bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of ’’Throwers Ten’’ Exercise Program on Pain and Function in Shoulder Impingement Syndrome
Authors: Hazar Zeynep , Baltacı Gul
Published: December 2014

Objectives:

The purpose of this study was to examine the effects of Throwers Ten (T10) exercise program on pain and function in patients with shoulder impingement syndrome.

Methods:

Twenty subjects who were assigned by random sampling to an experimental group (n=10) to which Throwers Ten (T10) exercise and a control group (n=10) to which ordinary physical treatment were applied. A 100 mm visual analogue scale (VAS) was used to evaluate the degree of pain. The Disability of Arm, Hand, and Shoulder (DASH) score was used to assess the functions of the upper extremity. To determine the range of motion, a universal goniometer was used to measure range of shoulder motion. Wilcoxon test was employed to examine differences in pain and function of the experimental group and the control group before and after the treatment.

Results:

There were significant differences in function and pain of the experimental group (p<0.05). The therapeutic effect in the experimental and control groups revealed significant differences in flexion, abduction, VAS and the DASH (p< 0.05); respectively.

Conclusion:

The results of this study suggest that Throwers Ten (T10) exercise would be positively affected pain alleviation and functional recovery in shoulder impingement patients.
Comparison of Ankle Proprioception Between Blind and Healthy Athletes
Authors: Özer Muhammet , Kaynak Haydar , Atik Aziz , Şilil Mehtap Kaçmaz , Altun Muammer , Akseki Devrim
Published: December 2014

Objectives:

The positive effect of the visual sensation on the proprioceptive quality is well known. Although other senses of the congenital blind individuals have been proven to be increased more than healthy ones, there has been no data about the proprioceptive quality of congenital blind persons. The aim of this study is to determine the quality of ankle proprioception in congenital blind athletes.

Methods:

15 congenital blind athletes (10 males and 5 females) with a mean age of 24 ± 2.9 (ranging from 20 to 29), and 15 healthy athletes (10 males and 5 females) with a mean age of 24.6 ± 3.05 (ranging from 20 to 29), from the same athletic department, were included in the study. Proprioception was evaluated by using the technique of joint position sense, and absolut errors during the reproduction of six target angles (plantar flexion 100, dorsiflexion 50, inversion 100 and 200, eversion 100 and 200) were detected in dominant and nondominant ankles of both groups. Athletes were measured both eyes open and closed. Statistical analysis was done by using Mann-Whitney U and Wilcoxon Signed Ranks tests.

Results:

When dominant extremities were compared while eyes open, there was only a difference in 50 dorsiflexion measurements statistically in favor of blind ones (p<0.05). When dominant extremities were compared while eyes closed, blind athletes got less wrong in four of the six target angles statistically (p<0.01), when non-dominant extremities were compared while eyes closed, blind athletes got less wrong in all angles statistically (p<0.01). The ankle proprioception of the blind athletes were better then the normal athletes. The ankle propriceptions of the normal athletes further deteriorated when their eyes were closed.

Conclusion:

We found that the ankle proprioceptions of congenital blind athletes were better than the normal athletes. So additional closed-eyes exercises can help to reach a high proprioceptive level of athletes in a normal season which in terms may decrease accidental traumas.
Functional Outcomes After Arthroscopic Cell-Free Osteochondral Scaffold Surgery
Authors: Başar Selda , Hazar Zeynep , Gem Mehmet , Kanatlı Ulunay
Published: December 2014

Objectives:

Treatment of osteochondral lesions of the talus is still controversial. Arthroscopic cell-free osteochondral scaffold technique used in knee surgery although experience with the use in the treatment of ankle is not enough. The purpose of this study was to investigate the functional outcomes after arthroscopic cell-free osteochondral scaffold technique in talus osteochondral lesion at the end of 1.year.

Methods:

Total of 15 patients (7 women, 8 men) undergone arthroscopic cell-free osteokondral scaffold surgery due to osteochondral lesion of the talus were included in this study (mean age; 41.6±15.7 years; range 17-67). At the end of the first year range of motion, muscle strength, ankle function and quality of life were assessed. Ankle range of motions were evaluated with universal goniometer and ankle muscle strength were measured with digital dynamometer (Baseline ®). Ankle functions were determined with the American Orthopedic Foot-Ankle society score (AOFAS). Quality of life was assessed with the Nottingham Health Profile.

Results:

There was no statistical difference between the operated side and the other side in the ankle joint range of motion (p>0.05). Ankle muscle strength was not different between the operated side and the other side except ankle dorsiflexion muscle strength (p>0.05). The American Orthopedic Foot-Ankle society score (AOFAS) revealed a significant improvement from 54±6.4 2 to 81±9.8 at the 12 months' evaluation. Total score of Nottingham Health Profile improved from 47.6 ± 20.3 to 29.9 ± 26.7.

Conclusion:

Arthroscopic cell-free osteokondral scaffold procedure appears to be a effective treatment with increasing the functional and quality of life, particularly in localized disease of the ankle joint such as talus osteochondral lesion.
Proximal Tibia Medial Biplanar Retrotubercle Open Wedge Osteotomy for Varus Knees with Medial Gonarthrosis
Authors: Türkmen İsmail , Esenkaya İrfan , Ünay Koray , Türkmensoy Fatih , Özkut Afşar Timuçin
Published: December 2014

Objectives:

The purpose of this study is to evaluate the early results of proximal tibia medial biplanar retrotubercle open wedge osteotomy for varus gonarthrosis and compare the results with the literatüre.

