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Objective: Interscalene block (ISB) has become an accepted and effective technique of anesthetic and perioperative analgesia, in arthroscopic shoulder surgery. We aimed to retrospectively evaluate a series of patients who underwent arthroscopic shoulder surgery under combined ISB and general anesthesia. Methods: A retrospective chart review was performed consisting 641 patients who had ISB performed between June 2007 – January 2013 for success rates, side effects and complications. Results: The overall success rate of the blocks was 96.5%, with a mean postoperative analgesia time of 15.5 hours. While no patient suffered permanent nerve injury as a result of ISB, the most common complication noted in this analysis was local anesthetic-related convulsion, which occurred in only one patient. Conclusion: Interscalene block and general anesthesia combination, which provides high patient satisfaction with low side effects and complication profile, can be recommended for patients undergoing arthroscopic shoulder surgery. Keywords: Shoulder, arthroscopy, brachial plexus block, general anesthesia

Amaç: ÇeşitIi seviyeIerden yapıIan Brakial pIeksus bIokIarı, postoperatif analjezi için artroskopik omuz cerrahisinde yaygın olarak kullanılmaktadır. Ancak, bloğun uygulandığı seviyeyle ilişkili yüksek hemidiyafragmatik paralizi insidansı, pulmoner fonksiyon bozukluğu olan hastalarda kullanımı sınırlamaktadır. Paradoksal olarak, pulmoner patolojili hastalarda analjezi için kullanılacak sistemik opioidlerin oksijenasyonu bozabileceği düşünüldüğünde analjezi yönetimleri özellikli hastalardır. Son araştırmalar frenik siniri koruyucu brakial pleksus blok yaklaşım alternatiflerini araştırmaktadır. Bu retrospektif çalışma ile, ultrason eşliğinde uygulanan kostoklavikular bloğun bilinen pulmoner patolojisi olan hastalardaki analjezik etkinliğinin ve diyafram fonksiyonlarına etkisinin araştırılması amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya Ocak 2020-Temmuz 2022 tarihleri arasında, kronik puImoner probIemi oIan, kostokIavikuIar bIok ve geneI anestezi kombinasyonu iIe anestezi yönetimIeri gerçekIeştiriIen artroskopik omuz cerrahisi geçiren vakaIar dahiI ediIdi. Demografik veriler, cerrahi endikasyonlar, uygulanan genel anestezi yöntemi, komplikasyonlar/yan etkiler, VAS skorları, analjezi süreleri, uygulanan anestezi tekniği için hasta ve cerrah memnuniyeti ile diyafram fonksiyonları retrospektif olarak kayıtlardan incelendi. Blok uygulanan tarafta hemi- diyafram fonksiyonları; diyafram tutulumunun derecesi; > %75 ise “tam”, %25,1-74,9 ise “kısmi diyafram paralizisi” ve < %25 ise “paralizi yok” olarak değerlendirildi. Bulgular: Çalışmaya dahil edilen 21 hastanın dördü Bankart diğerleri rotator kaf rüptürü endikasyonuyla opere edilmişti. Hastalarda komplikasyon gözlenmedi. Anestezi tekniğiyle ilgili hem hasta (%71,4) hem cerrah (%100) memnuniyet oranları yüksekti. Diyafragma ekskürsiyon oranları %25’ten düşüktü ve dolayısıyla hemi-diyafragma paralizisinin gerçekleşmediği görüldü. Kostoklavikular blokla ortalama 470 dakika postoperatif analjezi sağlandı. Sonuçlar: Kostoklavikular blok, diyafram fonksiyonunu korurken etkin cerrahi ve postoperatif analjezi sağlamıştır. Bu nedenle pulmoner patolojisi olan artroskopik omuz cerrahisi geçirecek hastalarda geleneksel interskalen bloğa bir alternatif olarak düşünülebilir. Anahtar kelimeler: brakial pleksus blok; diyafram; analjezi; akciğer hastalıklarıAbstract Aim: Brachial plexus blocks are widely used for post-operative analgesia in shoulder surgery. The high risk of hemidiaphragmatic paralysis limits its use in patients with pulmonary dysfunction. In patients with pulmonary diseases, the management of pain requires special approaches since systemic opioids may also decrease oxygenation. Latest studies search for alternative methods for phrenic nerve preserving brachial plexus block. This retrospective study aim to analyze the analgesic efficacy and diaphraghmatic effects of ultrasonography guided costoclavicular block in patients with pulmonary diseases. Material and Methods: The study includes patients with pulmonary diseases who undergone arthroscopic shoulder surgery under the combination of costoclavicular block and general anesthesia between January 2020 and July 2022. The demographic data, surgical indications, general anesthesia method, complications, VAS scores, the duration of analgesia, diaphragm functions, patient and surgeon satisfaction survey was collected from the records and analyzed retrospectively. The diaphragm functions were evaluated as complete  75%, partial 25.1-74.9%, no paralysis  25%. Results: Four of the 21 patients in the research underwent Bankart surgery, while the others were operated on for rotator cuff rupture. No complications were observed in the patients. Patient (71.4%) and surgeon (100%) satisfaction about the anesthesia method was high. Since the diaphragm excursion rates were below 25%, it was observed that hemidiaphragmatic paralysis did not occur. An average of 470 minutes of postoperative analgesia was achieved with costoclavicular block. Conclusion: While preserving diaphragmatic function, a costoclavicular block provided effective surgical and postoperative analgesia. As a result, it can be regarded as an alternative to conventional interscalene block in pulmonary pathology patients undergoing arthroscopic shoulder surgery. Key words: brachial plexus block; diaphragm; analgesia; lung diseases

