bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparative Study Between Total Contact Cast and Pressure-Relieving Ankle Foot Orthosis in Diabetic Neuropathic Foot Ulcers
Authors: Chakraborty Partha Pratim , Ray Sayantan , Biswas Dibakar , Baidya Arjun , Bhattacharjee Rana , Mukhopadhyay Pradip , Ghosh Sujoy , Mukhopadhyay Satinath , Chowdhury Subhankar
Published: December 2014

Background:

Off-loading of the ulcer area is extremely important for the healing of plantar ulcers. Off-loading with total contact cast (TCC) may be superior to other off-loading strategies studied so far, but practical limitations can dissuade clinicians from using this modality. This study was conducted to evaluate the efficacy of TCC compared with that of a pressure-relieving ankle foot orthosis (PRAFO) in healing of diabetic neuropathic foot ulcers and their effect on gait parameters.

Methods:

Thirty adult diabetic patients attending the foot clinic with neuropathic plantar ulcers irrespective of sex, age, duration and type of diabetes were randomly assigned to 1 of 2 off-loading modalities (TCC and PRAFO). Main outcome measures were ulcer healing after 4 weeks of randomization and effect of each of the modalities on various gait parameters.

Results:

The percentage reduction of the ulcer surface area at 4 weeks from baseline was 75.75 ± 9.25 with TCC and 34.72 ± 13.07 with PRAFO, which was significantly different ( P < .001). The results of this study however, showed that most of the gait parameters were better with PRAFO than with TCC.

Conclusions:

This study comprehensively evaluated the well known advantages and disadvantages of a removable (PRAFO) and a nonremovable device (TCC) in the treatment of diabetic neuropathic foot ulcer. Further studies are needed involving larger subjects and using 3D gait analysis to collect more accurate data on gait parameters and wound healing with different off-loading devices.
ASA Grade and Elderly Patients With Femoral Neck Fracture
Authors: Yeoh C. J. C. , Fazal M. A.
Published: December 2014

Purpose:

This prospective study was designed to evaluate the effect of American Society of Anaesthesiologists (ASA) score on time to surgery, length of hospital stay, and 30-day mortality in elderly patients with femoral neck fracture.

Methods:

A total of 249 patients admitted with femoral neck fracture were included in the study. Mean age was 84 years (95% confidence interval 83 to 85). Two patients were ASA I, 110 patients were ASA II, 125 were ASA III, and 12 were ASA IV.

Results:

The mean time to surgery was 18.9 hours for ASA I patients, 34.4 hours for ASA II patients, 42.8 hours for ASA III patients, and 61 hours for ASA IV patients ( P = .005). The mean hospital stay was 11.5 days (6.3-15.2) for ASA I patients, 17.6 days (4.2-98.8) for ASA II patients, 22.9 days (4.1-120.3) for ASA III patients, and 29 days (2.4-86.0) for ASA IV patients ( P = .026); 85% of the patients who died within 30 days of admission were of ASA III-IV.

Conclusion:

Our study shows that patients with higher ASA score have delay in surgery, longer hospital stay, and increase in 30-day mortality. We conclude that ASA grade is a simple and effective tool to predict the above-mentioned outcomes in these patients.
Assessing the Needs of the SMA Population
Authors: Halanski Matthew A. , Patterson Karen G. , Sund Sarah A. , Makholm Linda M. , Schroth Mary K.
Published: December 2014

To define issues of greatest importance to families and health care professionals (HCP) involved in caring for patients with spinal muscular atrophy (SMA), an electronic survey was distributed to patients, families, and HCPs to determine the most important issues facing patients with SMA. Seventy-seven patients/families (30 SMA type I, 36 SMA type II, 11 SMA type III) and 89 HCPs (17 pulmonologists; 10 physical, speech, and occupational therapists; 19 orthopedic surgeons, 12 neurologists; 13 nurses; 10 nutritionists; 8 others) completed the survey. Breathing issues, impact of diet, impact of disease on the family, spinal deformity, and surgical interventions were the five most frequently identified topics in order of importance to the patients/families. Important topics were similar for the HCP ranking those as follows: breathing issues, impact on family, spinal deformity, impact of diet, and impact of medications. This investigation reports the current most important perceived health care needs of patients with SMA. The perceived needs were similar between patients, families, and HCPs.
Concurrent Validity of Standards-Based Assessments of Teacher Candidate Readiness for Licensure
Authors: Waggoner Jacqueline , Carroll James B.
Published: December 2014

This study examined the concurrent validity of assessments based on a prescribed set of preparation standards of teacher candidate competency. Participants were 94 candidates from a small, comprehensive liberal arts university in the northwest. Teacher candidate performance measures included a Summary Student Teaching Evaluation, an evaluation of a Teacher Work Sample (TWS), learning gain scores from P-12 students during a unit of instruction completed as part of the TWS, and State licensure content area tests. Measures of student teaching showed strong correlations internally and moderate correlations with the TWS evaluation. Measures of the TWS showed moderate correlations internally. Learning gain scores and content area test scores were weakly correlated with all other measures of candidate performance. The absence of moderate or strong correlations among different assessments suggests they are measuring different constructs supporting the use of a comprehensive set of standards-based assessments to determine candidates’ readiness for licensure.
On a Rhetorical Technique in Leopold’s The Land Ethic
Authors: St. Maurice Henry
Published: December 2014

Analysis of definite articles in Leopold’s essay The Land Ethic found evidence of deliberate usage of a rhetorical device for emphasis. The device, a type of definite article, is commonly used and usually abused. Leopold’s uses evidently affected his essay’s contribution to environmental communications.
Central Defect Type Partıal ACL Injury Model on Goat Knees
Authors: Karakılıç Bekir , Taşkıran Emin , Doğanavşargil Başak , Çelik Salih
Published: December 2014

Objectives:

The aim of this study is to investigate the primary healing capacity of the anterior cruciate ligament (ACL) and the possible effect of fat pad excision on it. For this purpose, a central defect type ACL injury model was performed. Histopathological and biomechanical studies were performed on this model.

