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Öğe Arthroscopic treatment of intra-artricularly localised pigmented villonodular synovitis of the ankle: 4 cases with long-term follow-up(Elsevier Science Bv, 2017) Kanatli, Ulunay; Ataoglu, M. Baybars; Ozer, Mustafa; Yildirim, Ahmet; Cetinkaya, MehmetBackground context: Pigmented villonodular synovitis (PVNS) is a rare, locally aggressive benign proliferative pathology of synovial tissue. Lesions are classified regarding location as diffuse or localised which are same as histologically. Intra-articularly localised type is relatively rare, especially in the ankle joint. Because of the high recurrence rate and aggressive nature, localised lesions should be excised totally. Purpose: We performed a retrospective study of 4 patients with intra-articularly localised PVNS in the ankle joint who were treated by total arthroscopic excision and evaluated for functional results and recurrence rate. Study design: Case series. Patient sample: The mean age of the patients was 27 (17-46) years at the time of arthroscopic surgery. The mean follow-up time was 33 (24-48) months. Methods: Functional evaluation according to the Musculoskeletal Tumour Society Score was performed, and patients were evaluated for recurrence by MR imaging. Results: In all patients, functional results were excellent and there was no recurrence. Conclusions: This study demonstrates that the intra-articularly localised PVNS can be successfully treated with arthroscopic procedures without recurrence. (C) 2017 Published by Elsevier Ltd on behalf of European Foot and Ankle Society.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 Buford complex: prevalence and relationship with labral pathologies(Mosby-Elsevier, 2021) Ozer, Mustafa; Kaptan, A. Yigit; Ataoglu, M. Baybars; Cetinkaya, Mehmet; Ayanoglu, Tacettin; Ince, Bulent; Kanatli, UlunayBackground: This study aimed to determine the prevalence of the Buford complex and to investigate its association with labral pathologies (superior labrum anterior-posterior [SLAP] lesion and anterior, posterior, or multidirectional instability) using a very large patient database. Furthermore, the prevalence of the Buford complex in patients without any labral pathology was also determined. Methods: A total of 3129 consecutive shoulder arthroscopy procedures were retrospectively evaluated for the presence of the Buford complex and coexisting labral pathologies. The relationships between the Buford complex and SLAP lesions, as well as instability, were evaluated statistically. Results: The Buford complex was observed in 83 shoulders (2.65%). SLAP lesions were significantly more frequent in patients with the Buford complex than in those without it (81.9% vs. 33.1%, P < .001) Shoulders with the Buford complex presented a lower frequency of anterior instability (10.8% vs. 19.3%, P = .052) and a higher frequency of posterior instability (1.2% vs. 0.9%, P = .789). The prevalence of the Buford complex in patients with and without labial pathologies was 4.6% and 0.3%, respectively (P < .001). Conclusions: This study, to our knowledge, includes the largest cohort in the literature reporting the prevalence of the Buford complex (2.65%). In the 1461 patients without labral tears or multidirectional instability, the prevalence of the Buford complex was 0.3%. This result suggests that the real prevalence of the Buford complex might be lower than that reported previously. In addition to the aforementioned conclusions, the identification of the Buford complex should prompt a thorough evaluation for concomitant SLAP lesions. (C) 2020 Published by Elsevier Inc. on behalf of Journal of Shoulder and Elbow Surgery Board of Trustees.Öğe Capsular remnant in the rotator cuff footprint is a novel arthroscopic finding may indicate the etiology of the tear(Springer, 2023) Ayanoglu, Tacettin; Ciceklidag, Murat; Kaya, Ibrahim; Ozer, Mustafa; Sarikaya, Baran; Tokgoz, Mehmet Ali; Kanatli, UlunayPurposeThe aim of the study was that the capsule remnant is a common indicator of sub-acromial impingement syndrome and bursal side onset rotator cuff tears.MethodsSixty-three patients with capsule remnants in the rotator cuff footprint (Study group) were detected, while the 53 patients did not have any remnant on the tendon footprint (Control group) between 2015 and 2020 were included. Demographic data of patients, such as age, gender, and operated side information were obtained from the archive files. Acromion type, presence of osteophytes in the acromioclavicular joint, Acromiohumeral Distance (AHD), Acromial Index (AI), Critical Shoulder Angle (CSA), and Coracoacromial Ligament (CAL) degeneration values were evaluated from preoperative MRI, radiographic images, and arthroscopic video recordings.ResultsSevere stages of CAL degeneration were observed in 82.5% of the patients who had capsule remnant (p: 0.001). While type 2 acromion was found in 61.9%, and also acromioclavicular joint osteophyte was found in 58.7% of the patients in the study group. The mean AHD was 8.22 +/- 1.56 mm in the study group and 9.2 +/- 1.3 mm in the control group. The