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We examined labroligamentous structures in unstable anteroinferior glenohumeral joints using MR arthrography (MRA) to demonstrate that not all instabilities are Bankart lesions. We aimed to show that other surgical protocols besides classic Bankart repair are appropriate for labroligamentous lesions. The study included 35 patients (33 males and 2 females; mean age: 30.2; range: 18 to 57 years). MRA was performed in all patients. The lesions underlying patients' instability such as Bankart, anterior labral periosteal sleeve avulsion (ALPSA), and Perthes lesions were diagnosed by two radiologists. MRA yielded 16 diagnoses of Bankart lesions, 5 of ALPSA lesions, and 14 of Perthes lesions. Albeit invasive, MRA seems to be a more reliable and accurate diagnostic imaging modality for the classification and treatment of instabilities compared to standard MRI.

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Objective: This study aimed to evaluate the results of patients undergoing single-bundle anatomical reconstruction of the anterior cruciate ligament (ACL) with the anteromedial portal technique and the effects of surgical timing on the results.Methods: A total of 47 patients (44 males, three females; mean age: 27 years) were included in this study. Lachman test, pivot shift test and KT-2000 arthrometry, International Knee Documentation Committee (IKDC) and Lysholm activity scoring were used in the preoperative and final follow-up in order to clinically evaluate. Furthermore, 17 patients undergoing early surgery (within the first 6 months) and 30 patients undergoing late surgery were compared for the presence of additional pathologies and functional results. Results:The mean follow-up period was 25 months (range: 13-36 months). Lachman test, Pivot-shift test, KT-2000, Lysholm, and IKDC scores significantly improved during the final follow-up according to the preoperative values. Eighty-two percent (14/17) of patients in the early surgery group (ten medial, three lateral, and one bilateral) and 96% (29/30) of patients in the late surgery group (seventeen medial, five lateral, and seven bilateral) had meniscus tear, and the difference was statistically significant. Four patients requiring microfracture were present in the late surgery group. Functional outcome was better in patients in the early surgery group, although the difference was statistically not significant. Conclusion:Anatomical reconstruction of ACL with the anteromedial portal technique is an effective method to improve clinical and functional results. Additionally, early surgery will improve functional results because it will decrease the frequency of additional pathology. (JAREM 2016; 6: 88-93)

Purpose: To restore the normal axial alignment of the lower extremity is important in reconstructive knee surgery. The aim of this study was to evaluate lower-limb alignment and posterior tibial slope. Methods: Thirty-two male and 32 female outpatients aged 22 to 46 were recruited. A full weight-bearing anteroposterior radiograph of the entire lower limb was obtained for each subject. The axial alignment was measured based on the centers of the femoral head, knee, and ankle. The tibiofemoral (TF), tibial joint (TJ), and posterior tibial slope (TS) angles were determined. Results: The mean TF angle was more varus in women (177.8˚) than men (179.2˚), and the mean TJ angle was more medially inclined in women than men. Women had a greater TJ angle than men (93.3˚ vs. 91.6˚). The mean posterior TS was greater in men than women (16.0˚ vs. 12.5˚, p < 0.05), while the mean TS angle was greater in women (14.8˚) than men (12.3˚). Conclusion: Knee alignment and geometry vary among populations. In our study, the TF angle was varus among all participants. The knee joint was more medially inclined in women than men. And also the posterior TS was greater in women than men.

Objective: Several treatments have been proposed to treat lateral epicondylitis. Both steroid injection and extra-corporeal shock wave therapy (ESWT) are treatment modalities.Methods: Thirty-four patients suffering from lateral epicondylitis for at least 6 months were treated in this study. The patients were divided into two groups: the first group included 17 patients treated by ESWT, and the second group included 17 patients treated by local injection of steroid. The results were evaluated using the visual analog scale and the DASH score.Results: In the first group (ESWT), the mean follow-up period was 20.42 months. The VAS improved from 8.1 to 1.85, and the DASH score improved from 73.32 to 52.3. Moreover, 10 cases were satisfied, 2 cases were satisfied with reservation, and 5 cases were not satisfied. In the second group (steroid), the average follow-up period was 17.39 months. The VAS improved from 8.71 to 1.32, and the DASH score improved from 72 to 48.23. Concerning patient satisfaction, 13 cases were satisfied, 3 cases were satisfied with reservation, and 1 case was not satisfied. Yöntemler: Bu çalışmaya en az 6 aydır lateral epikondilitten dolayı ağrısı olan 34 hasta dahil edildi. Hastalar iki gruba ayrıldı, birinci gruptaki 17 hasta ESWT ile ve ikinci gruptaki 17 hasta ise streoid enjeksiyonu ile tedavi edildi. Sonuçlar Visual Analog Skala ve DASH skalaları kullanılarak değerlendirildi. Bulgular: Birinci gruptaki hastaların (ESWT) ortalama takip süresi 20,42 ay idi. Ortalama VAS skorunda 8,1 den 1,85'e kadar, ortalama DASH skorunda ise 73,32'den 52,3'e kadar bir düzelme sağlandı. 10 hastada tatmin edici sonuca ulaşılırken, 2 hastada sınırlı memnuniyet sağlandı, 5 hastada ise tatmin edici sonuç sağlanamadı. İkinci grupta (steroid enjeksiyonu) ise ortalama takip süresi 17,39 ay idi. Ortalama VAS skorunda 8,71 den 1,32'ye, ortalama DASH skorunda ise 72 den 48,23'e kadar düzelme sağlandı.13 hastada tatmin edici sonuca ulaşılırken, 3 hastada sınırlı memnuniyet sağlandı, 1 hastada ise tatmin edici sonuç sağlanamadı.Sonuç: Steroid enjeksiyonu ESWT ile karşılaştırıldığında ağrının giderilmesi, dirsek fonksiyonlarının iyileşmesi ve hasta memnuniyeti açısından daha iyi sonuçlara sahiptir. (JAREM 2014; 2: 58-61) Anahtar Sözcükler: Lateral epikondilit, ESWT, DASH skoru, streoid enjeksiyonu