Methods:

Total of ten female adolescent Anatolian Black Goats were included in the study. A midsubstance central defect was created successfully with a four mm. arthroscopic punch in the ACLs of right knees of all the subjects through a medial mini-arthrotomy and goats were assigned to groups whether the fat pad was preserved (group I, n=5) or excised completely (group II, n=5). The left knees served as control. The histopathological evaluations of the defect area were performed utilizing Hematoxylene-Eosine, Masson Trichrome, Van Gieson, and elastic Van Gieson staining as well as measurement of type I collagen immunohistochemically in one sample from each group at 10th week postoperatively. The remaining knees were evaluated biomechanically at the 12th week, measuring anterior tibial translation (ATT) of the knee joints at 90 degrees of flexion and tensile properties (Maximum Tensile Load (MTL), Maximum Elongation (ME), Stiffness (S), failure mode (FM)) of the femur-ACL-tibia complex. Statistical analysis was performed utilizing SPSS v18 package program. Mann – Whitney U and Wilcoxon’s signed rank test were used for inter and intragroup analysis, respectively. Statistical significance was set at 0.05.

Results:

Histopathological analysis revealed that the central defect area was fully filled macroscopically and microscopically. However, mucoid degeneration was observed in group II. Relative collagen type I content increased in group II. There was no significant difference both within and between groups in terms of ATT values (p=0.715 and p=0.149 respectively). There was no statistical significance between and within groups in terms of MTL and ME; however group II demonstrated greater stiffness than group I (p=0,043) Overall (n=16 knees), tibial avulsion was the commonest mode of failure (n=9) in both control and operated knees.

Conclusion:

These findings revealed that the central defect type partial ACL injury model acted stable on A-P direction and had full healing capacity. The excision of the fat-pad had no additional effect except increased stiffness. Tibial insertion site seemed to be the weakest portion of the femur-ACL-tibia complex in adolescent goat knees.
Incidence of Meniscal Tears Accompanying ACL Ruptures
Authors: Tatari Mehmet Hasan , Guliyev Vugar
Published: December 2014

Objectives:

Anterior cruciate ligament (ACL) injury is a common disorder in athletes and in most cases, meniscal tears accompany. These meniscal tears can be the result of the initial trauma or the consecutive injuries in the unoperated patients. The aim of the study was to compare the incidence of meniscal tears in the patients operated because of ACL defficiency in the early or late period after the initial trauma. The age of the patient and meniscal tear pattern were the other subjects compared.

Methods:

The groups included 42, 72 and 129 patients respectively. Among all groups, it was shown that in 125 cases (% 51.4), a meniscal tear accompanied the ACL tear. In Group 1, 18 cases (% 42.8) had meniscal tears while 29 patients (% 37) in Group 2 and 78 patients (% 60.4) in Group 3 had any kind of meniscal tear. Bucket handle tears constituted 38 % of all tears in Group 1, 53 % in Group 2 and 56 % in Group 3. There was a significant statistical difference between the groups among the presence of meniscal tear and the period between the initial trauma and operation time. When the patients accepted the operation in the first six months after the initial trauma, the incidence of the meniscal injury decreased significantly (chi-square test) (p <0,01). There was no statistical difference between three groups among the percentage of bucket handle tears (variance analysis: p=0,196). The statistical difference was not important between the groups among the age of the patients in relation with the pattern of the meniscal tears (variance analysis: p=0,236).

Results:

The groups included 42, 72 and 129 patients respectively. Among all groups, it was shown that in 125 cases (% 51.4), a meniscal tear accompanied the ACL tear. In Group 1, 18 cases (% 42.8) had meniscal tears while 29 patients (% 37) in Group 2 and 78 patients (% 60.4) in Group 3 had any kind of meniscal tear. Bucket handle tears constituted 38 % of all tears in Group 1, 53 % in Group 2 and 56 % in Group 3. There was a significant statistical difference between the groups among the presence of meniscal tear and the period between the initial trauma and operation time. When the patients accepted the operation in the first six months after the initial trauma, the incidence of the meniscal injury decreased significantly (chi-square test) (p <0,01). There was no statistical difference between three groups among the percentage of bucket handle tears (variance analysis: p=0,196). The statistical difference was not important between the groups among the age of the patients in relation with the pattern of the meniscal tears (variance analysis: p=0,236)

Conclusion:

We can say that the incidence of meniscal tears can be decreased if the patients with ACL injury are operated early after the initial trauma. Earlier ACL reconstruction means less meniscal tear.
The Effects of Additional Mechanical External Compression on Hemarthrosis After Arthroscopic External Capsular Release
Authors: Bilge Onur , Yel Mustafa , Doral Mahmut Nedim
Published: December 2014

Objectives:

Arthroscopic external capsular release has been frequently used especially in the treatment of symptomatic lateral patellar hyperpression syndrome. Hemarthrosis was reported among one of the most important complications of this procedure. The aim of this study was to demonstrate the effects of the postoperative application of mechanical external compression -in patients who undergone arthroscopic lateral capsular release- on the rates of postoperative bleeding and on pain scores.

