Aim: Total knee arthroplasty (TKA) is one of the most successful orthopedic surgeries. To further improve these outcomes, researchers have developed various types of prosthetics. This study aims to compare the clinical and radiological results of the common posterior cruciate ligament (PCL)-retaining (CR) and PCL-stabilized (PS) knee arthroplasties.

Material and Methods: We retrospectively evaluated the data of patients that were diagnosed with gonarthrosis in our clinic and who underwent knee replacement. The patients were evaluated using the American Knee Society score (AKSS) and radiographic assessment.

Results: There were a total of 115 subjects. Fifty-nine knees of 54 patients and 80 knees of 61 patients were included in the study. Forty-six of the 54 patients in the ligament-retaining group were female (86%) and 8 were male (14%). Fifty-two of the 61 patients in the ligament-stabilized group were female (85%) and 8 were male (15%).

The mean age was 67.4 years (54-82) in the ligament-retaining group and 65.4 years (42-85) in the ligament-stabilized group. The mean follow-up time in both groups was 32.6 months (12-98).

Discussion: The comparison of PCL-retaining and PCL-stabilized knee arthroplasties revealed that the ligament-stabilized group was superior in terms of the range of motion. The radiological examination revealed a difference in component alignment. The two groups did not differ significantly regarding other parameters.

Aim: This study aimed to determine the validity of the relationship between primary knee osteoarthritis and the ABO blood group system in the Turkish population and whether ABO group system could be a risk factor for early-onset knee osteoarthritis or revision surgery.

Material and Methods: A retrospective examination of the data of 2752 patients who underwent knee arthroplasty surgery in our clinic between 2011 and 2019 was carried out. A total of 2436 primary knee osteoarthritis (PKO) patients underwent total knee arthroplasty (TKA) surgery and 206 patients underwent revision knee arthroplasty (RKA). A control group was formed of 22350 individuals aged >40 years from the same geographical region. The frequency of the ABO subgroups (A, B, O, AB) was compared between the primary knee osteoarthritis group and the control group. In addition, ABO subgroups (A, B, O, AB) were determined in the group of patients aged <65 with knee osteoarthritis (early-onset knee osteoarthritis) or revision group.

Results: In the PKO group,  the female to male ratio was 8:1, and the mean age was 67.2±8 years. The most significant relationship between blood groups and osteoarthritis was found in Group A (p=0.001). Group AB had a significant but low relationship (p=0.002). However, no statistically significant difference was found between age <65 years and >65 years of age (p=0.642). In comparison with the PKO group and RKA, Group A in the revision group was seen at a statistically significantly higher rate (p=0.043). 

Discussion: Group A blood group was found to be associated with both primary knee osteoarthritis and revision knee arthroplasty. 


Monday, 10 August 2020 08:19

Mediopatellar plica syndrome of the knee

Plica is a general term for folds in the synovial membrane of the knee. Sometimes plica can progress to a pathologic level and clinically important condition. Normally, plica has an elastic structure and slides softly between femur condyles when flexing or extending the knee. If it is inflamed and thickened due to edema, it loses its elasticity and becomes symptomatic. 

Plica syndrome is a cause of frontal knee pain. Pain is generally located in the anterior knee, but can be seen in the anteromedial, anterolateral, medial, and lateral joint spaces. In physical examination, during knee extension, sensitivity is present 1-2 cm proximal and medial to the lower pole of the patella. It is a typical sign. Magnetic Resonance Image is the best non-invasive diagnostic tool for plica syndrome. 

In all cases, conservative treatment should be the first choice. Surgical treatment is used for patients who do not respond to conservative treatment.  Surgical excision of mediopatellar plica associated with cartilage degeneration appears to result in substantial clinical improvement, thus representing an effective treatment modality for this group of patients.

Multiligament injury of knee is usually the result of sports injury and trauma. Multiligament injury that caused by high-energy trauma often shows the coexistence with fracture and fracture-dislocation. It is vital to perform the surgical procedure in the correct order. Disruption of at least 2 of the 4 primary knee ligaments is called multiligament injury of knee. In most cases that also accompanied by knee dislocation, may seem reduced radiologically, but it is important to keep an eye open for the risk of vascular and nerve pathologies. Decision making in the multiligament injury of knee has some controversies, especially surgical versus conservative treatment, repair versus reconstruction of injured ligamentous structures, acute versus late surgery, and single versus two-staged surgery of injured ligaments. This review investigates the diagnosis and treatment of the multiligament injuries of knee. Possible complications, surgical tip and tricks were also shared with our clinical experiences.

Aim: Patellar instability is a common multifactorial knee pathology with a high recurrence rate. In this condition, the symptoms often continue and result in  the patient becoming susceptible to chondromalacia and osteoarthritis. Tibial tuberosity–trochlear groove distance (TT-TG) is very important in the evaluation  of patellofemoral joint instability. In this study, we investigated the normal value of TT-TG distance in men and women of different age groups and evaluated  the reliability of magnetic resonance imaging (MRI) in TT-TG distance measurement. Material and Method: The study was carried out between January 2017  and December 2017 on 99 patients over the age of 18, all reporting knee pain but presenting with normal knee examination and MRI findings. The patients  with abnormal findings on knee MRI or physical examination were excluded from the study. Results: The mean age of the patients was 41.1 ± 11.0 years with a  median of 40 (18–68) years. The mean TT-TG distance in the whole population was 9.3 ± 3.3 mm, with a mean value of 9.9 ± 3.6 mm in men and 8.8 ± 3.0 mm  in women. Within the male and female patient groups, the TT-TG distance did not significantly differ by age (p = 0.646 and p = 0.570, respectively). Discussion:  In the present study, no significant difference was identified in the TT-TG distance measurement between males and females in different age groups. From the  results of this study, it can be concluded that MRI is a reliable method for the evaluation of TT-TG distance.

