Do aggrecanase enzymes and adamts genes take part in hip osteoarthritis etiology?

Osteoartrit en sık görülen eklem dejeneratif ekle hastalığı olup sıklığı yaşla birlikte artan, eklem kıkırdağında erozyon, eklem kenarlarında osteofit, subkondral skleroz, sinoviyal membran ve eklem kapsülünde biyokimyasal ve morfolojik değişikliklerle karakterize dejeneratif bir eklem hastalığıdır. Osteoartrit etyolojisinde genetik, inflamatuar, metabolik ve travmatik faktörler suçlanmasına karşın tam olarak açıklığa kavuşturulamamıştır. 1997 yılında Agrekanazların keşfi ve ADAMTS genlerinin agrekanı parçalayan enzimler olarak tespit edilmesinden beri osteoartritle etyolojisindeki rolleri gerek hayvan çalışmaları gerekse insan çalışmaları ile kanıtlanmaya çalışılmıştır. Osteoartritte; ADAMTS1, 4, 5, 8, 9 ve 15 genleri suçlanmış ancak literatürde ADAMTS 4 ve 5'in en aktif Agrekanazlar olduğunu gösteren yayınlar vardır. Son yıllarda ADAMT4, ADAMTS5 dışında ADAMTS9 öne çıkan agrekanaz enzimlerindendir. Literatürde hem hayvan çalışmaları hem de klinik insan çalışmaları olmasına rağmen hangi agrekanazların öne çıktığını gösteren prospektif, kontrollü çalışma yoktur. Farklı evrelerde osteoartrit gelişen hastalardan alınan örneklerde enzim analizi yapılmış ancak osteoartrit bulunmayan hastalarla olanları karşılaştıran çalışma bulunmamaktadır. Bu çalışmadaki amacımız, cerrahi tedavi gerektirecek, son evre osteoartrit gelişen hastaların kıkırdaklarındaki protein ile agrekanaz enzim ölçümü ve kan örneklerindeki DNA polimorfizm ve RNA gen ekspresyonu analiz sonuçlarını kontrol grubu ile karşılaştırarak patogenezdeki rollerini göstermektir. Araştırma kapsamında, 15 tane kalça ekleminde osteoartrit gelişen, cerrahi tedavi gerektiren ve total kalça protezi uygulanan hasta ile 15 tane femur boyun kırığı gelişen, osteoartrit bulguları olmayan ve parsiyel kalça protezi uygulanan hastaların ameliyat sırasında alınan ve rezeke edildikten sonra çöpe atılan materyallerden doku örnekleri alınmıştır. Rezeksiyon materyallerinden kıkırdak örnekleri alındıktan sonra soğuk zincir kurallarına uygun olarak nakledip -80°C'de saklanarak Western blot yöntemi ile kıkırdaktan protein analizi, serumda ELISA yöntemi ile agrekanaz enzim ölçümü, kan örneklerinde PCR ile DNA'da polimorfizm ölçümü yapılmıştır. Sonuç olarak; ADAMTS genlerinini osteoartrit gelişiminde rolü olduğu ve ADAMTS-5'in kalça osteoartriti gelişiminde esas soumlu olan ADAMTS geni olduğu sonuçlarına vardık. Bu hastalığın patofizyolojisinde rol oynayan bu preoteolitik enzimlerin rollerinin tam olarak açıklığa kavuşturulması tedaviye yönelik yeni stratejilerin geliştirilmesine olanak sağlayacaktır. Enzim veya proteoliz sonucu oluşan ürünlerin tespiti erken tanı imkanı sağlayabilir. Patogenezdeki rolü ispatlanacak enzimlerin inhibitörlerinin geliştirilmesi sonucunda cerrahi tedaviye gereksinimin azalmasına ve yeni ilaç gelişimi ile medikal tedavi olanağı sağlayacağından etyolojisininin aydınlatılması hedeflenmektedir.Osteoarthritis is a degenerative joint disease which frequency increasing with age characterized by erosion of the articular cartilage, osteophytes at the edges of the joint, subchondral sclerosis, biochemical and morphological changes in the synovial membrane and joint capsule. Osteoarthritis is the most common degenerative joint disease. In 1991, John Sandy reported enzyme cutting site first time in the interglobuler domain of aggrecan. But this enzyme did not discovered at that time. These newly identified enzymes play an important function in the turnover of extracellular matrix proteins in various tissues and their dysregulation has been implicated in diseases such as cancer, arthritis, diabetes and atherosclerosis. 19 members of ADAMTS have been cloned, including ADAMTS1 to ADAMTS20 and 6 ADAMTS enzymes called group of aggrecanases (ADAMTS1, 4, 5, 8, 9, 15) with activity against aggrecan. Except ADAMTS4 and ADAMTS5, ADAMTS9 is a another aggrecanase may be new candidate for this question's answer. In both animal and human studies in the literature, although there are no prospective, controlled study, which indicating come forward in aggrecanase. The specimens taken from patients with different stages of osteoarthritis of the enzyme were analyzed, but those studies that compared with patients without osteoarthritis is not available. The aim of this project; will require surgical treatment, patients with end-stage osteoarthritis is their role in the pathogenesis show that testing enzyme aggrecanase with the protein in cartilage, and blood sample with the protein and RNA in gene expression analysis, DNA polymorphism results by comparing with the control group. Within this study, tissue samples will be taken resected during surgery after received and trashed materials of 15 patients developing osteoarthritis in the hip joint, 15 patients requiring surgery and who underwent total hip arthroplasty femoral neck fractured, without signs of osteoarthritis and patients who underwent partial hip replacement. After cartilage samples were taken from resection materials, will be transferred according to the rules of cold chain and will be stored at -80 ° C and will be tested the Western blot analysis of protein from cartilage and will be tested the aggrecanase enzymes in serum with ELISA and will be tested the polymorphisms in DNA by PCR in blood samples. As a result; we have to concludes that ADAMTS genes play a role in the development of hip osteoarthritis and ADAMTS-5 gene primarily responsible for the development of the hip osteoarthritis. Clarifiyng the exact role of proteolytic enzymes which involved iin the patophysiology of this disease will allow development of new treatment strategies. Proteolysis enzyme or detection of resulting products can arrange early diagnosis. To prove its role in the pathogenesis of the development of inhibitors of enzymes as a result of a reduction in the need for surgical treatment and medical treatment will provide an opportunity to clarify the etiologic aim