Makale, WOS:000941667500026, PubMed ID: 36945963, Background/aim: Rotator cuff rupture (RCR) and glenohumeral osteoarthritis (GHO) are two common disorders of the shoulder joint. However, there are very few reports that examine the relationship between them. This study aimed to present at least two years' clinical results of arthroscopic rotator cuff repair of full-thickness and massive tears accompanied by arthroscopically detected early-stage osteoarthritis.Materials and methods: From August 2016 to December 2017, three hundred and twenty patients with total or massive rotator cuff tears were evaluated retrospectively. Thirty-five patients who were determined as stage 1 and 2 according to the Outerbridge scale for cartilage lesions were found appropriate for investigation. Patients were assessed using the University of California Los Angeles (UCLA) score, and a visual analog scale (VAS) score before surgery and at the final follow-up. The American Shoulder and Elbow Surgeons (ASES) shoulder score was used to evaluate the final outcomes and compare the UCLA shoulder scores.Results: The UCLA scores increased from the preoperative value of 19.1 +/- 3.2 to 29.8 +/- 4.8 at the last follow-up and increased by an average of 10.7 +/- 6.0 (p < 0.001). The median VAS score decreased from the preoperative value of 3.0 to 1.0 (p < 0.001). Besides, the mean ASES score was found as 80.2 +/- 10.6. An excellent positive correlation was found between postoperative UCLA scores and ASES scores (r = 0.887; p < 0.001).Conclusion: To the best of our knowledge, this is one of the first arthroscopic comparative studies about the effect of early glenohumeral osteoarthritis on clinical outcomes after rotator cuff tear treatment. Finding good and excellent results up to 71% after RCR repair in patients with early-stage osteoarthritis was an indication that arthroscopic repair could be planned as the first-line treatment option for RCR pathologies in patients with early-stage degenerative arthritis without considering the rerupture rate., Department of Public Health, Gazi University Medical Faculty

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

WOS:000548799300001 Objectives The aim of this study is to demonstrate the importance of clinical diagnosis by comparing with preoperative physical examination and magnetic resonance imaging (MRI) images in patients who were arthroscopically diagnosed as having Superior Labrum Anterior-Posterior (SLAP) II lesions. Materials and Methods 134 patients, arthroscopically diagnosed as SLAP II, established the study group, and 200 patients who underwent shoulder arthroscopy for the other pathologies established the control group. Preoperative clinical examination of the patients, MRI findings, and the arthroscopic findings of the patients were recorded. Results Out of the patients diagnosed with a SLAP II lesion, 107 (79.9) of those had an MRI finding while only 60 (30%) of the control group had it. The O'Brien test results of the patients diagnosed with SLAP were positive in 111 (82.8%) while those diagnosed with intact superior labrum were positive in 132 (66%). Of the 134 patients with a SLAP II lesion, 89 (66.4%) had both O'Brien test positiveness and MRI finding, and 129 (96%) had at least one positive result of the O'Brien test or MRI examination Conclusion The O'Brien test and MRI examination are not capable enough to indicate a SLAP lesion one by one, because of the low sensitivity and specificity. But, combining the test with MRI findings provides more trustable information about the superior labrum.

