Abstract Objective: The aim of this study was to investigate the influence of the antiproliferative agent 5-Fluorouracil (5FU) over inhibition of spinal bone formation in an experimental rat model.\r\nMethods: The study included 30 6-month-old Sprague-Dawley rats divided into 3 groups. Aggressive periosteal denuding was performed by scalpel to induce punctuate bleeding in the posterior elements of the L4-L5 vertebrae in the spontaneous fusion model. Spinous processes were fixated by wires and no graft substitute was applied. Adcon-L was applied in Group 1, single-touch technique 5FU in Group 2. Group 3 was the control group. Rats were sacrificed at 4 weeks and specimens acquired for histological examination.\r\nResults: 5FU substantially inhibited fibroblast and inflammatory cell densities as well as bone formation compared to the control group. 5FU was considerably superior to Adcon-L with regard to inhibition of bone formation and inflammatory cells (p=0.0001).\r\nConclusion: 5FU can inhibit fusion, fibrosis and unwanted scar tissue in spinal surgery. We believe that after further studies on its local delivery dose, it can be used in humans for inhibition of unintended fusion. Özet Amaç: Bu çalışmanın amacı, antiproliferatif bir ajan olan 5-florourasilin (5FU) deneysel sıçan modelinde spinal kemik oluşumunun inhibisyonuna etkisinin araştırılması idi.\r\nÇalışma planı: Altı aylık 30 adet Sprague-Dawley sıçan çalışmaya alındı ve 3 grup oluşturuldu. Spontan füzyon modelinde L4-L5 omurlarının posterior elemanlarında noktasal kanama oluşturmak için bisturi ile agresif periostal soyma işlemi gerçekleştirildi. Spinöz çıkıntılar tellerle tespit edildi ve herhangi bir greft materyali uygulanmadı. Grup 1’e Adcon-L, Grup 2’ye tek dokunuş tekniği ile 5FU uygulanırken, Grup 3 kontrol grubunu oluşturdu. Dört hafta sonra sıçanlar sakrifiye edildi ve histolojik inceleme için örnekler alındı.\r\nBulgular: Bu çalışmada 5FU’nun, kontrol grubuna kıyasla, fibroblast ve enflamatuvar hücre yoğunluğu ve kemik formasyonunu önemli ölçüde inhibe ettiği gözlendi. Ayrıca, 5FU’nun kemik formasyonu ve enflamatuvar hücrelerin inhibisyonu açısından Adcon-L’ye göre belirgin şekilde üstün olduğu saptandı (p=0.0001).\r\nÇıkarımlar: Çalışmamız 5FU’nun spinal cerrahide füzyon, fibrozis ve istenmeyen skar doku oluşumunu inhibe edebildiğini göstermiştir. 5FU’nun lokal uygulama dozuyla ilgili gelecekteki çalışmalar sonrası insanlarda istenmeyen füzyonun inhibisyonu için kullanılabileceği düşüncesindeyiz.

OBJECTIVE:The aim of the study was to investigate the relation between health-related quality of life and risk of falling, fear of falling, and functional status in patients with hip arthroplasty.METHODS:In this cross-sectional study, 48 hips of 45 patients who aged between 33 and 79 (53.56 ± 12.50) years and had cementless total hip arthroplasty between 2010 and 2014 were evaluated. Twenty-seven of the patients participated in the study were female (60.0%) and 18 were male (40.0%). Health-related quality of life with Nottingham Health Profile, function of the hip joint with Harris Hip Score, risk of falling with Performance-Oriented Motion Assessment I, and fear of falling with Falls Efficacy Scale were assessed. In addition, chair stand test, 40-m walk test, stair-climb test, and single leg stance test were carried out. In analysing the relationships between these parameters, Pearson correlation analysis was employed. The level of significance was considered as p < 0.05.RESULTS:Among the cases, who were evaluated 87.10 ± 45.22 (22.43-214.71) weeks after the operation, a significant correlation was found between health-related quality of life and risk of falling, function of hip joint, and functional tests (p < 0.05).CONCLUSION:The evaluation of the factors related to health-related quality of life in hip arthroplasty patients may help identify patient needs and guide the rehabilitation process.

