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Öğe Arthroscopic-Assisted Latissimus Dorsi Tendon Transfer for Massive, Irreparable Rotator Cuff Tears: Technique and Short-Term Follow-Up of Patients With Pseudoparalysis(W B Saunders Co-Elsevier Inc, 2017) Kanatli, Ulunay; Ozer, Mustafa; Ataoglu, Muhammet Baybars; Ozturk, Burak Yagmur; Gul, Orkun; Cetinkaya, Mehmet; Ayanoglu, TacettinPurpose: To describe a modified technique for arthroscopic-assisted transfer of the latissimus dorsi tendon in a selected group of patients with irreparable rotator cuff tears and pseudoparalysis and to evaluate its short-term results. Methods: Fifteen patients with irreparable rotator cuff tears and pseudoparalysis treated by arthroscopic-assisted latissimus dorsi tendon transfer were included. The mean patient age was 61.53 +/- 6.24 years (range, 52-71 years). Patients were assessed with physical examination, University of California Los Angeles (UCLA) Score and Constant-Murley score, as well as visual analog scale score at a mean follow-up of 26.4 +/- 2.58 months (range, 24-31 months). Results: At final follow-up, mean UCLA score increased to 27.47 +/- 6.31 compared with the preoperative UCLA score of 6.53 +/- 2.1 (P < .001). Constant-Murley score was 21 +/- 7.41 and 59.73 +/- 13.62 (P < .001), visual analog scale pain score was 7.47 +/- 1.06 and 2.47 +/- 0.91 (P < .001), active forward flexion was 58 degrees +/- 21.11 degrees and 130 degrees +/- 30.05 degrees (P < .001), active abduction was 51 degrees +/- 1.64 degrees and 129.67 degrees +/- 25.45 degrees (P <.001), and active external rotation was 13.33 degrees +/- 21.68 degrees and 32 degrees +/- 18.03 degrees (P < .001) preoperatively and postoperatively, respectively. Mean acromiohumeral distance was 3.13 +/- 1.40 mm preoperatively, whereas it was 5.67 +/- 1.67 mm postoperatively (P < .001). No significant complications requiring a revision surgery was observed during the final follow-up. Conclusions: The modified technique of arthroscopic-assisted transfer of the latissimus dorsi tendon is a feasible, minimally invasive option for the surgical treatment of irreparable rotator cuff tears in a subset of patients with pseudoparalysis.Öğe The Correlation of the SLAP II Lesion Findings Between Physical Examination, Magnetic Resonance Imaging, and Arthroscopic Surgery(Springer Heidelberg, 2021) Kutuk, Ahmet Tolga; Kanatli, Ulunay; Ataoglu, Muhammet Baybars; Ayanoglu, Tacettin; Ozer, Mustafa; Cetinkaya, MehmetObjectives The aim of this study is to demonstrate the importance of clinical diagnosis by comparing with preoperative physical examination and magnetic resonance imaging (MRI) images in patients who were arthroscopically diagnosed as having Superior Labrum Anterior-Posterior (SLAP) II lesions. Materials and Methods 134 patients, arthroscopically diagnosed as SLAP II, established the study group, and 200 patients who underwent shoulder arthroscopy for the other pathologies established the control group. Preoperative clinical examination of the patients, MRI findings, and the arthroscopic findings of the patients were recorded. Results Out of the patients diagnosed with a SLAP II lesion, 107 (79.9) of those had an MRI finding while only 60 (30%) of the control group had it. The O'Brien test results of the patients diagnosed with SLAP were positive in 111 (82.8%) while those diagnosed with intact superior labrum were positive in 132 (66%). Of the 134 patients with a SLAP II lesion, 89 (66.4%) had both O'Brien test positiveness and MRI finding, and 129 (96%) had at least one positive result of the O'Brien test or MRI examination Conclusion The O'Brien test and MRI examination are not capable enough to indicate a SLAP lesion one by one, because of the low sensitivity and specificity. But, combining the test with MRI findings provides more trustable information about the superior labrum.