Purpose To determine the association between femoral torsion and anterior cruciate ligament (ACL) rupture and determine the level of torsion using magnetic resonance imaging (MRI). Methods The medical records of patients who were diagnosed with ACL injury were reviewed retrospectively. This descriptive epidemiological study included 2344 patients. MRI scans were examined and patients with femur and knee MRI scans obtained at the same time were identified (ACL‐deficient group). Twenty‐eight of them had femur and knee MRI scans because of an incidental benign lesion in the distal femur. Patients who were diagnosed with enchondroma were followed up by MRI evaluation of the femur and were randomly selected as controls. Supratrochanteric torsion (STT), infratrochanteric torsion (ITT), and femoral anteversion (FA) were measured by orthopedic surgeons with at least 5 years of experience. Results Age, sex, and side properties were similar in both groups. The mean FA values were 19.4 ± 3.0 degrees and 11.9 ± 2.0 degrees in the ACL‐deficient and control groups, respectively (p < 0.001). STT was similar in the ACL‐deficient and control groups [mean: 38.2 ± 4.3 and 37.7 ± 3.3, respectively, (n.s.)]. ITT was increased in the ACL‐deficient group compared with the control group (mean − 18.8 ± 4.3 and − 25.8 ± 3.8, respectively; p < 0.001). Conclusions According to our results, increased FA was associated with ACL rupture. Further, the torsional abnormality was developed from the ITT. We concluded that each ACL‐deficient patient should be assessed by a clinician for torsional abnormality using physical examination. Level of evidence III

No abstract

Aim: This retrospective study is aimed to analyze the effect of ultrasound-guided platelet-rich plasma (PRP) injections on grade 2 intrasubstance meniscal degenerations (IMDs). Materials and Methods: Fifteen patients who underwent PRP injections for symptomatic grade 2 meniscal lesions were included in the study. All injections were performed with ultrasound in the degenerated menisci. Patients were evaluated with Lysholm score and magnetic resonance imaging (MRI) before the injection and after a mean of 32-month follow-up. T2-weighted MRI images were evaluated on sagittal by two authors as double-blind. Results: Lysholm score was found to be statistically significantly increased, and in 67% of the patients, grade 2 degenerations were improved to grade 1. Conclusion: Intra-meniscal PRP injection under ultrasonography guidance provides good functional scores and radiological improvement in the patients with IMD.

ObjectiveThe aim of this study was to retrospectively compare a series of patients surgically treated with ORIF or early resection arthroplasty due to isolated comminuted radial head fractures.MethodsBetween the years 2009 and 2013, 34 patients with isolated comminuted fractures of the radial head (Mason Type 3) had been operated (ORIF in 19 patients, resection arthroplasty in 15 patients). The mean age of the patients in the ORIF group was 38.5 years and 54 years in the resection group. The carrying angle (CA) and ulnar variance were measured bilaterally, and radiographs were reviewed for degenerative elbow arthritis. The Mayo elbow performance score, Turkish version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH-T) and visual analog scale (VAS) were used to evaluate the clinical results.ResultsThe mean follow-up period in the ORIF group was 40.2 months and 44.4 months in the resection group. In the ORIF group, 11 patients were clinically rated excellent, six good, and two fair. In the resection group, seven patients had excellent, five had good, and two had fair scores. We did not find a statistically significant difference between the ORIF and resection groups regarding the clinical and radiological outcomes.ConclusionWith these short-term results, resection arthroplasty may be considered an effective method in the treatment of isolated comminuted radial head fractures, as it is less technically demanding and it also allows for early postoperative motion. However, the patients should be evaluated in detail, regarding ligamentous injuries prior to resection arthroplasty.Level of evidenceLevel III, Therapeutic study.

