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Purpose The aim of the ESSKA 2022 consensus Part III was to develop patient-focused, contemporary, evidence-based, guidelines on the indications for revision anterior cruciate ligament surgery (ACLRev). Methods The RAND/UCLA Appropriateness Method (RAM) was used to provide recommendations on the appropriateness of surgical treatment versus conservative treatment in different clinical scenarios based on current scientific evidence in conjunction with expert opinion. A core panel defined the clinical scenarios with a moderator and then guided a panel of 17 voting experts through the RAM tasks. Through a two-step voting process, the panel established a consensus as to the appropriateness of ACLRev for each scenario based on a nine-point Likert scale (in which a score in the range 1–3 was considered ‘inappropriate’, 4–6 ‘uncertain’, and 7–9 ‘appropriate’). Results The criteria used to define the scenarios were: age (18–35 years vs 36–50 years vs 51–60 years), sports activity and expectation (Tegner 0–3 vs 4–6 vs 7–10), instability symptoms (yes vs no), meniscus status (functional vs repairable vs non-functional meniscus), and osteoarthritis (OA) (Kellgren–Lawrence [KL] grade 0–I–II vs grade III). Based on these variables, a set of 108 clinical scenarios was developed. ACLRev was considered appropriate in 58%, inappropriate in 12% (meaning conservative treatment is indicated), and uncertain in 30%. Experts considered ACLRev appropriate for patients with instability symptoms, aged ≤ 50 years, regardless of sports activity level, meniscus status, and OA grade. Results were much more controversial in patients without instability symptoms, while higher inappropriateness was related to scenarios with older age (51–60 years), low sporting expectation, non-functional meniscus, and knee OA (KL III). Conclusion This expert consensus establishes guidelines as to the appropriateness of ACLRev based on defined criteria and provides a useful reference for clinical practice in determining treatment indications. Level of evidence II.

Background Simultaneous repairs of rotator cuff and biceps tenodesis can be managed by tenodesis of long head of biceps tendon to a subpectoral or suprapectoral area. This review investigated long head of biceps tendon tenodesis with concomitant rotator cuff repair and evaluated the clinical outcomes and incidences of complications based on tenodesis location. Methods Medline, Cochrane, and Embase databases were searched for published, randomized or nonrandomized controlled studies and prospective or retrospective case series with the phrases “suprapectoral,” “subpectoral,” “tenodesis,” and “long head of biceps tendon”. Those with a clinical evidence Level IV or higher were included. Non-English manuscripts, review articles, commentaries, letters, case reports, and sole long head of biceps tendon tenodesis articles were excluded. Results From 481 studies, 13 were chosen. In total, 1194 subpectoral and 2520 suprapectoral tenodesis cases were investigated. Postoperative Constant-Murley and American Shoulder and Elbow Surgeons mean scores showed similar good results. In terms of complication incidences, while transient nerve injuries were more commonly seen in patients with subpectoral tenodesis, persistent bicipital pain and Popeye deformity are mostly seen in patients with suprapectoral tenodesis. Discussion Biceps tenodesis to suprapectoral or subpectoral area with concomitant rotator cuff repair demonstrated similar outcomes. Popeye deformity and persistent bicipital pain were higher in suprapectoral area and transient neuropraxia was found to be higher in subpectoral area. Level of evidence: IV.

Boks ve taekwondo sporcularının fiziksel uygunluk ve vücut kompozisyonu ile ilgili birçok spesifik çalışma olmasına rağmen, şimdiye kadar karşılaştırmalı bir çalışmaya rastlanmamıştır. Bu nedenle bu çalışma, fiziksel uygunluk ve somatotip özellikleri açısından elit genç erkek boks ve tekvando sporcuları arasında fark olup olmadığını belirlemeyi amaçlamıştır. Bu çalışmaya 19 boks (ortalama yaş: 17.6 yıl) ve 21 tekvando (ortalama yaş: 17.4 yıl) elit sporcu gönüllü olarak katıldı. Sporcular, T-run, mekik-koş, otur ve uzan, koşu anaerobik sprint (RAST) ve karşı hareket atlama, görsel ve işitsel reaksiyonu içeren bir dizi test protokolü gerçekleştirdiler. Aynı zamanda, somatotip özelliklerini belirlemek için çeşitli antropometrik ve vücut kompozisyonu ölçümleri yapıldı. Boksörlerin tekvandoculardan daha iyi olduğu sadece patlayıcı güç (%9.8) ve görsel reaksiyon süresi (%9.1) açısından gruplar arasında anlamlı bir fark (p