Öğe Does glenoid bone loss accompany posterior shoulder instability with only labral tear? A magnetic resonance imaging-based study(Mosby-Elsevier, 2023) Orhan, Ozlem; Sezgin, Erdem Aras; Ozer, Mustafa; Ataoglu, Muhammet Baybars; Kanatli, UlunayBackground: The primary aim of this study was to investigate bone loss in the glenoid with magnetic resonance imaging in posterior shoulder instability with only a labral tear.Methods: A total of 76 patients operated on because of posterior and anteroposterior shoulder instability only with a labral tear between 2006 and 2019 (n = 40 and n = 36, respectively) were included in this study. The instability type, a presence of an additional superior labrum anteroposterior (SLAP) lesion, the number of dislocations, and the magnetic resonance imaging-based measurements (the glenoid diameter and the bone defect size in the glenoid, the Hill-Sachs lesion [HSL] and the reverse HSL [rHSL] length, the angle and the arc length of HSL and rHSL, and the humerus head diameter and its area) were analyzed.Results: The size of the anterior glenoid defect, the rHSL measurements (length, angle, and arc length), and the ratio of the anterior glenoid defect size to the glenoid diameter were significantly higher for anteroposterior instability (P < .01) cases. There was no significant difference (P = .49, .64, and .82, respectively) for the presence of an additional SLAP pathology, the glenoid diameter, the posterior glenoid defect, and the ratio of the posterior glenoid defect size to the glenoid diameter in posterior and anteroposterior instability groups. The increased number of dislocations was associated with increased rHSL length and total arc length (P = .04 and .03, respectively). An additional SLAP lesion in posterior shoulder instabilities was not associated with the bone defect size (P = .29).Conclusion: Although the posterior shoulder instability with only a labral tear is likely to cause a bone defect, we have shown that the instability is not expected to be caused by the bone defect. Therefore, this study points out that only soft tissue repair without considering the bone defect could be promising in this patient group.Level of evidence: Anatomy Study; Imaging (c) 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.Öğe The forelock sign: A new arthroscopic finding in partial subscapularis tears(Turkish Joint Diseases Foundation, 2019) Cetinkaya, Mehmet; Kanatli, Ulunay; Ataoglu, Muhammet Baybars; Ozer, Mustafa; Ayanoglu, Tacettin; Bolukbasi, SelcukObjectives: This study aims to identify the forelock sign of partial tears of the subscapularis and to compare the incidences of this sign and air bag sign. Patients and methods: One hundred and twenty patients (39 males, 81 females; mean age 51.3 years; range, 25 to 79) diagnosed as isolated subscapularis tear or isolated supraspinatus tear from among patients who underwent shoulder arthroscopy between January 2013 and January 2016 were divided into four groups of 30 patients each as the subscapularis tear (group 1), full-thickness supraspinatus tear (group 2), bursal-side supraspinatus tear (group 3), and articular-side supraspinatus tear (group 4) groups. All patients had video records of their operation. The integrity of the long head of biceps tendon (LHBT), Lafosse classification of the subscapularis tear, and the incidence of the forelock and air bag signs were evaluated. Results: The incidence of the air bag sign in group 1 was 10% and that of the forelock sign was 60%. The forelock sign was significantly more frequent in group 1 than in the other groups (odds ratio 10.46: 3.9-27.8 with 95% confidence interval) and the air bag sign (p<0.001). The LHBT was mostly pathologic in this group, which was also statistically significant (p<0.01). The incidence of the forelock sign in group 1 was similar in each LHBT pathology and Lafosse subgroups. Conclusion: The forelock sign identified in this study was significantly frequent (60%) in partial subscapularis tendon tears with strong inter- and intra-observer consistency while the air bag sign was rare (10%). The LHBT disorders were strongly associated with subscapularis tears; however, the forelock sign was not an indicator of the condition of the LHBT and type of partial subscapularis tendon tear according to the Lafosse classification.