Methods:

In this study, different clinical evaluations of 39 patients, who were diagnosed both clinically and radiologically as lateral patellar hyperpression syndrome and who were treated with arthroscopic external capsular release by radiofrequency probe, were compared retrospectively. The patients were evaluated in two groups: Group I (external capsular release, N:19) and Group II (external capsular release + mechanical external compression, N:20). The mean age of the patients was 38.5 +/- 7.3 and 42.3 +/-7.8, in group I and group II, respectively. The female / male ratio and right / left ratio was 17/2 and 16/4, and 9/10 and 9/11 in group I and group II, respectively. Postoperative drainage, cold compression, postoperative 24 hours of bed rest was applied to all patients. In addition, knee range of motion together with quadriceps strengthening exercises was started after postoperative 24 hours in both groups. In group II, mechanical external lateral compression with a steril roll bandage was applied just lateral to the patella and it was ended after one week. The clinical evaluations of the patients were performed first with VAS scoring preoperatively, at 1st and 6th month postoperatively and second with measurements of intraarticular bleeding amounts within the postoperative drains. For the statistical evaluations of the data, variance analysis and independent t-test were used.

Results:

The amounts of bleeding through the drains were 94.2 ml +/- 29.9 and 43.0 ml +/- 16.3 in group I and II, respectively (p<0.05). The VAS scores were found to decrease significantly at both early postoperative and late postoperative periods compared with preoperative period, in both groups (p<0.05). Although the decrease in VAS scores of early postoperative period was found to be more in group II than in group I, this decrease was not significant.

Conclusion:

One of the most frequent complications after arthroscopic external capsular release has been reported to be hemarthrosis, which is related with worse clinical outcomes after this surgical procedure. The most important result of this study revealed that the addition of immediate postoperative mechanical external compression application lateral to patella decreased postoperative amount of bleeding and subsequent hemarthrosis, without adding a significant clinical effect on VAS scores. In addition to the results of this study, prospective randomized studies are required further.
Measurement of Regional Bone Density of the Knee Following Anterior Cruciate Ligament Rupture by Computed Tomography
Authors: Balcı Ali , Gezer Naciye Sinem , Tatari Mehmet Hasan , Erduran Mehmet , Saleky Behzad , Kaya Erol , Özaksoy Dinç
Published: December 2014

Objectives:

The purpose of this study was to determine the regional bone mineral density changes of the knee after anterior cruciate ligament rupture and correlate with the duration after injury, age and gender of the patient.

Methods:

31 patients, diagnosed as anterior cruciate ligament rupture with between June 2010 and February 2014, were included in this retrospective study. The measurements were performed in seven predetermined regions by using axial and sagittal plane computed tomography images. The mean trabecular bone densities of these certain regions were measured in terms of Hounsfield units by using a circular region of interest approximately 10-15 mm in diameter.

Results:

The trabecular bone densities at four of seven regions were negatively correlated with the duration after injury in Spearman’s correlation analysis. The bone densities of D1 (anteromedial area of the proximal tibia), D2 (anterolateral area of the proximal tibia), D3 (posteromedial area of the proximal tibia) and D4 (posterocentral area of the proximal tibia) regions had statistically significant negative correlation with preoperative duration (P<0.05, r -0.410, -0.501, -0.418 and -0.439, respectively). Multiple linear regressions analysis demonstrated independent negative correlation between the duration after injury and only D1 region (p=0.009).

Conclusion:

The present study demonstrated that, bone mineral density of the knee decreases by the time after ACL rupture particularly in anteromedial area of proximal tibia corresponding to ACL fixation area (D1). Thus, prolonged preoperative duration may decrease bone quality and influence the success of reconstructive surgery.
Anterior Cruciate Ligament Reconstruction Using an Achilles Tendon Allograft Graft
Authors: Mermerkaya Musa Uğur , Atay Ahmet Özgür , Bekmez Şenol , Karaaslan Fatih , Alkan Erkan , Doral Mahmut Nedim
Published: December 2014

Objectives:

To compare femoral and tibial tunnel widening (TW) in patients undergoing anterior cruciate ligament (ACL) reconstruction using an interference screw (IS), or an EndoButton-Continuous Loop (EndoButton-CL®) on the femoral side, and an IS/staple on the tibial side.

Methods:

We retrospectively reviewed data on 46 patients who underwent arthroscopic ACL reconstruction with Achilles tendon allografting. Fixation was performed with a bioabsorbable IS (the IS group) in 24 patients (mean age 26.5 years), and with the EndoButton-CL device (the EB group) in 22 patients (mean age 28.1 years) on the femoral side. Evaluation included standardized anteroposterior (AP) and lateral radiography. The diameters of tunnels at the last follow-up visit (at a median time of 17 months postoperatively) were compared to those noted on radiographs taken 1 day postoperatively.

Results:

The two groups were similar in terms of age and gender distribution, the operated side, the size of the tunnel created, and the follow-up period (p>0.05). Femoral TW at the proximal and middle levels (on both anteroposterior and lateral views) in the IS group was significantly greater than in the EB group (p<0.050 for all comparisons). No significant difference in femoral TW at the distal level was evident between the groups, and tibial TW at all levels was similar in both groups (p>0.050).