Objective Comparing the effects of magnetically controlled growing rod (MCGR) and traditional growing rod (TGR) techniques on the sagittal plane in the treatment of early-onset scoliosis (EOS). Methods Twelve patients were operated using dual MCGR technique in one center, while 15 patients were operated using dual TGR technique for EOS in another center. Patients’ demographic characteristics, complications and radiological measurements such as cobb angle, thoracic kyphosis, lumbar lordosis, T1–S1 range (mm), proximal junctional angle, distal junctional angle, sagittal balance, coronal balance, pelvic incidence, sacral slope and pelvic tilt were assessed and compared in preoperative, postoperative and last follow-up period. Results Age and sex distributions were similar in both groups. The mean number of lengthening in the MCGR group was 12 (8–15) and 4.8 (3–7) in the TGR group. Two techniques were shown to be effective in controlling the curvature and in the increase of T1–S1 distance. In TGR group, four patients had rod fractures, six patients had screw pull-out and four patients had an infection, whereas three patients had screw pull-out and one patient had infection complications in the MCGR group. Conclusion There was no significant difference between the two groups in terms of cobb angle, coronal and sagittal balance and sagittal pelvic parameters. MCGR can cause hypokyphosis and proximal junctional kyphosis in a minimum 2-year follow-up period. The implant-related complications were less in the MCGR group. However, larger case groups and longer follow-up periods are required for the better understanding of the superiority of one method on other in terms of complications.

Background: Greater trochanter apophysiodesis (GTA) is relatively minimal invasive technique for the treatment of trochanteric overgrowth. Various types of implants can be used in each procedure. The purpose of this study was to compare outcomes of three different types of implants that were used in treatment of trochanteric overgrowth in Legg–Calve–Perthes disease. Materials and Methods: We retrospectively studied radiological results of three implants (screw, screw washer, and EP) on inhibiting trochanteric growth in 32 patients. Articulo-trochanteric and trochanter-trochanter distances (TTDs) were measured on radiographs. Embedding of implant evaluated on final radiographs. Results: The mean of age at the surgery was 10 ± 2.3 years, and the mean of follow up period was 50.0 ± 16.7 months. In all groups, articulo-trochanteric distance was decreased on final radiographs. In screw and screw washer group, increase of TTD was not statistically significant ( P < 0.05). Twelve, one, and two implants were embedded, respectively, in screw, screw washer, and EP groups. Two patients in EP group had revision surgery due to loosening. Conclusions: In this study group, GTA using screw and screw washer methods could slow down but did not restore trochanteric overgrowth. We suggest using washer to reduce embedding of the screw.

Objectives: Achilles tendon lengthening (ATL) is one of the most commonly performed procedures in paediatric orthopaedic surgery. An appropriate adjustment of the amount of ATL is crucial to avoid insufficient or excessive lengthening. However, there is currently no effective method to preoperatively calculate the tendon length needed for equinus deformity correction. Thus, in this study we evaluated the accuracy of a calculation using a mathematical model based on the law of cosines. Methods: A total of 16 feet of 14 patients who were scheduled for ATL surgery due to equinus deformity were included in the study. ATL surgery was performed using a standard Z-plasty technique. Calculation of the amount of ATL using the law of cosines, and assessments of intraoperative lengthening of the tendon, were performed in a double-blind manner. The extent of lengthening resulting from the two methods was then compared. Results: The mean ATL determined intraoperatively was 23.67 ± 8.7 mm, and that obtained using the cosine-based method was 22.49 ± 8.6 mm. Thus, the new method showed excellent statistical agreement with the actual lengthening performed during surgery. Conclusions: The required dimension of ATL can be calculated preoperatively using the mathematical formula presented here. The advantages of this approach are that it allows accurate tendon lengthening and reduces the size of the surgical incision.

Background: There are many studies suggesting that the pelvic radiographs taken in posterior-anterior (PA) projection cause far less radiation exposure than anterior-posterior (AP) projection. However, PA projection is rarely used in daily practice due to the concern that the obtained images will not provide radiological standards. Objectives: The aim of the study was to determine whether PA projections meet the radiological criteria of correct positioning as AP projections. Patients and Methods: In this prospective study, radiographs of 160 patients (80 PA and 80 AP images) were obtained randomly. Pelvic rotation index (PRI), symphysis ischium angle (SIA) and pelvic inclination index (PII) were used to evaluate whether the pelvic radiographs were suitable for radiological assessment. Results: The reliability of AP and PA projections was excellent for PRI (Intraclass correlation coefficient [ICC] = 0.66, 95% confidence interval [CI] = 0.90-0.98), SIA (ICC = 0.99, 95% CI = 0.90-0.98), and PII (ICC = 0.95, 95% CI = 0.90-0.98). Conclusion: PA projection instead of AP projection for pelvic radiography has no drawback in terms of acceptability criteria. Considering PA projection is a dose reducing technique requiring no additional equipment, it may be a safer option for children.