Browsing by Author "Akseki D."

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    The distal fascicle of the anterior inferior tibiofibular ligament as a cause of anterolateral ankle impingement. Results of arthroscopic resection
    (Scandinavian University Press, 1999) Akseki D.; Pinar H.; Bozkurt M.; Yaldiz K.; Araç S.
    We arthroscopically resected the impinged distal fascicle of the anterior inferior tibiofibular ligament (AITFL) in 21 patients (mean age 31 (11-68) years, 14 women) with chronic ankle pain after an ankle sprain. Clinical tests revealed moderate laxity in 2 and severe laxity in another 2, the remaining 17 ankles showing only mild laxity. During arthroscopy, an impinging distal fascicle of the AITFL was found in all cases. Following anterolateral synovectomy, the fascicle was excised. At the follow-up after mean 3 (2-4) years, good-to-excellent results were obtained in 17 patients. 19 patients were satisfied with the procedure and 17 patients returned to their previous level of activity. 2 patients who had mild laxity were graded as poor because of neuromas of the terminal branches of the superficial peroneal nerve. These patients became asymptomatic after an injection of steroids.
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    Bilateral discoid medial menisci
    (W.B. Saunders, 2000) Pinar H.; Akseki D.; Karaoǧlan O.; Özkan M.; Uluç E.
    This article adds 2 more cases of bilateral discoid medial menisci to the previously reported 9 cases. The radiographs of the first case revealed bilateral cupping of the medial tibial plateaus and a small lytic lesion of the left distal medial femoral metaphysis. Beside the posteriorly unstable incomplete type discoid medial meniscus, the left knee had several associated arthroscopic findings: depression of the medial tibial plateau with exposed subchondral bone, anomalous insertion of the anterior horn of the discoid meniscus to the anterior cruciate ligament, a pathological medial plica, and longitudinal deep fissures in the trochlea. The second case was a complete type with peripheral horizontal cleavage tears. Following arthroscopic surgery, magnetic resonance imaging (MRI) scans of the contralateral knees were obtained in both cases to search for bilaterality. MRI revealed discoid medial menisci in the unoperated knees as well. The short-term results of arthroscopic meniscectomy may not be as satisfactory as those reported for normal menisci.
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    Preoperative and postoperative intraarticular analgesia with tenoxicam after knee arthroscopy; [Diz artroskopisinde preoperatif ve postoperatif intraartiküler tenoksikam uygulamalarinin deǧerlendirilmesi]
    (2001) Akinci I.Ö.; Akseki D.; Özcan P.E.; Tuǧrul S.; Köknel Talu G.; Akpir K.
    The efficacy of preemptive analgesia is accepted and it is widely used in numerous surgical procedure except arthroscopy. In this study we compared preoperative and postoperative intraarticular tenoxicam for analgesia after knee arthroscopy. 30 patients were allocated randomly into three groups. Group 1 (n=10) recieved 20 mg intraarticular tenoxicam after the induction of anesthesia, 20 minutes before the surgical procedure. Group 2 (n=10) recieved 20 mg tenoxicam and Group 3 (n=10) recieved only intraarticular serum physiologic solution after the arthroscopy. Pain was assessed at postoperative 1., 2., 3., 4., 6., 12., 24. and 48. hours by the Visual Analog Scale. Supplemental analgesia was required by 8 patients in Group 3, 6 patients in Group 2 and only 1 patient in Group 1. Mean analgesic requirement time was 108. 3 (± 50.7) minutes in Group 3, 350 (± 125.3) minutes in Group 2 and 280 minutes in Group 1. We conclude that preemptive intraarticular tenoxicam produces more effective analgesia than other groups.
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    The anterior inferior tibiofibular ligament and talar impingement: A cadaveric study
    (Springer Verlag, 2002) Akseki D.; Pinar H.; Yaldiz K.; Akseki N.G.; Arman C.
