MCBÜ Açıkerişim Sistemi :: Browsing by Author "Okcu G."

Browsing by Author "Okcu G."

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Antegrade nailing of femoral shaft fractures combined with neck or distal femur fractures. A retrospective review of 25 cases, with a follow-up of 36-150 months
(2003) Okcu G.; Aktuglu K.
Introduction: Complex femoral fractures pose considerable therapeutic challenges to orthopedic surgeons. We present a retrospective review of 25 patients with complex femoral fractures treated with intramedullary locked nailing and supplemental screw fixation. Materials and methods: Fifteen patients with ipsilateral femoral neck and shaft fractures (group 1) and 10 patients with ipsilateral femoral shaft and distal femur fractures (group 2) were treated from 1990 to 1998. High-energy injuries occurred in all patients. There were 4 open fractures. Antegrade, locked nailing of diaphyseal fractures was performed in all cases. Supplemental screws for the neck were used in all patients in group 1 and in 3 patients in group 2. Results: All of the fractures united during the follow-up. Five patients in group 1 underwent reoperation (33.3%): one due to a delayed union, the second due to an implant failure, the third due to a nonunion of a neck fracture, and the last two because of an initially missed femoral neck fracture. None of the patients in group 2 underwent reoperation. Angular malalignment of the shaft was found in 6 fractures in group 1 (average 4.8°, range 3°-11°) and in 4 fractures in group 2 (average 6°, range 3°-12°). Shortening of the limb occurred in 3 patients in group 1 (average 1.4 cm, range 1-1.8) and in 1 patient in group 2 (2cm). Loss of fixation was seen in 1 patient in each group. Avascular necrosis and infection were not seen in any case in both groups. Conclusion: Femoral intramedullary nails with antegrade or retrograde options for insertion and different locking possibilities have extended the indications to include both diaphyseal and metaphyseal fractures. New nail designs, usually more expensive than the conventional nails, have been introduced into the market for this purpose. One has to keep in mind that antegrade, locked nailing of femoral shaft fractures combined with neck or distal femur fractures is a technically demanding but efficacious procedure. The success rate is high when the technique is meticulously implemented.
Lateral humeral rotation osteotomy for the treatment of obstetrical palsy of the brachial plexus; [Doǧumsal braki̇al pleksus felci̇nde humerus lateral rotasyon osteotomi̇si̇]
(2003) Okcu G.; Kapubaǧli A.
Introduction: Obstetrical palsy of the brachial plexus secondary to a difficult labor remains to be a challenging clinical problem, causing persistent neurologic impairment with varying degrees of functional deficit of the upper extremity if not treated properly. In our country, a considerable number of children with plexopathy have been referred to an eligible hospital or surgeon in the late period after developing persistent shoulder contractures and deformities because of lack of appropriate management. The purpose of this retrospective study is to review the outcomes of humerus lateral rotational osteotomy in children who had persistent shoulder contractures and deformities because of birth palsy. Patients and Methods: Twenty cases, with internal rotation and adduction contractures of the shoulder with a resulting joint deformity or subluxation secondary to Erb's palsy, were managed with lateral rotational osteotomy of the humerus over a 10-year period (1990-2000). The average age of the patients was 8.1 years at the time of operation (range, 5-13 years). Follow-up averaged 8 years. The modified classification system of Mallet was used to assess the function of the upper extremity before the operation and at the latest follow-up. The outcomes were compared statistically. Results: According to the modified classification system of Mallet, the patients had a median score of 3 for global abduction, 2 for global external rotation, 2 for hand-to-neck ability and 2 for hand-to-mouth ability preoperatively. At the time of final follow-up, all patients had improved shoulder function and obtained a median modified Mallet score of 4 for all abilities. Only a patient could not succeed in hand-to-neck activity because of an elbow flexion contracture. As assessed with use of modified Mallet classification, there was significant improvement in upper extremity function after humerus lateral rotation osteotomy (P<0.05). Discussion: Fixed adduction and internal rotation contracture of the arm, with loss of external rotation of the shoulder, is the most frequent deformity of the extremity associated with Erb's type brachial plexus birth injury. If this contracture is not treated early enough, it may result in progressive glenohumeral joint deformity and incongruency. Humerus lateral rotation osteotomy is an effective salvage procedure, for patients with this type of contractures secondary to chronic obstetrical brachial plexus palsy, when tendon transfers cannot be performed because of incongruency of glenohumeral joint. The present study supports that humerus lateral rotation osteotomy not only increases the functional range of motion of the upper extremity, but also enables the activities of daily life much better.