Conclusion:

Femoral ACL graft fixation using an EndoButton-CL reduced femoral TW compared to use of an IS.
Reducing Intra-Articular Haemarthrosis After Arthroscopic Anterior Cruciate Ligament Reconstruction
Authors: Karaaslan Fatih , Karaoğlu Sinan , Mermerkaya Musa Uğur
Published: December 2014

Objectives:

A significant proportion of surgeons use intra-articular drains after arthroscopic anterior cruciate ligament (ACL) reconstruction. Haemarthrosis and pain adversely affects the functional outcome of ACL reconstruction. The purpose of the study was to evaluate the effect of tranexamic acid (TXA) administration to minimize pain and stiffness of knee joint by reducing haemarthrosis.

Methods:

The study enrolled 123 patients who underwent arthroscopic anterior cruciate ligament reconstruction in a prospective, randomized, double-blind study. The patients who were randomized into the TXA group (71 patients) received both intravenous and intra-articular TXA. The control group (52 patients) did not receive TXA. The anesthetist, surgeon, and observer were blinded to the study group (double-blinded). TXA was administered as a bolus dose of 15 mg/kg 10 minutes before the inflation of the tourniquet on the first side. This was followed by continued intra-articular administration of 3 g at 10 minutes before the deflation of the tourniquet. Intravenous infusion of 10 mg/kg/h was continued for the next 3 hours. Equal volumes of placebo were administered at the same rate and by the same route. We measured volume of drained blood 48 hours postoperatively.

Results:

The mean (± SD) postoperative volume of blood loss from the drain in the TXA and control groups was 100.6 ± 72mL and 164.3 ± 75mL ml, respectively. The difference between the two groups was significant (p < 0.005).

Conclusion:

This prospective randomized study showed that during arthroscopic anterior cruciate ligament reconstruction, TXA reduced blood loss and helped to reduce haemarthrosis amount and frequency with negligible side effects. With regard to the administration route, combined intravenous–intra-articular administration of TXA significantly reduces blood loss and the need for puncturing associated with arthroscopic anterior cruciate ligament reconstruction without enhancing the risk of deepssssssahrombosis.
Are Early Results of Robotic Assisted Medial Unicompartmental Knee Arthroplasty Successful?
Authors: Haklar Uğur , Ulusoy Ertuğrul , Şimşek Tayfun , Terzi Nuray
Published: December 2014

Objectives:

Robotic surgery studies have been increasing in literature in the past years due to its operative advantages on reducing error and improving functional success in partial knee arthroplasty.

Methods:

Data were prospectively collected in 21 patients (31 knees) who underwent MAKOplasty, robotic assisted unicondylar medial knee arthroplasty, between June 2013 – January 2014 in our clinic with an average follow-up time of 5.5 months. Clinical outcomes were evaluated with American Knee Society Scoring System. Additionally, intra-operative digitally planned implant positions on the robot’s software were compared with post-operative radiographic component alignment. In the radiographic evaluation; anatomic axis of the tibia was observed in the coronal plane. Tibial posterior slope and flexion angle of the femoral component were observed in the sagittal plane.

Results:

Pre-operatively 1 patient was scored fair (60 points) and 20 patients were scored poor (mean, 46.6 points) on American Knee Society Scoring System. Post-operatively all 21 patients had excellent knee scores (mean, 99.67 points). Function-wise 7 patients were scored fair (mean, 60 points) and 14 patients were scored poor (mean, 30.7 points) again on American Knee Society Functional Scoring System. Post-operatively all 21 patients exhibited excellent function scores (mean, 99.04 points). In the radiological evaluation, intra-operative robotic analyses were compared with post-operative radiographic alignment. No significant difference was observed statistically (paired t-test, p < 0.05). This comparison is valuable as Lonner, Hernigou, Collier report that mal-alignment by as little as 2° may predispose to implant failures.

Conclusion:

Robotic assistance greatly improves clinical and functional outcomes and may help prevent implant failures due to surgical error and mal-alignment in partial knee arthroplasty.
Reducing Blood Loss in Simultaneous Bilateral Total Knee Arthroplasty
Authors: Karaaslan Fatih , Mermerkaya Musa Ugur , Karaoglu Sinan , Baktır Ali
Published: December 2014

Objectives:

We asked whether tranexamic acid administration could reduce blood loss and blood transfusion requirements after simultaneous bilateral total knee arthroplasty (TKA). This study examined the role of different method of tranexamic acid administration in TKA.

Methods:

The study enrolled 81 patients who underwent simultaneous bilateral total knee replacement in a prospective, randomized, double-blind study. The patients who were randomized into the TXA group received both intravenous and intra-articular TXA. The control group did not receive TXA. The anesthetist, surgeon, and observer were blinded to the study group (double-blinded). TXA was administered as a bolus dose of 15 mg/kg 10 min before the inflation of the tourniquet on the first side. This was followed by continued intra-articular administration of 3 g at 10 min before the deflation of the tourniquet. Intravenous infusion of 10 mg/kg/h was continued for the next 3 h. Equal volumes of placebo were administered at the same rate and by the same route. We measured volume of drained blood 48 hours postoperatively, decrease in hemoglobin levels 12 hours postoperatively, amount of blood transfused, and number of patients requiring allogenic blood transfusion (BT).

