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Öğe Do intra-articular pathologies accompanying symptomatic acromioclavicular joint degeneration vary across age groups?(2019) Özer, Mustafa; Ataoğlu, Muhammet Baybars; Çetinkaya, Mehmet; Ayanoğlu, Tacettin; Kaptan, Ahmet Yiğit; Kanatlı, UlunayObjectives: 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 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 . 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.Öğe Do subscapularis tears really result in superior humeral migration?(2018) Çetinkaya, Mehmet; Ataoğlu, Muhammet Baybars; Özer, Mustafa; Ayanoğlu, Tacettin; Öner, Ali Yusuf; Kanatlı, UlunayObjectives: The aim of this study was to analyse the effect of subscapularis tear on superior humeralexcursion (SHE) and acromiohumeral distance (AHD). The hypothesis was that subscapularis tears do notresult in superior humeral excursion.Methods: Patients who underwent shoulder arthroscopy between August of 2011 and 2015 werereevaluated. Those with isolated Bankart lesion were used as control group and included in the Group 1,isolated full-thickness supraspinatus tear in the Group 2, isolated subscapularis tear in the Group 3, andcombined subscapularis and supraspinatus tear in the Group 4. The mean SHE and AHD measurementson magnetic resonance imaging of these groups were compared to reveal any difference in superiorhumeral migration (SHM).Results: There were 30 patients in each group. The mean age of Group 1 (26.44± 8.34) was younger thanthe other 3 groups. The mean AHD and SHE were higher in Group 1 and 3 (Mean AHD: 12.89± 2.24 and12.28± 1.9, respectively. Mean SHE: 3.2 ± 0.99 and 2.78 ± 0.64, respectively) than Group 2 and 4(Mean AHD: 6.2± 1.78 and 6.16 ± 1.52, respectively. Mean SHE: 0.72 ± 0.65 and 1.24 ± 0.63, respectively).The AHD and SHE were strongly correlated with each other (Pearson correlation coefŞcient ¼ 0.184). Theinter-observer and intra-observer correlation of the measurements of SHE on MRI were excellent withintraclass correlation coefŞcient of 0.95 and 0.94, respectively.Conclusion: Subscapularis tears do not lead to SHM and subacromial impingement. However, superior rotator cuff tears can still lead to SHM and subacromial impingement even when subscapularis tendon is intact.Level of evidence: Level III, diagnostic study.Öğe Does the presence of arthroscopically detected stage 1-2 glenohumeral osteoarthritis have any clinical impact on the outcome of arthroscopic rotator cuff repairs?(TÜBİTAK (Scientific and Technological Research Council of Türkiye), 2023) Tokgöz, Mehmet Ali; Elma, Tarık; Yapar, Aliekber; Özer, Mustafa; Ataoğlu, Muhammet Baybars; Kanatlı, UlunayBackground/aim: Rotator cuff rupture (RCR) and glenohumeral osteoarthritis (GHO) are two common disorders of the shoulder joint. However, there are very few reports that examine the relationship between them. This study aimed to present at least two years' clinical results of arthroscopic rotator cuff repair of full-thickness and massive tears accompanied by arthroscopically detected early-stage osteoarthritis.Materials and methods: From August 2016 to December 2017, three hundred and twenty patients with total or massive rotator cuff tears were evaluated retrospectively. Thirty-five patients who were determined as stage 1 and 2 according to the Outerbridge scale for cartilage lesions were found appropriate for investigation. Patients were assessed using the University of California Los Angeles (UCLA) score, and a visual analog scale (VAS) score before surgery and at the final follow-up. The American Shoulder and Elbow Surgeons (ASES) shoulder score was used to evaluate the final outcomes and compare the UCLA shoulder scores.Results: The UCLA scores increased from the preoperative value of 19.1 +/- 3.2 to 29.8 +/- 4.8 at the last follow-up and increased by an average of 10.7 +/- 6.0 (p < 0.001). The median VAS score decreased from the preoperative value of 3.0 to 1.0 (p < 0.001). Besides, the mean ASES score was found as 80.2 +/- 10.6. An excellent positive correlation was found between postoperative UCLA scores and ASES scores (r = 0.887; p < 0.001).Conclusion: To the best of our knowledge, this is one of the first arthroscopic comparative studies about the effect of early glenohumeral osteoarthritis on clinical outcomes after rotator cuff tear treatment. Finding good and excellent results up to 71% after RCR repair in patients with early-stage osteoarthritis was an indication that arthroscopic repair could be planned as the first-line treatment option for RCR pathologies in patients with early-stage degenerative arthritis without considering the rerupture rate.