of demographic characteristics or additional intra-articular pathologies detected intraoperatively. Normal anterior laxity (<3 mm) was detected in 83.7% of the patients postoperatively, and all patients showed statistically significant pre- to postoperative improvement on the Tegner (from 4.1 to 4.3) and Lysholm (from 44.0 to 89.2) scores ( P < .05 for both). No significant difference in postoperative functional results or graft ligamentization was found between either the soft tissue interposition groups (groups 1 and 2) or the suspensory cortical button migration groups (groups M and non-M)., Conclusion: Differences between patients in soft tissue interposition and suspensory cortical button migration did not significantly affect postoperative clinical or functional outcomes or graft ligamentization after single-bundle ACLR., Competing Interests: The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2022.)

Introduction: The aim of the study was to make a prospective comparison of the radiological and clinical outcomes of patients undergoing single-bundle and double-bundle anterior cruciate ligament (ACL) reconstruction., Method: This prospective, case-controlled study included 65 patients, separated into 2 groups as 33 patients undergoing single bundle (SB), and 32 patients undergoing double bundle (DB) ACL reconstruction. The patients were evaluated clinically using the International Knee Documentation Committee (IKDC) and the Lysholm knee scores. Stability was evaluated with the KT-1000 Arthrometer Measurement, the Lachman and pivot shift tests. Magnetic resonance images (MRI) at 1 and 5 years postoperatively were evaluated by a musculoskeletal radiologist. All the operations were performed by a single surgeon and the clinical evaluations were made by an independent researcher., Results: Evaluation was made of a total of 53 patients (SB: 28, DB: 25). No statistically significant difference was determined between the groups regarding the postoperative IKDC and Lysholm scores. The pivot shift tests were negative in the DB group and positive in two patients of the SB group. The Lachman test was negative in all the patients. No significant difference was determined between the groups. No statistically significant difference was determined between the two groups in respect of the arthrometer measurements. In the SB group, revision surgery was performed in two patients due to graft failure. No graft failure findings were determined in the DB group, and no statistically significant difference was determined between the groups in respect of graft failure. On the MRIs taken at 1 year postoperatively, the ACL was seen to be hyperintense in 16 patients in the DB group and 6 patients in the SB group (p = 0.004). On the 5-year MRIs, ACL hypointensity could not be seen in three patients of the SB group and two of the DB group, with no difference determined between the groups (p > 0.05)., Conclusion: In the 5-year follow-up period, no difference was determined between patients undergoing SB ACL reconstruction and those undergoing DB ACL reconstruction regarding clinical scores, knee stability, and MRI findings, but graft maturation occurs later the patients undergoing DB reconstruction., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Ramp lesions are encountered in 16% to 24% of all anterior cruciate ligament (ACL) ruptures. However, isolated ramp lesions without a ruptured ACL have also been reported., Purpose: To evaluate outcomes after type 3 hidden ramp lesions without ACL rupture were treated with all-inside sutures passed through the standard anterior portal., Study Design: Case series, Level of evidence, 4., Methods: Included were 41 patients (26 female; 63.4%) with isolated type 3 ramp lesions who underwent surgery between January 2017 and January 2019. Patients with concomitant lateral meniscal injuries and revision meniscal surgeries were excluded. We retrospectively recorded patient age, sex, and body mass index (BMI), as well as follow-up periods, comorbidities, and postoperative and early midterm complications. The Lysholm, visual analog scale (VAS) for pain, and International Knee Documentation Committee (IKDC) scores were compared preoperatively to final follow-up. In addition, patients were classified as having either a sedentary or active lifestyle according to Sedentary Behavior Research Network (SBRN) criteria. The Shapiro-Wilk test was used to evaluate the normality of the data, and the Wilcoxon and Mann-Whitney U tests were used to compare preoperative and postoperative outcome scores. The Spearman test was employed to evaluate the correlation between patient variables., Results: The mean follow-up period was at 37.6 (range, 25-49) months. A total of 17 patients (41.46%) had a sedentary lifestyle based on SBRN criteria. All scores improved significantly from preoperatively to final follow-up (VAS, from 8.43 ± 1.53 to 2.34 ± 2.9; Lysholm, from 47.73 ± 17.02 to 85.37 ± 14.01; and IKDC, from 27.12 ± 14.81 to 85.32 ± 8.78; P < .001 for all). Although no significant relationship was established between patient activity level and postoperative Lysholm and IKDC scores, an inverse correlation was observed between BMI and Lysholm ( r =-0.9906) and BMI and IKDC ( r =-0.9402)., Conclusion: Satisfactory postoperative clinical results were obtained in patients with type 3 ramp lesions not accompanied by ACL rupture who were treated with all-inside suturing through standard anterior portals., Competing Interests: The authors have declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2022.)