Background It was hypnotized that presence and larger size of os trigonum (OT) can affect flexor hallucis longus tendon (FHL), so tenosynovitis, degeneration and partial tear can be developed. Methods A total of 98 (Study group: 50, Control: 48) subjects included to study and compered status of FHL lesions. Sagittal length and axial width of OT were measured on MRI to determine effect of OT on FHL lesions and correlated with arthroscopic findings. Results FHL tenosynovitis (p: 0,025), degeneration (p: 0,01) and partial tear (p: 0.008) was identified statistically high in study group. Statistical analysis revealed that as length of OT increased, frequency of degeneration (p: 0.03) and partial tear (p: 0.00) of FHL increased. Conclusion Analyzes were showed that the presence of os trigonum had an important role on the FHL pathologies. Additional finding of study was to demonstrate that possibility of FHL lesion increased as length of OT extended. Levels of Evidence Level 3

Background The use of pain coping questionnaires is advantageous when selecting cognitive and behavioral targets for chronic pain management. The objective of this study was to investigate adaptation, validity, and reliability of the Coping Strategies Questionnaire (CSQ) in Turkish population with chronic musculoskeletal pain. Methods The Turkish version of the questionnaire (CSQ-T) was checked in terms of reliability and validity with a convenience sample of 123 patients with chronic musculoskeletal pain. Reliability (test-retest) analyses were conducted by means of a retest 48 hours later with a sub-group of 40 patients. Construct validity of the CSQ was checked through convergent validity with the Hospital Anxiety and Depression Scale (HADS) and the Short Form-36 (SF-36) health survey. Results Cronbach's alpha of the subscales ranged from 0.814 to 0.934 and the test-retest reliability ranged from 0.800 to 0.944. Neither floor nor ceiling effects (15%) were found in the subscales (13.8%) and the total score (4.1%) of the CSQ-T. Factor analysis indicated that the scale had two factors. The total CSQ-T score was correlated with both the HADS (r: -0.636/-0.549) and the SF-36 (r: 0.701/0.768). Conclusion The CSQ-T is a reliable and valid measure for assessing patients with chronic musculoskeletal pain.

OBJECTIVES This study aims to identify the forelock sign of partial tears of the subscapularis and to compare the incidences of this sign and air bag sign. PATIENTS AND METHODS One hundred and twenty patients (39 males, 81 females; mean age 51.3 years; range, 25 to 79) diagnosed as isolated subscapularis tear or isolated supraspinatus tear from among patients who underwent shoulder arthroscopy between January 2013 and January 2016 were divided into four groups of 30 patients each as the subscapularis tear (group 1), full-thickness supraspinatus tear (group 2), bursal-side supraspinatus tear (group 3), and articular-side supraspinatus tear (group 4) groups. All patients had video records of their operation. The integrity of the long head of biceps tendon (LHBT), Lafosse classification of the subscapularis tear, and the incidence of the forelock and air bag signs were evaluated. RESULTS The incidence of the air bag sign in group 1 was 10% and that of the forelock sign was 60%. The forelock sign was significantly more frequent in group 1 than in the other groups (odds ratio 10.46: 3.9-27.8 with 95% confidence interval) and the air bag sign (p

OBJECTIVES This study aims to compare two single-step arthroscopic techniques, microfracture and cell-free scaffold implantation, in the treatment of talar osteochondral lesions (OCLs) clinically and radiologically. PATIENTS AND METHODS This retrospective study included 62 patients (35 males, 27 females; mean age 41±13 years; range, 15 to 65 years) diagnosed with talar OCLs between March 2007 and January 2015. Patients who were followed-up with a minimum of 24 months with lesions larger than 1 cm2 were included. Pre- and postoperative clinical evaluations were performed according to the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and radiological evaluations according to the magnetic resonance observation of cartilage repair tissue (MOCART) scale. RESULTS Patients were divided into microfracture (n=22) and scaffold (n=40) groups. The mean follow-up duration was 36.1±14.9 months. The mean preoperative AOFAS score increased from 60.6±13.9 to 82.1±11.8 in the microfracture group (p