Clinical results of lateral closing wedge high tibial osteotomy for osteoarthritis of the knee (Oblique osteotomy with tension band fixation); [Diz osteoartritinde lateral kapali kama yüksek tibial osteotominin klinik sonuçlari (Oblik osteotomi ve gergi bandi tespit teknigi).]
(2004) Yercan H.S.; Okcu G.; Aydogdu S.; Oziç U.
OBJECTIVES: We evaluated the preliminary results of oblique and lateral closing-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee. METHODS: Thirty-nine patients (29 women, 10 men; mean age 53 years; range 34 to 64 years) underwent oblique and lateral closing-wedge high tibial osteotomy followed by tension band plate fixation. According to the Ahlback system, seven patients had grade II, 27 patients had grade III, and five patients had grade IV osteoarthritis. Fixation was completed with a blade plate and two cortical screws. The results were evaluated using the Knee Society Score at the end of a mean follow-up of 23 months (range 12 to 41 months). RESULTS: The mean pre- and postoperative Knee Society scores were 43 (range 18-72) and 80 (range 20-90), and the mean Knee Function scores were 57 (range 45-90) and 72 (range 35-90), respectively (p<0.05). The mean preoperative deviation from the mechanical axis of the leg was 8.9 degrees varus (range 3 to 15 degrees). A mean correction of 11.6 degrees valgus (range 7 to 18 degrees) was afforded in order to obtain a slight valgus alignment. The mean postoperative femorotibial angle was 171 degrees (range 162-183 degrees). Complications were seen in 11 patients, which included severe overcorrection, fixation failure, transient nerve palsy, or pain over the fibular osteotomy site. CONCLUSION: Oblique high tibial osteotomy combined with tension band fixation is an effective procedure providing secure and durable fixation to allow early motion. It should be recalled that a high complication rate is likely during the learning curve, which adversely influences the clinical results.
The incidence and location of corona mortis: A study on 75 cadavers
(2004) Okcu G.; Erkan S.; Yercan H.S.; Ozic U.
We dissected 150 fresh cadaver halves by ilioinguinal exposure, and counted all vessels more than 2 mm in diameter, connecting the obturator system to the external iliac system. The distance between the symphysis pubis and the anastomotic vessels was measured. We found vascular anastomoses between the obturator and external iliac systems in 91 of 150 sides (61%), and anastomotic veins in 78 of 150 exposures (52%). Arterial connections were seen in 29 of the exposures (19%). The mean distance between the anastomotic arteries and the symphysis pubis was 64 (45-90) mm, and 56 (37-80) mm for the communicating veins. There seemed to be no significant difference between genders in the incidence of corona mortis and the distance between communicating vessels and the symphysis pubis.
Management of shotgun-induced fractures of the humerus with Ilizarov external fixator
(2004) Okcu G.; Aktuglu K.
We retrospectively reviewed 11 shotgun-induced open humeral fractures treated with immediate application of Ilizarov type ring external fixation. Eight patients had grade III A and three had grade III B open fractures. No patient had associated neurovascular injury. All fractures were stabilized with Ilizarov external fixator immediately after meticulous debridement and irrigation under emergent conditions. Complete bony union occurred in all patients in 14-44 weeks (mean, 21 weeks). One patient required a second intervention to adjust the external fixator rings. Two patients required a rotational fasciocutaneous flap to handle the soft tissue coverage problem. Superficial pin tract infection was present in eight patients; however none of them had deep infection or osteomyelitis. A good to excellent result was achieved in 10 patients according to the rating system of Smith and Cooney. Immediate Ilizarov external fixation is a safe method of obtaining a functional limb in the treatment of shotgun-induced open humeral fractures with severe soft tissue damage.
Intra-articular fractures of the tibial plafond. A comparison of the results using articulated and ring external fixators
(2004) Okcu G.; Aktuglu K.
