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Öğe Biceps tenodesis with interference screw: cyclic testing of different techniques(Springer, 2010) Hapa, Onur; Günay, Cüneyd; Kömürcü, Erkam; Çakıcı, Hüsamettin; Bozdağ, ErgunDifferent surgical techniques exist for biceps tenodesis. The most secure fixation technique is with interference screws. The purpose of the study was to compare the biomechanical performance of three different interference screw biceps tenodesis fixation methods, which involve different tunnel preparation methods. Using a sheep shoulder model and metal interference screws, a bone wedge technique was compared to serial tunnel dilation and a control group. After a preload, all repairs were cyclically loaded (20-60 N) for 100 cycles followed by destructive testing. Biceps tenodesis using an interference screw-bone wedge technique showed statistically lower cyclic displacement (8.1 +/- A 6.4 mm) than serial dilatation with an interference screw (21.3 +/- A 8.4 mm) or interference screw fixation alone (18.3 +/- A 8.3 mm) (P = 0.02). There were no statistically significant differences in ultimate failure strength for any of the interference screw biceps tenodesis techniques tested. The tunnel preparation method chosen for interference screw fixed biceps tenodesis can have a positive effect on tenodesis performance. Using the bone wedge technique may allow a more rapid rehabilitation program applicable for the traumatic biceps tendon rupture seen in young, athletic patients with high demands.Öğe Does platelet-rich plasma enhance micro fracture treatment for chronic focal chondral defects? An in-vivo study performed in a rat model(Turkish Assoc Orthopaedics Traumatology, 2013) Hapa, Onur; Çakıcı, Hüsamettin; Yüksel, Halil Yalçın; Fırat, Tülin; Kükner, AyselObjective: The purpose of the present study was to compare the effectiveness of platelet-rich plasma (PRP) + microfracture and microfracture treatments in the healing of chronic focal chondral defects. Methods: The study included 57 adult male Sprague-Dawley rats. Forty-two rats were divided into three groups of 14 rats with a chondral defect (control, microfracture only, PRP+microfracture). The remaining 15 rats were used to produce the PRP preparation. The rats were then euthanatized at 3 and 6 weeks after treatment and examined. Histological analysis using the modified Pineda scoring system and immunohistochemical staining for Type 2 collagen were performed. Results: At both time intervals, control group histological scores (Week 3: 8.8+/-1.2, Week 6: 8.5+/-0.7) were higher than microfracture (Week 3: 6.8+/-1.0, Week 6: 7.1+/-0.6) and PRP+microfracture (Week 3: 6.4+/-1.3, Week 6: 5.7+/-1.2) scores (p<0.05). The microfracture group score was higher at Week 6 than the PRP+microfracture group (p<0.05). The degree of Type 2 collagen staining was higher at Week 6 in the PRP+microfracture group and was unique in showing staining at the cell membrane. Conclusion: The addition of PRP application to microfracture treatment appears to enhance cartilage healing in chronic focal chondral defects.Öğe Does platelet-rich plasma enhance microfracture treatment for chronic focal chondral defects? An in-vivo study performed in a rat model(2013) Hapa, Onur; Çakici, Hüsamettin; Yüksel, Halil Yalçın; Firat, Tülin; Kükner, Aysel; Aygün, HayatiAmaç: Mevcut çalışmanın amacı trombositten zengin plazma (platelet-rich plasma, PRP) + mikrofraktür ile mikrofraktür tedavilerinin kronik fokal kondral defekt iyileşmesine etkisini karşılaştırmaktı. Çalışma planı: Bu çalışmada 57 adet erişkin erkek Sprague-Dawley sıçanı kullanıldı. Kırk iki sıçan kondral defekt oluşturulduktan sonra 14’erlikten 3 gruba (kontrol, sadece mikrofraktür, PRP+mikrofraktür) ayrıldı. Kalan 15 sıçan PRP hazırlanmasında kullanıldı. Tedaviden 3 ve 6 hafta sonra sıçanlara ötenazi uygulandı ve incelemeleri yapıldı. Uyarlanmış Pineda skorlama sistemi ile histolojik analiz ve Tip 2 kollajen için immünohistokimyasal boyama yapıldı. Bulgular: Her iki zaman aralığında da, kontrol grubu histolojik skorları (3. hafta: 8.8±1.2, 6. hafta: 8.5±0.7) mikrofraktür (3. hafta: 6.8±1.0, 6. hafta: 7.1±0.6) ve PRP+mikrofraktür (3. hafta: 6.4±1.3, 6. hafta: 5.7±1.2) gruplarından daha yüksekti (p<0.05). Altıncı hafta mikrofraktür grup skoru, 6. hafta PRP+mikrofraktür grubundan daha yüksekti (p<0.05). Tip 2 kollajen boyanma derecesi 6. haftada PRP+mikrofraktür grubunda daha yüksekti ve hücre membranında membranöz boyama gözlendiğinden benzersizdi. Çıkarımlar: Kronik fokal kondral defekt tedavisi için mikrofraktürlerle birlikte PRP uygulamasının kıkırdak iyileşmesini daha etkin kıldığı gözükmektedir.