    Impingement by the distal fascicle of the anterior inferior tibiofibular ligament (AITFL) is a relatively new entity among the known causes of anterolateral impingement syndromes of the ankle. This study investigated the anatomy of the anterior inferior tibiofibular ligament and its possible role in talar impingement in 47 ankles of 27 cadavers. The length, width, insertion point to the fibula and the interactions with talus were noted, as was the relationship of the fascicle and talus during different ankle movements before and after incision of the lateral ligaments. A distal fascicle of the AITFL was found in 39 of the 47 ankles (83%) and appeared as a single-complete ligament in the remaining 8 ankles (17%). The fascicle averaged 16.1±2.94 mm in length (range 10-21) and 4.2±1.00 mm in width (range, 3-7). The insertion point of the fascicle on the fibula averaged 10.3±2.27 mm (5-13) distal to the joint level. Contact between the ligament and the lateral dome of the talus was observed in 42 specimens (89.3%). Bending of the fascicle was observed in 8 of these 42 ankles with forced dorsiflexion. These 8 specimens were significantly wider and longer than the specimens without bending of the fascicle. Incision of the anterior talofibular ligament led to bending in dorsiflexion in additional 11 ankles. The total 19 fascicles with bending after incision of the anterior talofibular ligament were significantly longer and inserted more distally than the remaining 20 fascisles without bending. Manual traction simulating distraction during arthroscopic procedures relieved the contact. These findings show that the presence of the distal fascicle of the AITFL and its contact with the talus is a normal finding. However, it may become pathological due to anatomical variations and/or instability of the ankle resulting from torn lateral ligaments. When observed during an ankle arthroscopy, the surgeon should look for the criteria described in the present study to decide whether it is pathological and needs to be resected.
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    Comparison of four evaluation systems used for ankle injuries; [Ayak bilegi hastaliklarinda dört farkli degerlendirme yönteminin karşilaştirilmasi.]
    (2002) Akseki D.; Pinar H.; Bozkurt M.; Yaldiz K.
    OBJECTIVES: Unlike the knee and shoulder, no widely accepted scoring system exists for the ankle joint. The aim of this study was to compare the results of diverse scoring systems used in ankle injuries. METHODS: We compared the results of four evaluation systems used for the ankle including those proposed by (i) Meislin et al. (ME), (ii) Martin et al. (MA), (iii) Kaikkonen and Kannus (KK) and (iv) a modified Bray's system (B). With the use of these evaluation systems we assessed the results of (i) 21 patients who underwent arthroscopic treatment for anterolateral impingement of the ankle, (ii) 17 patients who underwent surgical treatment for bimalleolar ankle fractures, and (iii) 22 patients receiving conservative treatment for grade 2-3 lateral ankle sprains. Statistical analyses were made using the chi-square test. RESULTS: The four scoring systems yielded similar results ranging from 23% to 33% in three groups, whereas conflicting results were obtained in the remaining cases (67% to 77%). The scores indicating poor outcomes were the highest with the ME and MA systems which included more subjective criteria. Similarly, the number of excellent results were significantly lower in these two systems than those of B and KK (p<0.001). CONCLUSION: Due to the high incidence of conflicting results between the scoring systems used, any particular patient may be rated as fair with one system and excellent with another. A standard ankle scoring system requires the inclusion of objective, subjective, and functional criteria, with each patient being evaluated according to individual activity levels as well.
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    The accuracy of the clinical diagnosis of meniscal tears with or without associated anterior cruciate ligament tears; [Menisküs yirtiklarinin klinik tanisi ve eşlik eden ön çapraz bag lezyonunun taniya etkisi.]
    (2003) Akseki D.; Pinar H.; Karaoglan O.
    OBJECTIVES: Meniscal tears and anterior cruciate ligament (ACL) tears commonly coexist in sports injuries. The purpose of this study was to analyze the influence of ACL deficiency on our ability to diagnose meniscal tears. METHODS: The study included patients with a clinical diagnosis of medial meniscal tears with (group A; 26 patients; 22 males, 4 females; mean age 26.6 years; range 18 to 67 years) or without (group B; 17 males; mean age 28.2 years; range 19 to 49 years) associated ACL tears. Patients with lesions other than meniscal or ACL tears were excluded. Clinical evaluations were made with the use of medial joint line tenderness, McMurray, and hyperextension tests. Preoperative diagnoses were compared with arthroscopic results and the accuracy of the tests used were calculated. The two patient groups were also compared with regard to the Lysholm scale parameters and total Lysholm scores. Fisher's exact test and Mann-Whitney U-test were used for statistical analysis. RESULTS: Medial joint line tenderness was present in 82% in group A, and 73% in group B. McMurray test was positive in 82% in group A, and 62% in group B; hyperextension test was positive in 73% in group A, and 61% in group B. The total Lysholm scores were significantly different, being 69 in group A, and 61 in group B (p<0.05). CONCLUSION: Our findings suggest that the accuracy of a clinical diagnosis of a meniscal tear is decreased by the presence of an ACL tear. The coexistence of meniscal and ACL tears requires a more careful clinical evaluation and a more frequent need for magnetic resonance imaging.
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    Bilateral simultaneous knee arthroscopy; [Di̇z eklemi̇ni̇n eş zamanli bi̇lateral artroskopi̇si̇]
    (2003) Akseki D.; Pinar H.; Koşay C.; Karaoǧlan O.