Cell-free scaffolds used in cartilage regeneration are produced from different materials. The aim of this study is to compare the clinical and radiological results of two different scaffolds with hyaluronan- or chitosan-based structure used in the treatment of symptomatic condylar osteochondral lesions. The study comprises 69 patients who were operated for osteochondral lesion repair with hyaluronan- ( n  = 37) or chitosan-based ( n  = 32) scaffold. The International Knee Documentation Committee (IKDC), Lysholm Knee Scoring Scale and Visual Analog Scale (VAS) scores were collected for both groups at the preoperative and postoperative 3rd, 12th, and 24th months. Magnetic resonance imaging was performed between the 12th and 15th months postoperatively and this with magnetic resonance observation of cartilage repair tissue (MOCART) scoring were compared. Within group assessments demonstrate significant improvement in IKDC, Lysholm, and VAS scores at postoperative 3rd and 12th months. However, in both groups, IKDC, Lysholm and, VAS scores at the postoperative 24th month indicate no significant further improvement, compared with the 12th month results. There was no significant difference between the groups in terms of IKDC, Lysholm, VAS, and MOCART scores at any time period. This study shows that both scaffolds are useful in cartilage regeneration but have no clinical or radiological superiority to each other. Surgeons should select the method with which they feel comfortable. This is a level III, retrospective comparative study., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective: The aim of this study was to evaluate the functional results of hip arthroscopy for femoroacetabular impingement (FAI) performed via the periportal capsulotomy technique combined with capsular thinning and peripheral compartment first access., Methods: This prospective study included 34 patients (20 female, 14 male; mean age = 32.3 ± 12.5 years) treated for combined type FAI and labral tears between January 2016 and January 2018. In radiographic evaluation, center-edge angle (CEA) and alpha angle were measured preoperatively and postoperatively. Patients' functional status was assessed at 3, 6, 12, and 24 months using the modified Harris Hip Score (mHHS), Hip Disability and Osteoarthritis Outcome Score - Activities of Daily Living (HOOS-ADL), and Hip Disability and Osteoarthritis Outcome Score - Sports-Specific Subscale (HOOS-SSS), and visual analog scale (VAS)., Results: The mean alpha angle decreased from 55.5°±2.9° preoperatively to 48.3° ± 2.6° postoperatively. The mean CEA decreased from 39.2° ± 3.0° preoperatively to 32.9° ± 2.6° postoperatively. The mean duration of surgery was 96.7 ± 21.1 minutes; the mean traction time was 45.5 ± 14.6 minutes. The mean mHHS at the 3rd , 6th, 12th, and 24th months showed a statistically significant increase compared to the preoperative value (P < 0.05). The mean HOOS-ADL and HOOS-SSS at the postoperative 3rd, 6th, and 12th months demonstrated a statistically significant increase compared to the preoperative values (P < 0.05). The same scores measured at the 24th month, however, did not demonstrate a significant increase. The mean VAS scores at the 3rd and 6th months postoperative illustrated a significant decrease compared to the preoperative values (P < 0.05) whereas this significant decrease was not observed at the 12th and 24th months., Conclusion: The combined technique of periportal capsulotomy and capsular thinning used in this study seems to be a reliable surgical method with favorable functional results, a low complication rate, and a low risk of hip instability., Level of Evidence: Level IV, Therapeutic Study.

