BACKGROUND:To evaluate temporal changes in pericruciate fat pad (PFP) edema as a secondary MRI sign of anterior cruciate ligament (ACL) rupture and to determine the diagnostic performance of secondary MRI findings in patients undergoing ACL reconstruction. METHODS:This retrospective study included 188 patients who underwent primary arthroscopic ACL reconstruction with arthroscopically confirmed total ACL rupture. Six secondary MRI findings (anterior tibial translation, ACL-lateral tibial plateau angle, posterior cruciate ligament (PCL) angle, PCL line sign, PCL buckling, and PFP edema) were assessed using predefined criteria. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Intra- and inter-observer reliability were evaluated using intraclass correlation coefficients and Cohen's kappa. ROC analysis assessed the diagnostic performance of PFP edema relative to injury to MRI interval. RESULTS:All secondary findings were significantly associated with ACL rupture (p < 0.001). Overall sensitivity and specificity of PFP edema were 65.4% and 100%, respectively. With a 13-week injury-to-MRI cutoff, sensitivity increased to 85% while specificity and PPV remained 100% (NPV 78%). Other findings showed good diagnostic performance, including anterior tibial translation >5 mm (79.8%/92.5%), ACL-lateral tibial plateau angle <45°(88.8%/91.5%), PCL angle <107° (84.6%/94.5%), PCL line sign (70.2%/91.0%), and PCL buckling (72.3%/86.5%). CONCLUSION:PFP edema is a highly specific and time-dependent secondary MRI sign of ACL rupture, particularly within 13 weeks after injury, and may aid in diagnosis and estimation of injury chronicity when primary findings are inconclusive.

OBJECTIVES:This study aims to examine the relationship between foot angles and the presence and localization of osteochondral lesions of the talus (OLTs).PATIENTS AND METHODS:Between January 2014 and January 2019, a total of 152 patients with a diagnosis of medial OTLs (95 males, 57 females; mean age: 28.8±6.4 years; range, 18 to 40 years), 51 patients with a diagnosis of lateral OTLs (36 males, 15 females; mean age: 27.1±6.2 years; range, 18 to 39 years), and 114 patients without known foot-ankle trauma as the control group (56 males, 58 females; mean age: 29.0±6.1 years; range, 18 to 40 years) were included. Magnetic resonance imaging and radiographs of each group were analyzed retrospectively. Lateral talocalcaneal angle (LTCA), calcaneal inclination angle (CIA), Böhler angle (BA), and Gissane angle (GA) were measured on the images and the values were compared among the groups.RESULTS:The CIA had a significant relationship with the localization (p<0.001). It was higher in patients with OLTs and had an effect on localization. The mean CIA was 26.6º±3.9º in the medial OLTs group, 23.0º±3.5º in the lateral OLTs group, and 18.5º±3.6º in the control group. There was a significant difference in the LTCA between the control and OLTs groups (p<0.001). The LTCA was higher in patients with OLTs, but had no effect on localization. The mean LTCA was 41.1º±4.2º for medial OLTs, 41.3º±4.2º for lateral OLTs, and 35.7º±6.8º for the controls. No significant relationship was found for BA and GA among the three groups.CONCLUSION:Factors affecting the localization of OLTs are still not fully understood. However, foot morphology seems to play a role in determining medial or lateral localization. The LTCA is not related to the localization of OLTs; however, an increased LTCA may be related to the occurrence of OLTS. Increased CIA may be related to both OLTS localization and OLTs occurrence.

Objective:This study aimed to compare the clinical and functional outcomes of patients with large posterosuperior rotator cuff tears between those with intact rotator cables (crescent-shaped tears) and those with repaired rotator cables (U-, V-, or L-shaped tears). Methods:Eighty-two patients with a mean age of 64.05 ± 9.06 years who underwent arthroscopic repair due to large posterosuperior rotator cuff tears were evaluated with a follow-up period of 32 ± 5.9 months. Forty-two patients with an intact rotator cable and 40 patients with a repaired rotator cable (rotator cable restored with tendon-tendon sutures) were evaluated regarding preoperative and postoperative pain and functional outcomes. Results:There was no significant difference in the constant score between the rotator cable repaired and the intact group (P=.22). However, when the sub-dimensions of the Constant score were compared separately, the forward flexion was significantly higher in the group with the intact rotator cable (P=.002). When the postoperative visual analog scale (VAS) scores were compared, lower scores were observed in the group with the repaired rotator cable (P < .001). Conclusion:In large posterosuperior rotator cuff tears, patients with a repaired rotator cables experienced more significant pain relief compared to those with intact rotator cables, although their forward flexion was lower. Therefore, a detailed analysis of the tear type and the rotator cable condition in large posterosuperior rotator cuff tears may help predict postoperative pain and functional outcomes. Level of Evidence:Level III case-control study.