Purpose This systematic review aimed to clarify the relative strengths and weaknesses of the all-suture anchors (ASAs) in both clinical and experimental studies. Our hypothesis was that there would be similar clinical and experimental data for ASAs regarding the biomechanical properties, clinical outcomes and complication rates. Methods A systematic review of MEDLINE and Embase databases was performed. The inclusion criteria for clinical studies were both retrospective or prospective study design and minimum 1-year follow-up; for biomechanical studies, the inclusion criteria were performance on either cadaver and animal bones or synthetic surfaces. Studies were excluded if the studies were not in English or if they were review articles, commentaries, letters, case reports, or technical notes. The risk of bias assessment was done using the Methodological Index for Non-randomized Studies (MINORS) tool. Results We included 13 experimental and 3 clinical studies. The least displacement under cyclic loading was recorded with Q-Fix. Failure mode was mostly by suture breaking for the Q-Fix, whereas anchor pullout was the most common for the others. Cadaver humerus’ greater tuberosity seemed to be less durable for the ASAs. Tests on cadaver glenoid showed similar biomechanical properties when compared to a control anchor. Studies investigating clinical and radiologic findings were very few, and only 3 case series were included in this review. Clinical findings of patients treated with ASAs for instability and rotator cuff repair showed satisfactory results and little increase in the complication rate (retear or revision surgery because of loose anchor). Conclusions ASAs have similar or better biomechanical properties compared to regular anchors. Low-profile design seems to be an important advantage. Case series can not distinguish between the possible clinical benefits and/or risks. Clinical Relevance ASAs have similar biomechanical properties when compared with other types of anchors. Their strength and performance vary with anatomic location, which may influence clinical success.

Introduction While repairing a teared rotator cuff tendon with suture anchors and horizontal mattress suture configurations, knots should be secure at time zero while approximating the tendon to the bone, otherwise any failure in loop security may cause undesired clinical results. Optimum distance between suture limbs passed through the tendon, in other words the bite size, is still not clear in the literature. The aim of this study was to test the effect of loop size, which is directly related to the bite size, on loop security and elongation of a knot. Hypothesis We hypothesized that a knot with a smaller loop size would be more secure. We asked if a knot with shorter circumference (1) would offer a better knot security; (2) would produce less elongation following repeated traction cycles. Material and methods Two parallel metal rods in 3.0 mm diameter were fixed to load cells of dynamic testing machine. Four groups, from A to D, had the initial rod to rod distances of 2-4-6-8 mm respectively (n = 10). Surgeon's knots were prepared with 2/0 Ultrabraid® sutures around the rods. A tension meter was used for tying each half hitch under equal tension. Crosshead distances were recorded after 7 N pre-load and subsequent 1000 repetitive cyclic loads between 7-30 N. Results Elongations after a 7 N preload for groups A to D were 0.107 mm (± 0.006), 0.143 mm (± 0.018), 0,16 mm (± 0.025), 0.185 mm (± 0.018) respectively. This increase was significant (p 0.95) between each group except between groups B and C. Maximum elongations after 1000th cycle for groups A to D were 0.32 mm (± 0.124), 1.12 mm (± 0.333), 1.162 mm (± 0.211), 1.292 mm (± 0.241) respectively. Only samples in group A (0.732 mm ± 0.124) elongated significantly less than others (p 0.95). No knots unravelled or ruptured. Discussion This study basically reports that a knot with a shorter loop circumference has superior properties regarding loop security and resistance to elongation. From the perspective of clinical importance, shorter distance between suture limbs of mattress configuration may provide a more secure fixation of the rotator cuff tendon to the bone. Level of evidence II.