Strain ratio measurements of tendons vary because of the reference tissue selection. The main purpose of this study is to highlight, in detail, the numeric variability attributable to the use of various reference materials on strain ratio measurements of patellar and Achilles tendons. Measurements were performed at the proximal, middle and distal thirds of the patellar and Achilles tendons on the dominant site of healthy volunteers. A total of 3 references were used: the Hoffa's fat pad for the patellar tendon, the Kager's fat pad for the Achilles tendon, subcutaneous tissue and Aquaflex gel pads (Parker Laboratories, Fairfield, NJ, USA) for both tendons. Although the same methods were used by the same physician for each tendon site on repeated measurements, strain ratio values had numeric variability with various reference materials in each measurement. Therefore, comparison of numeric strain ratio results of various studies with various reference materials could confuse the clinical interpretations of these numeric data, and, using a reference material with standard stiffness like Aquaflex ultrasound gel pads, should be considered by verifying these results with further studies.

The aim of this study was to examine the diff erences of landing phase biomechanics between the players who had anterior cruciate ligament (ACL) reconstruction and healthy participants during single leg drop vertical jump. In this study, 11 soccer players who had anterior cruciate ligament reconstruction (aged 23.0±3.6 years, height 177±5.0 cm, weight 83.8±11.7 kg) and 9 healthy soccer players( aged 22.2±2.4 years, height 178±3.0 cm, weight 74.3±6.1 kg) participated voluntarily. During the data collection phase three high speed cameras synchronized to each other and force plate were used. Visual analysis programme and MATLAB were used to calculate kinetic and kinematic variables. Landing techniques of the subjects’ were examined by fl exion angle of knee, ground reaction force and moment parameters. The statistical analyses of the measured results were performed by t-test and Pearson Correlation analysis. According to the results, it was determined that peak vertical ground reaction force exhibited significant phase diff erences (p=0.00, and p=0.00, respectively) between the groups. Obtained results can be explained with “quadriceps avoidance” motion pattern which is characterized by decreased quadriceps activity and lower external knee fl exion moment in an eff ort to control anterior translation of the tibia in subjects with ACL reconstruction. A better understanding of the diff erent phases during single-leg landings can shed a light on mechanism of non-contact anterior crucaite ligament injuries therefore future researches should assess how phase diff erences aff ect drop vertical jump performance.

The aim of the present study was to investigate the effects of three different formulations of hyaluronic acid (HA): Low molecular weight (MW) Sinovial One®, medium MW Viscoplus® and high MW Durolane®, on chondrocyte proliferation and collagen type II (COL2A1), hypoxia-inducible factor 1α (HIF-1α) and chondroadherin (CHAD) expression in primary chondrocyte cultures. Standard primary chondrocyte cultures were established from osteochondral tissues surgically obtained from 6 patients with gonarthrosis. Cell morphology was evaluated using an inverted light microscope; cell proliferation was determined with a MTT assay and confirmed with acridine orange/propidium iodide staining. Levels of CHAD, COL2A1 and HIF-1α expression were assessed using specific TaqMan gene expression assays. The results demonstrated the positive effect of HA treatment on cell proliferation, which was independent from the MW. COL2A1 expression increased in the medium and high MW HA treated groups. It was observed that HIF-1α expression increased in the high MW treated group alone. CHAD expression increased only in the medium MW HA treated group. Evaluation of gene expression revealed that levels of expression increased as the duration of HA application increased, in the medium and high MW HA treated groups. In terms of increased viability and proliferation, a longer duration of HA application was more effective. Taken together, it may be concluded that the administration of medium and high MW HA may be a successful way of treating diseases affecting chondrocytes in a clinical setting.

It is primarily aimed to study polymorphisms in vitamin D receptor gene (VDR), which is one of the genetic factors having a role in the formation of lumbar pathologies and/or causing higher incidence of pathologic processes. Secondarily, it is aimed to create pre-data which may help professionals to administer more effective and protective interventions in this area. Without any language preference, we searched US National Library of Medicine National Institutes of Health, Embase, OVID, Cochrane Library database of clinical trials from 1989 to Mar 11 to 2017 Mar 12, and traced all the references of incorporated documents. The data were evaluated by using descriptive statistics. Results were shown as amount or frequency (%). In literature, some vitamin D receptor gene (VDR) polymorphisms have been found in relation to widespread osteochondral diseases. When VDR polymorphisms, vitamin D level and intervertebral disc pathologies have been examined, a satisfactory answer to the question whether specific pathologies could be suppressed in terms of genetics has not been found. By means of this study, it would be understood the genetic factors inhibiting physio pathological process concerning lumbar degenerative disc disease or the genetic factors playing role in identifying physio pathological process related to lumbar degenerative disc disease by defining them. Accordingly, effective and contraceptive treatment of lumbar degenerative disc disease might be ensured soon.