Objective: The aim of this study was to represent the findings and long-term clinical results of the children who underwent hip arthroscopy because of Legg-Calve-Perthes Disease (LCPD). Methods: This study included the retrospective findings of ten patients (mean age: 12.7 ± 2.75; range 7–16 years) who underwent arthroscopic hip debridement between 2010 and 2016 for LCPD disease. All of the patients underwent arthroscopic excision of the unstable osteochondral fragment following unsuccessful conservative treatment. In the statistical analysis, age, side, follow-up, Stulberg and Waldenström classification, preoperative and postoperative modified Harris Hip Score (mHHS) were evaluated. Results: The mean follow-up period was 55.4 ± 13.05 months (range: 40–72 months). There was no statistically significant association between good postoperative results and age, side, and the stage of the disease (p > 0.05). However, there was a significant difference between preoperative and postoperative mHHS (p = 0.005). Conclusion: This study demonstrates an increase in the functional results and life quality of the patients who underwent hip arthroscopy due to LCPD. It is thought that hip arthroscopy, a minimally invasive procedure, may have an important role in the algorithm of LCPD treatment, especially in patients with severe pain and mechanical symptoms. Level of evidence: Level IV, therapeutic study. Keywords: Perthes disease, Hip arthroscopy, Treatment, Modified Harris hip score, Limitation of motion

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.

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.

Introduction:Long head of biceps (LHB) pathologies are an important cause of pain and dysfunction. As LHB pathologies have specific components from other underlying or related pathologies, the LHB score is designed for an accurate assessment. The aim of this study was to adapt the LHB score into Turkish and to assess its validity and reliability.Materials and Methods:LHB score was translated and culturally adapted from English to Turkish, and then it was applied to 62 patients with biceps long head pathology. The reliability of the scale was checked through internal consistency and test–retest methods. Internal consistency was computed with Cronbach alpha value. Test–retest reliability was assessed using an intraclass correlation coefficient. American Shoulder and Elbow Surgeons Standard Shoulder Assessment Form and modified Constant–Murley score were used to analyze concurrent validity.Results:The Cronbach alpha value of the scale was found as .640. When the subsections of LHB score were computed separately, Cronbach alpha levels of pain/cramps and cosmesis sections were found as .753 and .774, respectively. The intraclass correlation coefficient value of the scale was found to be excellent (.940;P P P P Conclusion: The Turkish version of the LHB is a valid and reliable tool, especially for biceps pathologies.

Emotional and cognitive factors have been shown to affect pain, and one of the main factors in the development of this effect is pain catastrophizing. The present study aims to determine the effect and frequency of the pain catastrophizing in shoulder lesions and to examine the association between pain catastrophizing and to assess the pre-operative and post-operative functional outcomes.A total of 114 patients who underwent shoulder arthroscopy were included study. Pain catastrophizing scale, Tampa kinesiophobia scale, visual analog scale, and University of California at Los Angeles shoulder scale were used for evaluating patients' pre- and post-operative pain and functional situation.Pain catastrophizing was detected 42 of 114 patients (37%). Kinesiophobia was higher in patients who catastrophized shoulder pain (p0.0001). If participant had a labrum (p=0.038), supraspinatus (p=0.043), or biceps pathology (p=0.032), catastrophization was determined more often. There was catastrophization in 50% of patients with post-operative University of California at Los Angeles score which was evaluated as fair/poor (p=0.039).Pre- and post-operative results of the current study strengthened the data about importance of catastrophization. Catastrophization (+) patient group had lower functional capacity outcomes than that of the catastrophization (-) patient group. Decreased levels of pain catastrophizing and kinesiophobia in surgically and conservatively treated patients will result in more satisfactory clinical outcomes.

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.

Background: To determine the distribution of intra-articular lesions according to age and gender by retrospectively examining the archive records of patients who were operated due to ankle instability.Methods: The patient records of ankle arthroscopy procedures from between February 2009 to February 2020 were retrospectively evaluated. The information about patients such as age, gender, surgical site, intra-articular and surrounding lesions (osteochondral defects, degenerative cartilage changes, synovial disorders, impingement syndromes, flexor hallucis longus lesions and the presence of os trigonum) were noted and compared statistically.Results: The incidence of concomitant intra-articular pathology was found to be 78.2% in patients who underwent ankle arthroscopy due to instability. Anterior impingement syndrome in 74.5% of patients, osteochondral lesion in 41.2%, synovial hypertrophy in 15.8%, and degenerative arthritis in 9.1% of the patients were detected. The mean age of the patients with anterior impingement syndrome (p: 0.012), osteochondral defect (p: 0.001), and degenerative arthritis (p: 0.003) was found to be significantly higher than those without. The mean age of patients without additional pathology was 33.91±12.08, patients with an additional pathology were 37.77±12.35, and patients with more than one pathologies were found to be 42.15±11.79 (p: 0.003).Conclusions: The most important finding of this study was that the presence and number of pathologies accompanying ankle instability increased with age. Considering the incidence of concomitant lesions in patients to be operated due to chronic ankle instability, detailed evaluation of preoperative magnetic resonance imaging and performing diagnostic arthroscopy may be beneficial for determining the possibility of concomitant lesions.

