rBM-MSC and PRP promote the recovery of the tendon and increase its structural strength. The use of PRP and MSC provides hope for the treatment of the Achilles tendon ruptures that limit human beings' functionalities and quality of life, particularly for athletes. It is thought that the use of MSC can be more effective for tendon healing; hence, more extensive and advanced studies are needed on this topic.

ObjectiveThe aim of the present study was to evaluate the association between the calcaneal spur incidence and age, gender and side.MethodsLateral ankle X-rays of 1335 patients (550 (41.2%) females and 758 (58.8) males; mean age: 46.5 ± 13.5 years) who referred to our hospital because of trauma were reviewed. Incidence of plantar calcaneal spur, posterior calcaneal spur and association of such incidences with age, gender and side were all evaluated.ResultsIncidences of plantar calcaneal spur and posterior calcaneal spur were detected as 32.2% (male: 31%, female: 34%) and 13.1% (male: 11%, female: 16%), respectively. Incidence of plantar calcaneal spur increased by age whereas there was not any association with gender and location. The highest incidence was detected as 41.8% over 70 years of age. Incidence of posterior calcaneal spur increased by age and female gender whereas no significant association was observed with location. The highest incidence was detected as 22.3% between 61 and 70 years of age.ConclusionIncidences of plantar and posterior calcaneal spur were detected as 32.2% and 13.1%, respectively. Both plantar and posterior calcaneal spur incidence increases by age. Posterior calcaneal spur occurs significantly more frequently in females while, no difference is found between the males and females in incidence of the plantar calcaneal spur.Level of evidenceLevel IV, diagnostic study.

ObjectiveThe aim of this study was to compare midterm functional and radiographic results of minimal invasive plate osteosynthesis (MIPO) with intramedullary nailing (IMN) of simple intra-articular distal tibial fractures (AO-OTA type 43 C1-C2).MethodsSeventy-three simple intra-articular distal tibial fracture patients were evaluated retrospectively. All were treated between 2009 and 2014. The average age of the patients was 40.3 years. Thirty-seven patients were treated with IMN and 36 patients were treated with MIPO. Fibular plate osteosynthesis was applied in 5 cases (13.5%) in the IMN group and in 23 patients (63.9%) in the MIPO group.ResultsFunctional results and complications of IMN and MIPO methods were assessed in 73 patients. The average union time was 16.4 ± 2.7 weeks in the IMN group and 15.2 ± 1.8 weeks in the MIPO group (p = 0.079). The average Olerud-Molander Ankle Score was 87.8 ± 8.1 in the IMN group and 81.5 ± 11.8 in the MIPO group (p = 0.013). Four patients in the IMN group experienced valgus malunion, while it was not observed in any patients in the MIPO group (p = 0.042). Recurvatum malunion was detected in 10 patients in the MIPO group and not seen in the IMN group (p = 0.001). Ankle dorsiflexion angle was 25.8 ± 4.5° in the IMN group and 33.3 ± 8.9° in the MIPO group (p = 0.000).ConclusionSimple intra-articular distal tibial fractures are successfully treated with IMN and MIPO. Prevalence of valgus malunion was higher in the IMN group and recurvatum was more prevalent in the MIPO group. MIPO is the first preference according to the literature; however, successful results have been obtained with IMN in this fracture pattern.Level of EvidenceLevel III, Therapeutic Study.