Aim: Knee osteoarthritis (OA) is the most important reason for knee pain in middle- and advanced- aged patients. In the treatment of OA, pulsed radiofrequency (PRF) has been used as an alternative treatment modality. In this study, we aimed to evaluate long-term results of PFR on the clinical and functional states of the patients with knee OA who received intra-articular PFR injections. Material and Method: We retrospectively scanned the medical files of 7 patients whose knee pain persisted for at least one year but whose pain could not be controlled with various conservative treatment methods between March 2016 and August 2016 and who required intra-articular PFR application. Pain was evaluated using a VAS scale and the function of the knee joint with the WOMAC index. The study data were evaluated as early as the first month and at the sixth month in the long-term. Results: Mean VAS scores of the patients at the time of presentation and at 1 and 6 months after termination of the treatment were 8±0.81, 1.71±0.75, and 1.86±0.69 points, respectively. Mean WOMAC scores before and at 1 and 6 months after termination of the treatment were 69.5±4.92, 41.57±8.05, and 40.86±7.08 points, respectively. Discussion: We think that PRF can be successfully used in the treatment of knee pain, while decreasing analgesic use and its side effects.

Aim: Intra-articular application of platelet rich plasma (PRP) can be an alternative treatment method for knee osteoarthritis. The objective of this study was to compare the activation methods of platelet rich plasma before intra-articular application. Material and Method: A total 51 patients (76 knees) was randomly selected into two groups. In group 1, activation of PRP was managed by adding calcium chloride (CaCl). In group 2, activation of PRP was managed by keeping the solution at -70° degrees for 24 hours after preparation and immersed in water at 37oC for a period of 5 minutes for complete dissolution. Then PRP was applied. The patients were assessed with VAS and WOMAC pain scores both baseline and after 2nd, 6th and 12th months of the treatment. Results: VAS and WOMAC pain scores were significantly higher at baseline compared to the results obtained at the 2nd, 6th and 12th months (p=0.06). Following 2nd, 6th and 12th months a gradual downward tendency was seen in both scores, even though no significant difference was found between the groups after 2nd, 6th and 12th months. Discussion: Patients received some clinical benefits from both activation methods. There is no significant difference between activating PRP by CaCl or -70°C which compared in terms of clinical benefits. Therefore, blood storage at -70ºC may be preferred primary due to no need for additional material such as CaCl.

Aim: The goal in anterior cruciate ligament reconstruction (ACLR) is to restore the normal anatomic structure and function of the knee. In the significant proportion of patients after the traditional single-bundle ACLR, complaints of instability still continue. Anatomic double bundle ACLR may provide normal kinematics in knees, much closer to the natural anatomy. The aim of this study is to clinically assess the early outcomes of our anatomical double bundle ACLR. Material and Method: In our clinic between June 2009 and March 2010, performed the anatomic double bundle ACLR with autogenous hamstring grafts 20 patients were evaluated prospectively with Cincinnati, IKDC and Lysholm scores and in clinically for muscle strength and with Cybex II dynamometer. Results: The mean follow-up is 17.8 months (13-21 months). Patients’ scores of Cincinnati, IKDC and Lysholm were respectively, preoperative 18.1, 39.3 and 39.8, while the post-op increased to 27.2, 76.3 and 86.3. In their last check, 17 percent of the patients according to IKDC scores (85%) A (excellent) and B (good) group and 3 patients took place as C (adequate) group. The power measurements of quadriceps and hamstring muscle groups of patients who underwent surgery showed no significant difference compared with the intact knees. Discussion: Double-bundle ACL reconstruction is a satisfactory method. There is a need comparative, long-term studies in large numbers in order to determine improving clinical outcome, preventing degeneration and restoring the knee biomechanics better.

The avulsion fractures of tibial tubercle are seen very rare and usually occur during sports activities in adolescence boys. The injury mechanism often is sudden and strong contraction of the quadriceps muscle. Rarely, it can be seen in Osgood-Schlatter disease (OSH) with a simple trauma. In this case report, a 16 year-old male patient who admitted to emergency service because of knee pain with Ogden type IIB tibial tuberosity fracture in the basis OSH is discussed with literature.

Published in Case Report March 2015

Lipoma Arborescens is a rare intra-articular tumor. Knee is the most commonly affected joint, whereas ankle, hip, shoulder and elbow may be involved. There are few case reports published in the literature. We report a case with lipoma arborescens in the knee joint to improve the medical knowledge about the pathology and management of this rare entitiy. 20-year-old Caucasian female patient admitted to outpatient clinic with complaints of swelling and pain in her right knee. There was swelling and local tenderness in the suprapatellar region. Magnetic resonance imaging (MRI) findings include significant effusion in knee joint and suprapatellar compartment, remarkable suprapatellar mass was drawing attention at all sequences which have an isointense view with fat tissue. Tumor was resected totally, and the preoperative diagnosis of lipoma arborescens is confirmed after histopathological examination. This report notes the significance of both physical and histopathologic examination for the confirmation of such a rare intra-articular entity. When such lesions are suspected, MRI of the joint is necessary and total excision of the mass yields excellent outcome.

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