Introduction: Many factors can affect the return to pivoting sports, after an Anterior Cruciate Ligament Reconstruction. Prehabilitation, rehabilitation, surgical and psychological aspects play an essential role in the decision to return to sports. The purpose of this study is to reach an international consensus about the best conditions for returning to sports in soccer-one of the most demanding level I pivoting sports after anterior cruciate ligament (ACL) reconstruction. Methods: 34 International experts in the management of ACL injuries, representing all the Continents were convened and participated in a process based on the Delphi method to achieve a consensus. 37 statements related to ACL reconstruction were reviewed by the experts in three rounds of surveys in complete anonymity. The statements were prepared by the working group based on previous literature or systematic reviews. Rating agreement through a Likert Scale: strongly agree, agree, neither agree or disagree, disagree and strongly disagree was used. To define consensus, it was established that the assertions should achieve a 75% of agreement or disagreement. Results: Of the 37 statements, 10 achieved unanimous consensus, 18 non-unanimous consensus and 9 did not achieve consensus. In the preoperative, the correction of the range of motion deficit, the previous high level of participation in sports and a better knowledge of the injury by the patient and compliance to participate in Rehabilitation were the statements that reached unanimous consensus. During the surgery, the treatment of associated injuries, as well as the use of autografts, and the addition of a lateral extra-articular tenodesis in some particular cases (active young athletes

Pubmed'de indekslenmektedir Introduction: Many factors could affect the supraspinatus (SSP) muscle after tendon rupture. We aimed to determine how infraspinatus and subscapularis tendon problems affect supraspinatus muscle atrophy associated with tears, in a retrospective cohort study conducted in a tertiary-level centre. Materials and Methods: Fifty-eight patients with a full-thickness SSP tendon tear who fulfilled the inclusion criteria were enrolled in the study. They were evaluated for tear retraction, fatty degeneration, and other rotator cuff tendon pathologies. Supraspinatus muscle was assessed using the Goutallier classification, and its average area was also measured. Accompanying lesions of the subscapularis and infraspinatus tendons and degree of supraspinatus muscle atrophy were evaluated using magnetic resonance imaging. Results: Our results showed that supraspinatus tendon tears ranged between 3mm and 41mm, and the estimated average cross-sectional area of the SSP muscle was 247.6mm(2). Any degree of infraspinatus tendon pathology, ranging from tendinosis to full-thickness tears, was significantly correlated with the SSP muscle area (P < 0.05). The subscapularis tendon pathologies did not show a similar correlation. The interobserver and intraobserver reliabilities of the measurements were graded as excellent. Conclusion: Impairment of any of the rotator cuff muscles may affect the other muscles inversely. Our study showed that all infraspinatus tendon pathologies and partial subscapularis tears affect and alter the SSP muscle belly. We suggest early intervention for supraspinatus tears to avoid further fatty degeneration, as muscle atrophy and fatty degeneration progress in combination with the accompanying lesions.

Purpose The purpose of this experimental study was to investigate the effect of hyperbaric oxygen (HBO2) therapy combined with microfracture technique in the treatment of cartilage lesions. Methods Adult Wistar rats (n=44) were divided into six groups. In Groups A, B, C and D, ICRS* (* International Cartilage Repair Society) grade 4 cartilage lesions were made on the femoral sulcus of both knees. Lesions were microfractured on the left knees; the right knees had no further procedure. Groups E and F had no surgery. Groups A, C and E received HBO2 therapy once a day, six days a week postoperatively. Groups B, D and F had no HBO2 therapy. The animals in Groups A, B, E and F were sacrificed after two weeks; Groups C and D were sacrificed after four weeks. Semiquantitative scale - including filling of defect (microfracture hole), reparative tissue thickness, cell morphology and subchondral bone maturation - was used for evaluation. The Mann-Whitney test was used to compare individual and total scores. Results Total scores of the two-week group with adjuvant HBO2 therapy were significantly higher (P=0.0007) than the two-week standard treatment group. Except for subchondral bone maturation, individual scores were significantly higher in the two-week group with adjuvant HBO2 therapy. Total scores of the four-week groups were similar. Among individual scores of the four-week groups, filling of the defect (microfracture hole), and subchondral bone maturation were significantly higher (P=0.01, P=0.03) in groups with adjuvant HBO2 therapy. Conclusions Adjuvant HBO2 therapy accelerates the healing process of cartilage lesions treated with microfracture in rats.