-Four fluoroquinolones (pefloxacin, norfloxacin, ofloxacin and ciprofloxacin) were compared according to their biomechanical and histopathological effects on rat Achilles tendon. Wistar rats were divided into one untreated control and four treatment groups in parallel. Pefloxacin mesylate dihydrate (40 mg/kg), norfloxacin (40 mg/kg), ofloxacin (20 mg/kg) and ciprofloxacin (50 mg/kg) were administered by gavage twice daily for three consecutive weeks. 6 weeks after treatment, the test animals were euthanised and Achilles tendon specimens were collected. A computer monitored tensile testing machine was utilised for biomechanical testing. The mean elastic modulus of the control group was significantly higher than that of the norfloxacin and pefloxacin groups (p < 0.05 and p < 0.01, respectively). The mean yield force (YF) of the control group was significantly higher than those of ciprofloxacin, norfloxacin and pefloxacin groups (p < 0.001, p < 0.05 and p < 0.01, respectively). The mean ultimate tensile force (UTF) of the control group was significantly higher than of the ciprofloxacin, norfloxacin, and pefloxacin groups (p < 0.001, p < 0.05 and p < 0.01, respectively). Hyaline degeneration and fibre disarrangement were observed in the tendons of the ciprofloxacin, pefloxacin, and ofloxacin treated-groups, whereas myxomatous degeneration was observed only in the ciprofloxacin and pefloxacin groups. In conclusion, these findings in our rat model reveal significant deterioration of biomechanical parameters following fluoroquinolone exposure, and indicate significantly higher biomechanical toxicity for ciprofloxacin and pefloxacin.

ObjectiveThe aim of the present study was to evaluate histopathological and biomechanical effects of isotretinoin on Achilles tendon.Materials & methodsSixteen rats were divided into two groups including the control group (n = 8) and isotretinoin group (n = 8). The control group received 1.42 ml/kg soy oil per day whereas the isotretinoin group received 15 mg/kg/day (gavage dose 1.42 ml/kg) isotretinoin dissolved in soy oil through gavage method for 6 weeks. Achilles tendons were excised at the end of week 6. The tendon samples were evaluated by hematoxylin-eosin under a light microscope. Quantitative evaluation was performed via Movin and Bonar scoring. A computer-monitored tensile testing machine was utilised for biomechanical testing. Biomechanical characteristics of the tendon samples (elastic modulus, yield force, ultimate tensile force) were measured.ResultsHistopathological evaluation revealed a significantly higher Movin and Bonar scores in histopathological evaluation. Movin score in isotretinoin group was 4.1 ± 2.5 and it was 2.3 ± 1.0 in control group (p = 0.032). Bonar score in isotretinoin group was 2.9 ± 1.4 and it was 1.6 ± 0.7 in control group (p = 0.022). In line with histopathological evaluation, biomechanical measurements in isotretinoin group (elastic modulus, yield force, ultimate tensile force) were significantly lower than the control group. Elastic modulus in isotretinoin group was 227 ± 27.7 N/mm2 and in control group it was 281.7 ± 38.7 N/mm2 (p = 0.006). In isotretinoin group; yield force was 33.7 ± 4.3 Pa and in control group it was 40.8 ± 5.9 Pa (p = 0.021). Ultimate tensile force in isotretinoin group was 35.7 ± 4.2 Pa and in control group it was 44 ± 7 Pa (p = 0.009).ConclusionThe present study detected histopathological and biomechanical negative effect of isotretinoin on Achilles tendon. Therefore, isotretinoin should be questioned in medical history of patients with tendinopathy.

Sclerostin is produced almost exclusively by osteocytes, which also express receptors for 1,25 dihydroxyvitamin D3. The aim of this study was to investigate the effects of vitamin D3 treatment on serum sclerostin levels in young adult females with severe vitamin D deficiency. A total of 26 subjects were treated orally with calcium (1.200 mg/day for 2 months) and vitamin D3 (300.000 IU/week for 1 month). Serum 25-hydroxyvitamin D (25(OH)D) and sclerostin levels were measured before and after treatment. Baseline serum 25(OH)D and sclerostin levels were at 5.7 ± 2.4 ng/mL and 39.1 ± 14.4 pg/mL, respectively. Serum 25(OH)D was significantly increased, to 62.4 ± 18.7 ng/mL, following treatment; serum sclerostin was significantly decreased, to 29.3 ± 8.8 pg/mL. We conclude that serum sclerostin level is decreased following vitamin D3 treatment in patients with vitamin D deficiency.