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.

© 2020Background: This study aimed to determine the prevalence of the Buford complex and to investigate its association with labral pathologies (superior labrum anterior-posterior [SLAP] lesion and anterior, posterior, or multidirectional instability) using a very large patient database. Furthermore, the prevalence of the Buford complex in patients without any labral pathology was also determined. Methods: A total of 3129 consecutive shoulder arthroscopy procedures were retrospectively evaluated for the presence of the Buford complex and coexisting labral pathologies. The relationships between the Buford complex and SLAP lesions, as well as instability, were evaluated statistically. Results: The Buford complex was observed in 83 shoulders (2.65%). SLAP lesions were significantly more frequent in patients with the Buford complex than in those without it (81.9% vs. 33.1%, P < .001) Shoulders with the Buford complex presented a lower frequency of anterior instability (10.8% vs. 19.3%, P = .052) and a higher frequency of posterior instability (1.2% vs. 0.9%, P = .789). The prevalence of the Buford complex in patients with and without labral pathologies was 4.6% and 0.3%, respectively (P < .001). Conclusions: This study, to our knowledge, includes the largest cohort in the literature reporting the prevalence of the Buford complex (2.65%). In the 1461 patients without labral tears or multidirectional instability, the prevalence of the Buford complex was 0.3%. This result suggests that the real prevalence of the Buford complex might be lower than that reported previously. In addition to the aforementioned conclusions, the identification of the Buford complex should prompt a thorough evaluation for concomitant SLAP lesions.

Background context Pigmented villonodular synovitis (PVNS) is a rare, locally aggressive benign proliferative pathology of synovial tissue. Lesions are classified regarding location as diffuse or localised which are same as histologically. Intra-articularly localised type is relatively rare, especially in the ankle joint. Because of the high recurrence rate and aggressive nature, localised lesions should be excised totally. Purpose We performed a retrospective study of 4 patients with intra-articularly localised PVNS in the ankle joint who were treated by total arthroscopic excision and evaluated for functional results and recurrence rate. Study design Case series. Patient sample The mean age of the patients was 27 (17–46) years at the time of arthroscopic surgery. The mean follow-up time was 33 (24–48) months. Methods Functional evaluation according to the Musculoskeletal Tumour Society Score was performed, and patients were evaluated for recurrence by MR imaging. Results In all patients, functional results were excellent and there was no recurrence. Conclusions This study demonstrates that the intra-articularly localised PVNS can be successfully treated with arthroscopic procedures without recurrence.

Arthroscopic techniques have recently gained popularity for the treatment of osteochondral defects of the talus. The microfracture procedure is the most commonly applied arthroscopic technique. However, it is not effective for the treatment of larger lesions. Tissue-engineered scaffolds have been used for cartilage regeneration arthroscopically, and promising results have been reported. We treated larger osteochondral lesions of the talus with polyglycolic acid-hyaluronan scaffold biomaterial (Chondrotissue, BioTissue AG, Zurich, Switzerland) in a single-step arthroscopic surgery. Traction methods and fibrin glue were avoided.

Purpose: To describe a modified technique for arthroscopic-assisted transfer of the latissimus dorsi tendon in a selected group of patients with irreparable rotator cuff tears and pseudoparalysis and to evaluate its short-term results. Methods: Fifteen patients with irreparable rotator cuff tears and pseudoparalysis treated by arthroscopic-assisted latissimus dorsi tendon transfer were included. The mean patient age was 61.53 +/- 6.24 years (range, 52-71 years). Patients were assessed with physical examination, University of California Los Angeles (UCLA) Score and Constant-Murley score, as well as visual analog scale score at a mean follow-up of 26.4 +/- 2.58 months (range, 24-31 months). Results: At final follow-up, mean UCLA score increased to 27.47 +/- 6.31 compared with the preoperative UCLA score of 6.53 +/- 2.1 (P < .001). Constant-Murley score was 21 +/- 7.41 and 59.73 +/- 13.62 (P < .001), visual analog scale pain score was 7.47 +/- 1.06 and 2.47 +/- 0.91 (P < .001), active forward flexion was 58 degrees +/- 21.11 degrees and 130 degrees +/- 30.05 degrees (P < .001), active abduction was 51 degrees +/- 1.64 degrees and 129.67 degrees +/- 25.45 degrees (P

