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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, Mehmet
Background 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.
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, Tacettin
Purpose: 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.
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, Ulunay
Background: 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.
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, Ulunay
PurposeThe 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.
Combined erector spinae plane and interscalene brachial plexus block for surgical anesthesia of scapula fracture
(Elsevier Science Inc, 2019) Kilicaslan, Alper; Hacibeyoglu, Gulcin; Goger, Esra; Uzun, Sema Tuncer; Ozer, Mustafa
[Abstract Not Availabe]
Comparison of monoplanar versus biplanar medial opening-wedge high tibial osteotomy techniques for preventing lateral cortex fracture
(Springer, 2017) Turkmen, Faik; Kacira, Burkay K.; Ozkaya, Mustafa; Erkocak, Omer F.; Acar, Mehmet A.; Ozer, Mustafa; Toker, Serdar
The purpose of this study was to investigate the mechanical strength of both monoplanar and biplanar medial opening-wedge high tibial osteotomy (MOWHTO) procedures and assess the risk of lateral cortex disruption for both techniques. Twelve synthetic tibia models with cortical shells were used as test models. Saw cuts for monoplanar MOWHTO and biplanar MOWHTO were generated on the test models in equal numbers (n = 6 for both groups). Wedge opening load and wedge gap distance were evaluated via compressive tests. The mean gap distance just before the lateral cortex fracture in the monoplanar group was 14.7 +/- 2.9 mm, which was significantly narrower than that in the biplanar group of 19.1 +/- 2.0 mm (p = 0.015). The mean load just before the occurrence of lateral cortex fracture of 32.4 +/- 3.2 N in the monoplanar osteotomy group was significantly lower than that in the biplanar osteotomy group of 111.8 +/- 9.3 N (p = 0.009). Performing a MOWHTO via the biplanar rather than the monoplanar technique allows larger-sized wedges to be opened with less risk of lateral cortical fracture. Thus, larger gaps can be opened and higher angle corrections can be achieved using the biplanar osteotomy procedure. From a clinical viewpoint, the biplanar osteotomy technique reduced the risk of lateral cortical hinge fracture during MOWHTO.
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, Mehmet
Objectives 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.
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 Yigit
Purpose: 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.
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, Ulunay
Background: 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.
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, Ulunay
BackgroundLong 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.
Evaluation of the effect of vitamin D level on greater tuberosity primary bone marrow edema
(Wiley, 2023) Basbug, Veysel; Yaka, Haluk; Tekin, Alper Aziz; Duman, Numan; Demiryurek, Mehmet; Ozer, Mustafa
IntroductionThe anabolic effects of vitamin D on bone tissue have been demonstrated in experimental studies. The aim of this study was to evaluate the relationship between greater tuberosity primary bone marrow edema (GTPBMO) and vitamin D levels. Materials and MethodsThirty-nine patients (22 females and 17 males; mean age 49.02 +/- 13.08 years) with isolated GTPBMO between March 2016 and March 2018 were included in the study. Sixty patients (34 females and 26 males; mean age 43.45 +/- 12.61 years) who did not have any shoulder complaints and fulfilled the study criteria were selected as the control group. Both groups were compared in terms of vitamin D levels. ResultsThe mean vitamin D level was 13.43 +/- 9.02 ng/mL in the GTPBMO group. In contrast, mean vitamin D level was 21.54 +/- 8.03 ng/mL in the control group (p < 0.001). In the GTPBMO group, vitamin D deficiency was detected in 31 (79.5%) patients, vitamin D insufficiency was detected in 5 (12.8%) patients, and vitamin D levels were normal in 3 (7.7%) patients. In the control group, vitamin D deficiency was detected in 29 (48.3%) patients, vitamin D insufficiency was detected in 16 (26.7%) patients, and vitamin D levels were normal in 15 (25%) patients. ConclusionThe etiology of GTPBMO has not yet been fully understood, but the results obtained in this study show that vitamin D levels were significantly lower in patients with GTPBMO. The findings suggest that low vitamin D levels may be one of the contributing factors in the etiology of GTPBMO.