ObjectiveThe aim of this study to evaluate the effects of autologous conditioned serum (ACS) on the healing of transected rat Achilles tendons via the assessment of biomechanical and histological parameters.MethodsThe study was conducted on 45 male Sprague–Dawley rats. Five rats were used as donors for ACS preparation. Animals were randomly assigned to the experimental or control group. In both groups, the Achilles tendon was cut transversally and then sutured. In the placebo control and ACS-treated groups, saline or ACS, respectively, was injected into the repair zone three times after surgery. Ten rats from each group (ACS group, n = 20; control group, n = 20) were euthanized at days 15 and 30 after surgery for histopathological (n = 5) and biomechanical (n = 5) testing. The histopathological findings were interpreted using the Bonar and Movin scales. Tendon remodelling was evaluated via the immunohistochemical staining of collagen type 3. Biomechanical effects were assessed by tensile testing.ResultsThe Bonar and Movin scale scores were significantly better in the ACS-treated group on both day 15 (p = 0.003 and p = 0.003, respectively) and day 30 (p = 0.005 and p = 0.004, respectively). The immunohistochemical density of collagen type 3 was significantly lower in the ACS-treated group on day 30 (p = 0.018). The type 1/3 collagen ratios of the groups were similar on days 15 and 30, as determined by Sirius Red staining (p = 0.910 and p = 0.133, respectively). In the biomechanical assessment results, the ACS-treated group's maximum load to failure values were significantly higher on day 15 (p = 0.049).ConclusionInjection of ACS had a positive effect on the histopathological healing of rat Achilles tendons on days 15 and 30 and on biomechanical healing on day 15. ACS treatment contributed to lowering the collagen type 3 density by day 30. According to our study, ACS may be favourable for the treatment of human Achilles tendon injuries and tendinopathies.

Bu çalışmada diyabetik ayaklı hastalarda ve yeni tanı konulmuş tip 2 diabetes mellitus (DM)'lu hastalarda osteoprotegerin (OPG) ve 25-hidroksi D vitamini (25(OH)D) düzeyleri karşılaştırıldı ve diyabetik ayaklı hastalarda 25(OH)D eksikliğinin yaygınlığı ve şiddeti araştırıldı. Hastalar ve yöntemler: Bu ileriye dönük çalışma Haziran 2014 ve Mayıs 2015 tarihleri arasında hastanemize başvuran 58 diyabetik ayaklı hasta (42 erkek, 16 kadın; ort. yaş 63.6 yıl; dağılım, 31-90 yıl) ve 47 yeni tanı konulmuş tip 2 DM'li hasta (27 erkek, 20 kadın; ort. yaş 51.4 yıl; dağılım, 29-85 yıl) (kontrol grubu) olmak üzere 105 hasta üzerinde gerçekleştirildi. Her iki grupta 25(OH)D ve OPG serum düzeyleri ölçüldü ve karşılaştırıldı. Bulgular: Diyabetik ayak grubunda OPG düzeyleri kontrol grubundan anlamlı olarak daha yüksekti (p<0.05). Diyabetik ayak grubunda 25(OH)D düzeyleri kontrol grubundan anlamlı olarak daha düşüktü (p<0.05). Diyabetik ayaklı hastalarda OPG düzeyleri ve C-reaktif protein (CRP) ve kreatinin düzeyleri arasında pozitif ilişkiler vardı. Sonuç: Diyabetik ayaklı hastalarda yükselmiş OPG düzeyleri, OPG'nin CRP ve kreatinin ile pozitif ilişkisine bağlı olarak klinik durumun şiddetini gösterebilir. Diyabetik ayaklı hastaların çoğunluğunda ciddi 25(OH)D eksikliği tespit edildi. Diyabetik ayaklı hastalarda istenmeyen immünolojik değişiklikleri önlemek için D vitamini suplemantasyonu gerekli olabilir.