mean CSA was 43.3 +/- 4.9 in the study group and 40.8 +/- 4.2 in the control group. The AI was measured as 0.8 +/- 0.1 in the study group and 0.8 +/- 0.01 in the control group. As a result of these measurements, a statistical difference was found between the two groups in terms of type 2 acromion ratio (p < 0.001), presence of osteophytes in the acromioclavicular joint (p < 0.001), mean acromio-humeral distance (p < 0.001), critical shoulder angle (p = 0.004), and acromial index values (p < 0.001).ConclusionThe findings of sub-acromial impingement syndrome were found to be more prominent in patients with full-thickness degenerative tear and findings of capsular remnant in the footprint. If the presence of the current finding is detected during glenohumeral arthroscopy, sub-acromial impingement syndrome should be examined in more detail to reveal the underlying cause and prevent a recurrence.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 Could superior capsule findings be used as a predictor for partial bursal-sided rotator cuff tears?(Sage Publications Ltd, 2020) Kanatli, Ulunay; Ayanoglu, Tacettin; Esen, Erdinc; Ataoglu, Baybars; Ozer, Mustafa; Cetinkaya, Mehmet; Kaptan, Ahmet YigitPurpose: The purpose of this study was to investigate the relationship between the superior capsule tear patterns and synovitis with subacromial pathologies, such as bursal-sided rotator cuff tear and subacromial impingement syndrome. Methods: Fifty patients who underwent arthroscopic treatment for isolated bursal-sided tear were included in the study. Fifty more patients who underwent arthroscopic treatment for isolated Superior Labrum Anterior Posterior (SLAP) 2 lesion without pathology in the rotator cuff were included in the control group. Firstly, superior capsule tear and common synovitis on the rotator cable were assessed during glenohumeral joint examination. Coracoacromial Ligament (CAL) degeneration grading was performed according to the Royal Berkshire Hospital classification. Bursal-sided partial tear grading was done using Ellman classification. Whether or not there was a relationship between synovitis, classic capsule tear, plus reverse flap capsule tear, and partial bursal-sided tear existence. Results: There were 21 patients with reverse flap capsule tear in the study group and 3 patients in the control group. In addition, there were 13 patients with synovitis in the study group and 4 in the control group. Compared to the control group, there was also a significant positive correlation in the presence of both synovitis and reverse flap capsule tear with the presence of bursal-sided tear in the study group (p = 0.000). There was, however, no significant difference between the presence of classical capsule tear and the presence of bursal-sided tear (p = 0.485). Conclusion: This study shows that the presence of reverse flap capsule tear and synovitis was associated with partial bursal-sided tears. Therefore, if the reverse flap capsule tear or synovitis is detected in the superior capsule, the rotator cuff should be evaluated in more detail during subacromial bursoscopy in order not to miss a bursal-sided partial cuff tear.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 effect of bicipital groove morphology on the stability of the biceps long head tendon(Springer, 2021) Ulucakoy, Coskun; Kaptan, Ahmet Yigit; Yapar, Aliekber; Orhan, Ozlem; Ozer, Mustafa; Kanatli, UlunayBackgroundLong head of biceps tendon (LHBT) instability is an important source of pain and disability for the shoulder. Supraspinatus and subscapularis tendons contribute to the formation of the biceps pulley system, which maintains biceps stability during shoulder movements. The aim of this study is to evaluate the effect of morphology of bicipital groove on the stability of LHBT. Also, to evaluate the relationship between bicipital groove morphology and subscapularis rupture and supraspinatus rupture.Material and methodsSurgical images and magnetic resonance images of 200 patients who underwent shoulder arthroscopy surgery in our clinic between January 2016 and December 2017 were retrospectively analyzed. The depth of groove, medial wall angle and opening angle values of 200 patients were measured on MRI. The stability of the biceps long head tendon, rotator cuff tear and SLAP lesions was recorded by monitoring the shoulder arthroscopy records in each groups.ResultsThere were 200 patients, 131 male and 69 female, with an average age of 40.914.2 (range: 17.0-79.0) years. In 69 (34.5%) patients, long head of the biceps tendon (LHBT) instability was detected. The patients were divided into two groups according to LHBT instability.The subscapularis rupture was significantly more frequent in the group with LHBT instability (52.2%) than the group without LHBT instability (4.6%) (p<0.001). The supraspinatus tear was observed in 72.5% in the group with instability and 56.5% in the non-instability group, which shows a statistical difference between the two groups (p=0.027). The presence of SLAP was observed in similar rates in both groups (p=0.053). Mean depth of groove, medial wall angle, and opening angle measurements were similar in both groups (p=0.568, p=0.393 and p=0.598, respectively).ConclusionTo conclude, the morphology of the bicipital groove is not related to the stability of LHBT, and the soft tissue factors above the bicipital groove rather than bone morphology are important in stability. In addition, subscapularis rupture is a pre-disposing factor for LHBT instability; therefore, we recommend a more careful examination of LHBT in patients with subscapularis rupture.Level of evidence III.