The hypothesis of this clinical study was that coracoclavicular (CC) reconstruction using autogenic palmaris longus graft through the GraftRope (PLG) system (Arthrex, Inc., Naples, FL, USA) would provide superior clinical and radiologic results compared with modified Weaver-Dunn procedure with the dynamic TightRope (Arthrex, Inc.) system (WDT).Between 2008 and 2013, 32 patients (average age, 39.7 years; range, 22-60 years) underwent surgical reconstruction of chronic acromioclavicular (AC) joint dislocation. A modified WDT procedure was performed in 16 patients and autogenous PLG was performed in the other 16 patients. Patient data were collected retrospectively, with a final follow-up of 44.9 months (range, 29-60 months). The degree of AC joint displacement was evaluated by measuring the CC distance on the anteroposterior and axillary view. Clinical and functional outcomes were compared by American Shoulder and Elbow Surgeons and the Constant scores at final follow-up.Comparison between the WDT and PLG groups showed a significantly better outcome in the American Shoulder and Elbow Surgeons and the Constant scores (P .01), in favor of the PLG group. Both groups showed an increased CC distance compared with the uninjured side, with a mean difference of 1.1 mm for the PLG and 3.3 mm for the WDT groups. A tolerable loss of reduction within the follow-up time was observed. Reduction loss was higher with the WDT group (P .05).CC palmaris longus tendon graft reconstruction with GraftRope system was associated with functional and radiologic benefits. The palmaris longus graft with GraftRope system could be used in chronic cases.

The anatomy of the glenohumeral joint allows for a wide range of motion at the expense of stability. It is the most commonly dislocated joint of the human body. The risk for instability is greatest in overhead sports and collision sports, especially football, rugby, and wrestling. While not a true collision or overhead sport, basketball necessitates physical contact and frequent overhead movements, which can lead to an increased risk of shoulder instability. After an instability event, the treating physician must help the patient decide between nonoperative and operative management. Many variables contribute to this decision, including the age of the patient, duration of symptoms, type of instability, number of instability events, radiological findings, and timing of the injury (i.e., in season or out of season). In general, operative treatment reduces recurrence rates while increasing successful return to play compared to conservative treatment. Therefore, operative management tends to be the preferred approach, especially in young athletes. The following chapter will provide a comprehensive review on shoulder instability in the basketball athlete with a special focus on diagnosis, management, and rehabilitation for successful return to play.

The glenohumeral joint is often likened to a golf ball on a tee, which provides a functional benefit of a large arc of motion. In return, predisposition to an inherent instability is present, which can result in traumatic anterior shoulder dislocation. In the general population, the incidence of traumatic shoulder instability has been reported to be 1.7% [1, 2]. Anterior is the most common direction of glenohumeral joint dislocations, accounting for over 90% of all shoulder dislocations. As a common complication after an anterior shoulder dislocation, Bankart lesions can be seen specifically at the anteroinferior aspect of the glenoid labral complex.

Reverse shoulder arthroplasty (RSA) has been a great aide to the orthopedic surgeons for cuff tear arthropathies. RSAs should have a good biomechanical baseline; otherwise it may lead to some complications. First, the lack of rotator cuff muscles may predispose to instability. Next, stress on the deltoid from lateralization and/or distalization may lead to acromial fractures or deltoid insufficiency. Furthermore, changing the center of rotation may result in impingement between prosthesis and osseous structures. The purpose of this chapter is to define the biomechanics of failure of RSA in patients with cuff tear arthropathies.

Glenohumeral instability is a common cause of discomfort in general population; however, isolated posterior shoulder instability accounts for only little percentage of those. Treatment of posterior shoulder instability might be challenging for surgeons. Even though the first treatment of choice is mostly conservative, surgical intervention is mostly required to prevent recurrence. Surgical intervention involves either bone grafting and soft tissue procedures or both. Management of humeral head defects (reverse Hill-Sachs lesion) starting from diagnosis to surgical technique has been described step by step in this chapter.

Our job requires constant decision making, followed by application of these decisions into practice. It is the core of our profession. We select a logical choice from the available options day in, day out, constantly, be it selecting the optimal treatment for a degenerative meniscal tear in a middle-aged individual or a first-time shoulder dislocator in an adolescent athlete.