IntroductionThe anabolic effects of vitamin D on bone tissue have been demonstrated in experimental studies. The aim of this study was to evaluate the relationship between greater tuberosity primary bone marrow edema (GTPBMO) and vitamin D levels. Materials and MethodsThirty-nine patients (22 females and 17 males; mean age 49.02 +/- 13.08 years) with isolated GTPBMO between March 2016 and March 2018 were included in the study. Sixty patients (34 females and 26 males; mean age 43.45 +/- 12.61 years) who did not have any shoulder complaints and fulfilled the study criteria were selected as the control group. Both groups were compared in terms of vitamin D levels. ResultsThe mean vitamin D level was 13.43 +/- 9.02 ng/mL in the GTPBMO group. In contrast, mean vitamin D level was 21.54 +/- 8.03 ng/mL in the control group (p < 0.001). In the GTPBMO group, vitamin D deficiency was detected in 31 (79.5%) patients, vitamin D insufficiency was detected in 5 (12.8%) patients, and vitamin D levels were normal in 3 (7.7%) patients. In the control group, vitamin D deficiency was detected in 29 (48.3%) patients, vitamin D insufficiency was detected in 16 (26.7%) patients, and vitamin D levels were normal in 15 (25%) patients. ConclusionThe etiology of GTPBMO has not yet been fully understood, but the results obtained in this study show that vitamin D levels were significantly lower in patients with GTPBMO. The findings suggest that low vitamin D levels may be one of the contributing factors in the etiology of GTPBMO.

OBJECTIVES:This study aims to examine the relationship between low vitamin D levels and lateral epicondylitis (LE).PATIENTS AND METHODS:Between January 2016 and January 2018, a total of 40 patients (17 males, 23 females; mean age: 38.6±10.7 years; range, 18 to 59 years) diagnosed with LE were included as the study group, while 66 patients (33 males, 33 females; mean age: 33.6±12.5 years; range, 18 to 58 years) who did not have any elbow complaints and met the study criteria were included as the control group. Both groups were compared in terms of vitamin D levels, of which levels of >30 ng/mL were considered normal, levels between 20-30 ng/mL were accepted as vitamin D insufficiency, and levels <20 ng/mL were categorized as vitamin D deficiency.RESULTS:Vitamin D levels of the LE group were significantly lower than the control group (p<0.001). The mean vitamin D level was 16.47±8.22 (range, 8.32 to 39.55) ng/mL in the LE group, and 23.64±8.4 (range, 11.6 to 49) ng/mL in the control group. While 31 of the patients (77.5%) diagnosed with LE had vitamin D deficiency, four (10%) had vitamin D insufficiency, and five (12.5%) had normal vitamin D levels. In the control group, 29 (43.9%) patients had vitamin D deficiency, 20 (30.3%) had vitamin D insufficiency, and 17 (25.8%) had normal vitamin D levels.CONCLUSION:Although the etiology of LE has not been fully understood yet, vitamin D levels were significantly lower in LE patients in our study. This finding supports that low vitamin D may be one of the factors in the etiology of LE.

Backgraound: Transfix and Tightrope are widely used devices for femoral graft fixation in arthroscopic anterior cruciate ligament (ACL) reconstruction. The purpose of the study is to reveal differences between Transfix and Tightrope fixation technique by evaluating clinical results of cases. Materials and Methods: 87 patients who underwent arthroscopic ACL reconstruction for ACL rupture between January 2013 and June 2017 by the same senior surgeon and in whom the fixation methods evaluated in this study had been employed were retrospectively reviewed. Transfix was used in 45 (52%) patients and ACL Tightrope was used in 42 (48%) patients. In the first group (Transfix) mean age was 26,3± 5.8 (18-45) second group (Tightrope) mean age was 26,7± 6.1 (17-46). Patients in both groups were retrospectively screened for anamnesis and physical examination records in the hospital registry system. In addition, IKDC(International Knee Documentation Committee) and Lysholm scores were calculated in the preoperative and postoperative follow-up period, and all findings were evaluated over a mean period of 42.5 ± 7.4 (24-54) months. Results: Clinical evaluation and stability tests indicated that statistically no significant difference found between two groups. For the first group preoperative Lysholm scores was 47,3 and postoperatively 93 and second group scores were respectivly 47,6 and 94 (P<0.05). IKDC scoring system for first group preoperatively there were 13 poor, 26 good and 6 fair knees ; postoperatively 2 fair, 27 good and 16 excellent .In the second group preoperatively 11 poor, 25 fair and 6 good knees and postoperatively 2 fair, 26 good and 14 excellent knees evaluated. Conclucions: In ACL reconstruction for fixation femoral graft, Transfix and Tightrope are frequently used implants. Therefore, both femoral fixation implants can be safely used in arthroscopic ACL reconstruction based on the experience and preference of the surgeon, provided that they are properly applied.