Background: Osteochondral injuries constitute an entity that is widespread and can be seen in patients of all ages. Actual treatment modalities aim to relieve pain, obtain full range of movement of the joint, and improve the quality of life. There are many slow-acting chondroprotective agents prevalently used in the United States that are classified as nutritional support but not as medicines . This study presents the importance of clinical adverse effect profiles as well as the pharmacological mechanism of action and application of combinations of drugs that are widely prescribed and not subjected to control. Methods: Electronic databases were searched with keywords about the chondroprotective drugs without any language restriction. Evaluations of the descriptive statistics were represented via Microsoft Office Excel 2010 lists in the form of a mean±standard deviation or frequency (%). The first evaluation showed that 1502 studies were potentially relevant. Following exclusion of the 1277 studies which were not clinical, full versions of the remaining 225 studies were subjected to further evaluation. No controlled, blinded, randomized and/or comparative studies met the inclusion criteria of the study, and no studies evaluated the comparative clinical results of the hyaluronan of different molecular weights. Results: The findings of this study concluded that especially when prescribing drugs with ingredients like GS and CS, many patients’ pre-existing conditions must be considered, such as whether the patient has a glucose intolerance or not. Additionally, mineral toxication should be considered since the drugs contain minerals, and after the application of injected hyaluronan, complications should be considered. Conclusion: Clinical, controlled and comparative studies about the use of chondroprotective drugs must be performed to define the benefits of these drugs, if any, in order to determine the most suitable time for operative intervention.

The integration of stem cell technology and cell sheet engineering improved the potential use of cell sheet products in regenerative medicine. This review will discuss the use of mesenchymal stem cells (MSCs) in cell sheet-based tissue engineering. Besides their adhesiveness to plastic surfaces and their extensive differentiation potential in vitro, MSCs are easily accessible, expandable in vitro with acceptable genomic stability, and few ethical issues. With all these advantages, they are extremely well suited for cell sheet-based tissue engineering. This review will focus on the use of MSC sheets in osteogenic tissue engineering. Potential application techniques with or without scaffolds and/or grafts will be discussed. Finally, the importance of osteogenic induction of these MSC sheets in orthopaedic applications will be demonstrated.

Purpose: Methylphenidate (MPH) derivative drugs are used because of psychostimulants effects on attention-deficit hyperactivity disorder in children and adults. As far as we know, toxic or anti-proliferative effects of MPH against cartilage tissue were not studied in the literature. The present study was carried out to investigate the possible effects of MPH on the proliferation, viability and differentiation of primary human chondrocytes, in vitro. Methods: Monolayer primary chondrocyte cultures were prepared using osteochondral tissue obtained from patients who underwent a total knee prosthesis operation. Stock solution of MPH was prepared and aliquots having 1–1000 µM concentrations of the drug was composed. These solutions were applied to the wells containing cultured chondrocyte samples within the well plates. Control groups were composed of pure chondrocyte culture and no solution was added into them. All groups were evaluated at 24, 48 and 72 h in order to determine the possible negative effects of the drug on the chondrocytes. The data were evaluated by Tukey’s honestly significantly different test following analysis of variance. Results: In the group where MPH was applied, it was found that viability, proliferation and stage-specific embryonic antigen-1 protein expression were decreased in comparison to the control group. Conclusions: It was emphasized that clinicians should not disregard the fact that this drug might suppress chondrocyte cell proliferation and chondrogenic differentiation.