* Karahan, Mustafa ( Aksaray, Yazar ), Purpose: The purposes of this study were to examine the physical performance characteristics of Division-I (D-I) and Division-II (D-II) university male tennis players and to evaluate whether these characteristics could be determinative on the divisional differentiation. Material: Twenty athletes who compete in D=I (n=10) and D-II (n=10) of Turkey university tennis league (n=10) and also ranked in top-ten in their division voluntarily participated in this study. Results: Measurement of agility, upper and lower body explosive powers, fatigue index, aerobic and anaerobic powers was conducted on two non-consecutive days. Significant differences were observed in physical performance characteristics powers between the groups (p

The aim of this study is to identify the differences of physical performance characteristics between the amateur male adolescent soccer players in different age groups. One hundred and twenty-eight male players voluntarily participated in this study and athletes were classified in three chronological age groups as U-15, U-17 and U-19. Physical performance data showed that the U-15 group tended to be slower over 10 and 20 meters, and had the poorest agility and anaerobic power. Except for explosive power, the performance values of U-17 were lower than U-19 (p

The aim of our study was to evaluate the risk of medial glenoid perforation and possible injury to suprascapular nerve during arthroscopic SLAP repair using lateral transmuscular portal. Ten cadaveric shoulder girdles were isolated and drilled at superior glenoid rim from both anterior–superior portal (1 o’clock) and lateral transmuscular portal (12 o’clock) for SLAP repairs. Drill hole depth was determined by the manufacturer’s drill stop (20 mm), and any subsequent drill perforations through the medial bony surface of the glenoid were directly confirmed by dissection. The bone tunnel depth and subsequent distance to the suprascapular nerve, scapular height and width, were compared for investigated locations. Four perforations out of ten (40 %) occurred through anterior–superior portal with one associated nerve injury. One perforation out of ten (10 %) occurred through lateral transmuscular portal without any nerve injury. The mean depth was calculated as 17.6 mm (SD 3) for anterior–superior portal and 26.5 mm (SD 3.6) for lateral transmuscular portal (P

Introduction While repairing a teared rotator cuff tendon with suture anchors and horizontal mattress suture configurations, knots should be secure at time zero while approximating the tendon to the bone, otherwise any failure in loop security may cause undesired clinical results. Optimum distance between suture limbs passed through the tendon, in other words the bite size, is still not clear in the literature. The aim of this study was to test the effect of loop size, which is directly related to the bite size, on loop security and elongation of a knot. Hypothesis We hypothesized that a knot with a smaller loop size would be more secure. We asked if a knot with shorter circumference (1) would offer a better knot security, (2) would produce less elongation following repeated traction cycles. Material and methods Two parallel metal rods in 3.0 mm diameter were fixed to load cells of dynamic testing machine. Four groups, from A to D, had the initial rod to rod distances of 2–4–6–8 mm respectively (n = 10). Surgeon's knots were prepared with 2/0 Ultrabraid® sutures around the rods. A tension meter was used for tying each half hitch under equal tension. Crosshead distances were recorded after 7 N pre-load and subsequent 1000 repetitive cyclic loads between 7-30N. Results Elongations after a 7N preload for groups A to D were 0.107 mm (±0.006), 0.143 mm (±0.018), 0,16 mm (±0.025), 0.185 mm (±0.018) respectively. This increase was significant (p 0.95) between each group except between groups B and C. Maximum elongations after 1000th cycle for groups A to D were 0.32 mm (± 0.124), 1.12 mm (±0.333), 1.162 mm (±0.211), 1.292 mm (±0.241) respectively. Only samples in group A (0.732 mm ± 0.124) elongated significantly less than others (p 0.95). No knots unravelled or ruptured. Discussion This study basically reports that a knot with a shorter loop circumference has superior properties regarding loop security and resistance to elongation. From the perspective of clinical importance, shorter distance between suture limbs of mattress configuration may provide a more secure fixation of the rotator cuff tendon to the bone. Level of evidence II.

Augmentation of anterior cruciate ligament reconstruction with platelet-rich plasma and a gelatin sponge improves tendon to bone healing in a small animal model. A sponge may prolong platelet-rich plasma bioactivity time.