Öğe The effect of ethanol intake on tendon healing: a histological and biomechanical study in a rat model(Springer, 2009) Hapa, Onur; Çakıcı, Hüsamettin; Gideroğlu, Kaan; Özturan, Kutay; Kükner, Aysel; Buğdaycı, GülerEthanol has a suppressive effect on inflammation and the immune system, but the effect of ethanol on tendon healing in vivo has not been studied. The purpose of this study was to investigate the histological and biomechanical effects of ethanol intake on tendon healing in a rat tendon injury model. Forty-seven rats were randomly assigned to either ethanol or control groups. Progressively increasing concentrations of ethanol combined with glucose were administered to these rats in their drinking water. After 1 week, the Achilles tendon of each rat was injured proximal to its insertion on the calcaneus. All rats were euthanized at 4 weeks. The tendons were evaluated both histologically and biomechanically. The histologic examination of these tendons was done using a semi-quantitative 4-point scale to rate cell morphology, the degree of ground substance staining, collagen organization, and vascular changes. Load to failure (N) strength was obtained with biomechanical testing. Tendon failure loads were lower in the ethanol group (31.6 +/- A 8.8 N) than in the control group (39.7 +/- A 8.2 N) (P = 0.04). Histologic tenocyte scores were higher in the ethanol group (1.90 +/- A 0.73) than the control group (0.9 +/- A 0.73) (P = 0.01). Ethanol ingestion resulted in abnormal tenocyte morphology, disorganized collagen bundles with a tendency toward increased tenocyte number, and neovascularization 3 weeks after the tendon injury indicating delayed and abnormal healing. The healing tendons in the alcohol treated group failed at statistically lower loads than the control group.Öğe Effect of platelet-rich plasma on tendon-to-bone healing after rotator cuff repair in rats: an in vivo experimental study(Turkish Assoc Orthopaedics Traumatology, 2012) Hapa, Onur; Çakıcı, Hüsamettin; Kükner, Aysel; Aygün, Hayati; Sarkalkan, Nazlı; Baysal, GökhanObjective: The purpose of this experimental study was to analyze the effects of local autologous platelet-rich plasma (PRP) injection on tendon-to-bone healing in a rotator cuff repair model in rats. Methods: Rotator cuff injury was created in 68 left shoulders of rats. PRP was obtained from the blood of an additional 15 rats. The 68 rats were divided into 4 groups with 17 rats in each group; PRP group (Week 2), control group (Week 2), PRP group (Week 4), and control group (Week 4). Platelet-rich plasma or saline was injected to the repair area intraoperatively. Rats were sacrificed 2 and 4 weeks after the surgery. Histological analysis using a semiquantitative scoring was performed on 7 rats per group. Tendon integrity and increases in vascularity and inflammatory cells and the degree of new bone formation were evaluated and compared between the groups. The remaining tendons (n=10) were mechanically tested. Results: Degree of inflammation and vascularity were less in the study group at both time intervals (p<0.05). Tendon continuity was better in the study group at 2 weeks (p<0.05). Obvious new bone formation was detected in the control group at 4 weeks (p<0.05). Biomechanically, platelet-rich plasma-treated specimens were stronger at 2 weeks (p<0.05). Conclusion: Local autologous PRP injection may have beneficial effects on initial rotator cuff tendon-to-bone healing and enhance initial tendon-to-bone healing remodeling. This may represent a clinically important improvement in rotator cuff repair.