The medial patellofemoral ligament (MPFL) is the main medial stabilizer of the patella, while reconstruction of the ligament is a common surgery performed by orthopedic surgeons. Although several surgical methods have been described regarding MPFL reconstruction, the common goals of these surgeries are to imitate the anatomic features of the native MPFL. In the single-incision and single patellar tunnel and double-bundle MPFL reconstruction technique, we will present the anatomical footprint of the MPFL located in the medial aspect of the patella, which is filled with the graft. In this technique, graft fixation is performed in the femoral tunnel using only one bioabsorbable screw without the need for fixation in the patella., (© 2021 by the Arthroscopy Association of North America. Published by Elsevier.)

Osteochondral lesions in the talus are frequently seen disorders that can cause chronic ankle pain. Surgical treatment is determined by the size and location of the lesion. The microfracture procedure and additional application of scaffold technique have gained popularity for the treatment of small osteochondral defects. However, these techniques may be insufficient and have poor outcomes in deep lesions. Therefore, several different invasive surgical techniques that require the malleolar osteotomy have been described. Problems associated with the invasive surgical intervention may be seen such as reduction loss in the osteotomy site, delayed union or nonunion, permanent pain, and/or swelling. We describe a new all-arthroscopic technique for the treatment of deep talus osteochondral lesions using an autologous bone graft taken from the tibial plafond region together with a chitosan-based noncellular scaffold., (Copyright © 2021 by the American Academy of Orthopaedic Surgeons.)

Background: The aim of this study was to evaluate the clinical and radiologic results of 2 different scaffolds with hyaluronan or chitosan-based structure used in the treatment of talus osteochondral lesions., Methods: Eighty-one patients who underwent chondral lesion repair with hyaluronan (n = 42) or chitosan-based (n = 39) scaffold were included. American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) scores were evaluated within and between groups preoperatively and at the 3rd, 12th, and 24th month postoperatively. In all patients, magnetic resonance imaging was performed between the 12 and 18th month postoperatively and compared with magnetic resonance observation of cartilage repair tissue (MOCART) scoring., Results: Within-group evaluations revealed significant improvements in AOFAS and VAS scores at postoperative 3 and 12 months. The postoperative 24th-month results of AOFAS scores in any group did not differ significantly from the 12th-month results. There was no significant difference between the groups in comparison of AOFAS, VAS, and MOCART scores at any time period., Conclusion: Both scaffolds were found to be effective in cartilage healing but had no clinical or radiologic superiority to each other. This is the first study to compare the use of different cell-free scaffold types in osteochondral defects of the talus., Level of Evidence: Level III, retrospective comparative study.