Methods:

The results of proximal tibia medial biplanar retrotubercle open wedge osteotomy for 23 knees of 22 patients with medial gonarthrosis were evaluated clinically and radiologically.

Results:

Twenty of the patients were female and two were male. Mean age of the patients was 56.24; mean boy mass index was 31.95 and preoperative HSS (Hospital for Special Surgery) score was 68.7. Mean tibiofemoral axis was 186.39° and mean Insall-Salvatti index value was 1.04 preoperatively. Mean follow up period was 30.19 months. Mean HSS score was 86.48, femorotibial anatomic axis angle was 175° and Insall-Salvati index value 1.06 during the last follow-up. The improvement of the HSS score and the femorotibial anatomic axis angle was statistically significant. However, the change in Insall Salvati index values was statistically insignificant. Nonfatal pulmonary embolus in 1 patient, and deep vein thrombosis that occured one year after the procedure in 1 patient, rhabdomyolysis in 1 patient and loss of correction (relapse) in 1 patient were encountered as complications.

Conclusion:

Our results show that proximal tibia medial biplanar retrotubercle open wedge osteotomy improves the frontal and sagittal plane deformities without changing the patellar tendon length. Hence, possible patellofemoral problems are prevented and the clinical results are improved.
Epicondylitis Band or Corticosteroid Injection for Lateral Epicondylitis Treatment?
Authors: Allahverdi Ertuğrul , Allahverdi Tülay Diken , Türktaş Uğur
Published: December 2014

Objectives:

Comparison of the short and medium-term results of the epicondylitis brace with corticosteroid and local anesthetic injections for lateral epicondylitis.

Methods:

This was a retrospective and comparative study for the treatment of acute lateral epicondylitis. The patient groups A and B received two different treatments. There were 151 patients in Group A and 205 patients in Group B. Group A received the epicondylitis brace and Group B corticosteroid and local anesthetic injections. Both groups were also given stretch exercises and nonsteroidal anti-inflammatory drugs. Patients were assessed at weeks 1, 4, 12, and 24 and the Quick DASH scoring was performed on weeks 12 and 24.

Results:

At the 3rd month of treatment, Group A showed recovery rates of moderate, good and full in 18.5%, 32.5% and 30.5% respectively while these rates were 33.2%, 13.7% and 25.4% in Group B. The same rates at the end of months 6 were 17.2%, 41.1% and 17.2% in Group A and 28.3%, 1% and 17.2% in Group B.

Conclusion:

Combined treatment (physical therapy, nonsteroidal anti-inflammatory drugs) with an epicondylitis brace was more effective than combined treatment with steroid and local anesthetic injections in acute lateral epicondylitis.
Does Open Wedge Proximal Tibial Osteotomy Really Affect Tibial Slope and Patellar Height?
Authors: Akdeniz Olcay , Dinçer Cemal , Tatari Mehmet Hasan
Published: December 2014

Objectives:

Open wedge proximal tibial osteotomy has gained popularity over recent years. This technique has several advantages over lateral closed wedge osteotomy, like lack of any need for fibular osteotomy and freedom from peroneal nerve complications, easier and more precise correction, no limb shortening and easier access for an eventual total knee arthroplasty. However it was been shown that open wedge osteotomy may reduce patellar height and increase sagittal tibial slope which can cause patellofemoral problems. The aim of the study was to evaluate the alterations in the angle of posterior slope of the tibia and the degree of patellar height following medial opening wedge proximal tibial osteotomy in our patients.

Methods:

26 females and 7 males, with a mean age of 48, who underwent medial opening wedge proximal tibial osteotomy were included in the study. In all cases, the preoperative measured varus angle was overcorrected to between 5-8° valgus. The posterior slope of the tibia was determined by the proximal tibial anatomical axis and patellar height was measured retrospectively by the Caton index on the pre- and postoperative radiograms at the end of the second month.

Results:

Preoperatively, on the standing orthoroentgenograms, the mean mechanical axis deviation was 12,36° (8-20) and the mean posterior tibial slope in the sagittal view was 16,24° (10-23). The mean postoperative tibial slope was 17,85° (6-25). Using paired samples test, this increase was statistically significant (p=0.049). Preoperative mean Caton index was 1,35 (1,01-1,92) and the postoperative average was 1,73 (1,11-2,76). There was also a statistical significant increase between the pre-and postoperative values (p<0.001) with paired samples test. There was a positive correlation between preoperative mechanical axis deviation and postoperative slope angle (p=0,014) but there was no correlation between preoperative mechanical axis deviation and postoperative patellar height.

Conclusion:

In conclusion, tibial slope and patellar height are strongly affected by open wedge high tibial osteotomy and this might have an adverse effect on an eventual knee arthroplasty.
Quadriceps Muscle Mechanical Simulator for Training of Vastus Medialis Obliquus and Vastus Lateralis Obliquus Mechanical Properties
Authors: Irmak Rafet , Irmak Ahsen , Biçer Gökhan
Published: December 2014

Objectives:

In classical anatomy quadriceps muscle has four heads. Clinical studies have demostrated 6 heads of this muscle. These heads were demostrated seperately not only by their functional properties,but also by innervation and kinesiological properties. In our previous study we have developed and demostrated electrophysiological properties of vastus medialis obliquus by an electronic patient simulator. The purpose of this study is to develop a mechanical simulator which can be used to demostrate mechanical properties of 6 heads of quadriceps muscle and the screw home mechanism.