BACKGROUND:Use of biodegradable and biocompatible materials in the orthopedic surgery is gaining popularity. In this research, the rate of controlled release of a bilayered prototype biomaterial designed to promote osteoblastic and tenoblastic activity was calculated using pharmacochemical methods.METHODS:The first part of the design, composed of a sodium tetraborate, polyvinyl alcohol, and starch based hydrogel, was loaded with bone morphogenic protein-2. The second part which was composed of a sodium tetraborate, polyvinyl alcohol, and chitosan based hydrogel was loaded with bone morphogenic protein-12. Osteochondral and tendon tissue specimens were obtained from patients with a diagnosis of gonarthrosis and primary bone cells and tendon cells cultures were prepared following treatment with collagenase enzyme. Cell samples were collected from the groups by means of an invert light microscope and environmental scanning electron microscope underwent at the 1st and 21st days. The level of osteogenic differentiation was measured by the activity of alkaline phosphatase. For the statistical evaluation of the obtained data, groups were compared with post hoc Tukey test following analysis of variance. Level of significance was accepted to be <0,01.RESULTS:Both osteogenic and tenogenic stimulation were observed in the cultured specimens. In comparison to the control groups, the rate of proliferation of healthy cells was found to be higher in the groups to which the design was added (p < 0.01).CONCLUSIONS:Our research is a preliminary report that describes a study conducted in an in vitro experimental setting. We believe that such prototype systems may be pioneers in targeted drug therapies after reconstructional surgeries.

BACKGROUND:Although functional results of combined rehabilitation programs are reported, there have been no reports studying the effects of solo pendulum exercises on ultrasonographic measurements of acromiohumeral distance (AHD). OBJECTIVE:To investigate the effects of weighted and un-weighted pendulum exercises on ultrasonographic AHD and clinical symptoms in patients with subacromial impingement syndrome. METHODS:Patients with subacromial impingement syndrome were randomized to performing weighted (1.5 kilograms hand held dumbbell, N= 18) or un-weighted (free of weight, N= 16) pendulum exercises for 4 weeks, 3 sessions/day. Exercises were repeated for each direction of shoulder motion in each session (ten minutes). Clinical situation was evaluated by Constant score and Shoulder Pain Disability Index (SPADI). Ultrasonographic measurements of AHD at 0°, 30° and 60° shoulder abduction were performed. All clinical and ultrasonographic evaluations were performed at the beginning of the exercise program and at end of 4 weeks of exercise program. RESULTS:Thirty-four patients (23 females, 11 males; mean age 41.7 ± 8.9 years) were evaluated. Significant clinical improvements were detected in both exercise groups between pre and post-treatment evaluations (p < 0.05). There was no significant difference for pre and post-treatment AHD measurements at 0°, 30°, and 60° shoulder abduction between groups (p > 0.05). There was no significant difference for pre and post-treatment narrowing of AHD (narrowing of 0°-30°, and 0°-60°) between groups (p > 0.05). CONCLUSION:While significant clinical improvements were achieved with both weighted and un-weighted solo pendulum exercises, no significant difference was detected for ultrasonographic AHD measurements between exercise groups.

Purpose: The present study aimed to analyze the researches that are at the experimental phase concerning osteosarcoma treatment. The researches included drug delivery systems which allow controlled release and imbue small interfering-/micro-ribonucleic acid.Methods: Without any language preference, we searched US National Library of Medicine National Institutes of Health, Embase, OVID, Cochrane Library database of clinical trials from 1843 to May 25, 2016 and traced all the references of incorporated documents. The data were evaluated using descriptive statistics and the results are shown as frequency (%).Results: We haven't encountered any drug delivery system in which Small interfering ribonucleic acid/ micro ribonucleic acid oligonucleotides were embedded successfully against osteosarcoma. There has been only one research in which hairpin-ribonucleic acid was embedded.Conclusion: It was considered that drug delivery system enabling controlled oligonucleotide release in the treatment period of osteosarcoma was not projected for the clinical use. However, it cannot be neglected that the mentioned experimental studies with regard to osteosarcoma treatment establish the basis of target therapies. The method in question looks promising regarding effective treatment of osteosarcoma in the future.