Results:

Mean (± SD) postoperative volume of drained blood was lower in the group receiving tranexamic acid (509.39 ± 224.97mL) than in control subjects (961.37 ± 427.99mL). The mean hemoglobin decrease 12 hours postoperatively was lower in patients receiving tranexamic acid (2.07 ± 1.11g/dL) than in control subjects (3.21 ± 1.05g/dL). The amount of blood transfused and number of patients requiring blood transfusion were lower in patients receiving tranexamic acid than in control subjects.

Conclusion:

This prospective randomized study showed that during simultaneous bilateral TKA, TXA reduced blood loss and helped to reduce the BT amount and frequency with negligible side effects. With regard to the administration route, combined intravenous–intra-articular administration of TXA significantly reduces blood loss and the need for BT associated with bilateral simultaneous total knee replacement without enhancing the risk of deep vein thrombosis.
Correlation Between Asymmetric Resection of Posterior Femoral Condyles and Femoral Component Rotation in Total Knee Arthroplasty
Authors: Güngör Harun Reşit , Ök Nusret , Ağladıoğlu Kadir , Akkaya Semih , Kıter Esat
Published: December 2014

Objectives:

Pertaining to peculiar designs of current knee prostheses, more bone is removed from posteromedial femoral condyle than posterolateral condyle to obtain desired femoral component rotation. The aim of our study was to evaluate whether there is a correlation between the asymmetry of the cuts and the femoral component rotation in total knee arthroplasty.

Methods:

We built a model to simulate anterior chamfer cut (ACC) performed during total knee arthroplasty for measuring posterior condylar offset (PCO). Right knee axial MRI slices of a total 290 consecutive patients (142 male, 138 female, and mean age 31.39 ± 6.6) were examined. A parallel line to surgical transepiphyseal axis was drawn, and placed at the deepest part of trochlear groove. Posteromedial and posterolateral condylar offsets were measured by drawing perpendicular lines to ACC beginning from the intersection points of both anteromedial and anterolateral cortices to posterior joint line (PJL), respectively. Differences between posteromedial and posterolateral PCO were calculated, and femoral rotation angles (FRA) relative to PJL were measured.

Results:

The mean surgical FRA was 4.76 ± 1.16 degrees and the mean PCO differencesss- was 4.35 ± 1.04 mm for the whole group and there was no statistically significant difference between genders. There was a strong correlation between surgical FRA and PCO difference (p<0.0001, r=0.803). Linear regression analyses revealed that 0.8 mm of difference between the anteroposterior dimensions of medial and lateral PCO corresponds to 1 degree of surgical FRA (p<0.0001, R2=0.645).

Conclusion:

Correlation between the asymmetry of posterior chamfer cuts and achieved femoral component rotation can verify the accuracy of desired rotation, intraoperatively. However, further clinical investigations should be planned to test the results of our morphometric study.
Effects of Extracorporeal Shock Wave Therapy on Subacromial Impingement Syndrome
Authors: Öztürk Nur Selin , Gelecek Nihal , Savcı Sema
Published: December 2014

Objectives:

The purpose of this study was to investigate the effects of extracorporeal shock wave therapy (ESWT) on pain, functional level of the upper extremity, and quality of life (QOL) in patients with subacromial impingement syndrome (SIS).

Methods:

This study involved 60 patients with SIS (40 females, 20 males) with a mean age of 52.58 ± 8.05 years. Before the first measurements, all patients were separated into an ESWT group (Group I, n = 30) and a control group (Group II, n = 30) according to a simple random table. Standard physiotherapy and medium-energy ESWT were applied to Group I, and standard physiotherapy and sham ESWT were applied to Group II for 4 weeks. Pain, functional level of the upper extremity and QOL were evaluated before and after treatment.

Results:

After treatment, the visual analogue scale (VAS) score decreased , and Constant Shoulder Score, Shoulder Pain and Disablity Index (SPADI) and SF-36 score increased statistically in both groups (p < 0.05). Similarly, there were no statistically significant differences in the VAS score, Constant Shoulder Score, and SPADI between Groups I and II after treatment (p > 0.05).

Conclusion:

The results of our study show that applications of medium-energy ESWT at one session a week for 4 weeks had effects similar to those of standard physiotherapy and sham ESWT on shoulder pain, functional level of the upper extremity, and QOL in patients with SIS.
Effects of Proprioceptive Neuromuscular Facilitation and Mulligan Concepts on the Pain, Functional Level and Quality of Life on Subacromial Impingement Syndrome
Authors: Karakuş Sinem , Gelecek Nihal , Yeşilyaprak Sevgi Sevi
Published: December 2014

Objectives:

The purpose of the study was to investigate the effects of Proprioceptif Neuromuscular Facilitation (PNF) and Mulligan concepts on the pain, functional level and quality of life in the patients with subacromial impingement syndrome (SIS).

Methods:

This study was carried out on 40 patients (26 females, 14 males), mean age 50,3±1,13 years, who had been diagnosed as SIS admitted to the physical therapy and rehabilitation clinic. Before the beginning measurements all the patients were separated to 2 groups according to simple random table. Standard physical therapy and PNF were given to the Group I (n=20); and Standard physical therapy and Mulligan Concept were added to the Group II (n=20). In the evaluation process the demographic data of the patients, pain severity (VAS), functional level (Constant shoulder score) and quality of life (SF-36) measurement were done. The measurements were done before treatment, after treatment and 3 month later.

