BACKGROUND: Symptomatic degenerative meniscus tears are common in middle and old age. Arthroscopic partial meniscectomy (APM), physical therapy (PT) and hyaluronic acid injection (HAI) are the most commonly used treatment options. OBJECTIVES: The aim of our study is to compare the effectiveness of APM and PT in degenerative meniscus tears and to investigate the effect of HAI with a prospective, randomized, single-blind study. METHODS: The study included 192 patients with symptomatic degenerative meniscus tears. The patients were randomly divided into the four groups. The first group consisted of patients who underwent APM, the second group received HAI with APM, the third group received PT, and the fourth group received HAI with PT. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS) scores, and range of motion (ROM) values were used for evaluation. RESULTS: There was no difference between four groups according to age, gender, BMI, affected side, grade of osteoarthritis. In the 4 groups, WOMAC and VAS results at the 2nd and 6th months were better than pre-treatment. There was no difference between the groups in terms of WOMAC and VAS. In terms of ROM, the results were found better in PT group (Group 3, Group 4) at the 2nd and 6th months. However, the results were found worse in APM group (Group 1, Group 2). In addition, it was found that HAI applied with APM and PT had no effect on VAS, WOMAC, and ROM. It was determined that the increase of knee osteoarthritis negatively affected both the results of APM treatment and PT. VAS, WOMAC, and ROM results were found worse in patients with stage 3 osteoarthritis than grade 1 and 2, but there was no difference between grade 1 and 2. CONCLUSIONS: APM and PT give good results in terms of pain and functional results. However, ROM limitation develops after APM. Conversely, there is an increase in ROM after PT. Administration of HAI with these treatments has no effect on the results. PT is an easily applicable noninvasive method. Adding HAI to the treatment has no effect on the results and increases the cost.

Purpose To evaluate the efects of untreated stable ramp lesions on clinical and functional outcomes, return to sports rates, and complications of patients who underwent anterior cruciate ligament reconstruction. Methods A total of 879 patients with anterior cruciate ligament rupture were evaluated. Of these, 66 patients [33 patients with anterior cruciate ligament rupture and stable medial meniscal ramp lesion (ramp + group) and 33 patients with isolated anterior cruciate ligament rupture (ramp − group)] with a minimum 3-year of follow-up were included. Stable ramp lesions were not repaired in the ramp + group. Preoperative and postoperative Lachman and pivot-shift grades, Lysholm knee scores, International Knee Documentation Committee score and 12-Item Short Form Health Survey score were compared between groups. The return to sports rates, level of return to sports, time to return to sports and complications were compared. ResultsThe mean patient age was 27.8 ± 7.2 years. The mean follow-up period was 47.3 ± 9.4 months. There were no signiicant diferences between groups regarding preoperative and postoperative Lachman and pivot-shift grades, 12-Item Short Form Health Survey mental and physical component summary scores, Lysholm and International Knee Documentation Committee scores, and complication rates (n.s.). Although the return to sports rates (84.8% vs 90.1%) and the level of the return to sports (return to preinjury level: 75% vs 78%) were similar between groups (n.s.), the time to return to sports was signiicantly longer for patients with ramp lesions (11.1 ± 4.0 vs. 8.7 ± 2.5 months, p = 0.007). Conclusion Leaving the stable ramp lesion unrepaired does not negatively afect clinical and functional outcomes as well as return to sports rates after ACL reconstruction. However, the time to return to sports is prolonged in patients with ramp lesions In clinical practice, surgeons should be aware that repairing stable ramp lesions is not an absolute necessity and will not afect return to sport rates. Level of evidence Level III.