Background: Magnetic resonance arthrography, a procedure through which contrast agents containing gadolinium and/or iopromide are administered intra-articularly, has become a useful tool in musculoskeletal diagnosis. Nevertheless, despite being considered safe for systemic use, certain tissue toxicities have been identified for both drugs. In this study, the effects of short-term exposure of human primary chondrocyte cell cultures to gadolinium and/or iopromide contrast agents were examined by assaying for stage-specific embryonic antigen-1 (SSEA-1) protein expression (a chondrogenic differentiation marker), cell viability, toxicity, and proliferation.Methods: Human articular chondrocytes were grown in monolayer culture and were exposed to iopromide and/or gadolinium diethylenetriamine-pentaacetate (Gd-DPT) for 2 and 6 h. Cell cultures with no drug exposure were used as the control group. Cell differentiation status was assessed according to SSEA-1 protein expression. Contrast agent effects on cell viability and proliferation were analyzed using MTT analysis. Further, changes in cell morphology in relation to the control group were evaluated using inverted light microscopy, environmental scanning electron microscopy (ESEM), and 3-tesla magnetic resonance imaging. The obtained data were statistically compared.Results: When compared with the control group, both SSEA-1 protein expression and cell proliferation were lowest in the Gd-DPT group (P = 0.000). There was a statistically significant correlation between SSEA-1 expression and MTT results (rho = 0.351; P = 0.003).Conclusions: Nevertheless, the data obtained from in vitro experiments may not directly correspond to clinical applications. However, the mere fact that a drug used solely for diagnostic purposes may repress chondrocyte cell proliferation should be carefully considered by clinicians.

Although adverse effects of smoking on bone health are all well known, data on how smoking interacts with cartilage structure in otherwise healthy individuals remains conflicting. Here, we ascertain the effects of cigarette smoking on sonoelastographic properties of distal femoral cartilage in asymptomatic adults. Demographic characteristics and smoking habits (packets/year) of healthy volunteers were recorded. Medial, intercondylar, and lateral distal femoral cartilage thicknesses and strain ratios on the dominant extremity were measured with ultrasonography (US) and real time US elastography. A total of 88 subjects (71 M, 17 F; aged 18–56 years, N = 43 smokers and N = 45 nonsmokers) were evaluated. Mean amount of cigarette smoking was 10.3 ± 8.9 (1–45) packets/year. Medial, intercondylar and lateral cartilage were thicker in smokers than nonsmokers (p = 0.002, p = 0.017, and p = 0.004, respectively). Medial distal femoral cartilage strain ratio was lower in smokers (p = 0.003). The amount of smoking was positively correlated with cartilage thicknesses and negatively correlated with medial cartilage strain ratios (p < 0.05). Femoral cartilage is thicker in smokers but has less strain ratio representing harder cartilage on the medial side. Future studies are needed to understand how these structural changes in the knee cartilage should be interpreted with regard to the development of knee osteoarthritis in smokers.

AIMS:We ascertained effects of hand dominance in both right and left-handed volunteers on the thickness and cross sectional area (CSA) of pronator quadratus (PQ) muscle as measured by the axial and sagittal views of ultrasound imaging. Secondly, we also aimed to document the extent of the relationship between the PQ measurements and handgrip.MATERIALS AND METHODS:Healthy adults from the volunteer medical staff were included in the study. Handedness was assessed via The Flinders Handedness survey. The sonographic appearance of the PQ was evaluated on sagittal and axial images for both hands. CSA of PQ muscle was digitally drawn and calculated on the axial plane. Handgrip was measured by using adjustable-handle dynamometer.RESULTS:Eighty-nine healthy volunteers were included (54 right and 35 left-handed). Significant difference was detected between dominant and non-dominant hands in CSA and muscle thickness in both right and left-handed volunteers (p<0.05). These measurements were correlated with the handgrip strength (p<0.05, r=0.55, and r=0.43 for right-handed volunteers, r=0.67 and r=0.48 for left-handed volunteers, respectively). There were also significantly high correlations between the measurements of CSA and PQ thickness of the corresponding extremity in both right-handed and left-handed volunteers (p<0.05).CONCLUSIONS:A statistically significant difference exists between dominant and non-dominant hands in CSA and muscle thickness measured by US in both right and left handed volunteers, and this is correlated with handgrip strength. Hand dominance should be considered to compare healthy and affected sites during US of PQ while investigating for occult fractures of distal forearm or PQ atrophy due to anterior interosseous nerve injury.