Results:

Before treatment, VAS score, Constant shoulder score and quality of life scores were similar and there were no statistically differences between two groups (p>0.05). After treatment and 3 month later, VAS score decreased, Constant Shoulder score increased in both groups(p<0.05). For Group I, SF-36 physical component and mental component scores increased after treatment (p<0.05), but mental component score was not change in Group II (p>0.05). However, there were no statistically significant differences in the VAS score, Constant Shoulder Score, and mental health score between Groups I and II after treatment and 3 month (p > 0.05).

Conclusion:

The results of our study suggested that PNF and Mulligan concept could influence positively on shoulder pain, functional level of upper extremity and quality of life in patients with SIS and these effects were similar.
MRI Evaluation of Patella Alignment Before and After Anatomical Reconstruction of ACL Undergoing Unified Rehabilitation Programme Introduced by CMC Physical Therapy Team
Authors: Straszewski Dariusz , Plenzler Marcin , Szczepaniak Joanna , Śmigielski Robert , Ciszkowska-Łysoń Beata , Popieluch Marcin , Kopko Szymon
Published: December 2014

Objectives:

The aim of the study was to asses the impact of the functional rehabilitation on patella alignment with MRI imaging in patients who underwent the ACL reconstruction. The surgical approach with the use of patellar tendon graft is known to carry the risk of lowering patella height (patella baja), which, in turn, may lead to accelerated cartilage wear in patellofemoral joint.

Methods:

30 patients after the anatomical reconstruction of ACL took part in this study (23 male, and 7 female, mean age = 28 ± 10,6 years). During the procedure a patellar tendon graft was used. The Insali-Salvati ratio measured with MRI (images taken pre-procedural, and 9 months after the surgery) was used for the assessment of patellar alignment. The measurements were taken by one radiology specialist on MRI scans in sagittal view in PD sequence. During the examination, patellar joint was in flexion (approx.10 degrees). As the point of reference for patella’s position ISR ratio was in the range of 0.8 - 1.2. All patients were operated on by the same team of surgeons and underwent an unified rehabilitation programme led by a team of selected physiotherapists. The main features of the programme were: an early muscle activation (second day after the procedure); mobilisation of the patella and tissues of the anterior compartment of the knee; weight bearing co-contraction exercises, and the sensomotoric training of the entire kinetic chain of the lower limb. The data recorded was statistically analysed using the Wilcoxon signed-rank test in order to establish parameters’ changes within the study group..

Results:

The mean ISR value before the procedure was 0.84 (± 0,1), whereas 9 months after the surgery it was 0.85 (± 0,1). The results’ analysis did not show any statistically significant changes between ISR values. Nine months after the procedure patella baja has not been observed in any of the evaluated patients.

Conclusion:

The functional rehabilitation programme designed by the CMC team had no negative impact on patella alignment, as no patella baja, which is a common complication after these kinds of surgeries, has been observed. The applied functional rehabilitation programme enabled patients to keep the proper patella alignment, similar to the alignment recorded before the surgery.
Influence of Pectoralis Minor Muscle and Upper Trapez Muscle Tightness in Scapular Dyskinesis
Authors: Yeşilyaprak Sevgi Sevi , Yüksel Ertuğrul , Kalkan Serpil
Published: December 2014

Objectives:

Alterations in scapular kinematics were found in individuals with shoulder problems compared with healthy individuals. These alterations in scapular kinematics such as changes in the normal position or any abnormal motion of the scapula during active motions are defined as “’Scapular Dyskinesis (SD)”. Relationship between tight muscles and scapular kinematics has been investigated. Pectoralis Minor Muscle Tightness (PMMT) effects scapular motion and make changes in scapular kinematics. Although there are some studies indicating a possible relationship between PMM or Upper Trapezius Muscle Tightness (UTMT) and SD, this relationship hasn’t been investigated yet. The aim of this study was to evaluate the influence of PMMT and UTMT on SD in an asymptomatic population.

Methods:

One-hundred-eleven participants (mean age: 22.73±3.45 years old, 222 arms, 42 Female-69 Male) were recruited. Subjects were eligible if they were ≥18 years of age, having active full shoulder motion and who has no health problem to hinder them from participate. Individuals with symptoms produced by cervical spine motion, impingement syndrome, frozen shoulder, shoulder instability and a history of shoulder fracture/surgery were excluded. Scapular Dyskinesis Test (SDT) was used to identify SD. PMMT was determined by Pectoralis Minor Index (PMI), UTMT by UTMT Test. Logistic regression analysis performed to ascertain the effects of PMMT and UTMT on the likelihood that participants have SD.

Results:

SD was identified in 62 arms (27.9%), PMMT in 32 arms (14.4%), and UTMT in 75 arms (33.8%) in total number of participants. PMMT was determined in 23 arms (37.1%) and UTMT in 39 arms (62.9%) in participants with SD. The logistic regression model was statistically significant, X2=65.472, p<.000, df= 2. The model explained 36.8% (Nagelkerke R2) of the variance in SD and correctly classified 78.4% of cases. The Wald criterion demonstrated that both PMMT and UTMT made a significant contribution to prediction (p<0.000 for PMMT, p<0.000 for PMMT). People who have PMMT were 13.76 times more likely to exhibit SD than people who haven’t. People who have UTMT were 7.59 times more likely to exhibit SD than people who haven’t.