The purpose of this study was to evaluate safe depth for suture anchor insertion during acetabular labral repair and to determine the neighbouring structures at risk during drilling and anchor insertion. Ten human cadaveric hips (six males and four females) were obtained. Acetabular labral surface was prepared and marked for right hips as 12, 1 and 3 o’clock positions, for left hips 12, 11 and 9 o’clock positions. Those were defined as anterior, anterior–superior and superior zones, respectively. These labral positions were drilled at defined zones. After measurements, depth of the bone at 10° and 20° drill angles on zones was compared statistically. Acetabular bone widths at investigated labral insertion points did not statistically differ. A total of 14 injuries in 60 penetrations occurred (23.3 %) with free drill penetrations, and no injuries occurred with stopped drill penetrations. The bone depth was gradually decreasing from 10° to 20° drill angles and from anterior to superior inserting zones without significant importance. The risk of perforation to the pelvic cavity started with 20 mm drill depth, and the mean depth for all insertions was calculated as 31.7 mm (SD 2.6). It is anatomically possible that some pelvic structures sustain iatrogenic injury during acetabular drilling for anchor placement. Being aware of mean pelvic vault is important in which drilling after excessive pincer rim trimming could easily decrease the depth of acetabular bone without a standard. Careful drilling by using stopped drill bit is crucial to prevent iatrogenic injury.

Treatment of irreparable massive rotator cuff tears remains challenging and controversial. The decision-making process includes surgeon personal experience as well as scientific evidence. A thorough knowledge of existing treatment options and indications is crucial to achieve the best outcome. The chapter provides an overview of the different available treatments, including: scaffold augmentation, superior capsule reconstruction, subacromial biodegradable spacer, tendon transfers, up to reverse shoulder replacement.

ACL injuries in football are frequently encountered because of their high-intensity axial and valgus forces due to their competitive natural and challenging condition. Despite developing surgical techniques and rehabilitation protocols, approximately two-thirds of the operated athletes, 1 year after the operation, are seen to not be able to turn back their pre-injury sports conditions. Isokinetic force tests, subjective assessment forms, and functional performance tests have been argued generally in the literature to be back-to-sport determinants. Isokinetic tests are used to assess lower extremity strength. Clinical tests including force tests and laxity measurements that are done after the ACL surgery and rehabilitation are found to be poorly compatible with all patients’ functional abilities, and functional tests have been developed to help assess whether the athlete is ready to return to unlimited activity with surgery and treatment results. The back-to-sport criterion includes that there must be at least 85% of difference between the healthy side and the hamstring and quadriceps strength measured by the bound tests and the tolerance of patients in sport-specific. There are a variety of field tests and applications for the removal of side-by-side asymmetries in the athletes and for the examination of different dynamics together. The content of this study is to indicate the importance of the functional testing, the back-to-sport criteria of the athlete after the ACL injury, and the varieties and applications of the field test.

Sutures are used on a daily basis in orthopedic surgery for a wide variety of purposes. Although mostly depended onto the surgeon preferences, the selection of suture material is based on the tissues to be repaired. As surgical procedures and the handled tissues vary, it is important to understand the basic types of the suture materials. Synthetic suture materials overcome the use of natural suture materials for years. With modern sutures, it is likely to perform many surgical procedures with more confidence. This review will cover several different features of suture materials that are commonly used.

Pain management is crucial for a successful result after various knee surgeries. Opioids may be included in the postoperative pain management protocol but may be abused if not controlled. Following knee arthroscopy and related surgery, adolescent and young adult patients are commonly overprescribed opioids. The driving force behind opioid prescription should be explored in addition to reviewing and emphasizing perioperative interventions that can reduce postoperative opioid consumption, including wound injections and peripheral nerve blocks.