Background: Ankle sprains occur frequently in both athletes and the general population. The social and economic consequences can be significant. In an effort to understand the injury, dynamic and static structures around the ankle have been investigated in detail, but anatomical factors predisposing to lateral ankle instability have not been fully clarified. The aim of this study was to radiologically investigate the relationship between bony variations of the distal tibiofibular joint and arthroscopically proven ankle instability. Methods: Fifty patients with arthroscopically proven ankle instability and 50 patients without instability were included in this study. Measurements were obtained from a magnetic resonance imaging (MRI) section 1 cm proximal to the tibiotalar joint; distal tibiofibular joint anterior facet length ( a), posterior facet length ( b), angle between the anterior and posterior facets ( c), fibular notch depth ( d), tibia thickness ( e), and fibula thickness ( f) was measured. Results: It was found that instability was more frequent when the length of a ( P < .001) and e ( P < .001) were shorter. In addition, when value of a/ b and e/f were evaluated, it was observed that the number of individuals who had instability increased as the ratio became smaller ( P < .016-.020, respectively). Pearson correlation analysis indicated strong negative correlation between the values of a- e and instability ( r = −0.348, P < .001, and r = −0.328, P = .001; respectively). Conclusion: Lateral ankle sprains are common, and a clear understanding of the relevant structures and clinical function of the ankle complex should extend beyond the talocrural joint. This study demonstrated that the presence of narrow anterior facet ( a) and thinner tibia ( e) were strongly correlated with lateral ankle instability. Level of Evidence: Level III, retrospective case control study.

Objective Patients who underwent arthroscopic repair for partial rotator cuff tears were evaluated retrospectively. This study purposed to assess the postoperative clinical results of arthroscopic treatment of intratendinous rotator cuff tears and to investigate the effect of the tear type on the postoperative clinical outcomes. Methods Overall, 60 patients [36 women and 24 men; mean age: 48.6±12.2 years (range 33-67 years)] who underwent arthroscopic repair of Ellman stage 3 partial rotator cuff tear were evaluated retrospectively. These patients were grouped into the following three groups: articular-sided tears, bursal-sided tears, and intratendinous tears, with 20 patients included in each group. Subacromial decompression, acromioplasty, and tear repair without transforming to full-thickness tear were applied to the bursal-sided tears. The same technique was performed for intratendinous ruptures, with the only technical difference was that the capsular tissue was preserved during debridement of intratendinous tears. The articular-sided tears were transformed to complete tears and repaired arthroscopically. The preoperative and postoperative ASES scores and range of motion improvements were evaluated in all patients. The mean follow-up time was 44±6.5 months (range: 36-62 months). Results No significant intergroup differences were observed concerning the age and the mean follow-up duration (p=0.524, p=0.665). A similar increase in ASES scores was observed for all three types of tears (bursal-sided tears: 31.09-82.65; articular-sided tears: 35.50--84.00; intratendinous tears: 34.01-83.49). Statistically, no significant intergroup difference was observed concerning ASES score improvement (p=0.585). An increase in mean forward flexion, abduction, and external rotation were observed, especially, a statistically significant increase in flexion (p=0.001) and abduction (p=0.001) in all three types of tears. No patient experienced any intraoperative or postoperative complications. Conclusion The results of arthroscopic treatment of intratendinous tears were similar to the other types of partial tears, and the results of arthroscopic treatment of grade 3 partial rotator cuff tears revealed satisfactory outcomes, regardless of the type of the tear. Level of evidence Level III, Therapeutic study.