Conclusion:

It was determined that people with PMMT and UTMT are more likely to exhibit SD than people who have normal muscle length in this asymptomatic population. Assessment of PMMT and UTMT could be included as a routine part of the scapula and scapular dyskinesia examination. This investigation should be repeated in symptomatic population who has shoulder problems. The effects of various interventions for lengthening these muscles in scapular dyskinesia, needs further research.
Core Stabilization Training After Anterior Cruciate Ligament Reconstruction
Authors: Medeni Özge Çınar , Bayramlar Kezban , Baltacı Gül , Yanmış İbrahim
Published: December 2014

Objectives:

The aim of this study was to compare the effects of core stabilization exercises and conventional rehabilitation exercises after anterior cruciate ligament reconstruction in terms of knee joint laxity, knee muscle strength, postural stability and functional tests.

Methods:

Twenty eight patients reconstructed with hamstring tendon were included. Thirteen patients evaluated after a conventional rehabilitation and fifteen after a core stabilization programme. Single-limb postural stability assessment, isokinetic knee muscle strength test, instrumented ligament laxity test, functional hop tests were done to both groups after 16th week. Single-limb postural stability was assessed with stabilometer in both eyes open and eyes-closed conditions. Healthy legs were evaluated as internal controls.

Results:

Knee flexor and extensor strength indices were not different between groups (p>.05). H/Q strength ratio was different at 180 °/s (p<.05). Knee laxity was not different between groups (p<.05). There was no significant difference in hop distance and hop index between groups (p>.05). Conventional training group had deficit in overall stability score in eyes closed condition (p>.05), but core stabilization group did not have any postural stability deficit (p>.05).

Conclusion:

Better H/Q strength ratio was seen in core stabilization group. Core stabilization exercises improved postural stability more than classic rehabilitation.
Effects of Body Mass Index, Infrapatellar Fat Pad Volume and Age on Patellar Cartilage Defect
Authors: Duran Semra , Akşahin Ertugrul , Kocadal Onur , Aktekin Cem Nuri , Hapa Onur , Genctürk Zeynep Bıyıklı
Published: December 2014

Objectives:

The aim of this study was to evaluate the associations between patellar cartilage defects and body mass index (BMI), infrapatellar fat pad (IPFP) volume and age.

Methods:

100 patients who met the inclusion criteria and were aged 18 to 60, were evaluated retrospectively. The BMI’s of the participants were evaluated according to their weight and height. For detecting and measuring patellar cartilage defects, axial sequences were used and sagittal sequences for were used to evaluate IPFP volumes in MRI.

Results:

40 patients were found to have patellar cartilage defects. In this group, age and BMI were higher in both sexes when compared with the controls (P<0.05). The IPFP volume was lower in the group with the patellar cartilage defect when compared with the control group (P<0.05). The IPFP volume was statistically significantly lower in women (P<0.05).

Conclusion:

Patellar cartilage defects were found to be related to age and BMI. In women, the decrease in IPFP volume seems to be one of the causative factors for patellar cartilage defects. The effect of IPFP volume on articular cartilage in healthy people is unknown. Further studies focusing on patellofemoral cartilage damage are needed to reveal this association.
Medial Opening Wedge High Tibial Osteotomy Fixation with Short Plate without any Graft, Synthetic Material or Spacer
Authors: Türkmen Faik , Sever Cem , Kacıra Burkay Kutluhan , Demirayak Mehmet , Acar Mehmet Ali , Toker Serdar
Published: December 2014

Objectives:

Medial opening-wedge high tibial osteotomy (MOWHTO) is an effective surgical procedure for patients who have medial compartmental osteoarthritis of the knee with varus deformity of the limb. The abnormal load on the medial compartment of the knee relocates to the lateral compartment with this procedure. A gap occurs on the proximal tibia during the correction of varus deformity. Filling this gap with bone grafts or synthetic materials has gained wide acceptance for preventing nonunion or osteotomy site collapse. The aim of this study is to report our results of MOWHTOs performed without any bone graft or any other synthetic materials.

Methods:

We evaluated 41 MOWHTOs performed between 2009 and 2012 with no use of bone grafts, synthetic materials or spacers. Age of the patients ranged from 43 to 67. Thirty five of the patients were female and 3 of them were male. The follow-up time was 6 months.

Results:

There were no any non-unions or loss of correction. The mean bone union time was 12,8 weeks. No major complications were seen.

Conclusion:

The results of our study has shown that achieve satisfactory results can be obtained in MOWHTO without using any bone graft, synthetic materials or spacer.
A Comparison of Pre and Post-Season Proprioception, Functional Endurance, and Coordination Changes of Professional Soccer Players
Authors: Günaydın Özge Ece , Tunay Volga Bayrakçı , Baltacı Gül
Published: December 2014

Objectives:

Soccer is amongst the most popular sports in the world, and also it is one of the sports in which physical injury occurs most. The aim of the present study was to investigate soccer players’ pre- and post-season physical injury-related parameters, to analyze the effectiveness of the training program, and to evaluate changes in their physical performance throughout the season.

Methods:

In the present study, 16 soccer players (mean age: 18.87±0.61 years) and 16 sedentary individuals (mean age: 20.93±4.48 years) were recruited. In both groups, proprioception, functional endurance, and coordination were assessed. Soccer players were assessed twice: pre- and post-season, while the sedentary group was assessed only once.