Short-Term Results of Patients Undergoing Arthroscopic Subacromial Decompression and Acromioplasty

Aim: The aim of this study is to evaluate the arthroscopic surgery results of cases with isolated subacromialimpingement syndrome (SIS) that do not respond to conservative treatment.Material and Methods: 44 patients who had arthroscopic subacromial decompression and acromiplasty due to SISbetween 2015 and 2018, were retrospectively analyzed. Patients with isolated subacromial impingement syndrome whodid not respond to conservative treatment including drugs, physiotherapy, exercises and subacromial steroid injectionswere included. For the patients, preoperative and postoperative The American Shoulder and Elbow Surgeons Shoulder(ASES) Scores were measured.Results: Forty-four patients with a mean follow-up of 26.4 months (ranging from 24 to 35 months; SD: 7.3) and a meanage of 51.4 (ranging from 39 to 55; SD: 6.96) were reached. Thirty (68%) of the patients were female and fourteen(32%) were male. There were no significant differences between groups according to the age, sex, and follow-up time(p>0.50). There were type 3 acromion in total of 7 patients and type 2 acromion in 18 patients. The overall meanpreperative ASES score was 38.8 (ranging from 36.6 to 41.8). And, the mean postoperaive ASES score was 84.9(ranging from 76.2 to 88.3).Conclusion: The short-term clinical results of subacromial decompression and acromioplasty in patients who do notrespond to conservative treatment has successfull results that support literature knowledge