    Objectives: The purpose of this study was to analyse the arthroscopic findings when both knees were symptomatic, to find the incidence of lesions of surgical significance in the secondly arthroscoped (less symptomatic) knee and to report patient satisfaction. Methods: Twenty-two consecutive patients underwent arthroscopy of both of their knees in the same session because of bilateral symptoms. There were 11 men and 11 women whose ages ranged between 22 and 68 years (average 42 years). The right knee in 8, and the left knee in 12 were more symptomatic; the symptoms were graded as equal by two patients. Major complaints were pain (all knees), locking (n=10), giving-way (n=9), inability to squat (n=13). Results: The primary lesions of surgical significance in the firstly arthroscoped knees were as follows: medial meniscus tear 11, lateral meniscus tear 3, hyperthrophic medial plicae 1, chronic synovitis 1, medial synovitis 1, loose body 1, and degenerative arthritis 4 knee. Eighteen of these knees had associated surgical lesions. Surgically significant lesions were seen in all of the contralateral knees except for one in which only lavage was done. The lesions of both knees were similar in 16 patients. Fourteen patients were satisfied with the bilateral procedure. The remaining 4, who were not satisfied had mild to moderate degenerative arthritis in common. Conclusion: Bilateral surgical arthroscopy of the knee is well tolerated by the patients and has a high satisfaction rate. A surgically treatable lesion can be found also in the less symptomatic knee in most of the cases.
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    A new weight-bearing meniscal test and a comparison with McMurray's test and joint line tenderness
    (W.B. Saunders, 2004) Akseki D.; Özcan O.; Boya H.; Pinar H.
    Purpose: The purpose of this study was to describe a new weight-bearing McMurray's test (Ege's test) and to compare its diagnostic value with McMurray's test and joint line tenderness (JLT). We also aimed to determine if associated lesions had any effect on the diagnostic values of the 3 tests. Type of Study: Prospective controlled trial, clinical study. Methods: The study group consisted of 150 consecutive patients who had had symptoms related to intra-articular knee pathology, and arthroscopic diagnoses were used as the gold standard. Results: There were a total of 211 diagnoses on arthroscopy. A meniscus tear was found in 127 of the 150 patients; 90 had medial, 28 had lateral, and 9 had tears of both menisci. There were no statistically significant differences between the 3 tests in detecting a meniscal tear (P >. 05). However, better accuracy, sensitivity, and specificity rates were obtained with Ege's test for medial meniscal lesions (71%, 67%, and 81%, respectively). JLT also gave superior accuracy rates (71%), but the specificity of Ege's test was apparently higher than JLT (81% v 44%). The highest positive predictive value was also obtained with Ege's test (86%), whereas a superior negative predictive value was obtained with JLT (67%) in medial meniscal tears. Lateral meniscal tears were diagnosed more accurately than medial meniscal tears, and Ege's test gave results superior to the others (84%, 64%, 90% for accuracy, sensitivity, and specificity, respectively). Higher positive predictive values were obtained with McMurray's and Ege's tests than with JLT, but similar negative predictive values were achieved in all. A torn anterior cruciate ligament did not decrease the diagnostic values of the 3 tests, whereas the number of associated lesions in the knee negatively affected the diagnostic capabilities of the tests. Conclusions: Accuracies of traditional clinical meniscus tests may be improved by including Ege's test in the clinical examination. Level of Evidence: Level II, diagnostic.
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    The evaluation of the proximal tibiofibular joint for patients with lateral knee pain
    (Elsevier, 2004) Bozkurt M.; Yilmaz E.; Akseki D.; Havitcioglu H.; Günal I.
    In contrast to important functions of the proximal tibiofibular joint (PTFJ), there appear a few clinical and radiological studies concerning the PTFJ pathologies. Although almost all of the joints have been investigated in detail by MRI, review of the literature reveals none on the pathologies of PTFJ. Thirty-eight knees of 32 patients with lateral knee pain were evaluated clinically and radiologically. All had tenderness over the PTFJ and lateral hamstring tightness. MRI examination revealed effusion of the PTFJ in 22 knees and partial ruptures of anterior or posterior tibiofibular ligament, lateral collateral ligament or biceps femoris tendon in 25 knees. All patients were treated by manipulative physiotherapy of the PTFJ and strengthening and stretching exercises of the surrounding structures. All patients were followed-up 12-36 months (mean 28 months) after the treatment protocol, and complete relief of the symptoms was recorded in 28 of the 38 knees. Although spontaneous pain was not present in five patients, there was tenderness over the PTFJ by palpation. No change in the symptoms was recorded in five patients. These results suggest that PTFJ pathologies should be kept in mind in the evaluation of lateral knee pain and MRI examination provides useful information. © 2003 Elsevier B.V. All rights reserved.