Methods:

Quadriceps femoris muscle has 6 heads: rectus femoris, vastus intermedius, vastus medialis obliquus, vastus medialis longus, vastus lateralis obliquus and vastus lateralis longus. The fundamental mechanical properties of each head is seperated by insersio and angle of pull. Main design principle was to demostrate all heads with insersio and angle of pull properties. Second design principle was to demostrate the screw-home mechanism which is the result of difference in articular surfaces of medial and lateral of condyles of femur.

Results:

Final design of the simulator consists of three planes for demostration of angle of pull and pulling forces (patellar plane, proximal and distal planes) of each heads. On each plane channels were graved as origo and insersio for demostration of angle of pull. Distal plane was movable for demostration of pulling forces in different angels of knee flexion and extention. Also proximal plane was adjustable to demostrate different sitting and standing positions. Srew home mechanism was demostrated by specially designed hingle mechanism. Left and right side hingle mechanisms have different radii as femoral condyles and this difference can cause rotation in terminal extension as in the screw home mechanism.

Conclusion:

Vastus medialis obliquus, vastus lateralis obliquus and screw-home mechanism have clinical significance. We were not able to find any study which deals with training of screw home mechanism and vastus medialis obliqus and wastus lateralis obliquus muscles in the literature. The purpose of this study was to develop a simulator which can demostrate mechanical properties of vastus medialis obliquus and vastus lateralis muscles and screw home mechanism. As a result a traning simulator with stated properties was developed. In this simulator force measurement is acheived with analog dynamometers and future studies may focus on improvement of this simulator with digital force measurement.
Original Algorithm of Rehabilitation Protocol with Use of Ultrasound - Study Based on Achilles Tendon Reconstruction Cases
Authors: Rosińska Agnieszka Barbara , Ciszkowska-Łysoń Beata , Śmigielski Robert
Published: December 2014

Objectives:

The study was conducted in order to indicate the usefulness of an ultrasound examination in physiotherapy of patients who underwent Achilles tendon reconstruction. The aim was to eliminate the risk of the procedure’s common complication, i.e.: the formation of adhesions between surrounding tissues and the tendon.

Methods:

This study analyses 10 cases of anatomical reconstruction of the Achilles tendon. In all cases the surgeon, the physical therapist and the rehabilitation protocol were the same. The algorithm: 1. The weekly protocol included: • the evaluation of: ROM, gliding, tissues swelling, tendon ripple, bursa and fat body movement, possible gaps, and vascularity; • medical examination including: observation, palpation, and ultrasound examination. 2. Every PT session was preluded by an examination including: observation, palpation, and ultrasound evaluation. 3. The US examination was performed to evaluate the functioning of tissues in regard to the tendon’s healing stage. • 2-3 weeks after the surgery: the assessment of gliding during passive plantar flexion, the examination included the use of modified Thompson’s test; • after 3 weeks: the assessment of tendon tension and the isometric plantar flexion strength of the medial gastrocnemius muscle; • 3rd and 6th week: the assessment of swelling, vascularity (before and after the PT session including the cooling of the tendon), Kager’s triangle fat body assessment, and active gliding evaluation, testing the gastrocnemius muscle strength during active movement, • from 6th week until the end of physiotherapy: the evaluation of tendon gliding and gastrocnemius’ strength (body weight bearing); • the final US examination performed by the radiology specialist in the 12th week after the surgery, the assessment of gliding and muscle strength.

Results:

During the final medical examination performed by the doctor in 12th week after the surgery, there were no tendon adhesions between the tendon and surrounding tissues that would limit the tendon’s gliding within its sheath. The weekly US examination helped while choosing appropriate physical therapy methods that increased the functional recovery of the Achilles tendon.

Conclusion:

1. The use of ultrasound device during each PT session enables the therapist to choose appropriate methods in order to optimise the rehabilitation process depending on the current condition of the patient. This approach creates good conditions for the optimal functional recovery. 2. The ultrasound works like a biofeedback.
Effects of Sacroiliac Joint Mobilization on Hamstring Muscle Flexibility and Quadriceps Muscle Strength
Authors: Tamer Seval , Öz Müzeyyen , Ülger Özlem
Published: December 2014

Objectives:

The aim of this study was to determine the effect of sacroiliac joint mobilization (SJM) in cases with sacroiliac joint dysfunction (SJD) on hamstring muscle flexibility and quadriceps muscle strength.

Methods:

Seven subjects age average (min- max) was 21.85 (21-23) years with SJD were included. Hamstring muscle flexibility was measured with passive knee extension (PKE) method by using goniometer; quadriceps muscle strength was measured by using a hand dynamometer. After osteopathic evaluation (sacroiliac joint stress and mobility tests) appropriate mobilization methods (ilium anterior, ilium posterior and sacrum R / R dysfunction mobilization) were performed in patients with sacroiliac joint dysfunction. All measurements were repeated before, immediately and 4 days after application. For statistical analysis, Friedman and Wilcoxon-Signed test was used.