We retrospectively reviewed 60 fractures of the tibial plafond treated by either an ankle-sparing diaphyseal-epiphyseal technique using the Ilizarov ring fixator or by an ankle-spanning technique using a monolateral articulated external fixator. The Ilizarov ring fixator was applied in 24 fractures and the monolateral articulated transarticular external fixator in 20. Both techniques were combined with limited open reduction and internal fixation of the articular surface if necessary. Between three and nine years after the injury, all patients returned for clinical and radiological assessment and evaluation of ankle function using the modified Mazur score. There were no significant differences between the two groups in terms of age, gender, mechanism of injury, type of fracture or length of follow-up. The mean functional ankle score was 86 points for the Ilizarov group and 82 points for the articulated fixator group. The difference was not significant (p = 0.07). There were no significant differences between the groups with regard to the radiographic score and late complications. Patients treated with the Ilizarov ring fixator had significantly better ankle and subtalar movement. We conclude that both techniques of external fixation are satisfactory methods of treatment for fractures of the tibial plafond, but that the total arc of movement of the joint is preserved better without bridging the ankle. © 2004 British Editorial Society of Bone and Joint Surgery.
Assessment of quality of life of patients after hemiarthroplasty for proximal femoral fractures; [Femur üst uç kiriklari nedeniyle hemiartroplasti ile tedavi edilen hastalarda yaşam kalitesinin degerlendirilmesi.]
(2005) Vatansever A.; Oziç U.; Okcu G.
OBJECTIVES: The quality of life of patients was assessed with the SF-36 Health Survey following hemiarthroplasty for hip fractures. METHODS: Forty patients were divided into two groups according to the type of hip fracture. Group 1 included femoral neck fractures (24 patients; 21 women, 3 men; mean age 76 years; range 64 to 94 years) treated with straight stem prostheses. Group 2 included intertrochanteric femoral fractures (16 patients; 13 women, 3 men; mean age 81 years; range 62 to 102 years) treated with calcar replacement prostheses (Leinbach). The SF-36 questionnaire was administered before and at least six months after surgery to assess changes in the quality of life. The effect of gender, fracture type, and the type of prosthesis on the SF-36 scores were examined. RESULTS: In group 1, the mean preoperative and postoperative physical health scores were 53.4 and 41.7, the mean mental health scores were 55.2 and 48.5, respectively. The mean corresponding scores were 52.8 and 35.1 for physical health, and 55.2 and 48.9 for mental health in group 2, respectively. Significant decreases were found in physical health and mental health scores postoperatively (p<0.05), with all the patients having decreased quality of life compared to the preoperative levels. The highest decrease was observed in physical role (56.8%), followed by physical function (42.8%) and mental role (42.9%) scores. The least affected were mental health (10.3%) scores. Gender, fracture type, and the type of prosthesis were not found to have a significant effect on the summary scores (p>0.05). CONCLUSION: Health related quality of life significantly decreases following hemiarthroplasty in elderly patients with hip fractures. Nonetheless, arthroplasty procedures enable these patients to maintain basic activities of daily living.
Management of shotgun induced open fractures of the humerus with Ilizarov external fixator
(2005) Okcu G.; Aktuglu K.
BACKGROUND: Our aim was to evaluate the clinical efficacy of Ilizarov external fixator used for the management of shotgun induced open humeral fractures with special emphasize on neurovascular sequelae. METHODS: The authors retrospectively reviewed eleven shotgun induced open humeral fractures managed with emergent application of Ilizarov external fixator. No patient had associated neurovascular injury. All fractures were stabilized with Ilizarov external fixator immediately after meticulous debridement and irrigation under emergent conditions . RESULTS: With Ilizarov fixation technique complete bony union occurred in all patients within 14 to 44 weeks (average, 21 weeks) postoperatively.. One patient required a second intervention in order to adjust the external fixator rings. Two patients required a rotational fasciocutaneous flap so as to handle the soft tissue coverage problem. Superficial pin tract infection was present in eight patients, however in none of the patients deep tissue infection or osteomyelitis has been observed. Good to excellent results were achieved in 10 patients with Ilizarov fixation technique according to the rating system proposed by Smith and Cooney. CONCLUSION: Emergent Ilizarov external fixation is a safe method of obtaining a functional limb in the management of shotgun induced open humeral fractures with severe soft tissue damage.