Purpose: To investigate the site of pudendal nerve compression and the relation between traction force and abduction angle regarding pressure levels at setup for hip arthroscopy., Methods: A total of 17 hips from 9 fresh-frozen cadavers (6 male and 3 female cadavers) were used. The pudendal nerves were dissected, and 3 FlexiForce force sensors (Tekscan, Boston, MA) were implanted on the pudendal nerve where the inferior rectal nerve, perineal nerve, and dorsal nerve of the clitoris/penis emerge. A custom-made traction table in a supine position was used with a padded perineal post of 9 cm. Recordings were made at 0, 10, 20, 30, and 40 kg of traction at varying hip abduction angles of 0°, 15°, 30°, and 45°., Results: The tuber ischiadicum (perineal nerve) and genital region (dorsal nerve of penis/clitoris) had statistically higher pressure values when compared with the pudendal canal (inferior rectal nerve) (P < .05). There was a significant increase in forces acting on the pudendal nerve with increasing application of 0 to 40 kg of traction in steps of 10 kg, with the exception of the pudendal canal sensor and reading of the perineal nerve sensor at 45° of hip abduction (P < .004 with Bonferroni correction for significant values). On the contrary, hip abduction angle had no statistically significant effect on pudendal nerve compression. (All specific P values with Bonferroni correction were greater than .003.), Conclusions: To avoid nerve palsy completely, the etiopathogenesis of compressive neuropathy should be identified. The location for compression and relation between different traction positions and forces are clarified in this study. This information can be used for further research and prevention., Clinical Relevance: This study adds objective data on the etiopathogenesis of pudendal nerve compression, which potentially contributes to prevention of pudendal nerve palsy as a common complication of hip arthroscopy., (Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: The purpose of this study was to examine outcomes following arthroscopic Bankart repair with the focus on strength after the repair., Methods: 56 shoulders with Bankart lesion were operated on arthroscopically. Gender, mechanism of the first dislocation, number of dislocations, dominant side, operated side and the number of anchors used for surgery were recorded. DASH and Oxford instability scoring systems were applied preoperatively and compared to scores at the 24-month follow-up. The scoring systems were also applied to contralateral shoulders at the 24th month of follow-up. Range of motion was measured with a goniometer. Muscle strength was analyzed with a dynamometer simultaneously with the muscle activity of four perishoulder muscles. The data were recorded with surface EMG. Range of motion, muscle strength and activity were evaluated according to the contralateral shoulder at the 24th month of follow-up., Results: Male/female ratio was 42/14 with a mean age of 32 years. The mean number of dislocations was 3 ± 1 and all were traumatic dislocations. The number of mean anchors used was 3.1 and the mean follow-up period was 24 months. In clinical evaluation, the preoperative and postoperative results of the DASH and Oxford instability scores of the unstable shoulders were significantly different. In the comparison between the operated and contralateral shoulders, there was no significant difference in DASH and Oxford instability scores at the 24th month of follow-up. There was no significant loss of range of motion. Only internal rotation strength was significantly reduced and there was no significant change in the EMG patterns., Conclusions: Although good clinical results can be achieved, internal rotation strength is reduced after arthroscopic surgery, but daily activities are not affected. There is no guarantee for patients of excellent recovery., Level of Evidence: Level III cohort study.

Introduction: Chronic non-specific synovitis has a higher recurrence rate with arthroscopic synovectomy due to the insufficient removal of all pathological tissues. Neither has radiosynoviorthesis been sufficiently effective in treatment in contrast to cases of chronic specific synovitis such as rheumatoid arthritis. This study aimed to investigate the efficiency of combined arthroscopic and radionuclide synovectomy in chronic non-specific synovitis of the knee with the evaluation of clinical and radiological results., Materials and Methods: 14 knees of 14 patients (11 female, 3 male) diagnosed as chronic non-specific synovitis were treated with arthroscopic subtotal synovectomy combined with radiosynoviorthesis. The efficiency was evaluated retrospectively by comparing preoperative and postoperative modified cincinnati knee score, Visual Analogue Scale, joint USG and MRI. The mean age was 29.2 ± 10.3 years and the mean follow-up period was 30.3 ± 3.7 months., Results: Clinical parameters such as pain, limitation of motion and effusion were regressed. Daily activities at the final follow-up were significantly better than in the preoperative period. The mean modified cincinnati knee score of the patients increased from 25.8 ± 8.7 preoperatively to 67.8 ± 13.4 postoperatively (p = 0.002). The mean VAS score was 7.2 ± 1.1 preoperatively and 1.3 ± 0.8 postoperatively (p = 0.003). Clinically and radiologically on MRI there was no recurrence. Mean synovial membrane thickness was 4.5 ± 2.4 mm in the preoperative period. At the final follow-up, noticeable regression of synovial membrane thickness (2.1 ± 0.5 mm) was recorded in the knee joint USG (p = 0.015). No complications were observed., Conclusion: The combination of arthroscopic subtotal synovectomy and radiosynoviorthesis can be an effective treatment modality for chronic non-specific synovitis of the knee.