Öğe The effects of leukotriene receptor antagonist montelukast on histological, radiological and densitometric parameters of fracture healing(2011) Çakıcı, Hüsamettin; Hapa, Onur; Gideroğlu, Kaan; Özturan, Kutay; Güven, MelihAmaç: Bu çalışmada lökotrien reseptör antagonisti montelukastın kırık iyileşmesi üzerine olan etkileri incelendi ve sıçan tibia kırık modelinde montelukastla artmış kırık iyileşmesi görülebileceği hipotezi araştırıldı. Gereç ve yöntemler: Altmış erişkin (6 aylık) dişi Wistar albino cinsi sıçan (ortalama ağırlıkları 220 g, dağılım 210-270 g) rastgele şekilde iki gruba ayrıldı: montelukast grubu (n=30) ve kontrol grubu (n=30). Kapalı tibia kırığı oluşturuldu ve intramedüller Kirschner teliyle fikse edildi. Kırıktan üç ve altı hafta sonra sıçanlar sakrifiye edildi. Radyolojik ve histolojik değerlendirmeler yapıldı ve kemik mineral yoğunlukları ölçüldü. Bulgular: Çalışma sırasında montelukast grubunda üç, kontrol grubunda ise yalnızca bir sıçan öldü. Gruplar arasında hayvanların başlangıç, 3. hafta ve 6. haftadaki ağırlıkları açısından istatistiksel bir fark bulunmadı (p>0.05). Kemik mineral yoğunluğu kontrol ve çalışma grubunda sırasıyla 3. haftada 0.13±0.009 g/cm2 ve 0.13±0.01 g/cm2, 6. haftada ise 0.16±0.02 g/cm2 v e 0 .13±0.01 g /cm2 olarak bulundu. Histopatolojik skor kontrol ve çalışma gruplarında sırasıyla 3. haftada 3.42±0.6 ve 3.0±0.0, 6. haftada ise 3.5±0.5 ve 3.4±0.8 olarak bulundu. Radyolojik skor kontrol ve çalışma gruplarında sırasıyla 3. haftada 1.19±0.6 ve 1.0±0.6, 6. haftada ise 3.0±0.8 ve 2.9±0.9 olarak bulundu. Değerlendirilen hiçbir parametre açısından her iki zaman aralığında iki grup arasında anlamlı fark saptanmadı (p>0.05). Sonuç: Bizim çalışmamızda lökotrien reseptör antagonistinin 3. ve 6. haftalarda kırık iyileşmesine olumlu etkisi olmadığı görüldü.Öğe The Effects of Montelukast on Random Pattern Skin Flap Survival: An Experimental Study in Rats(Elsevier Science Inc, 2008) Gideroğlu, Kaan; Yılmaz, Fahrettin; Aksoy, Fadullah; Buğdaycı, Güler; Çakıcı, Hüsamettin; Hapa, OnurBACKGROUND: A variety of methods to improve skin flap survival, including the use of pharmacologic agents, have been intensively investigated. Decreasing neutrophil-mediated inflammation and tissue injury has been reported to be effective in improving flap survival. Montelukast is a selective reversible cysteinyl leukotriene receptor-1 antagonist that has been found to have protective effects against renal ischemia reperfusion injury and burn-induced oxidative injury of the skin in rats. However, its effects on skin flap survival have not been previously reported. OBJECTIVE: The aim of this study was to investigate the effects of montelukast on neutrophil-mediated random pattern skin flap survival. METHODS: Mate Sprague-Dawley rats weighing 230 to 250 g were randomly divided into 2 groups-the montelukast-treated group and the control group. Caudally based rectangular random pattern skin flaps 3 x 9 cm were elevated on the backs of the rats. The flaps were sutured into their original places. In the montelukast group, 1 mL of solution containing 10 mg/kg montelukast was administered intraperitoneally (IP) 30 minutes before surgery and then daily for 6 days. In the control group, I mL of saline was administered IP 30 minutes before surgery and then daily for 6 days. To observe the effects of montelukast, myeloperoxidase (MPO) activity, an index of tissue neutrophil infiltration, was measured from extracted skin tissue 12 hours after flap elevation. Flap viability was evaluated 7 days after surgery by measuring necrotic flap area and total flap area. RESULTS: Sixteen rats (mean [SD] weight, 240.6 [6.6] g) were equally divided between the 2 groups. All rats survived throughout the study period. Mean (SD) MPO activity in flap tissue was significantly lower in the montelukast group than in the control group (14.57 [2.33] vs 21.28 [4.86] U/g protein; P = 0.005). The percentage of necrotic flap area was significantly lower in the montelukast group than in the control group (17.17 [7-95] vs 37.51 [10.72]; P = 0.001). CONCLUSION: This small, experimental, in vivo animal study found that montelukast was associated with both lower MPO activity and a lower percentage of necrotic random pattern skin flap area. Future studies are needed to clarify these findings. (Curr Ther Res Clin Exp. 2008;69:459-465) (C) 2008 Excerpta Medica Inc.