Öğe The high frequency of superior labrum, biceps tendon, and superior rotator cuff pathologies in patients with subscapularis tears: A cohort study(Elsevier Science Bv, 2018) Ataoglu, Muhammet Baybars; Cetinkaya, Mehmet; Ozer, Mustafa; Ayanoglu, Tacettin; Kanatli, UlunayBackground: The purpose of this study was to assess the frequency of superior labrum anterior posterior (SLAP) lesions, long head of biceps tendon (LHBT) pathologies, and superior rotator cuff tears accompanying subscapularis tears. We hypothesised that LHBT lesions, superior rotator cuff tears, and especially SLAP lesions were very frequent with subscapularis tears. Methods: The digital files of patients who underwent shoulder arthroscopy were reviewed retrospectively. One hundred and eleven patients with subscapularis tears evident on surgery videos were examined. Superior labrum, LHBT, and superior rotator cuff lesions were investigated by the authors of this study. The statistical analyses were made with SPSS statistics software, and significance was set at P < 0.05 value. Results: There were 111 patients with both subscapularis tears and surgery videos. The mean age was 58.09 +/- 10.21, and 63.1% of the patients were female. 98.2% of the 111 patients had a SLAP lesion. 7.2% of those were SLAP I and 91% were SLAP II lesions while 1.8% were healthy. The 75.7% of the patients had a LHBT pathology, and 83.8% had superior cuff tear. Conclusions: Subscapularis tears were almost always accompanied by SLAP lesions. On the other hand, biceps tendon pathologies and superior rotator cuff tears were also very frequent with subscapularis tears. Level of evidence: Prognostic study, Level IV (retrospective cohort study). (C) 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.Öğe Lesser tuberosity cysts and their relationship with subscapularis tears and subcoracoid impingement(Springer Japan Kk, 2017) Cetinkaya, Mehmet; Oner, Ali Yusuf; Ataoglu, Muhammet Baybars; Ozer, Mustafa; Ayanoglu, Tacettin; Kanatli, UlunayBackground: We aimed to evaluate cysts in the lesser tuberosity of humeral head seen on magnetic resonance imaging (MRI) and their relationship with subcoracoid impingement and subscapularis tears evident on arthroscopic surgery videos. Our hypothesis was that the cysts would be more frequent with subscapularis tears and in the case of subcoracoid impingement. Methods: Patients who underwent shoulder arthroscopy between January 2010 and January 2016 were retrieved to evaluate subscapularis tears on surgery videos and lesser tuberosity cysts (LTC), coracohumeral distances (CHD) on both sagittal oblique and transverse sections of MRI retrospectively. There were 137 patients meeting the study criteria with subscapularis tear evident on surgery video and having preoperatively studied magnetic resonance images. All the tears were classified according to the Lafosse's system. The control group was constituted with 121 patients who underwent shoulder arthroscopy and were diagnosed with no subscapularis tear. Then, any statistically significant relationship between these parameters was investigated by the use of statistics software. Results: The mean age (57), gender distribution (female for 67.1%), and involved shoulder (right for 62.8%) rate of the groups were statistically similar. The existence rate of LTC was 55.5% and 19% for the study and control groups, respectively (P = .000). The study group was then evaluated in two groups regarding the existence of a cyst in the lesser tuberosity. There was no statistical difference between these two groups in terms of coracohumeral distances and tear type (P > .05). The study group was also divided into two depending on the transverse section CHD whether it was under 7 mm or not. There was still no statistical difference between these subgroups in terms of a cyst existence (P > .05). The supraspinatus tear rate and age distribution was also not differing in patients with and without LTC. Conclusions: The LTCs were significantly associated with subscapularis tears, and could be used as an indicator in the interpretation of MRI scans. However, there was no relationship between the subcoracoid impingement and LTCs. (C) 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.