Öğe Evaluation of the relationship between scapula morphology and anterior shoulder dislocation accompanying greater tuberosity fracture(Elsevier Sci Ltd, 2023) Ozer, Mustafa; Yaka, Haluk; Turkmen, Faik; Kacira, Burkay Kutluhan; Kaptan, Ahmet Yigit; Kanatli, UlunayIntroduction: It is estimated that 5-30% of traumatic anterior shoulder dislocations are accompanied by greater tuberosity fracture (GTF), and the pathomechanism of these fractures is not yet clear. Our hypothesis is to examine the relationship between the scapula morphology and anterior shoulder dislocation (ASD) accompanying GTF. Materials and methods: The patients were divided into two groups according to the accompanying GTF. 40 patients with isolated traumatic ASD and 31 patients with accompanying GTF were included in the study. Critical shoulder angle (CSA), glenoid inclination (GI), acromial index (AI) and greater tuberosity angle (GTA) values were measured in two sessions by two independent observers in the standard antero-posterior radiographs of the patients in both groups. Results: The mean CSA was 40.82 degrees +/- 3.19 degrees and 35.49 degrees +/- 2.19 degrees in accompanying GTF group and the isolated ASD group, respectively. The mean CSA was significantly higher in accompanying GTF group than isolated ASD group (P<0.001). The GI was significantly higher in the isolated ASD than in accompanying GTF group (P = 0.001). The mean GI was 18.7 degrees +/- 6.85 degrees and 10.45 degrees +/- 4.87 degrees in accompanying GTF group and the isolated ASD, respectively. Cut-off value of CSA and GI was 38 degrees (88.2% sensitivity,88.9% specificity) and 14.5 degrees (70.6% sensitivity and 72.2% specificity), respectively. There was no significant difference regarding the mean GTA and AI values between GTF group and the isolated ASD group (P = 0.98, P = 0.63). Conclusions: Increased CSA and GI values are associated with traumatic anterior shoulder dislocation accom-panied by greater tuberosity fracture.Öğe The Evaluation of Two Different Surgical Approaches in Total Hip Arthroplasty According to the Patient Satisfaction, Plantar Pressure Distribution and Trendelenburg Sign(2019) Yildirim, Ahmet; Ayanaoğlu, Tacettin; Mustafa , Özer; Esen, Erdinç; Kanatli, Ulunay; Bölükbaşi, SelçukThe aim of this prospective study was to analyze the results of two different surgical aproaches for total hip arthroplasty as Trendelenburg sign, plantar pressure distribution with the help of dynamic pedobarography and clinical results by Harris Hip Score. A total of 28 patients who underwent unilateral total hip arthroplasty using two different types of lateral approach as conventional lateral Hardinge approach and intermuscular Hardinge approach described by Pai were included in this study. Plantar pressures have maesured by EMED-SF pedobarography device and analysed by the help of a commercial software; that seperates the foot to the four different parts which are called masks. Trendelenburg’s sign has been estimated as grade 1 and grade 2 by the method which was described by Hardcastle and Nade. Clinical outcome was measured by comparing Harris Hip Scores pre-operatively and postoperatively at last clinic visit. In both groups after the two years from the surgery; total contact time has increased at the operation side when the results were compared before the surgery at the same side and at the other side after the surgery. Also when we looked at the first and second masks which show the significant part of the stance phase; contact areas have similarly increased and the changes at the peak pressures were similar as contact areas. In both groups Harris Hip score was increased significantly after the operation. This is the first study to compare two different lateral approaches by pedobarographic analysis, clinical evaluation and functional scoring. The fuctional and clinical early results are similar in both lateral hip approaches for total hip arthroplasty when superior gluteal nerve protection, conjuant tendon repair and postoperative rehabilitation have done well.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 Is prenatal testosterone-estrogen balance related to critical shoulder angle?