Results:

Immediately after SIJ mobilization for 7 patients, hamstring muscle flexibility was evaluated and compared with pretreatment status; bilateral hamstring muscle flexibility improvement was observed (p <0.05). When the results at 4 days were compared with the pretreatment measurements, generated effect continued in the dominant side (p <0.05) and there were no changes observed in the non-dominant side (p> 0.05). When immediate and 4th-day measurements were compared, bilateral improvement was maintained(p> 0.05). When pretreatment and immediate posttreatment rsults were analysed, bilateral quadriceps muscle strength was found to be increased (p <0.05). When 4th- day and pretreatment measures were compared the effects were bilaterally maintained (p <0.05). Comparison of immediate postapplication and 4th-day measurements revealed that bilateral improvement continued (p> 0.05).

Conclusion:

In SJD patients known with hamstring muscle flexibility loss and quadriceps muscle weakness, private sacroiliac joint mobilization is effective in enhancing hamstring muscle flexibility and quadriceps muscle strength, so SJD could be considered for increasing quadriceps muscle strength and hamstring muscle flexibility.
Effect of Kınesıotapıng and Knee Brace on Functıonal Performance in Recreatıonal Athletes
Authors: Ulusoy Burak , İldiz Bülent , Tunay Volga Bayrakçı
Published: December 2014

Objectives:

Kinesiotaping is a popular taping method that is used for both therapeutic and performance enchancement purposes. Knee braces are widely used for prevention in sport injuries but their performance effectiveness is still controversial. The aim of this study was to determine whether kinesiotape or brace was more effective on functional performance.

Methods:

A total twenty male recreational football players (Mean±Standart Deviation (SD) age: 22.5±0.68 years, height: 175.15±3.37 cm, body weight: 74.52±12.41 kg), voluntarily participated in this study. Participants were tested with kinesiotape, with brace and without kinesiotape and brace. Tests were applied one day after patellar kinesiotaping (correction technique). Balance property measured with Modified Y balance Test (dynamic test), agility measured by T test, muscle strength and anaerobic power assessed by vertical jump and triple hop tests. Wilcoxon signed rank test was employed for determining the statistical significance of tests with kinesiotape, with brace and without kinesiotape and brace.

Results:

In analysis; There were statistically significant differences found in Triple hop test with kinesiotaping and without kinesiotaping and brace, in T test with bracing and kinesiotaping, in vertical jump with kinesiotaping and without kinesiotaping and brace (p<0.001) (in the favour of kinesiotaping in all tests) No statistically significant difference was found in modified Y balance test all groups (p> 0.05).

Conclusion:

Consequently, kinesiotaping had positive effects on agility and muscle strength but had no effects on balance in football players. On the other hand, brace had no effects on functional performance tests.
Arthroscopic Lateral Retinacular Ligament Release in Patellofemoral Pain Syndrome
Authors: Başaran Teoman , Atay Ahmet Ozgur , Doral Mahmut Nedim , Başaran Pınar Özge
Published: December 2014

Objectives:

Arthroscopic lateral retinacular release in patellofemoral pain syndrome Comparing the amount of hemorrhage and times of release between electrocautery and a new techniques for arthroscopic lateral release with scissors

Methods:

77 patients included in this prospective randomized controlled study. Inclusion Criteria: 1. Over the age of fourteen and have anterior knee pain syndrome 2. Tightness in lateral part of knee 3. Despite receiving conservative treatment for 6 months, patients who have anterior knee pain complaints Exclusion Criteria: 1. Diseases that prolong bleeding time 2. Drugs that prolong bleeding time 3. Abnormal APTT-INR levels 4. Patients underwent anterior cruciate reconstruction surgery 5. Patients underwent microfracture surgery 6. Patients underwent meniscus repair surgery 7. Patients underwent synovectomy -- Due to inflammatory diseases and synovial chondromatosis is excluded from the study. In this study 77 (25M 52W med age 50,14 ± 14,17 ) patients divided into three groups which was similar in age and sex. All patients underwent standard arthroscopic surgery for patellofemoral knee sydrome and meniscal debridement 1. Group 1 (Control) (n:10) LRL was preserved 2. Group 2 (Scissors) (n:33) LRL was released with Scissors 3. Group 3 (Electrocautery) (n:34) LRL was released with Electrocautery

Results:

There was no difference between the groups in terms of socio-demographic characteristics. All lateral ligaments releases were performed under tourniquet . The release is not considered to be complete unless the patella can be stood on its medial edge without difficulty . In all patients, surgery duration was recorded. To calculate the amount of bleeding the blood in the drainage tube was recorded for 24 hours after surgery. For 67 patients based on clinical examination at surgery and in the immediate postoperative period, all releases were felt to be adequate. For all groups total bleeding at 24 h postoperatively is the statistically same (p:0.850) . In first 8 hours the amount of bleeding is more in scissors group (p:0.002). Lateral release time is longer in electrocautery group (380 seconds) than in scissors group (24 seconds). In release with electrocautery sometimes we used additional techniques scissors and scalpel for enough release. There was no difference between groups in terms of complications such as deep vein thrombosis , hemarthrosis or severe complications.