Evaluation of the Prevalence of Os Trigonum and Talus Osteochondral Lesions in Ankle Magnetic Resonance Imaging of Patients With Ankle Impingement Syndrome
(Elsevier Science Inc, 2019) Ozer, Mustafa; Yildirim, Ahmet
The prevalence of os trigonum and osteochondral lesions of talus (OCLT) have been presented in different prevalences among different groups in the literature for the patients with ankle impingement syndrome. Our main objective in the study was to determine the possible relationship between the impingement syndrome and the prevalence of os trigonum and OCLT in specific groups. The presence of anterior ankle impingement syndrome (AAIS), posterior ankle impingement syndrome (PAIS), os trigonum, OCLT, and the location of OCLT were evaluated in a blinded manner on magnetic resonance imaging from patients clinically considered to be diagnosed with ankle impingement syndrome from January 2014 to July 2017. The patients were separated into specific groups according to the confirmation of their clinical diagnosis of ankle impingement syndrome on magnetic resonance imaging . A total of 333 patients were included. The prevalence of os trigonum was found to be 1.3% in patients with PAIS(-) AAIS(+), 7.7% in patients with PAIS(-) AAIS(-), 63.3% in patients with PAIS(+) AAIS(-), and 81.1% in patients with PAIS(+) AAIS(+) (p < .001). The prevalence of OCLT was found to be 41.3% in patients with PAIS(-) AAIS(+), 23.1% in patients with PAIS(-) AAIS(-), 18.3% in patients with PAIS(+) AAIS(-), and 27% in patients with PAIS(+) AAIS(+) (p= .005). Our study showed that, for patients with isolated PAIS and AAIS combined with PAIS, the prevalence of os trigonum was 63.3% and 81.1%, respectively, which is more common than previously reported. For patients with isolated AAIS and PAIS, the prevalence of OCLT was 41.3% and 18.3%, respectively. Of the OCLTs combined with ankle impingement syndromes, 87.1% were medially located. (C) 2018 by the American College of Foot and Ankle Surgeons. All rights reserved.
Evaluation of the relationship between lateral epicondylitis and vitamin D
(Turkish Joint Diseases Foundation, 2022) Yaka, Haluk; Basbug, Veysel; Tekin, Alper Aziz; Ozer, Mustafa
Objectives: This study aims to examine the relationship between low vitamin D levels and lateral epicondylitis (LE). Patients and methods: Between January 2016 and January 2018, a total of 40 patients (17 males, 23 females; mean age: 38.6 +/- 10.7 years; range, 18 to 59 years) diagnosed with LE were included as the study group, while 66 patients (33 males, 33 females; mean age: 33.6 +/- 12.5 years; range, 18 to 58 years) who did not have any elbow complaints and met the study criteria were included as the control group. Both groups were compared in terms of vitamin D levels, of which levels of >30 ng/mL were considered normal, levels between 20-30 ng/mL were accepted as vitamin D insufficiency, and levels <20 ng/mL were categorized as vitamin D deficiency. Results: Vitamin D levels of the LE group were significantly lower than the control group (p<0.001). The mean vitamin D level was 16.47 +/- 8.22 (range, 8.32 to 39.55) ng/mL in the LE group, and 23.64 +/- 8.4 (range, 11.6 to 49) ng/mL in the control group. While 31 of the patients (77.5%) diagnosed with LE had vitamin D deficiency, four (10%) had vitamin D insufficiency, and five (12.5%) had normal vitamin D levels. In the control group, 29 (43.9%) patients had vitamin D deficiency, 20 (30.3%) had vitamin D insufficiency, and 17 (25.8%) had normal vitamin D levels. Conclusion: Although the etiology of LE has not been fully understood yet, vitamin D levels were significantly lower in LE patients in our study. This finding supports that low vitamin D may be one of the factors in the etiology of LE.
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, Ulunay
Introduction: 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.
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, Selcuk
Objectives: 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.
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, Ulunay
Background: 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.
Is medial or lateral localization of osteochondral lesions of talus related to foot angles?
(Turkish Joint Diseases Foundation, 2024) Yaka, Haluk; Kesik, Kayhan; Basbug, Veysel; Kucuksen, Muhammed Furkan; Ozer, Mustafa
Objectives: This study aims to examine the relationship between foot angles and the presence and localization of osteochondral lesions of the talus (OLTs). Patients and methods: Between January 2014 and January 2019, a total of 152 patients with a diagnosis of medial OTLs (95 males, 57 females; mean age: 28.8 +/- 6.4 years; range, 18 to 40 years), 51 patients with a diagnosis of lateral OTLs (36 males, 15 females; mean age: 27.1 +/- 6.2 years; range, 18 to 39 years), and 114 patients without known foot-ankle trauma as the control group (56 males, 58 females; mean age: 29.0 +/- 6.1 years; range, 18 to 40 years) were included. Magnetic resonance imaging and radiographs of each group were analyzed retrospectively. Lateral talocalcaneal angle (LTCA), calcaneal inclination angle (CIA), Bohler angle (BA), and Gissane angle (GA) were measured on the images and the values were compared among the groups. Results: The CIA had a significant relationship with the localization (p < 0.001). It was higher in patients with OLTs and had an effect on localization. The mean CIA was 26.6 degrees +/- 3.9 degrees in the medial OLTs group, 23.0 degrees +/- 3.5 degrees in the lateral OLTs group, and 18.5 degrees +/- 3.6 degrees in the control group. There was a significant difference in the LTCA between the control and OLTs groups (p < 0.001). The LTCA was higher in patients with OLTs, but had no effect on localization. The mean LTCA was 41.1 degrees +/- 4.2 degrees for medial OLTs, 41.3 degrees +/- 4.2 degrees for lateral OLTs, and 35.7 degrees +/- 6.8 degrees for the controls. No significant relationship was found for BA and GA among the three groups. Conclusion: Factors affecting the localization of OLTs are still not fully understood. However, foot morphology seems to play a role in determining medial or lateral localization. The LTCA is not related to the localization of OLTs; however, an increased LTCA may be related to the occurrence of OLTS. Increased CIA may be related to both OLTS localization and OLTs occurrence.
