Background The aim of this study was to evaluate and compare the functional outcomes and complication rates of patients in short-term and midterm follow-up period when medial unicompartmental knee arthroplasty (UKA)-applied patients were grouped according to BMI values. Methods One hundred four patients (mean age 60.2 ± 7.4 (range, 49–80)) to whom medial UKA was applied between 2011 to 2016 with a minimum of 2 years follow-up were grouped as normal and overweight (less than 30 kg/m 2 ), obese (30–34.9 kg/m 2 ) and morbidly obese (BMI ≥ 35 kg/m 2 ) according to their BMI. The postoperative Knee Society Scores (KSS), functional Knee Society Scores (fKSS), Oxford Knee Scores (OKS), visual analogue scale (VAS) and range of motion (ROM) results and complication rate of these groups were compared statistically. The implant positioning of the patients requiring revision was analysed according to the Oxford radiological criteria. Results The average BMI of 104 patients was 34.4 (range, 22–56.9). Twenty-six (25%) of these were normal or overweight, 40 (38.5%) were obese and 38 (36.5%) were morbidly obese. However, in these BMI groups, there was no significant difference between the preoperative VAS, postoperative VAS and VAS score changes among these three groups ( p > 0.05). The postop KSS, f KSS and OKS were significantly poorer in the morbidly obese group by 75.2, 70.5 and 33.1, respectively. Furthermore, amount of ROM changes (4.2°) were significantly poorer in the morbidly obese group ( p < 0.05). Complications including eminence fractures, insert dislocations, tibial component collapses and superficial infections developed in 10 patients (9.6%). Six of them (60%) were morbidly obese, and four of them (40%) were obese. Furthermore, 11 (10.6%) of the patients required revision. Eight (72.7%) of the patients were morbidly obese, and three (27.3%) of them were obese. Conclusions We concluded that morbid obesity is an independent risk factor for functional outcomes and implant survival after UKA. However, it is possible to obtain excellent results for obese and overweight patients with good planning and correct surgical technique. Morbid obese patients should be preoperatively informed about poor functional outcome and high complication rate. Treatment of morbid obesity before UKA surgery may be a good option.

Background. The aim of this study is to determine the diagnostic accuracy of lever sign test in acute, chronic, and postreconstructive ACL injuries. Methods. In total, 78 patients (69 male, 9 female) were subjected to clinical instability tests including Lachman, anterior drawer, pivot shift, and lever sign when an injury of the ACL was suspected. All tests were performed bilaterally in all patients in acute, chronic period and patients who underwent surgery after the anaesthesia and after the reconstruction at the last follow-up by two senior orthopaedic surgeons. MRI was taken from all patients and MRI image was taken as the reference test when evaluating the accuracy of the tests. Results. The mean age of patients was 26.2±6.4 years (range, 17-44 years). Sensitivity and accuracy values of the Lachman, anterior drawer, pivot shift, and lever tests in the acute phase were calculated as 80.6%, 77.4%, 51.6%, 91.9% and 76.9%, 75.6%, 60.3%, 92.3%, respectively, and in the chronic (preanaesthesia) phase were calculated as 83.9%, 79.0%, 56.5%, 91.9% and 80.8%, 78.2%, 64.1%, 92.3%, respectively. Lachman, anterior drawer, pivot shift, and lever sign Acute’s significant [AUC: 0.716, 0.731, 0.727, 0.928, respectively] activity were observed in the prediction of ACL rupture in MRI. Conclusion. An ideal test to diagnose the integrity of the ACL should be easy to perform and reproducible with high sensitivity and specificity. From this perspective, the lever test seems to be a good test for clinicians in acute, chronic and postreconstructive ACL injuries.

Knee arthroscopy may be called the most commonly and increasingly performed orthopaedic procedure. Posterior medial compartment visualization may be quite challenging. The aim of the present study is to detect objective measurement of medial joint space widening with percutaneous “pie crust” release of medial collateral ligament (MCL) during knee arthroscopy. We used this technique for all knees that require any intervention in the posteromedial compartment and for tight knees in which adequate visualization of the posteromedial compartment cannot be obtained. Eighteen patients (18 knees) were included in this study. Patients were evaluated clinically with the Lysholm and Tegner scores at the final office visit. Joint balance, valgus instability, pain or tenderness on MCL region, and numbness over the medial side of the joint were also noted. Measurements of medial joint space (mm) were obtained at three different times with perioperative C-arm images: normal, controlled valgus force, and after pie crusting. The median follow-up time was 9 (6–12) months. Final follow-up Lysholm (p < 0.05) and Tegner scores (p < 0.05) increased significantly compared with preoperative scores. At the final follow-up, there was no pain or tenderness over MCL and there were no signs of saphenous nerve or vein injury. Medial joint space values in after pie crusting increased significantly (p < 0.05) compared with neutral position measurements and controlled valgus force application (p < 0.05). Controlled release of the MCL in knees provided ∼2.45 times wider visualization place. Furthermore, pie crusting of MCL is a safe and effective technique that provides enough space for visualization and instrumentation in knees. This is a Level IV study.