Conclusion:

In this study the amount of bleeding was the same in the groups but surgery duration was longer in electrocautery group. Our new technique for intraarticular arthroscopy guided lateral retinacular release uses with scissors which is simple, effective, rapid, and have resulted a few surgical complications such as superficial skin infection which responds oral antibiotics. Electrocautery is difficult and needs experience.
Original Functional Rehabilitation Programme Based on Healing Physiology After Reconstruction of Articular Cartilage in Knee Joint
Authors: Guliyan Volodymyr , Plenzler Marcin , Straszewski Dariusz , Paśnik Marcin , Korbolewska Olga , Suszczyński Wojciech , Śmigielski Robert
Published: December 2014

Objectives:

The evaluation of the quality of articular cartilage remodelling by means of arthroscopy findings and MRI imaging in a patient, who completed the original rehabilitation program.

Methods:

The rehabilitation program was conducted according to the Carolina Medical Center rehabilitation protocol. The patient was a 46 years old woman with fourth-degree cartilage damage (Outerbridge classification) located on the right medial femoral condyle of the following size: 1.5x2cm and 1x1.5cm. An arthroscopic micro-fracture repair of the cartilage was performed on the medial femoral condyle of the right knee. After the surgery the original rehabilitation program has been divided into 4 stages based on biological aspects of the physiology of cartilage tissue healing and biomechanics of the knee joint. 18 months after the reconstruction and a complete rehabilitation program, the patient underwent another right knee arthroscopy. During the surgery cartilage was been reevaluated in vivo. A pre-operative MRI was made, as well as a post-operative one after the second arthroscopy. The aim of the MRI examination was to objectify the treatment’s results.

Results:

The applied surgical treatment and following rehabilitation resulted in the remodelling of the cartilage-like tissue, which was observed in, both, the arthroscopy and the MRI imaging. The MRI evaluation of the quality of the cartilage tissue 18 months after the reconstruction gave very good results according to the MOCART scale (magnetic resonance observation of cartilage repair tissue).

Conclusion:

The positive results of the cartilage remodelling process recorded after the application of the original rehabilitation programme encourages to continue the study on a larger group of patients.
Is There any Relationship Between the Grade of Mucoid Degeneration of Torn Menisci and Biochemical Marker Levels in Synovial Fluid?
Authors: Pınar Halit İbrahim , Iscen Oktay , Keles Didem , Ozkal Sermin , Oktay Gulgun
Published: December 2014

Objectives:

Mucoid degeneration (MD) leads to nontraumatic tears of the meniscus even in the young population. The tears are often irrepairable. The purpose of this study is to find out if there is any relationship between the severity of mucoid degeneration (MD) and the biochemical environment of the knee. Our hypothesis is that meniscal tears due to more severe MD are associated with higher levels of markers in the synovial fluid.

Methods:

Synovial fluid samples were taken during isolated arthroscopic meniscectomies. Samples of excised menisci were sent to the department of pathology for grading of MD. According to the Copenhaver staging classification, stage 1-2 menisci comprised group A (n:13), and grade 3 menisci group B (n:19). Cases with instability and with greater than grade 2 chondral lesions were excluded. Synovial fluid samples were also aspirated from 9 normal knees of individuals operated from other sites of lower extremities; these comprised the control group (C). The synovial fluids were examined for MMP-3,TIMP-1,COMP and proteoglycan (PG)fragment levels. Results were statistically analyzed with nonparametric Mann Whitney's U test.

Results:

PG fragment levels were significantly higher in group B as compared to group A (p=0.044).When groups B and C were compared, the difference between PG fragment levels almost displayed significance (p=0.055).There were no significant differences between the groups A,B and C for MMP-3,TIMP-1,and COMP levels. MMP-3 levels were significantly higher for traumatic meniscal tears than nontraumatic tears (p=0.025).

Conclusion:

In this study, our hypothesis was partially confirmed. Higher levels of PG fragments were found in knees with higher grade of meniscal mucoid degeneration. MD may be associated with an insidious degenerative process in the knee.
Subacromial Tenoxicam Injection in the Treatment of Impingement Syndrome
Authors: Çift Hakan , Özkan Feyza Ünlü , Şeker Ali , İşyar Mehmet , Ceyhan Erman , Mahiroğulları Mahir
Published: December 2014

Objectives:

As subacromial bursa injection is widely used for pain relief and functional improvements in patients with periarticular shoulder disorder, we aimed to present our results of subacromial tenoxicam injection in the treatment of impingement syndrome.

Methods:

Patients presented to the Department of Orthopaedics and Traumatology, Istanbul Medipol University with the primary complaints of shoulder pain from January 2012 to June 2013 were selected. Those who met the following inclusion criteria were finally considered: 1) who had a clinical sign of a painful arc and positive in Hawkins test and/or Neer impingement sign; 2) who had a precise rotator cuff injury including partial cuff tears, or subacromial bursitis detected during ultrasonography or MRI. The exclusion criteria were as follows: 1) who underwent shoulder surgery; 2) who had full thickness rotator cuff rupture; 3) who had hemiplegic shoulder pain; and 4) who displayed any suspected fracture on X-ray or had a recent shoulder trauma; 5) who showed limited active ROM and stiffness due to adhesive capsulitis. Thirty one shoulders out of thirty patients were treated with subacromial tenoxicam injection. Ten of them were left shoulders. Fifteen of the patients were women.. Patients had a mean age of 51.6 (30-73). Patients were evaluated 4 times. Before the first injection, 1 week after the first injection, 2 weeks after the second injection and 3 weeks after the third injection. In every injection 20 mg tenoxicam was performed.

