Three-dimentional reposition of tibial tubercle and surgical procedure of permanent dislocation of the patella

Four knees of 3 patients were treated with medial patellofemoral ligament (MPFL) reconstruction and Fulkerson osteotomy for the dislocation of the permanent patella. Perioperative flexion limitation was treated with tibial tubercle elevation. In this study, we evaluated newly applied patella height and range of motion (ROM). Four knees of 3 patients (2 females and 1 male) underwent surgery. The mean age was 24.6 years (between 17 and 30 years). The mean follow-up period was 35 months (between 30 and 40 months). Mean preoperative ROM, mean perioperative ROM before tubercle elevation and mean postoperative ROM after tubercle elevation were 126 degrees (between 125 and 130 degrees), 71 degrees (between 60 and 80 degrees), and 131 degrees (between 130 and 135 degrees), respectively. Mean Lysholm score increased from 66 to 100. Tibial tubercle transfer/osteotomy and medial patellofemoral reconstruction are good treatment options for the dislocation of the permanent patella. In addition, during the recentering of the patella located in the outer part of the trochlea or rarely of the lateral condyle, the flexion can be restricted depending on the shortness of the extensor mechanisms. In our study, we elevated the tibial tubercle, and patella height remained within physiological limits. We believe tubercle elevation is a convenient solution for the flexion limitation that occurs during the reconstruction of the dislocation of the patella. [Med-Science 2023; 12(3.000): 753-7

Intra-Articular Polyacrylamide Hydrogel Injections Are Not Innocent

Osteoarthritis is a chronic disorder characterized by joint cartilage degeneration with concomitant changes in the synovium and subchondral bone metabolism. Many conservative treatment modalities, one of which is intra-articular injections, have been described for the treatment of this disorder. Traditionally, hyaluranic acid and corticosteroids are the agents that have been used for this purpose. Recently, polyacrylamide hydrogels are being used widely. Biocompatibility, nonbioabsorbability, and anti-infectious effect obtained by silver addition made polyacrylamide hydrogels more popular. In this paper, we present a case and the method of our management, in whom host tissue reaction (foreign body granuloma, edema, inflammation, and redness induration) has been observed, as the first and unique adverse effect reported in the literature

Treatment of thoracic disc herniations with posterior transforaminal thoracic interbody fusion

Giriş: Torakal disk hernileri (TDH)'nin tedavisi servikal ve lomber disk hernilerine oranla daha az görülmelerine bağlı olarak hala tartışmalıdır. Bu retrospektif çalışmanın amacı TDH nedeni ile posterior transforaminal torasik interbody füzyon (TTIF) ve diskektomi ile birlikte posterior enstrümantasyon ve füzyon yapılan hastaların sonuçlarını açıklamaktır.Metot: TDH'ne bağlı kronik ağrı şikayeti nedeni ile TTIF yöntemiyle tedavisi yapılan ve en az 1 yıllık takibi olan 10 hasta çalışmaya dâhil edildi. 10 hastadan bir tanesinde iki seviyeli TDH mevcuttu. Diskler santral ve parasantral olarak sınıflandırıldı. Cerrahi sırasındaki ortalama yaş 53.5 yıl, ortalama takip süresi 32.6 ay olarak kaydedildi. Pre- ve postoperatif ağrı durumu Visual Analog Score (VAS) sistemine göre değerlendirildi. Serimizdeki tüm hastalarda sonuçlar ve komplikasyonlar retrospektif olarak kaydedildi. Füzyon durumu düz grafi ve bilgisayarlı tomografi kullanılarak değerlendirildi. Sonuçlar: Tüm hastalarda takip süresinin sonunda radyolojik olarak füzyon elde edildi. Hiçbir hastada enstrüman yetmezliği saptanmadı. Ortalama VAS skoru preoperatif 7.4, postoperatif 1.9 olarak saptandı. Bir hastada postoperatif yara yeri enfeksiyonu gelişti ve cerrahi debridman ile tamamen iyileşti. Çıkarım: Transforaminal torasik interbody füzyon ve segmental enstrümantasyon eşzamanlı dekompresyon ve stabilizasyonu temin eden ve tüm TDH tiplerinde uygulanabilen efektif bir metottur.Introduction: Treatment of thoracic disc herniations (TDH) remains controversial due to its lower incidence than herniations in the cervical or lumbar spine. The objectives of this retrospective study are to demonstrate the surgical outcomes of the patients with TDH undergoing posterior transforaminal thoracic interbody fusion (TTIF) and discectomy with posterior instrumentation and fusion.Materials and methods: We enrolled 10 patients who underwent TTIF for chronic pain due to TDH and were followed for at least 1 year. Of the 10 patients, one had TDHs at two levels. Discs were classified as central or paracentral. The mean age at surgery was 53.5 years and the average period of follow up was 32.6 months. The pre- and postoperative pain status was evaluated according to the Visual Analog Score (VAS). Outcomes and complications were retrospectively assessed in this patient series. Status of fusion was evaluated using plain radiographs and computed tomography.Results: None of the patients with follow-up showed any signs of instrument migration or failure, and each went on to radiographic fusion. Average pre- and postoperative VAS scores were 7.4 and 1.9 points. One patient developed postoperative wound infection requiring additional operative debridement. Conclusions: A transforaminal thoracic interbody fusion combined with segmental fusion offers a means of achieving concurrent decompression and segmental stabilization and is an option for certain subtypes of TDH

Massive Retracted Irreparable Rotator Cuff Tears: What Is the Effect of Conservative Therapy?

Introduction: Massive, irreparable, retracted cuff tears, without surgical intervention need to be treated with conservative therapy. In this study we aimed to determine the efficacy of conservative treatment in such tears. Material and Methods: We retrospectively reviewed 33 patients with massive rotator cuff tears treated nonoperatively. Data were obtained from direct examination, medical records, plain radiographs, and magnetic resonance imaging (MRI). Radiographic classification has been made by plain AP views. The fatty muscle degeneration and the stage of retraction of the cuff were evaluated with MRI. Rehabilitation program was given to all patients. Results: The mean age at the initial examination was 71 (range, 50-84) years. The mean follow-up time was 5.5 (range, 2-10) years. Patients with Grade 3-5 tears and Stage III retractions had a higher incidence of fatty muscle degeneration of the subscapularis muscle. Deltoid muscle strength was found to be increased significantly at the latest follow-up. Conclusion: Exercise therapy should be kept in mind as a kind of rehabilitation method in patients with a symptomatic massive rotator cuff tear. It's essential that more randomised clinical investigations have to be conducted to find out the best management practice for this condition