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    Cartilage defects of the knee joint: evaluation, classification, and natural course; [Diz ekleminin kikirdak defektlerinde deǧerlendirme, siniflama ve doǧal seyir.]
    (2007) Akseki D.; Pinar H.; Oziç U.
    Cartilage defects of the knee joint may be either isolated or in conjunction with various disorders of the knee. There are no clinical complaints and physical findings specific for joint defects. In addition, except for some magnetic resonance imaging techniques, there are no specific imaging methods for diagnosis. Therefore, arthroscopic evaluation is the gold standard for the diagnosis. Although there are many studies on the treatment of cartilage defects, natural course of the defects has been evaluated in only a few studies. Furthermore, controversy exists as to how and in which direction different treatment methods affect the natural course of cartilage defects. This review addresses factors affecting the natural course of cartilage defects; yet, the exact indications, timing, and methods of treatment, and whether any treatment is necessary remain unclear. Prospective, randomized, and controlled studies are needed to evaluate the results of different treatment methods on the natural course of cartilage defects.
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    Proprioception of the knee joint in patellofemoral pain syndrome; [Patellofemoral aǧrı sendromunda diz ekleminin propriyosepsiyonu]
    (Ekin Medical Publishing, 2008) Akseki D.; Akkaya G.; Erduran M.; Pinar H.
    Objectives: The importance of proprioception in the etiology, treatment, and prevention of sports injuries and joint diseases has become increasingly clear. The purpose of this study was to investigate knee proprioception in patients with patellofemoral pain syndrome (PFPS). Methods: The study included 28 patients (18 females, 10 males; mean age 28 years; range 16 to 48 years) with a clinical diagnosis of unilateral PFPS and 27 normal volunteers (13 females, 14 males; mean age 26 years; range 19 to 32 years) without any complaint related to the knee. The mean duration of complaints was 35.8 weeks (range 2 weeks to 3 years). In both patient and control groups, proprioception of the knee was measured by means of active joint position sense at four different target angles (15°, 30°, 45°, 60°) with the use of a digital goniometer and the results were compared. Results: Proprioceptive errors were greater at all target angles in the affected knees compared to those measured in the contralateral knees and both knees of the controls. Differences between affected knees and contralateral knees ranged from 1.01(0.25° to 1.65(0.43° and were significant at three target angles (15°, 30°, 60°; p(0.05). Comparisons between the affected knees and both knees of the controls also showed significant differences at all target angles ranging from 2.48(0.92° to 3.87(2.46° (p(0.001). Errors obtained in the normal knees of the patients were also significantly greater compared to those seen in both knees of the controls, exceeding 2.7° at some target angles (p<0.001). Conclusion: Our results show that patients with PFPS have impaired proprioception in the affected knee accompanied by significant losses in the proprioception of the contralateral normal knee. Based on these findings, proprioceptive rehabilitation techniques should be incorporated into the treatment of PFPS. (2008 Turkish Association of Orthopaedics and Traumatology.
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    Comparison of ankle proprioception between blind and healthy athletes
    (SAGE Publications Ltd, 2014) Özer M.; Kaynak H.; Atik A.; Şilil M.K.; Altun M.; Akseki D.
    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. © The Author(s) 2014.
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    Effect of hot and cold applications on elbow proprioception
    (Edizioni Minerva Medica, 2019) Kaynak H.; Altun M.; Özer M.; Akseki D.
    BACKGROUND: Purpose of this study was to investigate the effects of cold application (CA) and hot application (HA) on elbow proprioception in healthy volunteers. CA and HA were applied locally during 15 minutes on the elbow joint and the effect was measured after that. METHODS: A repeated-measure design with 6 (2x3) randomly assigned test conditions: 1) no application on 30° angle; 2) after HA on 30° angle; 3) after CA on 30° angle; 4) no application on 60° angle; 5) after HA on 60o angle and 6) after CA on 60o angle. A total of 82 healthy volunteers (35 women, 47 men) whose ages ranged between 18 and 28 years (20.93±2.13) were included in the study. Proprioception of the elbow was measured by using a digital goniometer with the technique of active joint position sense at the beginning of the study. The tests were repeated at weekly intervals after applying cold or hot in mixed order. Two target angles were defined 30 and 60 degrees of elbow flexion. RESULTS: Reproduction errors were significantly decreased following HA in both target angles (P<0.017). Following CA, significantly increased reproduction error was found only in 30-degree target angle (P<0.017). CONCLUSIONS: We obtained increased elbow proprioception following HA, which means increased proprioceptive acuity of the elbow but a decrease following CA in healthy volunteers. These findings may be useful in prevention and treatment of sports injuries, if supported by future studies. © 2018 EDIZIONI MINERVA MEDICA.