Results:

Pre-season concentric and eccentric coordination levels of the soccer players were found to be higher than those of the sedentary group (p<0.05). In addition, post-season concentric coordination levels of the soccer players were higher than those of the sedentary group (p<0.05). In terms of proprioception levels, no statistical difference was observed between pre- and post-season in the soccer group and between groups (p>0.05). When the pre-season values were compared with the post-season values in the soccer group, while there was a significant decrease in concentric coordination values (p<0.05). There was a significant increase in concentric endurance values (p<0.05).

Conclusion:

Pre- and post-season detailed evaluations of the soccer players would be beneficial in terms of not only identifying their physical needs and the shortcomings in their physical fitness but also they would be beneficial in designing the training programs.
Total Knee Arthroplasty Infected by Brucella Melitensis
Authors: Karaaslan Fatih , Mermerkaya Musa sUğur , Karaoğlu Sinan
Published: December 2014

Objectives:

Brucella infection associated with arthroplasty is a rare event. We present the long-term results of two-stage revision knee arthroplasty due to TKA infection by Brucella melitensis.

Methods:

A 62-year-old man presented with a 4-month history of night sweats, high body temperature, and right knee pain in 2003. Two years previously, he had undergone a right TKA for treatment of gonarthrosis. Upon examination, the knee appeared swollen, warm, and sore, and a sinus tract formation had developed at the incision area. Bacteriologic cultures taken from the sinus tract discharge revealed B. melitensis. The patient’s erythrocyte sedimentation rate (ESR) was 83 mm/h, C-reactive protein (CRP) level was 12.38 mg/L, and blood leukocyte concentration was 9425/mm3. Plain radiography confirmed septic loosening. A two-stage revision TKA was planned. The first stage involved removal of the infected prosthesis and debridement of the remaining cement and necrotic tissue. Removal of the prosthetic components and cement and application of an antibiotic-loaded spacer (teicoplanin-impregnated) was also performed in the first stage. Oral rifampicin (900 mg) and doxycycline (300 mg) were administered daily for 12 weeks postoperatively. At the end of the antibiotic therapy, the patient was seen as an outpatient, and his ESR, CRP level, and antibody titer had decreased to normal values. Finally, prosthetic revision was performed in the second stage of the TKA.

Results:

Ten years following surgery, the patient had returned to full activities of daily living, described no knee pain, and was very satisfied with the outcome. No abnormalities associated with the femoral, tibial, or patellar components were observed on plain radiography 10 years following surgery. The results of a Brucella agglutination test at that time were negative.

Conclusion:

Osteoarticular disease related to Brucella remains a problem in endemic regions. Brucellosis should be kept in mind in the differential diagnosis of prosthetic joint infections, especially in patients with a history of brucellosis and exposure to possible sources of the bacteria. We believe that two-stage revision arthroplasty is the first-line treatment of a loose TKA infected with B. melitensis. In addition, if a systemic Brucella infection is identified, the patient should be managed with two-stage revision surgery.
The Effect of Hamstring Muscle Tightness on Knee Joint Proprioceptive Sense
Authors: Tamer Seval , Yakut Yavuz , Can Filiz , Ülger Özlem
Published: December 2014

Objectives:

Hamstring muscle tightness is a major musculoskeletal problem that predisposes the knee to injury . Proprioception sense is an important factor for injuries and we have not found any studies on the effect of hamstring muscle tightness on knee joint proprioceptive . Therefore, the aim of this study was to determine the effect of hamstring muscle tightness on knee joint proprioceptive sense.

Methods:

61 healthy individuals, without any orthopedic or neurological symptoms that affect the knee joint proprioception sense, were included in this study. Individuals' socio-demographic data were recorded. Hamstring muscle tightness was measured with active knee extension (ACE) method by using goniometer. Individuals with hamstring muscle tightness (ACE over of 20 °) was Group 1 and individuals without tightness (ACE 20 ° and under) was Group 2. Proprioceptive component of joint position sense and kinaesthesia was evaluated for the sense of proprioception. Prosport 1000 PMS (Tümer Machine Ankara, Turkey) instrument was used and visual, auditory, tactile, sensory input have been eliminated. Passive placement method and 20 and 40 degrees of knee flexion target angles was used for measurement. For joint position sense target angle predict degree, for kinesthesia perceive movement sense degree was recorded. Instrument moved 10 degrees/sec for joint position sense and 0.4 degrees/sec for kinesthesia. All measurements were repeated three times for dominant and non-dominant side. SPSS version 21 was used for statistical analysis and p values of 0.05 and less were considered evidence of statistically significant findings. Mann-Whitney U rank test was used to compare findings of two groups.

Results:

Individuals’ socio-demographic data were similar (p> 0.05). No difference was found between the groups’ dominant and non-dominant sides’ AKE values (p> 0.05). Similarly for dominant and non-dominant side kinaesthesia values in 20 °and 40°, joint position sense values in 20 ° and 40 ° did not show statistically significant differences between the groups (p> 0.05).

Conclusion:

This study showed that hamstring muscle tightness was not effective on knee joint kinesthesia and joint position sense for both dominant and non-dominant side. This result indicates that joint position and kinesthesia were not effective enough to show the effect of hamstring muscle tightness on knee joint proprioception, so other proprioceptive components like muscle strength, range of motion, strength and agility could be considered.