Objective: The aim of this study is to investigate neurologic complications of closed wedge valgization osteotomy technique using electrophysiological methods.Methods: Eleven extremities of 11 patients (mean age 52.75±5.39) with medial gonarthrosis and varus deformity were included. All patients underwent closed wedge valgization osteotomy in order to correct varus deformity. Results:The post-operative amplitude of nervus peroneus superficialis significantly decreased when compared to pre-operative amplitude. The mean pre-operative N. peroneus superficialis amplitude was 12.77, whereas it reduced to 5.44 postoperatively (p<0.05). Other nerve conduction velocity investigations showed no significant differences between pre-and post-operative values. A Needle Electromyography (EMG) study demonstrated neurogenic involvement in 4 patients after surgery. All of these 4 patients had denervation in the m.extensor hallucis longus needle EMG study. In 2 patients, the musculus tibialis anterior needle EMG study showed neurogenic involvement. One of these had denervation. One patient showed denervation in the m.extensor digitorum brevis needle EMG study. Conclusion:Although fibula osteotomy used in the closed wedge osteotomy technique was applied from the safe zone, electrophysiological investigations suggested that this zone may, in fact, not be safe. (JAREM 2014; 1: 12-7) Key Words: Closed wedge, high tibial osteotomy, valgization osteotomy, peroneal nevre ÖZET Amaç: Bu çalışmanın amacı kapalı kama valgizasyon osteotomisi tekniğinin nörolojik komplikasyonlarını elektrofizyolojik yöntemlerle araştırmaktır.Yöntemler: Ortalama yaşları 52,75 (±5,39) olan varus deformitesi bulunan medial gonartrozlu 11 hastanın 11 ekstremitesi çalışmaya alınarak mevcut varus deformitelerini düzeltme amacıyla uygulanan kapalı kama valgizasyon osteotomisi uygulanan hasta grubu çalışmaya dahil edilmiştir. Bulgular: Nervus peroneus süperfisialis amplitüdü incelendiğinde ameliyat öncesine göre ameliyat sonrası ortalama olarak anlamlı şekilde azalma saptanmıştır. Ameliyat öncesi ortalama N. peroneus süperfisialis amplitüdü 12,77 iken ameliyat sonrası ortalama değer 5,44 olarak bulunmuştur (p<0,05). Diğer sinir ileti hızları incelemelerinde ise ameliyat öncesi ve sonrası arasında istatiksel olarak anlamlı fark saptanmamıştır. İğne Elektromyografi (EMG) çalışmasında ise 4 hastada ameliyat sonrası incelemede nörojen tutulum saptanmıştır. Dört hastanın tamamında m. ekstansör hallusis longus iğne EMG çalışmasında denervasyon saptanmıştır. İki hastanın musculus tibialis anterior iğne EMG çalışmasında nörojen tutulum saptanmıştır. Bunlardan birinde denervasyon saptanmıştır. Bir hastada m. ekstansör dijitorum brevis iğne EMG çalışmasında denervasyon saptanmıştır.Sonuç: Kapalı kama osteotomi tekniğinde kullanılan fibula osteotomisi güvenli bölgeden yapılmasına rağmen elektrofizyolojik inceleme sonuçları bu bölgenin güvenli olduğu konusunda şüphe uyandırmaktadır. (JAREM 2014; 1: 12-7) Anahtar Sözcükler: Kapalı kama, yüksek tibial osteotomi, valg...