Clinical and functional outcomes of a novel transosseous device to treat rotator cuff tears: A minimum 2-year follow-up

karaduman, zekeriya okan/0000-0002-6719-3666; turhan, yalcin/0000-0002-1440-9566WOS: 000486499500001PubMed: 31530075Purpose: Despite the improvements in the repair equipment techniques of rotator cuff, a gold standard method has not been defined yet and transosseous fixation through deltoid-splitting (mini-open) approach is still regarded as a good option. The primary purpose of this study is to present satisfactory clinical and functional outcomes with a novel transosseous device in full-thickness rotator cuff tear through deltoid-splitting. Materials and Methods: This retrospective study was performed on 70 consecutive patients who underwent surgery by a single surgeon from June 2014 to June 2016 for a full-thickness rotator cuff tear and was managed with a novel transosseous device. Total number of patients, mean age, percentage of male and female patients, mean duration of follow-up, percentage of involvement of the dominant extremity, affected shoulder, and tear size were recorded. Functional and clinical outcomes were assessed baseline and postoperatively at 3 and 6 months and final follow-up using Disabilities of the Arm, Shoulder and Hand (Q-DASH) and Constant-Murley scores. Results: A total of 70 (49 (70%) female, 21 (30%) male) patients whose mean age was 58.66 +/- 9.19 (38-77) years were included. The mean surgery time was 35.33 +/- 5.34 (28-55) min. The mean follow-up time was 28.31 +/- 3.03 (24-36) months. According to the DeOrio and Cofield classification, 15 (21.43%) tears were small, 33 (47.14%) medium, 16 (22.86%) large, and 6 (8.57%) massive. By the final follow-up, the mean Constant-Murley score had significantly improved from 27.67 +/- 7.46 (13-41) to 81.25 +/- 3.77 (74-87; p = 0.0001) and the Q-DASH score had decreased from 82.34 +/- 10.37 (65.91-100) to 10.28 +/- 6.88 (0-23.45; p = 0.0001). There were no significant differences in the Constant-Murley or Q-DASH score at baseline-final follow-up between the small, medium, large, and massive tear groups (p > 0.05). Conclusions: Treatment of full-thickness rotator cuff tear using this novel transosseous device significantly improved functional and clinical scores. However, further long-term prospective randomized multicenter trials involving comparative studies are necessary to confirm these findings

Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios.

This study aims to assess the mortality and morbidity rates of patients with intertrochanteric femoral fractures who were performed proximal femoral nail-antirotation (PFNA) or cemented, bipolar hemiarthroplasty with calcar replacement

Multiple cervical spinous process fracture (clay shoveler fracture): Case report

Clay-Shoveler’s is fracture of one or more spinous processes to include lower cervical or upper thoracic vertebrae. In this article, it was aimed to investigate possible mechanisms of Clay-Shoveler’s fracture and share radiological results of q case of 11 years (2003) follow-up after the traffic accident. A 25-year-old male patient complained of neck pain spreading to both shoulders, andthere was an in-car traffic accident two weeks ago. Patient’s motion restriction was 50% for active flexion, lateral flexion and rotation, and 20% for active extension movement. Imaging revealed a minimal inferior displaced avulsion fracture in C6, C7 and T1 vertebra spinous processes. Patient returned to daily activities in 3rd month after immobilization with medical treatment and neck collar.Clay-Shoveler’s fracture is most commonly seen in T1, then C7, T2, T3 and C6. Surgical treatment is not planned because patient has no limitation of neck movements and neck pain which responds to medical treatment

Semptomatik akromioklaviküler eklem dejenerasyonuna eşlik eden eklem içi patolojiler yaş gruplarına göre farklılık gösterir mi?

