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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.
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    Biomechanical Analysis of Tibiofibular Syndesmosis Injury Fixation Methods: A Finite Element Analysis
    (Elsevier Science Inc, 2023) Mercan, Numan; Yildirim, Ahmet; Dere, Yunus
    The optimal treatment strategy after syndesmotic injuries is still controversial. In our study, we aimed to evaluate ideal fixation method in syndesmotic injury by using finite element analysis method. A 3D SolidWorks model file was created by taking computed tomography (CT) images of the area from the right foot base to the knee joint level of a healthy adult male. The intact model, injury model, and 8 different fixation models were created that 3.5 mm screw and suture-button were used in. The models were compared in terms of lateral fibular translation, posterior fibular translation and external rotation of fibula compared to tibia and stress values occurred on screws and suture-buttons. In the hybrid-1 model, lateral fibular translation and external fibular rotation values were obtained as close to the intact model. Von Mises stresses occurred in the screw (435.7 MPa) and suture-button (424.7 MPa) that used in hybrid-1 model was more than single screw at 4 cm model (316.8 MPa) and single suture-button at 2 cm model (160.7 MPa). In the Hybrid-1 model, the screw compensates for posterior fibular translation and external fibular rotation, while the suture-button compensates for lateral fibular translation. Also, the effect of the distal suture-button preventing diastasis in case of proximal screw failure, it was concluded that the hybrid-1 model can be used as a good treatment alternative in the surgical treatment of distal tibiofibular syndesmotic injuries.(c) 2022 by the American College of Foot and Ankle Surgeons. All rights reserved.
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    Effectiveness of gonarthrosis treatment via intra-articular injections of linear vs. cross-linked hyaluronic acids
    (Turkish Joint Diseases Foundation, 2023) Yilmaz, Selcuk; Kurt, Mehmet; Kekec, Ahmet Fevzi; Yildirim, Ahmet
    Objectives: The study aimed to compare the outcomes of single-dose cross-linked hyaluronic acid and the linear regimen of three doses of HA knee injections among patients with gonarthrosis.Patients and methods: This single-center, retrospective study was conducted with 60 patients (47 females, 13 males; mean age: 57.9 +/- 4.29 years; range, 50 to 65 years) with Kellgren-Lawrence Grade 2 or 3 gonarthrosis between February 2020 and February 2022. Patients were either subjected to intra-articular cross-linked hyaluronic acid (n=30) or linear hyaluronic acid (n=30) injection treatments. Comprehensive assessments of the patients were conducted prior to the injections, as well as at three and six months after injection. The two injection groups were compared regarding the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford Knee Score.Results: Both injections showed a statistically significant improvement from baseline in both WOMAC and Oxford Knee Score at three and six months (p<0.001). There was no notable distinction in the alteration of WOMAC knee scores between the two injection types. However, a notable discrepancy was observed in the elevation of Oxford Knee Score among patients who received cross-linked knee injections compared to those who underwent linear hyaluronic acid knee injections, signifying a significant increase in the former group (p<0.001).Conclusion: The advantage of a single-dose administration of cross-linked HA knee injections, as opposed to the three-dose regimen required for linear hyaluronic acid, translates into reduced time and cost for the injection process. Moreover, this approach minimizes injection-associated discomfort for patients due to the singular dose administration.
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    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.
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    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, Selçuk
    The 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.
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    Mid-term results of autologous matrix-induced chondrogenesis surgery with or without scaffolds for arthroscopic treatment of deep talus osteochondral lesions: A comparative study
    (Turkish Joint Diseases Foundation, 2023) Kekec, Ahmet Fevzi; Yildirim, Ahmet
    Objectives: This study aims to investigate the effectiveness of arthroscopic autologous matrix-induced chondrogenesis (AMIC) procedure with or without polyglycolic acid-hyaluronic acid ( PGA-HA)-based cell-free scaffold (CFS) in Bristol E4 and E5 osteochondral lesion of the talus (OLT) ranging between 1.5 and 3 cm(2). Patients and methods: Between March 2018 and March 2021, a total of 47 patients with OLTs (29 males, 18 females; mean age: 22.8 +/- 2.3 years; range, 18 to 65 years) were retrospectively analyzed. The patients were divided into two groups based on the procedures applied. Patients in the first group (Group 1, n= 23) underwent the AMIC procedure alone (curettage, microfracture, and grafting), while patients in the second group (Group 2, n=24) underwent AMIC procedure with PGA-HA-based CFS. The localization of the lesions was evaluated. All OLTs were diagnosed with preoperative radiography and magnetic resonance imaging ( MRI). During the preoperative period, lesion stages were evaluated based on the Bristol staging system, and the postoperative results were evaluated based on the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system. Results: The mean follow- up was 36.2 +/- 5.6 months. In the early period, the three-month functional scores were comparable between the groups. While a significant increase was observed in the American Orthopaedic Foot and Ankle Society (AOFAS) scores from the mean preoperative of 62.71 +/- 4.44 points to the postoperative of 86.00 +/- 6.58 points in Group 1, a significant increase in the AOFAS score was observed from 65.28 +/- 7.91 points to 95.42 +/- 4.41 points in Group 2 at 12-month follow-up (p= 0.016, p=0.011, respectively). The functional scores tended to progress after 12 months. Radiologically, a complete defect filling was observed in a mean of 10.5 +/- 2.7 months. No graft hypertrophy was recorded in any patients. The AOFAS and MOCART scores in Group 2 were found to be statistically significantly higher than that in Group 1 (p= 0.034 for AOFAS 1/AOFAS 2 and p=0.006 for MOCART 1/MOCART 2). Overall, there was a positive, but weak, significant correlation between the final AOFAS scores and MOCART scores (r= 0.347, p<0.001). Conclusion: Arthroscopic AMIC procedure in deep OLTs between 1.5 cm(2) and 3 cm(2) can yield a statistically significant improvement both clinically and radiologically; however, the use of a PGA-HA-based CFS in addition to this procedure can improve the clinical and radiological recovery.
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    Morphometric risk factors effects on anterior cruciate ligament injury
    (Turkish Joint Diseases Foundation, 2023) Gultekin, Muhammet Zeki; Dincel, Yasar Mahsut; Keskin, Zeynep; Arslan, Serdar; Yildirim, Ahmet
    Objectives: This study aims to compare the morphometric differences between patients with and without an anterior cruciate ligament (ACL) injury and to investigate the anatomical risk factors associated with ACL injury. Patients and methods: Between February 2020 and February 2022, a total of 100 patients (57 males, 43 females; mean age: 36.2 +/- 6.8 years; range, 18 to 45 years) who were operated for isolated non-contact ACL tear as the patient group and a total of 100 healthy individuals (58 males, 42 females; mean age: 35.0 +/- 6.9 years; range, 18 to 45 years) without an ACL tear as the control group were included. Magnetic resonance imaging scans of the knee joint were included in the study. Morphological variables of the ACL, distal femur, proximal tibia, and menisci were measured. Results: The mean ACL inclination angle and medial meniscus bone angle were 37.7 +/- 3.8 and 20.2 +/- 2.9 in the patient group and 48.1 +/- 3.3 and 25.0 +/- 2.9 in the control group. According to the results of multivariate analysis, those with small ACL inclination angle and medial meniscus bone angle were more likely to have ACL tear (odds ratio: 0.128, intraclass correlation coefficient: 0.038-0.430, p= 0.001). Conclusion: Small ACL inclination angle and medial meniscus bone angle can be a risk factor for ACL tear.