The purpose of this study is to determine the immediate effects of pH change on the metabolism of bovine chondrocytes. Bovine osteochondral explants were pre-cultured and placed in Ringer’s lactate solution. Thirty explants were randomly divided into 3 groups. Buffered Ringer’s lactate, pH 7.2, was used in Group I; buffered Ringer’s lactate, pH 7.4 (normal bovine knee joint pH), was used in Group II; and this group was also set as the control group. Buffered Ringer’s lactate, pH 7.6, was used in Group III. All specimens were soaked for 2 h. RNA yield analyses were performed to evaluate the changes in cartilage metabolism at different pH levels. Mean RNA yields of (hypoxia-induced factor) 1α that were immersed at pH 7.2 and 7.6 were 10.5- and 9.9-fold from base, respectively, which were lower compared to explants at pH 7.4 which was found as 15.2-fold. Mean RNA yields of aggrecan that were immersed at pH 7.2 and 7.6 were 12.2- and 13.6-fold from base, respectively, which were lower compared to explants at pH 7.4 which was found as 20-fold. RNA yields of collagen type II at pH 7.2 and 7.6 were 16.1- and 16.6-fold from base, respectively, which were lower compared to explants immersed at pH 7.4 which was found as 22.1-fold. The findings of the presented study suggest that short-term exposures to both acidic and basic pH may have effects on chondrocyte function. Our findings also indicate that exposures to solutions with a pH different from normal by only 0.2 unit could suppress chondrocyte metabolism and RNA synthesis. Using buffered irrigation solutions with a pH closer to the normal joint pH could be more physiologic and causes less ultra-structural damage than regular irrigation solutions. II.

Failure in maintaining the integrity of meniscus results in increased stresses on the cartilage, leading to cartilage degeneration, irreversible joint damage and osteoarthiritis. This finding led to increased tendency towards meniscus preserving surgery over partial or total meniscectomy. Meniscus scaffolds are developed to overcome devastating outcomes of partial meniscectomies. In order to establish the ideal scaffold, numerous biomaterials have been studied so far. Currently, meniscal scaffolds represent a rather good treatment option for patients with painful knees after partial meniscectomy. With correct indications and appropriate technical implantation, relief of symptoms along with improvement in functional status can be expected in majority of patients. Implantation of meniscal scaffolds does not preclude accompanying surgical procedures in most cases and combined surgical procedures are rather common. Still there is space for further improvements in the scaffold technology as current implants in use still have inferior mechanical properties when compared to the native meniscus.

This book aims to provide orthopedic surgeons with all the information that they will require in order to set up and run a motor skills course that will meet the needs of junior staff in Orthopedic Sports Medicine and help in training better surgeons for the future. The coverage is wide-ranging, from the fundamentals of what it takes to be a sports surgeon through to validation methods that measure teaching effectiveness and the certification of surgical skills at the end of the course. Clear guidance is provided on how to teach concepts of surgical skill and the strategy and practical details of designing a training program, with inclusion of a helpful checklist of do’s and don’ts. Different basic training modalities are described, with a particular focus on the FAST system adopted by the Arthroscopy Association of North America, and the role of simulators in surgical skills training is discussed. The book has been produced in cooperation with ISAKOS and the authors are leading professionals from around the world who offer a truly global and multidisciplinary perspective on the subject., info:eu-repo/semantics/publishedVersion

Bones are dynamic tissues with a great organization in structure not only a static support also with a great cellular and mineral capacity. The biology of bone fracture healing is a very complex process, through the understanding of the healing phases, is critical. Fracture healing can be divided into two main categories: primary bone healing and secondary bone healing although both healing responses can interact. Primary bone healing is similar to the bone remodeling which occurs under low interfragmentary movement or rigid fixation and under compression. Secondary bone healing is associated with motion on the fracture site, involves an inflammatory response and hematoma formation, repair phase (soft callus and hard callus), and remodeling. After a fracture blood vessels disruption, it leads to hematoma formation and the hematoma is intruded with immune cells; an inflammatory response elicits with pro-inflammatory cytokines IL-1, IL-6, TNF-α, and IFN-ϒ. The control of inflammatory response is critical for further process. After resolution of the inflammatory response, mesenchymal stem cells accumulate to the fracture side and differentiate into chondrocytes and osteoblasts. Further, with the controlled activity of macrophages, T- and B-lymphocytes, cytokines, and growth factors, soft callus is produced with endochondral formation followed by hard callus. Fracture healing is completed by the remodeling phase characterized by the balance between osteoblast and osteoclast functions under both systemic and local control pathways.