WOS:000462121500002PubMed ID: 30885102Objectives: This study aims to evaluate the accompanying intraarticular pathologies in patients who underwent arthroscopic distal clavicle resection (DCR) for symptomatic acromioclavicular (AC) joint degeneration based on age groups and to reveal which additional pathologies should be considered across different age groups during physical examination of patients suspected of AC joint degeneration. Patients and methods: The study included 156 patients (55 males, 101 females; mean age 57.210.0 years; range, 35 to 80 years) who underwent arthroscopic DCR between January 2006 and December 2017 and had at least one clinical positive test for AC joint degeneration during the preoperative physical examination. The patients were divided into three groups as those aged 50 years (group 1), between 50-65 years (group 2), and 65 years (group 3). The concomitant intra-articular pathologies were evaluated across different age groups and compared between the groups. Results: Concomitant intra-articular pathologies were detected in 117 (75%) of a total of 156 patients. Additional pathology rate increased with increasing age (p0.002). More than one concomitant intraarticular pathologies were detected in 37 patients (23.7%). This rate increased with increasing age (p0.002). The number of patients with superior labrum anterior posterior (SLAP) lesion as the only additional pathology was 33 (21.2%). This rate decreased with increasing age (p0.015). In group 1, the rate of concomitant SLAP lesion was 44.1%. Conclusion: The high incidence of intra-articular pathologies accompanying symptomatic AC joint degeneration raises the importance of careful physical examination, detailed imaging, and arthroscopic surgery to obtain good results in patients scheduled for DCR. The frequency of AC joint degeneration and concomitant SLAP lesions, particularly in younger patients, should be considered during clinical examinations.Amaç: Bu çalışmada semptomatik akromioklaviküler (AK) eklem dejenerasyonu için artroskopik distal klavikula rezeksiyonu (DKR) uygulanan hastalarda eşlik eden eklem içi patolojiler yaş gruplarına göre değerlendirildi ve AK eklem dejenerasyonundan şüphelenilen hastalarda fizik muayene sırasında farklı yaş gruplarında hangi ek patolojilerin düşünülmesi gerektiği ortaya koyuldu. Hastalar ve yöntemler: Çalışmaya Ocak 2006 - Aralık 2017 tarihleri arasında artroskopik DKR uygulanan ve ameliyat öncesi fizik muayenesinde AK eklem dejenerasyonu ile ilişkili en az bir klinik testi pozitif olan 156 hasta (55 erkek, 101 kadın; ort. yaş 57.210.0 yıl; dağılım, 35-80 yıl) dahil edildi. Hastalar 50 yaş (grup 1), 50-65 yaş arası (grup 2) ve 65 yaş (grup 3) olmak üzere üç gruba ayrıldı. Eşlik eden eklem içi patolojiler farklı yaş gruplarına göre değerlendirildi ve gruplar arasında karşılaştırıldı. Bulgular: Toplam 156 hastanın 117’sinde (%75) eşlik eden eklem içi patoloji saptandı. Yaş arttıkça ek patoloji oranı arttı (p0.002). Otuz yedi hastada (%23.7) birden fazla eşlik eden eklem içi patoloji saptandı. Bu oran yaş arttıkça arttı (p0.002). Ek patoloji olarak sadece superior labrum anterior posterior (SLAP) lezyonu olan hasta sayısı 33 (%21.2) idi. Bu oran yaş arttıkça azaldı (p0.015). Grup 1’de, eşlik eden SLAP lezyonu oranı %44.1 idi.Sonuç: Semptomatik AK eklem dejenerasyonuna eşlik eden eklem içi patolojilerin yüksek ortaya çıkış sıklığı, DKR planlanan hastalarda iyi sonuçlar alınması için dikkatli fizik muayene, detaylı görüntüleme ve artroskopik cerrahinin önemini artırmaktadır. Akromioklaviküler eklem dejenerasyonu ve eşlik eden SLAP lezyonlarının sıklığı özellikle daha genç hastalarda klinik muayeneler sırasında akılda tutulmalıdır

The effect of patient position to dexa measurement

Aim: The aim was to compare and contrast the lumbal area DEXA measurements made in lateral and front-back positions in theclinically diagnosed female patients with osteoporosis.Material and methods: From the female patients that were referred to our clinic due to low energy fractures that occurred in areasother than the vertabrae, whom were thought to have osteoporotic fractures, were postmenaposal with no known history of diseases, and medication that can lead to osteoporosis and fracture, with no known previous diagnosis of osteoporosis, 39 patients have been included in the study. Anteroposterior and lateral standart lumbar DEXA measurements were performed on all patientsResults: The results of our study revealed that the the laterally performed lumbar Dual Energy X-ray Absorbsiometer (DEXA)measurements have diagnostic advantage in osteoporosis over anteroposteriorly performed measurements . The antiosteoporotic treatment would have beeen prescribed to 82% of the patients if the anteroposteriorly performed lumbar region Dual Energy X-ray Absorbsiometer (DEXA) measurements were taken into account, while when laterally performed measurements were taken into account the percentage was 97.5%.Conclusion: If lateral lumbar area Dual Energy X-ray Absorbsiometer (DEXA) measurements are used in diagnosing osteoporosismore patients would receive the required treatment and the risk of the osteoporotic low energy fractures could be lowered