ÖZAmaç: Bu çalışmada, tam kat orta ile büyük boyutlu rotator manşet yırtığı olan hastalar için yaygın olarak kullanılan iki transosseöz eşdeğeri artroskopik rotator manşet onarımı tekniği olan düğümsüz ve medial düğümlü dikiş köprüsünün klinik sonuçları ve onarım bütünlüğü karşılaştırıldı. Hastalar ve yöntemler: Çalışmaya manşet yırtığı olan 121 hasta (55 erkek, 66 kadın; ort. yaş 56.7±7.3 yıl; dağılım, 39-72 yıl) dahil edildi. Toplamda 64 omuz konvansiyonel medial düğümlü dikiş köprüsü tekniği (grup A) ve 57 omuz düğümsüz dikiş köprüsü tekniği (grup B) kullanılarak ameliyat edildi. Constant skoru, görsel analog ölçeği (GAÖ) ve aktif öne fleksiyon açısı ameliyat öncesinde ve ameliyattan minimum 12 ay sonra değerlendirildi. Ameliyat sonrası rotator manşet bütünlüğü ortalama 19±4.7 ay sonra manyetik rezonans görüntüleme (MRG) ile değerlendirildi. Bulgular: Yaş, cinsiyet, vücut kitle indeksi değeri ve sagital MRG'de yırtığın ön-arka genişliği bakımından gruplar arasında anlamlı farklılık gözlenmedi. Ameliyat sonrası ortalama Constant skoru grup A'da 32.3±8.5 puandan 84±11.6 puana ve grup B'de 31.3±9.3 puandan 86.4±8.7 puana yükselirken (p<0.001) ortalama GAÖ skoru grup A'da 6.0±1.0'dan 1.3±1.2'ye, grup B'de 6.4±1.0'dan 1.0±0.8'e düştü (p<0.001). Kontrol MRG'lere göre, tekrar yırtık oranı grup A'da %10.9 (n=7) ve grup B'de %8.8 (n=5) idi. Gruplar arasında ne klinik skorlarda ne de tekrar yırtık oranlarında istatistiksel olarak anlamlı farklılık bulunmadı (p>0.05). Sonuç: Medial düğümlü tekniğe kıyasla daha az zaman alan ve daha basit olan düğümsüz teknik, ameliyattan en az bir yıl sonra benzer tatmin edici sonuçlar sağlar.Anahtar sözcükler: Çift sıra, düğümsüz dikiş köprüsü, medial düğümlü dikiş köprüsü, rotator manşet onarımı, transosseöz eşdeğeri onarım. ABSTRACTObjectives: This study aims to compare the clinical results and repair integrity of two of the commonly used transosseousequivalent arthroscopic rotator cuff repair techniques, which are the knotless and the medial knotted suture bridge, for patients with full-thickness medium to large-sized rotator cuff tears. Patients and methods:The study included 121 patients (55 males, 66 females; mean age 56.7±7.3 years; range, 39 to 72 years) with cuff tears. In total, 64 shoulders were operated on using the conventional medial knotted suture bridge technique (group A) and 57 shoulders were operated on using the knotless suture bridge technique (group B). The Constant score, visual analog scale (VAS) and active forward flexion angle were assessed preoperatively and after a minimum of 12 months postoperatively. Postoperative rotator cuff integrity was evaluated by magnetic resonance imaging (MRI) after a mean of 19±4.7 months. Results: There were no significant differences between the groups in terms of age, gender, body mass index, and anteroposterior extension of the tear on the sagittal MRIs. Postoperatively, the mean Constant score increased from 32.3±8.5 points to 84±11.6 points in group A and from 31.3±9.3 points to 86.4±8.7 points in group B (p<0.001), while th...

Objective:This study aimed to compare the clinical results and complications as well as patient satisfaction in patients with carpal tunnel syndrome operated with open carpal tunnel release (OCTR) or endoscopic carpal tunnel release (ECTR) techniques.Methods:This study conducted in Istanbul Training and Research Hospital between August 2016 and January 2018. A total of 54 patients were operated with the ECTR technique and 50 patients were operated with the OCTR technique after failing nonsurgical treatment. Patients functional scores are assessed with the carpal tunnel syndrome-functional status score (CTS-FSS) and carpal tunnel syndrome-symptom severity score (CTS-SSS). Operation time, incision length and complications of the two techniques were noted and compared.Results:The age, sex distribution, distribution of sides, and complaint period were not significant (p > 0.05) between the groups. The preoperative or postoperative CTS-SSS and CTS-FSS values did not differ significantly (p > 0.05). Incision length, time to return to work and return to daily life in the OCTR group was significantly higher than the ECTR group (p < 0.05).Conclusion:ECTR has similar results in terms of symptom relief, severity, functional status, pillar pain and complication rates compared to OCTR. However, it has the advantages of early return to daily life, early return to work and less incision length.