Purpose: The aim of this study was to compare the results of intramedullary nail (IMN) and minimally invasive percutaneous plate osteosynthesis (MIPPO) applications in the treatment of extra-articular distal tibia fractures.Materials and Methods: Thirty eight patients who underwent IMN and 31 patients who underwent MIPPO for extra-articular distal tibia fracture between January 2016 and April 2017 were included in the study. The mean follow-up period was 20.12 +/- 3.93 months. In patients, a comparison was made between groups by evaluating age, sex, side of injury, injury mechanism, presence of open fracture, presence of fibular fracture, union rates, infection rates, Olerud-Molander ankle score (OMAS) and malunion.Results: In the IMN group; the rate of concomitant fibula fracture was 18.4% and a plate was applied to 7.9% of all group. In the MIPPO group, the rate of concomitant fibula fracture was found in 58% of the patients, and a plate application was performed for 54.8% of all group. At the 6th month after surgery, the rate of union was found to be 92.1% in the IMN group, while it was 90.3% in the MIPPO group. The follow-up OMAS score was 85 +/- 16.56 in the IMN group and 84.19 +/- 17.08 in the MIPPO group.Conclusion: Our study showed that IMN and MIPPO applications do not have a significant superiority to each other in the treatment of extra-articular distal tibia fractures, and both techniques can be successfully applied with low complications, high union rates and good functional results.

Amaç: Bu çalışmanın amacı eklem uzanımı olmayan distal tibia kırıklarının tedavisinde intramedüller çivi (İMÇ) ve minimal invaziv perkütan plak osteosentez (MİPPO) uygulamaları sonuçlarının karşılaştırılmasıdır.Gereç ve Yöntem: Ocak 2016 ve Nisan 2017 tarihleri arasında eklem uzanımı olmayan distal tibia kırığı nedeniyle İMÇ uygulanan 38 hasta ve MİPPO uygulanan 31 hasta çalışmaya dahil edildi. Ortalama takip süresi 20,12±3,93 aydı. Hastalarda; yaş, cinsiyet, taraf, yaralanma mekanizması, açık kırık varlığı, fibula kırığı varlığı, kaynama oranları, enfeksiyon oranları, Olerud-Molander ayak bileği skoru (OMAS) ve dizilim bozuklukları değerlendirilerek gruplar arasında karşılaştırma yapıldı. Bulgular: İMÇ uygulanan grupta; eşlik eden fibula kırığı oranı %18.4 bulunurken, %7.9 fibula kırığına yönelik plak uygulanmıştı. MİPPO uygulanan grupta ise eşlik eden fibula kırığı oranı %58 hastada bulunurken, %54.8 fibula kırığına yönelik plak uygulanmıştı. Cerrahi sonrası 6. ayda kaynama oranı İMÇ uygulanan grupta % 92,1 olarak bulunurken, MİPPO uygulanan grupta % 90,3 olarak bulundu. Takip OMAS skoru İMÇ uygulanan grupta 85±16.56 olarak bulunurken, MİPPO uygulanan grupta 84.19±17.08 olarak bulundu.Sonuç: Çalışmamız; eklem uzanımı olmayan distal tibia kırıklarında, İMÇ ve MİPPO uygulamalarının birbirine belirgin bir üstünlüğünün olmadığını, her iki tekniğin düşük komplikasyon, yüksek kaynama oranları ve iyi fonksiyonel sonuçlar ile başarılı bir şekilde uygulanabileceğini desteklemektedir.

ÖzAmaç: Çalışmadaki amacımız, derin yerleşimli yumuşak doku yabancı cisimlerinin tipinin ve yerleşim yerlerinin belirlenerek, cinsiyet ve yaş grupları arasındaki farklılıkların