Relationship between coracoid overlap and subscapularis tears

Amaç: Bu çalışmanın amacı izole subskapularis yırtıklarında etiyolojik bir faktör olan subkorakoid sıkışmada korakoid taşmanın bir risk faktörü olarak geçerliliğini araştırmaktır.Gereç ve Yöntem: Omuz artroskopisi uygulanan hastalardan izole subskapularis ve izole tam kat supraspinatus yırtıklı hastalar randomize olarak seçilerek iki grup oluşturuldu. Manyetik rezonans görüntüleme ve ameliyat videoları retrospektif olarak tekrar incelenerek T1 aksiyel manyetik rezonans görüntüleme kesitlerinde korakoid taşma miktarı ve korakoid taşma/humerus başı çapı oranı hesaplandı ve ortalamaları karşılaştırıldı.Bulgular: Çalışmada her iki grupta 28’er hasta olmak üzere toplam 56 hasta vardı. Hastaların yaş ortalamaları Grup 1 ve 2’de sırasıyla 48.719.66 ve 64.856.1 olarak bulundu. Cinsiyet ve ameliyat olan taraf bakımından fark yoktu. Ortalama korakoid taşma değerleri Grup 1 ve 2’de sırasıyla 16.085.6 ve 14.655.92, korakoid taşma/humerus başı çapı oranı ise 0.330.11 ve 0.290.11 bulundu. Ortalama korakoid taşma ve korakoid taşma/humerus başı çapı değerleri bakımından iki grup arasında anlamlı fark saptanmadı.Sonuç: Korakoid taşma ile subkorakoid sıkışma arasında istatistiksel olarak gerçek anlamda bir ilişki yoktur. Subskapularis yırtıklarında varlığı hala tartışmalı olan subkorakoid sıkışmaya bu çalışma ile de kanıt bulunamamıştır.Purpose: The aim of this study was to investigate the validity of the coracoid overlap as a risk factor of the subcoracoid impingement which is an etiologic factor in isolated subscapularis tears.Materials and Methods: Two groups were constituted including isolated subscapularis and isolated full-thickness supraspinatus tears selected randomly from patients who underwent shoulder arthroscopy. The magnetic resonance imaging and surgery videos were reviewed retrospectively to calculate and compare the means of the coracoid overlap and coracoid overlap/humeral head diameter ratio measured on T1 transverse magnetic resonance imaging sections.Results: There were a total of 56 patients including 28 in each group. The mean age of the groups were found to be 48.719.66 and 64.856.1 in Group 1 and 2, respectively. There was no significant difference in terms of age and involved shoulder. The mean coracoid overlap values were found to be 16.085.6 and 14.655.92 and coracoid overlap/humeral head diameter ratios were found to be 0.330.11 and 0.290.11 in Groups 1 and 2, respectively. There was no significant difference in terms of coracoid overlap values and coracoid overlap/humeral head diameter ratiosConclusion: There is actually no statistically significant relationship between coracoid overlap and subcoracoid impingement. There could be found no evidence also with this study for subcoracoid impingement which is still controversial in subscapularis tears

Do partial rotator cuff tears cause humeral migration?

Aim: This study aims to analyze the effect of symptomatic partial and full-thickness rotator cuff tears on humeral migration. The hypothesis of the study was that superior humeral migration varies according to the type of rotator cuff tear. Methods: 80 patients who underwent arthroscopic repair between 2017 and 2021 were retrospectively evaluated. Humerus migration directions and distances of patients in the isolated Bankart lesion (Group 1), bursal-side partial (Group 2), articular-side partial (Group 3), and full-thickness rotator cuff tear (Group 4) groups whose diagnosis was confirmed by shoulder arthroscopic intervention MRI were recorded and evaluated. Results: There was no significant difference between the groups according to age (p=0.295). Migration distance values of isolated Bankart lesions (Group 1) were significantly lower in men (p<0.005). While superior migration rates were significantly increased in full-thickness tears, they were similar in partial tears (p<0.005). The mean migration distance was similar between groups (p=0.153). Conclusion: Symptomatic full-thickness rotator cuff tears lead to humeral migration. Superior humeral migration was not found to be significant in partial rotator cuff tears, regardless of bursal or articular