Osteochondritis dissecans (OCD) of the knee is a frequent cause of pain and functional limitation among skeletally immature and young athletes. Chronic overuse of the lower extremity in young soccer players can cause OCD at the knee and ankle joints; furthermore, with increased competitiveness of amateur sports, more injuries may cause OCD. Increased joint stress, such as an increased pressure at the medial femoral condyle in young patients with genu varum, might cause decreased blood flow and trigger the development of OCD. Symptoms are usually preceded by trauma in 40–60% of the cases. Juveniles and adolescents will complain of vague, nonspecific poorly localized anterior knee pain with variable intermittent amount of swelling, locking of the knee grinding, or catching; pain is aggravated by activity and relieved by rest. If not recognized and appropriately treated, it can create further limitation and lead to early osteoarthritis. OCD is a disorder of one or more ossification centers, characterized by sequential degeneration or aseptic necrosis and recalcification. OCD lesions involve both bone and cartilage but appear to affect the subchondral bone primarily and secondarily affect the articular cartilage.

Tissue engineering became one of the hot topics of medicine just after the review article by Langer and Vacanti in 1993 with title “Tissue Engineering,” and today tissue engineering is known to be a multidisciplinary field that applies the principles of engineering and life sciences toward the development of biological substitutes that restore, maintain, or improve tissue function or a whole organ [1]. The strategies of tissue engineering or in other words “regenerative medicine” require both relation and communication of cells with tissue by signaling pathways [1–3].

Football is a very popular sport with more than 260 million active practitioners worldwide, and its practice puts in risk the players of every age, at all playing levels and field positions, to an injury. Due to the way football is played, the injury incidence is higher in the lower than in the upper extremity, but goalkeepers (GK), however, due to the specificity of this job, are prone to upper-extremity injury, with a five times higher incidence compared to outfield players.

Anterior cruciate ligament (ACL) reconstruction in most cases is an elective surgery with many potential complications. Early (non-emergent) surgery may increase the risk of certain complications including significant postoperative stiffness with loss of motion. Delaying surgery by a few weeks to allow the acutely injured knee to regain motion and gain quad control decreases the risk for these adverse effects. However, delayed ACL reconstruction with the intent of returning to normal activities months after the initial injury may lead to an increased risk of injury to cartilage and menisci. By choosing a delayed surgical treatment pathway, we are not intending to return the patient to sports; rather, we plan to get them through the acute inflammatory phase prior to reconstruction. We know by experience and by numerous well-designed studies that returning a patient with a potentially unstable knee to at risk activities including sports and certain occupations can lead to further injuries with irreversible damage.

The road from learner to being an expert is very complex, and it is not possible to explain it simply. To understand the principles of learning and performance of motor skills, one must be familiar with the science of motor learning. Arthroscopic surgical procedures require basic unique surgical skills, which are acquired throughout residency or postgraduate programs. A motor skill is a voluntary musculoskeletal system movement that is goal oriented and is performed to achieve an object. Arthroscopic surgical skills would be described as fine motor skills because a gross motor skill would be a skill requiring large muscle groups.

Kocaoglu B, Cabukoglu C, Ozeras N, Seyhan M, Karahan M, Yalcin S. The effect of therapeutic ultrasound on metallic implants: a study in rats. Objective To investigate whether therapeutic ultrasound (US) use over metallic implants has the potential for adverse effects as a result of greater temperature increases at the tissue-metal interface. Design A randomized controlled trial. Setting A research laboratory. Animals Sprague-Dawley rats (N=40; weight, 230–300g) were used and divided into 3 study groups. Interventions In group 1, both limbs of 10 rats were used for evaluation of temperature changes. Metal pins were placed into the femur of the left limb, and the right limbs were used as controls. A thermal sensor was placed into the medulla to record the elevation of tissue temperature during US application. In groups 2 and 3 with 15 rats in each, a midshaft femoral fracture was produced, and intramedullary fixation was performed with metal pins. Group 2 received US treatment for 5 minutes daily and continued for 27 days. Group 3 served as controls. Main Outcome Measures The rats in groups 2 and 3 were killed on postoperative day 30. The specimens were evaluated by radiology, histopathology, and biomechanics. Results The presence of metal in bone did not cause an increased temperature rise. US application did not increase or decrease callus formation, and there was no tissue necrosis. The average removal torques of pins in groups did not show a significant difference. Conclusions Internal fixation with metallic implants may not be a contraindication for therapeutic US treatment.