Results:

In order to relieve the pain; two patients were given only one injection, thirteen patients were given two injections and “3 injections protocol” were done to fifteen patients. The mean pre- and posttreatment VAS scores were 7.9 (between, 7-9) and 2.7 (between, 2-4) points respectively. The average pre and posttreatment DASH scores were 59.41 (between, 45-80) and 14 (between, 8.3-25.8) points respectively. The mean pre and posttreatment range of motion were 106.1 (between, 80-130 and 170i7 (between, 140-180) degrees respectively. Differences between all pre- and post-treatment parameters were statistically significant (p<0.05).

Conclusion:

Tenoxicam is a cheap NSAID and an analgesic of the oxicam class, is closely related to proxicam, and has a long half-life, which enables it to be administrated once daily. It also readily penetrates the synovial fluid and intraarticular intravenous administration provides superior postoperative analgesic benefits. Tenoxicam also has the ability to prevent adhesion formation. Besides it has no detrimental effect on cartilage structure. It can be safely administrated intraarticularly. Given the positive therapeutic effects of subacromial tenoxicam injection, it can be used as an alternative treatment option.
Arthroscopical Fixation of Patellar Osteochondral Fracture in a Pediatric Patient
Authors: Güney Ahmet , Argün Ali Saltuk , Kahraman Murat , Karaman İbrahim , Bilal Ökkeş
Published: December 2014

Objectives:

Aim of this article is to present a pediatric patient with patellar osteochondral fracture treated by arthroscopical fixation and discuss through the literature. Patellar osteochondral fractures are kind of injuries mostly seen in adolescents and young adults, generally occur after trauma causing dislocation of patella and frequently accompanied by chondral damage in the lateral femoral condyle. Surgical intervention is indicated for the displaced and intraarticular fragments.

Methods:

Thirteen-year-old male patient referred our clinic with a swollen knee, limitation in knee movements, after he had fallen on his right knee while skating 2 weeks previously and was also unable to stand on his right leg. Plain radiogram, computerized tomography and magnetic resonance images of the right knee evaluated in our clinic and a chondral defect (17x10mm in size) in distal of medial marge of patella and an intraarticular osteochondral fragment just inferomedial to patella and anterior to lateral femoral condyle was determined.

Results:

In the arthroscopical evaluation osteochondral defect and intraarticular fragment were observed. In addition there was chondral lesion on the chondral surface of lateral femoral condyle. Osteochondral fragment was replaced to the distal part of medial marge of patella as arthroscopically, then retrograde fixed using 2 compressive screws (24x2.7 mm and 26x2.7 mm) from patella to the fragment.

Conclusion:

As patellar osteochondral fractures usually occur following acute dislocation of patella, rarely may occur without dislocation. We could find 2 cases in the literature which aren't accompanied by dislocation of patella. One of them is a non-displaced fracture and the other one is an osteochondral fragment with 15x20 mm in size which was resected due to inconformity. Eighty percent of acute dislocations of patella are accompanied by contusions on lateral femoral condyle and intraarticular fragments are present in 11 to 74 percent of cases. In this article we present 13 year-old male patient with an osteochondral fracture in the inferior of medial marge of patella without dislocation of patella, which was displaced into joint space and accompanied by a chondral lesion on the lateral femoral condyle, and then treated by artroscopical reduction and fixation. Our case seems to be original due to occuring without dislocation of patella and being the first case treated by arthroscopical intervention. Displaced and intraarticular patellar osteochondral fractures should be replaced and fixed by surgically. We consider that when compared with open joint surgery, arthroscopical replacement and fixation of osteochondral fractures causes lower morbidity and helps to improve rehabilitation of the patient.
Analgesic Effect of Femoral Nerve Block on Postoperative Pain and Ambulation after Total Knee Arthroplasty
Authors: Mouzopoulos Georgios , Nomikos Georgios , Tsembeli Anastasia , Vasiliadis Vasilios
Published: December 2014

Objectives:

Determine the analgesic effect of a single injection femoral nerve block on postoperative pain and ambulation, after total knee arthroplasty.

Methods:

In a prospective study, 84 patients undergoing total knee arthroplasty were randomly assigned to receive: either one single injection femoral nerve block and 100mg paracetamol combined with lornoxicam 4 mg administrated twice intravenously for 5 days (group 1, n=42) or only the aforementioned analgesics without nerve block for the same period (group 2, n=42). Distance walked on 5 first postoperative days and VAS pain score during first 5 days were reported. Patients with bilateral osteoarthritis, previous leg injury or serious cardiovascular disease were excluded. Statistical analysis was performed by statistical packet STATA 8.0 and significance was set at p-value <0.05.

Results:

Patients of group 1 walked longer distance than patients of group 2 on postoperative day 1, 2 and 3 (p<0.05).The VAS pain score decreased significantly from 7.8/10 to 4.1./10 in Group 1 (P<0.05) and from average 8.1/10 to 5.9/10 in Group 2 (p<0.05) at 5 days after surgery. Patients of group 1 experienced less pain than patients of group2 at 5 days after surgery according to VAS pain score (p<0.05).

Conclusion:

Single shot of femoral nerve block provides efficient pain relief on early postoperative period after total knee arthroplasty. This is associated with better ambulatory performance.
Effect of Plyometric Training on Prevention of ACL Injuries in Females Volleyball Players
Authors: Enginsu Müjdat , Lokmaoğlu Recep , Korkmaz Erol , Arıbaş İlker , Selimoğlu Şafak
Published: December 2014

Objectives:

To verify the effects of plyometric training on prevention of ACL injuries with lower limp kinematics,eccentric hip and knee torques,and functional performance.