Although the implementation of reverse total shoulder arthroplasty (RTSA) is more common today, the complication rates in the literature still reach as high as 68%. The instability following the RTSA is the most frequent reason for revision surgery and the most difficult problem to fix. Moreover, this complication has a very high recurrence rate. The factors affecting the stability of the RTSA are compressive forces, humerosocket depth, and glenosphere dimensions. The risk factors for instability are the component malposition, insufficient soft tissue tension and soft tissue coverage, choice of deltopectoral approach, subscapularis deficiency, body mass index over 30 kg/m2, male gender, any previous history of surgery performed on the affected shoulder, impingement of the components, heterotopic ossification, axillary nerve palsy, and asymmetrical polyethylene wear. Following the development of the instability, deltoid muscle and axillary nerve integrity, glenoid and humeral component position, and bone pathologies and defects should be evaluated. If these are normal, close reduction can be considered as the initial intervention in these patients. Open reduction is the second option if the close reduction fails. In these patients, glenoid and humeral components, polyethylene insert wear, bone pathologies and defects, and soft tissue tension should be evaluated. Appropriate soft tissue tension can be restored by increasing the humeral length or lateralization of the joint center of rotation offset in patients with instability due to soft tissue laxity. Humeral shortening and excessive glenoid medialization are the main problems in recurrence. In patients with humeral shortening without excessive glenoid medialization, the stability is ensured by one or more of the following: implementing a higher sized insert, metal heightener (spacer), longer cemented humeral stem, and a structural humeral bone graft. If a longer humeral stem comes up short, the stability is reexamined following changing the glenosphere with a higher sized or eccentric one. The glenoid offset is enhanced in patients with excessive glenoid medialization by lateralization or increasing the size of glenosphere and in those with glenoid defect by using bone grafts. The instability risk can be kept to minimum by choosing the most appropriate technique considering the implant design, placement of the components in anatomical position (height and version), avoiding any potential impingement, and adjusting the soft tissue tension by minimal damage.

BackgroundWe investigated the role of first metatarsal head shape in the etiology of hallux valgus. By pedobarographic analysis, we evaluated whether first metatarsal head shape causes an alteration in plantar pressure values that would result in metatarsalgia.MethodsReferrals to our clinic for metatarsalgia, plantar fasciitis, and calcaneal spur were scanned retrospectively. Patients with severe hallux valgus, pes planus, gastrocnemius stiffness, generalized joint laxity, neuromuscular disease, or a history of lower-extremity orthopedic surgery were excluded. Sixty-two patients with plantar pressure assessment and radiographic evaluation were included. These patients were invited for reassessment after 10 years. Feet were divided into three groups by metatarsal head shape: round, square, and chevron. On anteroposterior radiographs, the hallux valgus and intermetatarsal angles, relative first metatarsal length, lateral sesamoid subluxation, and presence of bipartite sesamoid were noted. Plantar pressure was assessed with pedobarography.ResultsFeet with round-shaped first metatarsal heads had a statistically significantly greater progression in hallux valgus angle than the other shapes. Plantar pressures under the first, second and third, and fourth and fifth metatarsals increased with time. This can explain the mechanism of transfer metatarsalgia and painful callosities under the first metatarsal in hallux valgus. There was no correlation between hallux valgus angle, relative metatarsal length, and lateral sesamoid subluxation.ConclusionsWe found a strong relation between round-shaped first metatarsal head and hallux valgus angle progression. No patients had a risk factor responsible for hallux valgus. In other words, this study gives approximately 10-year natural history results in nearly normal feet.

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.

The glenoid baseplate survival is of paramount importance for the outcome of anatomical and reverse total shoulder arthroplasty procedures. Various prosthetic designs have been described and experienced to decrease the failure rates and improve patients’ satisfaction. Most of the orthopaedic surgeons have a great eagerness to implant and advocate the success of uncemented prosthetic components in arthroplasty procedures to avoid complications of cementing and troubles during the revision procedures. However, higher rates of failure were almost always reported for metal-backed glenoid components in the literature. Studies in the literature have consistently reported unsatisfactory results following implantation of uncemented metal-backed glenoid components. The most common complication of total shoulder arthroplasty (TSA) is the failure of the polyethylene glenoid component which accounts for the majority of the deleterious outcomes and manifests clinically by pain, loss of function, and presence of a clunking noise. High rates of radiolucency at the bone-cement interface were previously reported numbers of times in the literature. However, this fact does not always show up clinically as symptomatic loosening during the postoperative follow-ups. This chapter aimed to compare the mostly implanted materials named pegged and keeled glenoid components to provide a guide to the shoulder surgeons in decision-making for TSA procedures.