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To evaluate the short-term clinical and radiological outcomes with degenerative changes in patients over 40 years old following isolated vertical medial meniscal tear repair. Methods: Between 2007 and 2015, 438 patients underwent arthroscopic meniscal repair. Thirty-three patients aged over 40 years with isolated vertical medial meniscal repair (23 males and 10 females, mean age 46.1 + 7.0; range 40-67) were included in the study. Preoperative and postoperative physical examination findings, Lysholm knee score, the International Knee Documentation Committee score, magnetic resonance imaging findings, and Kellgren-Lawrence osteoarthritis stage were evaluated. Results: The mean follow-up period was 31.1 months + 20.1 (range 12-100 months). There was statistically significant improvement in functional scores (p < 0.05) and physical examination findings. In 22 patients (66.7%), improvement in the clinical and radiological results was detected (p < 0.05). However, no correlation was found between clinical and radiological outcomes. There was also no significant change in osteoarthritis stages at the last follow-up visit. No significant difference was found between smokers and nonsmokers regarding clinical outcomes. Conclusion: Successful clinical and radiological outcomes can be obtained following isolated vertical medial meniscal tear repair in patients older than 40 years. Age is not the sole criterion for the success of meniscal repair; rather, the functional capacity of the patient, the location of the tear, the grade of knee joint arthritis, and the quality of the meniscal tissue should be taken into consideration.

PurposeTo investigate the effect of preoperative coronal tibiofemoral subluxation (CTFS) on functional outcome, prosthesis type, insert thickness and revision rates in patients who underwent total knee arthroplasty (TKA). MethodsA total of 224 knees of 186 patients were included. Patients were divided into two groups as either with (Group 1, 114 knees of 86 patients) or without (Group 2, 124 knees of 100 patients) coronal lateral tibiofemoral subluxation. The mean follow‐up period was 71.3 ± 7.3 (range 60–84) months in group 1 and 69.4 ± 6.6 (range 61–79) months in group 2 (n.s.). Coronal tibiofemoral subluxation degree was measured in degrees on standing anteroposterior knee radiographs. Group 1 was divided into three subgroups according to amount of subluxation (< 5 mm, 6–10 mm and > 10 mm). Functional outcome was evaluated using the Western Ontario and McMaster Osteoarthritis Index (WOMAC) score and Knee Injury and Osteoarthritis Outcome Score (KOOS) preoperatively and at the last follow‐up visit. Prosthesis type, insert thickness and revision rates were compared between the two groups. ResultsThere were no significant differences between the two groups regarding patient demographics, prosthesis type, and revision rates (n.s.). The insert thickness was found significantly higher in group 1 (p < 0.001). The preoperative and postoperative WOMAC and KOOS scores were found no significantly different between the two groups (n.s.). Among subluxation (+) subgroups, there was no significant difference in functional outcome scores and revision rates (n.s.). However, prosthesis type and insert thickness were significantly associated with the amount of subluxation (p = 0.009 and p = 0.001, respectively). There was no significant correlation between the degree of lower extremity deformity and coronal tibiofemoral amount of subluxation (n.s.). ConclusionPreoperative CTFS does not adversely affect the WOMAC score, KOOS and revision rates after TKA. In the clinical practice, surgeons should be aware of the need for a posterior cruciate stabilizing prosthesis and a thicker insert in the presence of CTFS, especially with subluxation greater than 10 mm and to consider a spared bony resection on the tibia in patients suffering from CTFS. Level of evidenceIV.

PurposeThis study investigated the short-term effects of KT on back pain (BP) in patients with Lenke Type 1 adolescent idiopathic scoliosis (AIS).MethodsWe chosen Lenke Type 1 scoliosis who have had only back pain (the localization of the pain: the only in the apical convex edge). Forty patients suffering from BP with Lenke Type 1 AIS were randomly separated into two groups, Group 1 (20 patients) and Group 2 (20 patients). Group 1 was given KT with tension and home exercises and Group 2 was given KT without tension and home exercises. KT and home exercises was applied to the thoracic area of the patients in both groups for four weeks. Pain intensity was measured using a visual analog scale (VAS) and SRS-22 (subtotal SRS-20) before and after treatment.ResultsMean age of both groups was 16.1 years. Mean Cobb angle of the thoracic scoliosis was 31.8° (range: 17°–44°) in Group 1 and 32.8° (range: 19°–43°) in Group 2 before the treatment. The decrease in VAS score of Group 1 after taping was higher than that of Group 2. The difference between the pre- and post-treatment VAS scores of both groups was statistically significant (p < 0.05). The increase in mean SRS-20 score of Group 1 following taping application was significantly higher than the increase in the control group (p < 0.05).ConclusionResults demonstrated that KT application with tension effectively leads to back pain relief shortly after application. In addition, KT has a positive impact on quality of life. Thus, KT may be a suitable intervention in treating back pain of patients with AIS.Level of EvidenceLevel 1, Therapeutic study