Ganglion cysts of the proximal tibiofibular joint review of literature with three case reports
(2006) Vatansever A.; Bal E.; Okcu G.
Proximal tibiofibular ganglion is a rare disorder. It may settle down in the subcutaneous tissue or may develop along the peroneal muscles and nerve. Common clinical findings are various sizes of mass, pain and hypoesthesis due to compression neuropathy. We report three cases of proximal tibiofibular ganglion and review the literature about the diagnostic tools, recurrence rates and treatment modalities. © Springer-Verlag 2005.
Is it possible to decrease skin temperature with ice packs under casts and bandages?
(2006) Okcu G.; Yercan H.S.
Introduction: There is a general belief that the presence of a cast or a bandage eliminates the lowering effects of skin temperature when local cold therapy applied on the surface of the cast or bandage. The purpose of this study is to determine the magnitude of temperature changes at the skin of the ankle after the application of frozen ice packs to the surface of various casts and bandages both in normal and swollen ankles. Materials and methods: Thirty-two healthy subjects (Group A) and 12 patients with Grade III inversion type acute ankle sprain (Group B) were randomly divided into four groups. The sensor of the digital thermometer was secured to the ankle over the anterior talo-fibular ligament in every subject before placement of a bandage or cast. Robert Jones bandage, elastic support bandage, a below-knee plaster cast and synthetic below-knee cast were applied in groups 1, 2, 3 and 4, respectively. Two frozen ice packs were placed around the cast or bandage at the level of sensor, and skin temperatures were recorded. Results: The skin temperature under dressings and casts decreased significantly relative to the baseline temperatures with local cold therapy in all groups. The fall in the temperature with cryotherapy in group A showed a three-phase pattern of change between groups 1 and 2, groups 2 and 3 and groups 2 and 4 during the experiment. The fall in the skin temperature with ice packs differed significantly between groups 1 and 3, and also groups 1 and 4 from the beginning till the end of the experiment. There was no significant difference between groups 3 and 4 in terms of skin temperature fall with cryotherapy during the whole experiment. The results were similar in group B. Conclusion: A bandage or cast does not prevent measurable skin temperature lowering by frozen ice packs both in normal and swollen ankles. © Springer-Verlag 2006.
An unusual rotational injury: Pantibial ligamentous injury
(2006) Yercan H.S.; Okcu G.; Erkan S.; Ozic U.
Pantibial ligamentous injury including knee dislocation and tibiotalar joint subluxation is an uncommon severe rotational injury. A 21-year-old male injured his right knee falling from a motorcycle. Physical examination revealed effusion on the right knee and ankle, and posterior translation of the tibia as well. The MRI of the right knee and ankle demonstrated the following findings: a complete disruption of cruciate ligaments, the medial collateral ligament, posteromedial corner injury together with a peripheric tear in the medial meniscus, the ruptured deltoid ligament, ankle syndesmosis space widening (>5 mm) and lateral subluxation of talus. Deltoid ligament of the right ankle was repaired and ankle syndesmosis was fixed with a cortical screw. The PCL and ACL were reconstructed arthroscopically with autogeneous bone-patellar tendon-bone graft. The midsubstance tear of MCL, posteromedial corner and medial meniscus tear were primarily repaired with nonabsorbable sutures. 3 years after the surgery, the patient was called for the final examination. MRI and X-ray findings of the knee and ankle joint demonstrated the continuity of ACL, PCL, MCL, and deltoid ligament. The patient, who is a farmer, can go back to his job and perform his daily activities. We presented a previously unreported case that involves both simultaneous occurrence of knee dislocation and tibiotalar joint subluxation. We used the term "Pantibial ligamentous injury" for this case. © Springer-Verlag 2005.
Reconstruction of diabetic foot ulcers by lateral supramalleolar flap
(2007) Yercan H.S.; Ozalp T.; Okcu G.