(Elsevier Ireland Ltd, 2023) Yaka, Haluk; Baako, Yahaya; Ozer, Mustafa; Kanatli, UlunayBackground: The 2D:4D ratio (an indicator of prenatal testosterone-estrogen balance) is the ratio of the second finger length to the fourth finger length. We hypothesized that low 2D:4D values indicating high prenatal testosterone exposure may be associated with increased critical shoulder angle (CSA).Aims: The aim of this study was to evaluate the relationship between CSA and 2D:4D ratio.Methods: Meeting the study criteria, 252 patients were included in the study. We measured CSA on true anterior-posterior radiographs, glenoid version(GV) and glenoid inclination(GI) on MRI images and the lengths of the second and fourth fingers on both hands of the patients. Additionally, we compared 2D:4D ratios and CSA, GV, GI measurements.Results: We found a significant negative correlation between CSA and the 2D:4D ratio in both hands (p < 0.001). Patients with CSA > 35 degrees had a significantly lower 2D:4D ratio than patients with CSA < 35 degrees (p < 0.001). When the patients were grouped according to CSA35 degrees, the cut-off value for the left-hand 2D:4D ratio was 0.96, which showed 84.8 % sensitivity and 83.3 % specificity(AUC:0.911). Patients were compared in terms of CSA by categorizing as 2D:4D > 1 and 2D:4D < 1. Accordingly, the CSA value was significantly lower in patients with 2D:4D > 1. In the classification made according to this length classification of the left hand, the cut-off value was 30.25 degrees. This value showed 92.2 % sensitivity and 85 % specificity(AUC:0.956).Conclusion: The 2D:4D ratio is related to CSA. A low 2D:4D ratio(<0.96), indicating high intrauterine testosterone exposure, is associated with CSA > 35 degrees, while a high 2D:4D ratio (>1), indicating low intrauterine testosterone exposure, is associated with a low CSA(<30.25 degrees).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 The middle glenohumeral ligament: a classification based on arthroscopic evaluation(Mosby-Elsevier, 2022) Kaptan, Ahmet Yigit; Ozer, Mustafa; Alim, Ece; Percin, Ali; Ayanoglu, Tacettin; Ozturk, Burak Yagmur; Kanatli, UlunayBackground: Although middle glenohumeral ligament (MGHL) variations have been shown in the literature, their clinical effect and relationship with intra-articular pathologies have yet to be revealed, except for the Buford complex. This study was designed to classify MGHL and to reveal its relationship with clinical pathologies. Methods: A total of 843 consecutive shoulder arthroscopies were evaluated retrospectively, and a classification system was proposed for MGHL with regard to its structure and its relation to the anterior labrum. The associations of each MGHL type with superior labrum anterior-posterior (SLAP) lesions, subscapularis tears, and anterior instability were investigated. Results: MGHL variations were grouped into 6 types according to the classification. A significant difference in favor of type 6 MGHL (Buford complex) was observed in the distribution of SLAP lesions (P < .001). There was no significant difference between MGHL types and the distribution of anterior instability history (P = .131) and subscapularis tears (P = .324). Conclusion: SLAP lesions accompany type 6 MGHLs (Buford complex) significantly more frequently than other types. There is also a negative relation between the anterior instability and thicker MGHL variants. (C) 2021 Journal of Shoulder and Elbow Surgery Board of Trustees. 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 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 The Relationship Between Fibular Notch Anatomy and ATFL Rupture(Elsevier Science Inc, 2023) Yaka, Haluk; Ozer, Mustafa; Turkmen, Faik; Demirel, Ahmet; Kanatli, UlunayThe anterior talofibular ligament (ATFL) is the first to be damaged during a lateral ankle sprain. Dynamic and static structures have been investigated to better understand ATFL rupture, but the predisposing factors have not been fully elucidated. This study aims to define the fibular notch version that can evaluate the position of the fibular notch relative to the tibia and investigate the relationship between the fibular notch version (FNV) and ATFL rupture. This study included 71 patients with isolated ATFL rupture diagnosed clinically and radiologically and 71 control patients without any foot or ankle pathologies. Anterior facet length (AFL), posterior facet length (PFL), anterior-posterior facet angle (APFA), fibular notch depth (ND), and FNV measurements were performed on axial magnetic resonance images (MRI). We defined FNV as a parameter that evaluates the fibular notch's relative position to the distal tibia. The mean FNV was 16.6 & DEG; & PLUSMN; 4.9 & DEG; in patients with ATFL rupture and 12.4 & DEG; & PLUSMN; 5.6 & DEG; in the control group; when both groups were compared, FNV measurements were significantly higher in patients with ATFL rupture (p = .002). The mean APFA was 123.9 & DEG; & PLUSMN; 10 & DEG; in the group with ATFL rupture and 129.7 & DEG; & PLUSMN; 7.8 & DEG; in the control group. When both groups were compared, APFA was significantly lower in patients with ATFL rupture (p = .014). There was no significant difference between the groups regarding AFL, PFL, and ND. A more posterior (retroverted) fibular notch and a lower fibular notch angle seem to be associated with higher rates of ATFL rupture. & COPY; 2023 by the American College of Foot and Ankle Surgeons. All rights reserved.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.