Öğe The effect of patient position to dexa measurement(2018) Özer, Mustafa; Ataoğlu, Muhammet Baybars; Ayanoğlu, Tacettin; Yıldırım, Ahmet; Hatipoğlu, M. Yasin; Çetinkaya, MehmetAim: 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 patients. Results: 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 osteoporosis more patients would receive the required treatment and the risk of the osteoporotic low energy fractures could be lowered.Öğe Hip arthroscopy for Legg-Calve-Perthes disease in paediatric population(2019) Kanatlı, Ulunay; Ayanoğlu, Tacettin; Özer, Mustafa; Ataoğlu, Muhammet Baybars; Çetinkaya, MehmetObjective: The aim of this study was to represent the ?ndings and long-term clinical results of the children who underwent hip arthroscopy because of Legg-Calve-Perthes Disease (LCPD). Methods: This study included the retrospective ?ndings of ten patients (mean age: 12.7 2.75; range 7 e16 years) who underwent arthroscopic hip debridement between 2010 and 2016 for LCPD disease. All of the patients underwent arthroscopic excision of the unstable osteochondral fragment following unsuccessful conservative treatment. In the statistical analysis, age, side, follow-up, Stulberg and Waldenstrom classi?cation, preoperative and postoperative modi?ed Harris Hip Score (mHHS) were evaluated. Results: The mean follow-up period was 55.4 13.05 months (range: 40e72 months). There was no statistically signi?cant association between good postoperative results and age, side, and the stage of the disease (p 0.05). However, there was a signi?cant difference between preoperative and postoperative mHHS (p 0.005). Conclusion: This study demonstrates an increase in the functional results and life quality of the patients who underwent hip arthroscopy due to LCPD. It is thought that hip arthroscopy, a minimally invasive procedure, may have an important role in the algorithm of LCPD treatment, especially in patients with severe pain and mechanical symptoms.Öğe Is lesser tuberosity morphology related to subscapularis tears and anterior shoulder instability?(Springer, 2023) Yaka, Haluk; Özer, Mustafa; Kanatlı, UlunayPurpose: Although the morphological relationship of the scapula and the humeral head has been claimed to be related to shoulder pathologies, few studies examined the relationship between subscapularis (Ssc) tears and lesser tuberosity (LT)— humeral head (HH) and between Ssc tears and HH—glenoid. This study aims to evaluate the relationship of LT with HH and glenoid in patients with Ssc tears and anterior shoulder instability (ASI). We hypothesized that the glenoid, HH, and their combined relationship with LT may impact Ssc tears and ASI. Material and methods: The study included 34 patients with ASI, 28 patients with isolated Ssc tears, and 40 patients as the control group. The radius of HH (Hr), the distance between the center of HH and LT (LTr), and the glenoid radius (Gr) were measured in shoulder magnetic resonance (MR) images. The LTr to Hr (LTr/Hr) ratio was defned as the lesser tuberosity humeral head index (LTHHI), whereas the LTr to Gr (LTr/Gr) ratio was defned as the lesser tuberosity-glenoid index (LTGI). The three groups were compared regarding LTHHI, LTGI, LTr, Hr, and Gr. Results: There was a signifcant diference between each group concerning LTGI (p<0.001). LTGI values below 1.99 showed 93.1% sensitivity and 93.3% specifcity for Ssc tears, while values above 2.24 showed 86.7% sensitivity and 86.2% specifc ity for ASI. Also, there was a signifcant diference when the groups were compared for LTHHI (p<0.001). This rate was lowest for Ssc tears, and LTHHI values below 1.17 showed 82.8% sensitivity and 80.1% specifcity. Conclusion: LTGI may be a new predictive factor showing 93.1% sensitivity and 93.3% specifcity for Ssc tears and 86.7% sensitivity and 86.2% specifcity for ASI. In addition, LTHHI may be a new predictive factor showing 82.8% sensitivity and 80.1% specifcity for Ssc tears. Level of evidence: III retrospective comparative study.Öğe Is routine coracoplasty necessary in isolated subscapularis tears?(2019) Ayanaoğlu, Tacettin; Ataoğlu, Baybars; Özer, Mustafa; Çetinkaya, Mehmet; Kaptan, Ahmet Yiğit; Kanatlı, UlunayObjectives: This study aims to investigate the effect of simultaneous coracoplasty on postoperative clinical outcomes of patients undergoing shoulder arthroscopy due to the tear of the isolated subscapularis. Patients and methods: The study included 53 patients (16 males, 37 females; mean age 55.8 years; range, 44 to 70 years) who underwent arthroscopic repair for isolated subscapularis tear (type 2 and type 3) with anterior shoulder pain and tenderness. All patients had a coracohumeral distance of less than 7 mm on the preoperative magnetic resonance images and a minimum follow-up period of two years. Patients were divided into two groups as group 1 including patients who underwent coracoplasty and group 2 including those who did not undergo coracoplasty. Patients were evaluated pre- and postoperatively by the University of California Los Angeles (UCLA) shoulder score and the simple shoulder test (SST) score. Results: There were no significant differences between the groups in terms of age, gender and follow-up time (p0.05). The preoperative mean UCLA score was 19.65 for group 1 and 20.45 for group 2. The postoperative mean UCLA scores were 27.92 and 29.00, respectively. The preoperative mean SST score was 4.9 for group 1 and 5.1 for group 2. The postoperative mean SST scores were 10.0 and 9.5, respectively. Functional scores increased significantly in both groups postoperatively when compared to the preoperative values (p0.01). However, there was no statistically significant difference in terms of the increase in UCLA and SST scores between the two groups (p0.05). Conclusion: We believe that concomitant coracoplasty during arthroscopic repair may not be a necessary routine in the treatment of isolated subscapularis tears.Öğe Korakoid taşma ile subskapularis yırtıkların ilişkisi(2018) Çetinkaya, Mehmet; Ataoğlu, Muhammet Baybars; Özer, Mustafa; Ayanoğlu, Tacettin; Kaptan, Ahmet Yiğit; Kanatlı, UlunayAmaç: 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.Öğe Multiple cervical spinous process fracture (clay shoveler fracture): Case report(2017) Ayanoğlu, Tacettin; Ataoğlu, Muhammet Baybars; Özer, Mustafa; Yıldırım, Ahmet; Tokgöz, Mehmet AliClay-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.Öğe Omuz iç rotasyonunun korakohumeral ve akromiyo aralığa etkisinin üç boyutlu tomografi ile değerlendirilmesi(2018) Özer, Mustafa; Çetinkaya, Mehmet; Koçkara, Nizamettin; Ataoğlu, Muhammet Baybars; Genç, Erdinç; Kanatlı, UlunayAmaç: Bu çalışmanın amacı korakohumeral aralık ve akromiyohumeral aralık miktarının omzun pasif iç rotasyonu ile gerçekten azalıp azalmadığını değerlendirmekti. Gereç ve Yöntem: Çalışmada Mayıs 2016 ile Ekim 2016 arasında poliklinikte rotator kılıf hasarı ön tanısı ile bilgisayarlı tomografi artrografi çekilen hastalar kullanıldı. Bilgisayarlı tomografi artrografi tetkiki omuz nötral ve iç rotasyonda olmak üzere iki kez yapıldı ve görüntülerin 3 boyutlu rekonstrüksiyonları oluşturuldu. Bu iki bilgisayarlı tomografi tetkikinin 3 boyutlu bilgisayarlı tomografi görüntülerinde korakohumeral aralık ve akromiyohumeral aralık ölçümleri yapıldı. Bulgular: Çalışmaya yaş ortalamaları 64.069.06 olan 17 hasta dahil edildi. Tam kat supraspinatus yırtığı olanlarla olmayanlar değerlendirildiğinde, korakohumeral aralık ve akromiyohumeral aralığın omzun nötral ve iç rotasyonundaki ölçümlerinin ortalamaları arasında istatistiksel olarak anlamlı fark görülmedi. Kadın ve erkekler arasında ölçüm ortalaması arasında istatistiksel fark yoktu. Sonuç: Omzun pasif iç rotasyonu ile korakohumeral aralık anlamlı derecede daralmaktadır. Üç boyutlu bilgisayarlı tomografi ile yapılan ölçümler korakoid anatomisi ve korakoidin çeşitli parametreleri ile ilgili bize daha güvenilir bilgi verebilirler.Öğe Radiological and clinical evaluation of long head of biceps tendon function in the glenohumeral(Turkish Joint Diseases Foundation, 2023) Duman, Numan; Özer, MustafaObjectives: The aim of the study was to investigate the relationship between biceps pathologies and radiological measurements in massive rotator cuff tears treated arthroscopically. Patients and methods: Between December 2015 and December 2018, a total of 145 patients (56 males, 89 females; mean age: 62.2 +/- 9.7 years; range, 28 to 87 years) with supraspinatus and/or infraspinatus full-thickness tear larger than 3 cm and who underwent arthroscopic rotator cuff repair were retrospectively analyzed. Biceps pathologies detected during arthroscopy were divided into four groups. Group 1: biceps tendinitis or without biceps pathology; Group 2: biceps partial/degeneration tear; Group 3: biceps dislocation/instability; Group 4: complete biceps head rupture. Radiological measurements were calculated from the preoperative magnetic resonance imaging and anteroposterior X-ray images of the patients. Results: A total of 65.5% of the lesions were on the right arm and 34.5% were on the left arm. All patients had posterior superior rotator cuff tears which could be surgically repaired. A total of 22.1% of the patients had no biceps tendinitis/biceps pathology, 20.7% had biceps instability/dislocation, 28.3% had biceps degeneration/partial rupture, and 29% of patients had biceps total rupture. Patients in Group 4 had a statistically significantly higher superior migration of the humeral head distance (p= 0.012) than Group 2, and patients in Group 2 had a statistically significantly higher coracohumeral distance (p= 0.042) than patients in Group 4. There was no significant difference in the other measurements among the groups. Conclusion: The long head of the biceps, of which function has not yet been clearly elucidated, is one of the superior and anterior stabilizing forces of the humeral head.