Objectives: To report a series of 8 diabetic patients in whom the reconstruction of large-sized defect of the foot was performed using lateral supramalleolar flap. Methods: Coverage of the soft tissue defect was carried out by a lateral supramalleolar flap in 8 patients who had large-sized, non-healing ulcers at the Celal Bayar University, Department of Orthopedics and Traumatology, Manisa, Turkey, between 1998-2003. The mean age was 54 years. Preoperatively Doppler flowmeter evaluation was performed, and the ischemic index was calculated in all patients. Results: The flaps survived except for one patient who had a large defect on the heel with low ischemic index. The average healing time of the ulcer region and recovery of regular walking status was 34 days. The average healing period of the donor site was 35 days. After the average follow-up period of 40 months, neither infection nor a recurrence of the ulcer was encountered. The major problem of the donor area was skin graft breakdown and its non-aesthetic appearance due to hypertrophic granulation tissue. Conclusions: The lateral supramalleolar flap is a reliable option for the reconstruction of large-sized diabetic ulcers involving the dorsal aspect of the foot. This can also be used in conjunction with local muscle flaps, such as abductor hallucis for covering deep and large heel defects when the sural neurocutaneous flap is contraindicated.
A rare disorder: Idiopathic tumoral calcinosis
(2007) Ovali G.Y.; Tarhan S.; Serter S.; Bayindir P.; Okcu G.; Demireli P.; Pabuscu Y.
[No abstract available]
Synovial hemangiohamartomas of the knee joint
(2007) Yercan H.S.; Okcu G.; Erkan S.
Hemangioma or vascular malformation of the synovium is rare and presents a difficult problem in diagnosis and treatment. A long history of joint pain and recurrent non-traumatic hemarthrosis usually draws attention to the hemangioma of the knee joint. The lesion can be seen in two different formations; the synovial hemangioma or the arteriovenous malformation named as hemangiohamartomas, both of which involve the synovium and cause non-traumatic episodes of hemarthrosis. MRI scanning together with arthroscopy is a diagnostic tool to demonstrate the extent and the nature of the lesion. We treated the three patients at different ages. All patients underwent standard radiographic examination, CT scans, MRI and diagnostic arthroscopy. After frozen section taken via arthroscopically, the lesions were excised by arthrotomy. The mean follow-up was 38 months (31-45) and all patients are asymptomatic postoperatively. Three additional cases and a review of the literature are presented because of the rarity of the lesion. © Springer-Verlag 2006.
Midterm results of the Chiari pelvic ostetomy for acetabular dysplasia; [Asetabuler displazide Chiari pelvik osteotomisinin orta dönem sonuçlari]
(2008) Kapubaǧli A.; Okcu G.
Objectives: We evaluated the midterm clinical and radiographic results of the Chiari pelvic osteotomy in the treatment of acetabular dysplasia. Patients and methods: Forty-two hips of 36 patients (23 females, 13 males; mean age 17 years; range 12 to 42 years) were treated with the Chiaxi pelvic osteotomy for painful acetabular dysplasia. Six patients (16.7%) had bilateral surgery. Preoperatively, the mean duration of hip pain and/or limping was 34.6 months and 12 hips exhibited mild-to-moderate osteoarthrosis. Clinically, the patients were evaluated with the Harris hip score and correlations were sought between the hip scores and radiographic measurements. The mean follow-up was 88 months (range 48 to 164 months). Results: After exclusion of one hip that required total hip arthroplasty 12 years after osteotomy, the mean Harris hip score increased from 73±5 preoperatively to 89±6 at the last follow-up. Postoperatively, 35 hips (85.4%) exhibited slight or no pain. Clinical results were excellent in 20 hips (48.8%), good in 15 hips (36.6%), and fair in six hips (14.6%). Thirty patients (83.3%) were satisfied with the operation. No significant correlations were found between Harris hip scores and the percentage coverage of the femoral head, center-edge angle, and acetabular angle. However, the percentage medialization of the distal fragment (r=0.28, p=0.042), the level of osteotomy (r= -0.6, p<0.0001), the severity of preoperative osteoarthrosis (r= -0.85, p<0.0001), and age (r= -0.66, p<0.0001) were significantly correlated with the hip scores. Complications included superficial infection in two hips, injury to the lateral femoral cutaneous nerve in 10 hips, and delayed union in two hips. Conclusion: Our results suggest that the Chiari pelvic osteotomy provides a significant clinical improvement in patients with painful acetabular dysplasia.