Study Design: A retrospective study., Objective: The objectives of this study were to show the advantages of an alternative segmental spinal instrumentation technique, termed subtransverse process wiring, and compare it with a sublaminar wiring technique in the treatment of idiopathic thoracic scoliosis., Summary of Background Data: High rates of neurological complications and the need for high experience limit the use of the sublaminar wiring technique, although it is an effective segmental spinal instrumentation technique in the treatment of scoliosis. This is the first study to correlate sublaminar wiring and subtransverse process wiring techniques clinically., Methods: In a retrospective study, 64 patients with idiopathic thoracic scoliosis were chosen randomly. Nineteen patients were treated with subtransverse process wires (group A), and 45 patients were treated with sublaminar wires (group B)., Results: The mean follow-up period was 50.9 months (25 to 90 mo) in group A and 57.9 months (26 to 108 mo) in group B. The average deformity correction was 26.5 degrees (52.9%) in group A and 28.9 degrees (54.1%) in group B. The average correction loss was 2.9 degrees (17.2%) in group A and 6.4 degrees (27%) in group B. None of the patients developed neurological complications in group A. In group B, 5 (11.1%) intraoperative dural tears, 4 (8.9%) neurological deficits, and 8 (14.4%) transient dysesthesia syndromes were seen. The average operation time was 3.6 hours (3 to 4 h) in group A and 4.9 hours (3.75 to 8 h) in group B. The average replacement of blood (erythrocyte suspension) was 2.9 U (2 to 5 U) in group A and 3.1 U (2 to 6 U) in group B., Conclusions: Sublaminar wiring is a time-consuming technique with high risks of neurological complications, whereas subtransverse process wiring is an easy and neurologically safe method, which maintains effective deformity correction and stability of the correction.

Objective: The aim of this study was to compare the clinical and radiological results of plate-screw and tension band fixation in isolated Danis-Weber Type A and B lateral malleolar fractures., Methods: A total of 135 cases of lateral malleolar fractures (82 Danis-Weber Type B and 53 Type A) operated on in 4 different centers and 6 orthopaedic clinics between November 2005 and December 2010 were reviewed retrospectively. Eigthy-one patients (55 Type B and 26 Type A) had lateral 1/3 tubular plate and screw fixation (Group 1), while the remaining 54 patients (27 Type B and 27 Type A) were operated on with tension band technique (Group 2). The clinical and radiological results of the groups were compared. Student t test was used in statistical analysis., Results: The mean length of surgical incision scar was 4.9 cm (4.5-5.4 cm) for Type A fractures and 6.8 cm (5.6-7.5 cm) for Type B in Group 1 and 4.0 cm (3.5-5.2 cm) for Type A and 5.3 cm (5.0-5.9 cm) for Type B fractures in Group 2. Radiological union was obtained at mean of 10 weeks (7-13 weeks) in Group 1 and 9 weeks (7-12) in Group 2. The implant had to be removed in 12 patients in Group 1 and in one patient in Group 2. The mean AOFAS Score was 90 (72-100) and 92 (70-100) in Groups 1 and 2, respectively., Conclusion: Both plate-screw and tension band techniques revealed excellent results in isolated Danis-Weber Type A and B fractures. The tension band technique may be an alternative fixation method in the treatment of these fractures.

Lipoma arborescens is a rare intraarticular lesion, mainly affecting the knee. A fourteen-year-old girl presented with a slow-growing painless mass in the right knee, of a six-year history. There were no limitations in the movements of the knee. Magnetic resonance imaging (MRI) revealed multiple lesions showing villous lipomatous proliferation of the synovium in the supra- and retropatellar regions and effusion in the knee joint. The mass was excised with arthrotomy and synovectomy and a histopathologic diagnosis of lipoma arborescens was made. Two years postoperatively, and when the right knee was completely asymptomatic, she developed a similar mass in the suprapatellar region of the left knee. An MRI scan showed a mass lesion in the supra- and retropatellar regions, effusion in the knee joint, and a synovial cyst in the popliteal fossa. Again, arthrotomy and synovectomy were performed and the histopathologic diagnosis was lipoma arborescens. This case differs from simultaneously involved knees in that lipoma arborescens in the contralateral knee developed two years after the initial operation.