Öğe Midterm outcomes after arthroscopic repair of partial rotator cuff tears: A retrospective study of correlation between partial tear types and surgical technique(Turkish Assoc Orthopaedics Traumatology, 2020) Kanatli, Ulunay; Ayanoglu, Tacettin; Ataoglu, Muhammet Baybars; Ozer, Mustafa; Cetinkaya, Mehmet; Eren, Toygun KaganObjective: Patients who underwent arthroscopic repair for partial rotator cuff tears were evaluated retrospectively. This study purposed to assess the postoperative clinical results of arthroscopic treatment of intratendinous rotator cuff tears and to investigate the effect of the tear type on the postoperative clinical outcomes. Methods: Overall, 60 patients [36 women and 24 men; mean age: 48.6 +/- 12.2 years (range 33-67 years)] who underwent arthroscopic repair of Ellman stage 3 partial rotator cuff tear were evaluated retrospectively. These patients were grouped into the following three groups: articular-sided tears, bursal-sided tears, and intratendinous tears, with 20 patients included in each group. Subacromial decompression, acromioplasty, and tear repair without transforming to full-thickness tear were applied to the bursal-sided tears. The same technique was performed for intratendinous ruptures, with the only technical difference was that the capsular tissue was preserved during debridement of intratendinous tears. The articular-sided tears were transformed to complete tears and repaired arthroscopically. The preoperative and postoperative ASES scores and range of motion improvements were evaluated in all patients. The mean follow-up time was 44 +/- 6.5 months (range: 36-62 months). Results: No significant intergroup differences were observed concerning the age and the mean follow-up duration (p=0524, p=0.665). A similar increase in ASES scores was observed for all three types of tears (bursal-sided tears: 31.09-82.65; articular-sided tears: 35.50--84.00; intratendinous tears: 34.01-83.49). Statistically, no significant intergroup difference was observed concerning ASES score improvement (p=0.585). An increase in mean forward flexion, abduction, and external rotation were observed, especially, a statistically significant increase in flexion (p=0.001) and abduction (p=0.001) in all three types of tears. No patient experienced any intraoperative or postoperative complications. Conclusion: The results of arthroscopic treatment of intratendinous tears were similar to the other types of partial tears, and the results of arthroscopic treatment of grade 3 partial rotator cuff tears revealed satisfactory outcomes, regardless of the type of the tear.Öğe Multiple Subscapularis Tendon Sign A New Risk Factor for Recurrence After Arthroscopic Anterior Shoulder Instability Surgery(Sage Publications Inc, 2019) Kanatli, Ulunay; Ozer, Mustafa; Gem, Mehmet; Ozturk, Burak Yagmur; Ataoglu, Muhammet Baybars; Cetinkaya, Mehmet; Ayanoglu, TacettinBackground: Being able to predict recurrence after the treatment of shoulder instability would be helpful in planning the appropriate treatment. Purpose: To define the multiple subscapularis tendon sign (MSTS) as a novel anatomic variant and a possible risk factor for the recurrence of shoulder instability after anterior stabilization and to evaluate it, together with the other risk factors as described in the literature. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 87 patients met the study criteria and underwent arthroscopic stabilization for anterior shoulder instability. The MSTS was evaluated in this study group. Age, sex, hand dominance, number of preoperative shoulder dislocations, history of overhead or contact sports participation, type of labral lesion, number of anchors used in surgery, presence of the drive-through sign, presence of the MSTS, Oxford Shoulder Score results, and the association of these parameters with recurrence were assessed. The mean follow-up time was 81.0 +/- 27.9 months (range, 48-139 months). Results: Nine (10.3%) patients experienced recurrent instability. The presence of the MSTS (P = .009), existence of an anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion (P = .04), and history of overhead or contact sports participation (P = .04) were significant risk factors for recurrence. The recurrence rates were as follows: 30.7% with the MSTS; 40% with the MSTS and an ALPSA lesion; and 75% with the MSTS, an ALPSA lesion, and a history of overhead or contact sports participation. Conclusion: The MSTS is a variation of the anterior shoulder joint capsule. It is a sign of capsular insufficiency or thinning, which may be a risk factor for recurrence after anterior stabilization. Considering the low success rates of anterior capsulolabral repair in patients participating in overhead or contact sports, especially when an ALPSA lesion is present, encountering the MSTS during surgery in this at-risk group may be an indicator for the surgeon to choose the surgical procedure more carefully.Öğe Osteoid Osteoma at the Proximal Diaphysis of the Fifth Metatarsal A Case Report(Amer Podiatric Med Assoc, 2017) Ataoglu, Muhammet Baybars; Ali, Ali Kh.; Ozer, Mustafa; Topcu, Huseyin Nevzat; Cetinkaya, Mehmet; Kulduk, GamzeThe foot is rarely the focus of osteoid osteoma, and only a few of those cases are related to the fifth metatarsal. The present case demonstrates that atypical symptoms with suspicious findings on plain radiographs that are not associated with trauma must be analyzed carefully to determine the nature of the lesion and perform the precise treatment to obtain and sustain the cure. A 29-year-old man presented to the outpatient clinic with a 2-year history of chronic pain in the lateral aspect of his left forefoot. The onset was not related to trauma, surgery, local infection, osteomyelitis, or another entity regarding the proximal fifth metatarsal. The patient noted that the pain was aggravated at night and typically subsided with the use of salicylates or other nonsteroidal anti-inflammatory drugs. Initial plain radiographs demonstrated cortical thickening and a lytic lesion at the proximal diaphysis of the fifth metatarsal. Because the pain relief was transient, we suspected an osteoid osteoma lesion, and subsequent magnetic resonance imaging manifested pathognomonic signs of subperiosteal osteoid osteoma. Diagnosis was followed by planning of the surgery that ended the patient's symptoms.Öğe Partial and full-thickness rotator cuff tears in patients younger than 45 years(Turkish Assoc Orthopaedics Traumatology, 2020) Kaptan, Ahmet Yigit; Ulucakoy, Coskun; Ozer, Mustafa; Cetinkaya, Mehmet; Ayanoglu, Tacettin; Ataoglu, Muhammet Baybars; Kanatli, UlunayObjective: The aim of this study was to evaluate the results of the arthroscopic repair in patients with partial and full thickness rotator cuff tears and less than 45 years of age. Methods: Fifty patients (26 women and 24 men; mean age: 41.4 +/- 3.96 years; range: 31-45) with rotator cuff tear, and who were treated with the arthroscopic repair, were included in the study. Twenty patients had full thickness and 30 had partial-thickness tears. The final functional evaluation was conducted at a mean of 42.4 months (range, 24 to 95 months; SD:13.3). The American Shoulder and Elbow Surgeon (ASES) self-report score and the University of California at Los Angeles Shoulder Score (UCLA Shoulder Score) were used as validated scoring systems. Results: At the final follow-up, the mean ASES and UCLA scores improved significantly to 72.3 and 26.5, respectively, in the full-thickness group (p<0.01). The mean ASES and UCLA scores improved significantly to 70.7 and 25.3, respectively, in the bursal-side group (p<0.01). The mean ASES and UCLA scores improved significantly to 75.3 and 27.1, respectively, in the joint-side group (p<0.01). There were no significant differences between the groups according to the postoperative ASES score (p>0.06) and UCLA score (p<0.37). Conclusion: The arthroscopic repair of the joint-sided tears and bursal-sided tears has good functional outcomes as full thickness rotator cuff tears, and the surgical option should be considered in younger population if the conservative treatment fails.