Does timing matter in performing kyphoplasty ? Acute versus chronic compression fractures
(2009) Erkan S.; Özalp T.R.; Yercan H.S.; Okcu G.
The objective of this prospective consecutive cohort study was to compare the clinical outcomes, the radiographic outcomes and the complication rates of symptomatic acute (< 10 weeks) and chronic (> 16 weeks) osteoporotic vertebral compression fractures (VCFs) treated with kyphoplasty. Twenty-eight consecutive patients had 52 symptomatic osteoporotic VCFs treated with kyphoplasty ; 5 of these patients were treated in two sessions. The Oswestry Disability Index (ODI) for back pain, a Visual Analog Scale for pain assessment, a patients' satisfaction scale, and medication usage served to evaluate the clinical outcomes. All these variables improved significantly in both groups, and more so in the acute group, but the difference was most often not significant. Vertebral height, local kyphosis angle, global sagittal alignment and dynamic fracture mobility significantly improved in both groups (except global sagittal alignment), and again more so in the acute group (except global sagittal alignment); the difference between groups was significant regarding radiological variables, except global sagittal alignment. Timing of kyphoplasty certainly matters, as the clinical and radiological outcomes were mostly better in acute fractures than in chronic fractures, which somehow responded satisfactorily. Controlled studies (kyphoplasty versus natural history) are needed to establish the real value of the procedure. © 2009, Acta Orthopædica Belgica.
Treatment options for radial neck fractures in children
(2009) Okcu G.
Fractures of the neck of the radius in children are an unsolved and difficult problem. It is a comparatively rare injury and constitutes 5-10% of all elbow fractures. Its prognosis has been considered to be relatively good by many. On the other hand, these fractures remain a source of considerable controversy and have many possible complications that are usually hazardous for the elbow function. The complex anatomy of the elbow and its vascular blood supply makes treatment challenging. The radial head and its blood supply can be damaged by the original trauma and/or by surgical trauma, such as open reduction or forceful manipulations. The choice of treatment is determined by the degree of radial head angulation, which also affects the long-term results. Severe angulation and translation increases the risk of complications, mainly malunion, avascular necrosis of the head, cubitus valgus and stiffness of the joint. Conservative treatment is usually successful for the nondisplaced and minimally displaced fractures. Many studies have postulated that fractures with moderate or severe angulation require reduction. Several methods have been described for fracture reduction, but they are not without complications. In January 1980, Metaizeau proposed intramedullary nailing as a surgical option for the treatment of radial neck fractures. The main advantage of intramedullary nailing is that it simultaneously allows accurate and stable reduction without disturbing the blood supply. © 2009 Future Medicine Ltd.
The influence of sagittal cervical profile, gender and age on the thoracic kyphosis
(2010) Erkan S.; Yercan H.S.; Okcu G.; Özalp R.T.
The objective of this prospective consecutive cohort study was to investigate the effect of sagittal cervical profile, gender and age on the thoracic kyphosis in 228 subjects, mainly adults, free of spinal complaints and with a thoracic kyphosis of less than 50°. The subjects, who were actually treated for lower extremity problems, were divided into two groups : the 68 subjects in group 1 (30%) had loss of cervical lordosis, while the 160 subjects in group 2 (70%) had a physiological cervical lordosis. In group 1 (loss of cervical lordosis) the mean angles of the upper (T1T6), lower (T7T12), and whole (T1T12) thoracic kyphosis were 8° ± 2 (range : 3-28°), 15° ± 4 (range : 6-40°), and 24° ± 6 (range : 10-46°), respectively. In group 2 the normal cervical lordosis seemed to lead to a compensatory increase in these values : 13° ±4 (range, 4-35°) (p = 0.008), 21° ± 5 (range : 6-45°) (p = 0.012), and 34°±8 (range: 12-50°) (p = 0.007). In both groups gender had no significant effect on the values of the thoracic kyphosis (p>0.05). Also age had no influence, neither in group 1 nor in group 2 as a whole, but in group 2 advanced age (> 50 years) was correlated with a significant increase in the lower (T7T12) (p = 0.009) and whole (T1T12) thoracic kyphosis (p = 0.007). This study yields standards for reference for the normal curvatures of the spine in the sagittal plane. The literature is quite controversial on this matter. © 2010, Acta Orthopsdica Belgica.