Is prenatal testosterone-estrogen balance associated with psoriasis?
(Wiley, 2020) Ozer, Ilkay; Temiz, Selami A.; Ataseven, Arzu; Dursun, Recep; Uyar, Mehmet; Ozer, Mustafa
The etiopathogenesis of psoriasis is not understood; however, psoriasis is affected by hormones, particularly the sex steroids. The second-to-fourth digit (2D:4D) ratio, which is an indicator of prenatal sex hormone balance, has been studied in various diseases that are affected by hormones. A total of 369 individuals comprising 172 patients with psoriasis and 197 healthy volunteers were included in the study. Patients with psoriasis were divided into type-1 and type-2, according to age of onset and family history. The 2D:4D ratio of both hands was recorded for all participants. Females in the psoriasis group had a lower 2D:4D ratio in both hands compared with those in the control group, with no significant difference. Males in the psoriasis group had a higher 2D:4D ratio for both hands compared with those in the control group (P= .009 andP < .001 for the right and left hands, respectively). Further, male patients with type-1 psoriasis had a lower 2D:4D ratio compared to those with type-2 psoriasis. Our results suggest that an alteration of the estrogen-testosterone balance due to prenatal testosterone activity is an independent predisposing factor for psoriasis in males.
Is prenatal testosterone-estrogen balance related to critical shoulder angle?
(Elsevier Ireland Ltd, 2023) Yaka, Haluk; Baako, Yahaya; Ozer, Mustafa; Kanatli, Ulunay
Background: 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).
Is the ratio of the index to ring finger length, a potential marker for prenatal testosterone-estrogen balance, related to posterior tibial slope?
(Elsevier, 2023) Yaka, Haluk; Ozer, Mustafa
Background: The 2D:4D ratio, an indicator of prenatal testosterone-estrogen balance, is the index finger (second finger) size's ratio to the ring finger (fourth finger) size. Asymmetric growth in the proximal tibial growth plate is considered to cause the increased posterior tibial slope (PTS) formation. Factors determining the amount of this asymmetry still need clarification. This study aims to evaluate the relationship between the 2D:4D ratio, which indicates the prenatal testosterone-estrogen balance, and the PTS. Method: Meeting the study criteria, 267 patients were included in the study. We measured the medial PTS (MPTS) and lateral PTS (LPTS) 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 MPTS and LPTS measurements. Results: We found a significant negative correlation between MPTS and the 2D:4D ratio, as well as between LPTS and the 2D:4D ratio in both hands (MPTS left vs. right hand: P < 0.001, r = -0.627 vs. P < 0.001, r = -0.498) (LPTS left vs. right hand: P < 0.001, r = 0.589 vs. P < 0.001, r = 0.404). Separately among males and females, there was a significant negative correlation between MPTS and the 2D:4D ratio, as well as between LPTS and the 2D:4D ratio in both hands (for males: MPTS left vs. right hand: P < 0.001, r = -0.607 vs. P < 0.001, r = -0.540)(for males: LPTS left vs.right hand: P < 0.001, r = 0.451 vs. P < 0.001, r = 0.406) (for females:MPTS left vs. right hand: P < 0.001, r = -0.638 vs. P < 0.001, r = -0.446) (for females:LPTS left vs.right hand: P < 0.001, r = 0.618 vs. P < 0.001, r = 0.403). Conclusions: The 2D:4D ratio, an indicator of intrauterine testosterone-estrogen balance, is related to PTS. The effect of testosterone on the growth plate of the proximal tibia may be one of the factors determining the PTS value. Level of evidence: III retrospective comparative study. & COPY; 2023 Elsevier B.V. All rights reserved.

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