Methods:

36 females volleyball players were divided into a training group (TG no:18) that carried out the plyometric training for 12 weeks,and a control group (CG no:18)that carried out no physical training.24 plyometric trainin sessions during approximately 12 weeks with 3 sessions ,30 minutes per week on alternate days. Lower limb kinematics (maximum excursion of hip adduction,hip medial rotation,and knee abduction during the single leg squat),eccentric hip (abductor,adductor,medial and lateral rotator) isokinetic peak torques and knee (flexor and extansor) isokinetic peak torques,and fuctional performance(trşpl hpo test and the 6-m timed hop test).

Results:

After 12 weeks, only the TG significantly reduced the values for the maximum excursion of knee abduction (P=0.01) and hip adduction (P 0.001).Similarly ,only the TG significantly increased the eccentic hip abductor (P 0.001) and adductor (P=0.01) torques.Finally,only the TG significantly increased the values in the tripl hop test (P 0.001) and significantly decreased the values in the 6-m timed hop test (P 0.001) after intervention.

Conclusion:

Plyometric training alters lower limb kinematics and increases eccentric hip torque and functional performance, suggesting the incorporation of these exercises in preventive programs for ACL injuries.
Overuse Injuries in Youth Football Players
Authors: Enginsu Müjdat , Lokmaoğlu Recep , Hayırlıoğlu Coşkun , Selimoğlu Şafak , Efendioğlu Hüseyin
Published: December 2014

Objectives:

Youth football players encounter many injuries especially during the school period when they are trying to make scool and football together. Due to consistent team selection in competetion, school matches, academy leaque matches and age group national team matches, as a result of high intensity training at a young age they are extremely overloaded.

Methods:

145 football players of 13-19 age group playing in the academy leaque of Bursaspor have been observed for 10 months (Augost 2013-May 2014) ,injuries caused by overuse and that require at least 2 days break from sports activities.

Results:

Were determined on 45 football players while lower extremities upper group (hamstring, quadriceps)muscles constitued the majority of the injuries; In the adductor region were also seen often. The most striking finding is epiphyses avulsion fractures on the 3 players.

Conclusion:

There are many risk factors causing injuries releated to overuse in youth athletes.Such as previous injuries,anatomic malalignment,extreme flexibility,loss of bone mineral density,overload to physes,high intensity training,when rest is not adequate, and not appropriate recovery.Limitation of sports specific repetatif movements(eg,pitching limits);scheduled rest periods and recovery time;such modifications to be individualized based upon the sport and the athlete's age,growt rate,readiness;optimal preparation of the preseason conditioning program;well neuromusculer training before workout;exact monitoring of the training and determination of the occasions on which injuries occur are important in preventing such injuries.
Delayed Pulmonary Embolism Following Achilles Tendon Repair
Authors: Çolak İlker , Eceviz Engin , Baysal Özgür , Bekler Halil İbrahim
Published: December 2014

Objectives:

It is well known that venous thromboembolism is a common complication after lower limb injuries which requires long term immobilization, however venous thromboembolism prophylaxis after achilles tendon rupture is stil controversial. In this report our aim is to present a case of pulmonary embolism which developed 47 days after surgical repair of achilles tendon rupture and diagnosed factor V leiden heterozygous mutation.

Methods:

Case presentation: A 28 – years- old man was admitted to emergency department with left heel pain and he could not bear weight on it. Achilles tendon rupture was confirmed with physical examination and MRI and patient operated under the spinal anesthesia. Tendon was repaired with the modified Kesler technique. Patient was cast-immobilized and ambulating with crutches and rested for 47 days at home, when he was admitted to emergency department again with acute severe dyspnea, pain on right side, hemoptysis. There was no chronic disease history in in the patient´s anamnesis except migraine diagnosis. There were slight inspiratory rales in right lower lobe in auscultation of respiratuary system examination. Cardiovascular system and abdomen examination were normal. Plasma concentration of D-dimer was 1227 μg/mL in the laboratory evaluations. Patient was diagnosed pulmonary embolus (PE) by ventilation/perfusion lung scan. Result of detailed evaluation, genetic analysis showed that patient has factor V leiden heterozygous mutation. Patient hospitalized in Department of Chest Diseases and low-molecular-weight heparin was used to treat and 5 mg orally Warfarin was used for six months.

Results:

Conclusion:

The incidence of deep venus thrombosis (DVT) and PE after Achilles tendon rupture were highly variable in the literature. This could depend on different designs used in studies. The most recent antihrombotic guidelines suggested no DVT prophylaxis for this type injuries. Existing orthopaedic guidelines does not provide optimal DVT/PE prophylaxis for injuries under the knee requires immobilization. Further research is needed to investigate the benefits of DVT prophylaxis on patients following Achilles tendon rupture.
Arthroscopic Reconstruction of Chronic Isolated Posterior Cruciate Ligament Instability in a Professional Dancer
Authors: Aksu Neslihan , Abay Burak , Soydan Ramazan , Ercan Ertuğrul
Published: December 2014

Objectives:

Chronic isolated injuries of the posterior cruciate ligament (PCL) are very rare in the literature. PCL injuries are often presented undiagnosed because of the weak signs of the injury compared to the anterior cruciate ligament (ACL) injuries. We report the surgical outcome of arthroscopic reconstruction of the chronic isolated PCL rupture with ipsilateral autologous hamstring tendon in a professional Caucasian dancer.