Öğe Radiological Evaluation of Distal Tibiofibular Joint Anatomy Variations in Patients with and Without Syndesmotic Injury(Springer Heidelberg, 2023) Ataoglu, Muhammet Baybars; Tokgoz, Mehmet Ali; Ozer, Mustafa; Kokturk, Anil; Yaka, Haluk; Ergisi, YilmazIntroductionSyndesmosis injuries are a common and debilitating problem affecting the ankle joint, but the precise causes of these injuries remain unclear. In the current retrospective study, it was aimed to investigate the relationship between variations in the distal tibiofibular syndesmosis and surgically proven syndesmosis injuries.Patients and MethodA total of 57 patients with surgically proven syndesmosis injuries and 51 patients without syndesmosis injuries were included as the control group. Computed tomography (CT) scans were used to measure six anatomical features 1 cm proximal to the tibiotalar joint, including the anterior facet length (a), posterior facet length (b), angle between the anterior and posterior facets (c), fibular incisura depth (d), tibia thickness (e), and fibula thickness (f).ResultsComparing the measurements of the patients with and without syndesmosis injury, it was demonstrated that the anterior facet length (a) (p = 0.022) was shorter and the a-b difference (anterior facet length-posterior facet length difference) (p = 0.010) tended toward negative values. Pearson correlation analysis demonstrated that a (r = - 0.211, p < 0.033) and a-b (r = - 0.254, p = 0.010) measurements were strongly negatively correlated with syndesmosis injury.DiscussionOur study findings suggest that the shortness of the anterior facet and the difference in length are related to syndesmosis injuries. To the best of our knowledge, this is the first study to report this relationship with syndesmosis. This study sheds light on the underlying mechanisms of syndesmosis injury, which could help clinicians in the diagnosis, treatment, and prevention of this common ankle injury.Level of evidence: Level 4: case-control study.Öğe Subscapularis Tendon Slip Number and Coracoid Overlap Are More Related Parameters for Subcoracoid Impingement in Subscapularis Tears: A Magnetic Resonance Imaging Comparison Study(W B Saunders Co-Elsevier Inc, 2017) Cetinkaya, Mehmet; Ataoglu, Muhammet Baybars; Ozer, Mustafa; Ayanoglu, Tacettin; Kanatli, UlunayPurpose: To investigate the effects of the subscapularis tendon slip number (STSN) and coracoid morphology by magnetic resonance imaging in patients with and without subscapularis tears. Methods: Patients who underwent shoulder arthroscopy between February 2004 and June 2015 were re-evaluated. Those with a subscapularis tear (study group) and those with other pathologies (control group) were compared with each other. Magnetic resonance imaging scans and surgery videos of the patients were reassessed. Transverse and sagittal coracohumeral distance (CHD), coracoid overlap (CO), coraco-coracoid base angle (CBA), coracoglenoid distance (CGD), and STSN were measured. Results: The study and control groups comprised 141 and 78 patients, respectively. The mean age was 57.01 +/- 10.95 (similar in both the groups). The mean transverse CHD and sagittal CHD were not different between the groups and also between female and male patients. For the study and control groups, the mean CBA and CGD values were also similar. The mean CO was 24.01 +/- 4.9 and 21.29 +/- 4.58 for the study and control groups, respectively (P < .001). With the receiver operating characteristic curve of the CO, the sensitivity was 62% and the specificity was 64% at the cutoff value of 22.85 mm. The STSN was in the range between 1 and 6; the STSN was 3 or less in 61.5% of the study group and in 38.5% of the control group (P = .005). Conclusions: The CO was the most valuable parameter predicting any potential subcoracoid impingement, and the STSN was inversely correlated with subscapularis tears. However, in predicting a potential subcoracoid impingement, the CHD measurements were not significant, as well the CGD and CBA.Öğe Untitled Reply(Sage Publications Ltd, 2020) Kanatli, Ulunay; Ayanoglu, Tacettin; Esen, Erdinc; Ataoglu, Muhammet Baybars; Ozer, Mustafa; Cetinkaya, Mehmet; Kaptan, Ahmet Yigit[Abstract Not Availabe]