A novel technique for reconstruction of the medial patellofemoral ligament in skeletally immature patients
(2011) Yercan H.S.; Erkan S.; Okcu G.; Özalp R.T.
Habitual or recurrent dislocation of the patella in the skeletally immature patient is a particularly demanding problem since the etiology is frequently multifactorial. The surgical techniques successfully performed in adults with patellar instability may risk injury to an open growth plate if applied to children. We present a technique that preserves femoral and patellar insertion anatomy of medial patellofemoral ligament (MPFL) using a free semitendinosus autograft together with tenodesis to the adductor magnus tendon without damaging open physis on the patellar attachment of MPFL. A 3-cm long longitudinal skin incision is performed 10 mm distal to the tibial tuberosity on the anteromedial side. The semitendinosus tendon is harvested with the stripper. The semitendinosus tendon is placed on a preparation board and cleaned of muscle tissue. The usable part of the tendon should be at least 20 cm long and 4 mm wide. The two free ends of the graft are sutured with Krakow technique. A medial longitudinal incision 2 cm in length is made to expose the MPFL and to abrade the patellar attachment of vastus medialis obliquus. The first patellar tunnel is created with 4.5 mm drill at the mid aspect of the medial patella in the anteroposterior and proximal-distal direction. The drill hole is formed parallel to the articular surface of the center of the patella. The second tunnel is created with 3.2 mm drill and the entry point is localized at the center of the patella. These two tunnels intersect to form a single tunnel. The semitendinosus autograft is run through the bone tunnel in the patella. Double-stranded semitendinosus autograft is placed in the presynovial fatty plane between the second and the third layer of the medial retinaculum, and tenodesis to adductor magnus tendon is applied by a moderate medial force with the knee flexed at 30°. Aftercare includes immobilization of the joint limited to 30° flexion using an above-knee splint for 2 weeks. No recurrent dislocation was observed in three patients (4 knees) at a mean follow-up time of 17.7 months. Both range of motion and radiological finding were restored to normal limits. © 2011 Springer-Verlag.
Factors causing stiff knee after total knee arthroplasty; [Total diz artroplastisi sonrası diz sertliǧine neden olan faktörler]
(Turkish Joint Diseases Foundation, 2011) Erkan S.; Yercan H.S.; Okcu G.; Özalp R.T.
Objectives: In this study, the factors causing stiff knee after primary total knee arthroplasty (TKA) in patients with medial compartment osteoarthrosis were evaluated. Patients and methods: Primary TKA surgery was performed in fifty-three knees in 48 patients (42 females, 6 males; mean age 67.2±8.5; range 59 to 76 years) diagnosed with medial compartment osteoarthrosis. Five patients (10%) out of fortyeight underwent bilateral primary TKA. In the patients who had bilateral TKA, the second operation was performed six months later. Patello-femoral arthroplasty was performed in none of the patients. In the final follow-up, the knees, which had more than 10° of extension limitation and less than 95° of flexion, were defined as post-TKA stiff knee. The patients who developed stiff knee were classified as group 1 and the patients who did not develop stiff knee were classified as group 2. The possible factors that may cause stiff knee after TKA such as age, gender, range of knee flexion and extension, flexion arc, tibiofemoral angle, tibial slope angle, the change in the height of the joint line, the length of the patellar tendon, the change in the American Knee Society scores, body mass index, and the sizes and positions of the components were evaluated and compared pre- and postoperatively within and between both groups. Results: Stiff knee was found in eight knees of six patients (16%) after TKA. In group 1, the mean extension range was 14.9°±4.6° and the mean flexion range was 82.6°±7.4°. In group 1, among the factors that may cause knee stiffness; preoperative flexion range and American Knee Society scores were found to be significant (p=0.028 and p=0.036, respectively). The American Knee Society scores were observed to be significantly lower in group 1 when compared to group 2 postoperatively (p=0.018). Conclusion: If the preoperative flexion range is limited and the American Knee Society scores are low, then the stiff knee is more likely to occur in patients who will undergo TKA. Age, gender, tibiofemoral angle, tibial slope angle, the change in the height of the joint line, the length of the patellar tendon, and the sizes and positions of the components have no significant effect on the development of stiff knee after TKA.

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