After the anterior cruciate ligament (ACL) reconstruction, a loss of proprioception is observed and it can continue years after the operation. The aim of this study is to evaluate proprioception in standing position at different knee flexion angles in patients who underwent ACL reconstruction with tibialis anterior tendon allograft. The study included 34 patients who underwent ACL reconstruction with tibialis anterior tendon allograft and 34 healthy individuals. Proprioception was evaluated in standing position at 15 degrees, 30 degrees, 60 degrees flexion angles with the active joint position sense (AJPS) method using digital inclinometer. Proprioception deviation angle was found to be higher in the operated leg at 30 degrees and 60 degrees flexion angles in the patient group compared with the other leg (p < 0.05), the biggest proprioception difference was between the 15 degrees and 60 degrees flexion angles in both the patient and the control group (p < 0.05) that the difference between 15 degrees and 30 degrees flexion angles is lowest (p < 0.05), and that these differences are higher in the operated leg of the patient group compared with the other leg of the patient group and to the dominant leg of the control group (p < 0.05). As approximately 4 years after ACL reconstruction with tibialis anterior tendon allograft, loss of proprioception at 60 degrees knee flexion continued, ACL injury related to loss of proprioception may occur at angles higher than 30 degrees flexion. Thus, patients may be provided with proprioception-enhancing rehabilitation in the long term, particularly, at flexion angles above medium levels.

PubMedID: 28096004 Pain assessment has a key role in relief of the postoperative pain. In this study, we aimed to examine the effect of the Standard Pain Assessment Protocol (SPAP), which we developed based on acute pain guidelines, on pain level, and analgesic consumption. The study population consisted of a total of 101 patients who had arthroscopic shoulder surgery. The routine pain assessment was administered to the control group, while the SPAP was administered to the study group. The routine pain therapy of the clinic was administered to the subjects from both groups based on the pain assessment. Throughout the study, pain was assessed nearly two times more in the study group (p < 0.001) and the mean pain levels were lower at 8th–11th hours in the study group (p < 0.001). Pain assessment was not performed after 12th hour despite the severe pain in the control group, and, therefore, analgesia was administered at irregular intervals or was not administered at all. However, the hours of analgesic administration were found to be more regular according to the pain levels of the patients in the study group. In conclusion, the SPAP reduced the pain level by providing regular analgesia when used in combination with regular pain assessment. Perspective This article highlights the appropriate assessment for patients with surgical pain. In majority of literature on the subject, the authors emphasize the importance of Standard Pain Assessment Protocol to provide adequate pain relief. © 2016 Elsevier Inc.

Although, trauma, foot deformity (pes planovalgus), systemic diseases such as diabetes mellitus and lupus, drugs (steroids, antineoplastic) and excessive alcohol consumption have all been accused in the etiology of avascular necrosis of the tarsal bones, spontaneous avascular necrosis of the navicular bone, especially in adults, is a rare entity. In this article, we report a 50-year-old female patient with bilateral, spontaneous avascular necrosis of the navicular bone and related severe talonavicular arthrosis. Clinical and radiological findings were concordant with Muller-Weiss disease, which is a rare disease with complex idiopathic foot condition of the adult tarsal navicular bone characterized by progressive navicular fragmentation and talonavicular joint destruction. The patient was successfully treated with two-staged bilateral talonavicular arthrodesis.

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.

Background The purpose of this study was to assess the frequency of superior labrum anterior posterior (SLAP) lesions, long head of biceps tendon (LHBT) pathologies, and superior rotator cuff tears accompanying subscapularis tears. We hypothesised that LHBT lesions, superior rotator cuff tears, and especially SLAP lesions were very frequent with subscapularis tears. Methods The digital files of patients who underwent shoulder arthroscopy were reviewed retrospectively. One hundred and eleven patients with subscapularis tears evident on surgery videos were examined. Superior labrum, LHBT, and superior rotator cuff lesions were investigated by the authors of this study. The statistical analyses were made with SPSS statistics software, and significance was set at P Results There were 111 patients with both subscapularis tears and surgery videos. The mean age was 58.09 ± 10.21, and 63.1% of the patients were female. 98.2% of the 111 patients had a SLAP lesion. 7.2% of those were SLAP I and 91% were SLAP II lesions while 1.8% were healthy. The 75.7% of the patients had a LHBT pathology, and 83.8% had superior cuff tear. Conclusions Subscapularis tears were almost always accompanied by SLAP lesions. On the other hand, biceps tendon pathologies and superior rotator cuff tears were also very frequent with subscapularis tears. Level of evidence Prognostic study, Level IV (retrospective cohort study).