Methods:

A 21-year-old male professional Caucasian dancer presented severe instability without any pain in his right knee lasting for one year. The patient did not describe any specific traumatic event but his both knees received repeatitive direct pretibial trauma during hyperflexion of the knee while landing to the floor. At the physical examination, posterior sagging of the tibia was observed on the affected side at 90o of knee flexion and step off test and posterior drawer test were positive preoperatively under general anesthesia. The Tegner Lysholm score was evaluated as 59 (poor). A magnetic resonance image (MRI) revealed the isolated total rupture of PCL. The treatment of choice was arthroscopic single bundle reconstruction of PCL with ipsilateral autologous hamstring tendon. A standard arthroscopic exploration of the joint was performed preoperatively and we didn't observe any meniscal, cartilage or ligamentous lesion. Anteromedial and anterolateral portals were made in order to visualize the posterior cortex of the tibia with a 70 degree scope. Intra-operative fluroscopy was used to confirm proper tunnel position. During postoperatively first week, the patient was allowed to mobilize nonweight bearing with the use of two crutches without functional knee brace. Quadriceps musculature and passive range of motion was trained.

Results:

At the 6 month- follow-up, the patient achieved full symmetric restoration of motion. He had returned to full daily activies. The Tegner Lysholm score was evaluated as 95 (excellent) postoperatively. Functional examination of the right knee reveled 140 of flexion, and full knee extension. No posterior sagging was observed and step off test and posterior drawer test was negative. The complaint of instability was disappeared. At 1-year follow-up, clinical findings were unremarkable, with no sign of re-rupture and he returned to his professional career.

Conclusion:

Surgical reconstruction technique of the PCL and associated rehabilitation protocols has not yet been fully standardized and much work still has be done optimizing correct treatment of PCL injuries. The arthroscopic reconstruction of chronic isolated PCL instability is a very difficult technique as well as its diagnosis. The reconstruction is very beneficial in the athletes and the patients who are not responding well to the conservative treatment.
Size and surface modification of amorphous silica particles determine their effects on the activity of human CYP3A4 in vitro
Authors: Imai Shunji , Yoshioka Yasuo , Morishita Yuki , Yoshida Tokuyuki , Uji Miyuki , Nagano Kazuya , Mukai Yohei , Kamada Haruhiko , Tsunoda Shin-ichi , Higashisaka Kazuma , Tsutsumi Yasuo
Published: December 2014

Because of their useful chemical and physical properties, nanomaterials are widely used around the world - for example, as additives in food and medicines - and such uses are expected to become more prevalent in the future. Therefore, collecting information about the effects of nanomaterials on metabolic enzymes is important. Here, we examined the effects of amorphous silica particles with various sizes and surface modifications on cytochrome P450 3A4 (CYP3A4) activity by means of two different in vitro assays. Silica nanoparticles with diameters of 30 and 70 nm (nSP30 and nSP70, respectively) tended to inhibit CYP3A4 activity in human liver microsomes (HLMs), but the inhibitory activity of both types of nanoparticles was decreased by carboxyl modification. In contrast, amine-modified nSP70 activated CYP3A4 activity. In HepG2 cells, nSP30 inhibited CYP3A4 activity more strongly than the larger silica particles did. Taken together, these results suggest that the size and surface characteristics of the silica particles determined their effects on CYP3A4 activity and that it may be possible to develop silica particles that do not have undesirable effects on metabolic enzymes by altering their size and surface characteristics.
Should all elective knee radiographs requested by general practitioners be performed weight-bearing?
Authors: Chen Alvin , Balogun-Lynch Joshua , Aggarwal Kavita , Dick Elizabeth , Gupte Chinmay M
Published: December 2014

The aims of this study were to: [1] Assess the number of patients with suspected knee osteoarthritis that underwent repeat weight-bearing(WB) knee radiographs in the orthopaedic clinic following initial non-WB radiograph requested by their general practitioner (GP). [2] Confirm whether repeating WB knee views changed radiology reports. [3] Determine the number of London trusts with protocols for routinely performing WB views. A Retrospective cohort study of 1968 patients aged >40 years referred to a London teaching hospital for knee radiographs over 12 months. Radiographs were identified as WB/non-WB. Subsequent repeat WB views performed in those that went on to have an orthopaedic consultation were also documented. A consultant musculoskeletal radiologist reported both images. A proforma containing a likert scale of severity for commonly reported abnormalities in knee osteoarthritis and criteria from the Kellgren and Lawrence scale was used for reporting. London NHS Trusts were surveyed to identify if protocols were in place for performing WB views. A total of 1,968 patients underwent knee radiographs, of which 1922 (97.7%) had initial non-WB radiographs. Of the 56 patients in this group that underwent required repeat WB radiographs, joint space narrowing was reported as more severe on WB versus non-WB radiographs (p = 0.035). Only 54% of departments routinely performed WB radiographs. Few patients (2.3%) referred by GPs have WB radiographs requested. Some of those referred for a specialist opinion required repeat WB views. Nearly half of London hospitals do not routinely perform WB radiographs. This represents a significant financial burden to the NHS, increased radiation exposure and wasted patient/clinician time. We propose that all GP requested knee radiographs be performed as WB unless otherwise stated.