AIM:We aimed to reveal whether there are prospective suggestions for effective and standard platelet-rich plasma applications. METHODS:We searched for clinical trials and traced all the references of incorporated documents. RESULTS:In literature, there was no study indicating which disease is treated by which mechanism of action, how much dose and content are prepared and applied, when the treatment is applied and how many cures are applied. CONCLUSION:Guides introducing which concentrations of PRP are used for which diseases are to be prepared immediately by a committee which is comprised of primarily orthopedists, clinical pharmacologists and toxicologists.

BACKGROUND Impaired postural balance due to somatosensory data loss with mechanical instability has been shown in patients with ACL deficiency. OBJECTIVE To assess postural balance in patients with ACL insufficiency prior to surgery and following reconstruction with serial evaluations. METHODS Thirty patients (mean age of 27.7 ± 6.7 years) who underwent arthroscopic reconstruction of ACL with bone-patellar tendon-bone autograft were examined for clinical and functional variables at preoperative day and postoperative 12th week. Posturographic analysis were performed by using Tetrax Interactive Balance System (Sunlight Medical Ltd, Israel) at preoperative day, at 4th, 8th, and 12th weeks following reconstruction. Data computed by posturographic software by the considerations of the oscillation velocities of body sways is fall risk as a numeric value (0-100, lower values indicate better condition). RESULTS All of the patients (mean age of 27.7 ± 6.7 years) had significant improvements for clinical, functional evaluations and fall risk (p< 0.05). Mean fall risk was within high-risk category (59.9 ± 22.8) preoperatively. The highest fall risk was detected at postoperative 4th week. Patients had high fall risk at 8th week similar to preoperative value. Mean fall risk decreased to low level risk at 12th week. Preoperative symptom duration had relationships with preoperative fall risk and postoperative improvement of fall risk (p= 0.001, r= -0.632, p= 0.001, r= -0.870, respectively). The improvement of fall risk was higher in patients with symptoms shorter than 6 months (p= 0.001). CONCLUSIONS According to these results, mean fall risk of patients with ACL insufficiency was within high risk category preoperatively, and fall risk improves after surgical reconstruction, but as the duration of complaints lengthens especially longer than 6 months, the improvement of fall risk decreases following reconstruction.

OBJECTIVES:This study aims to evaluate sonoelastographic properties of the distal femoral cartilage in patients with anterior cruciate ligament (ACL) reconstruction.PATIENTS AND METHODS:Demographic characteristics and operative data of 28 patients (27 males, 1 female; mean age 31.7±7.1 years; range 22 to 48 years) with unilateral ACL reconstruction were evaluated. Reconstruction was performed with patellar tendon graft in 22 patients (78.6%) and hamstring tendon graft in six patients (21.4%). Lysholm knee score was used for functional evaluation and chair stand test was used for lower extremity strength. Medial, intercondylar, and lateral distal femoral cartilage thicknesses of operated knees and healthy knees were measured with B-mode ultrasound, while strain ratios were measured with real time sonoelastography.RESULTS:Postoperative mean follow-up duration was 20.4±9.8 months. Mean Lysholm knee and patient satisfaction scores were 88.0±8.5 and 8.2±1.8, respectively. Cartilage thicknesses were similar between operated and healthy knees (all p>0.05). Sonoelastographic strain ratio of medial distal femoral cartilage in operated knees was significantly higher (softer cartilage) (p=0.026). There was a negative correlation between strain ratio difference of medial cartilage of operated knees and lower extremity muscle strength (p=0.009, r= -0.487).CONCLUSION:While there was no difference for cartilage thickness between operated and healthy knees in B-mode ultrasound evaluation, detection of sonoelastographic strain ratio changes in medial distal femoral cartilage on the operated sides may indicate early structural changes following ACL reconstruction. Further studies are required to highlight the clinical effects of this relationship between the changes in cartilage structure and sonoelastography features.

Patellar tendon donor site has been previously evaluated in patients with auto-graft bone–tendon–bone (BTB) anterior cruciate ligament (ACL) reconstruction using either magnetic resonance imaging or B mode ultrasound. However, donor site patellar tendon strain ratio—reflecting structural features—has not been studied with US elastography. Here, we ascertain real-time elastography properties of patellar tendon donor site and clinical relevance of these properties in patients with auto-graft BTB ACL reconstruction in the postoperative period.