Öğe Effects of montelukast on tendon healing in a murine model(Springer, 2017) Gideroğlu, Kaan; Çakıcı, Hüsamettin; Hapa, Onur; Özturan, Kutay E.; Bozdağ, Ergun; Yılmaz, FahriBackground Tendon injury induces a local inflammatory response characterized by the production of pro-inflammatory cytokines. The aim of this study is to investigate the effects of montelukast sodium on the healing of tendons through histological and biomechanical evaluations. Methods Forty-eight female Wistar albino rats were randomly assigned to an experimental group that received montelukast sodium (n = 24) and a control group (n = 24) that did not. Tendon injury was created in the Achilles tendon. The experimental group was injected intraperitoneally (IP) with 1 ml of 1 mg/kg montelukast sodium solution once a day prior to the surgery and during the experimental research. The control group was injected with saline solution. Two weeks later, eight rats in each group underwent a histological evaluation. In the fourth week, eight rats underwent a histological evaluation and the other eight rats went through a biomechanical evaluation. Results Based on the histological evaluation in the second week, it was observed that the severity of the inflammation was less in the experimental group that received montelukast sodium (p < 0.05). In terms of the formation of collagen, no significant difference was observed between the groups in the second and fourth weeks. Tendon breaking loads were 33.2 +/- 10.95 and 38.8 +/- 10.90 N for the montelukast group and the control group, respectively. However, the difference between the groups was found to be statistically insignificant (p > 0.05). Conclusions There was no negative effect on the healing of tendons due to injection of montelukast sodium. In addition, observing less inflammation in the experimental group in the earlier phase suggests that montelukast sodium may help in preventing tendon adhesion after reconstructive treatment.Öğe Is there a relation between hip torsion, coverage and osteoarthritis of the knee?(British Editorial Society of Bone and Joint Surgery, 2009) Hapa, Onur; Muratlı, Hasan Hilmi; Çakıcı, Hüsamettin; Akşahin, Ertuğrul; Gülçek, Serap; Akşahin, Ertuğrul; Biçimoğlu, AliPurpose: Biomechanic factors play a role in the pathogenesis of knee osteoarthritis. The aim of the study was to find out whether there is a relation between femoral, acetabular anteversions, anterior, posterior acetabular coverages and primary osteoarthritis of the knee. Methods: Thirty patients with primary osteoarthritis of the knee and 29 control subjects were enrolled into the study. Femoral anteversion, acetabular anteversion, McKibbin's instability index, anterior acetabular sector and posterior acetabular sector angles were measured using tomographic scanograms. Results: There was no difference between groups for each parameter (P > 0.05). Conclusion: This study did not show any relationship between the axial plane changes in the hip joint and primary knee osteoarthritis. © EPOS 2008.Öğe Patellar tendon ossification after partial patellectomy: A case report(2010) Çakıcı, Hüsamettin; Hapa, Onur; Özturan, Kutay; Guven, Melih; Yücel, İstemiIntroduction. Patellar tendon ossification is a rare pathology that may be seen as a complication after sleeve fractures of the tibial tuberosity, total patellectomy during arthroplasty, intramedullary nailing of tibial fractures, anterior cruciate ligament reconstruction with patellar tendon autograft and knee injury without fracture. However, its occurrence after partial patellectomy surgery has never been reported in the literature. Case presentation. We present the case of a 35-year-old Turkish man with a comminuted inferior patellar pole fracture that was treated with partial patellectomy. During the follow-up period, his patellar tendon healed with ossification and then ruptured from the inferior attachment to the tibial tubercle. The ossification was excised and the tendon was subsequently repaired. Conclusion. To the best of our knowledge, this is the first report of patellar tendon ossification occurring after partial patellectomy. Orthopaedic surgeons are thus cautioned to be conscious of this rare complication after partial patellectomy. © 2010 Cakici et al; licensee BioMed Central Ltd.Öğe Treatment of plantar fasciitis using four different local injection modalities a randomized prospective clinical trial(Amer Podiatric Med Assoc, 2009) Kalacı, Aydıner; Çakıcı, Hüsamettin; Hapa, Onur; Yanat, Ahmet Nedim; Doğramacı, Yunus; Sevinç, Teoman ToniBackground: To determine the effectiveness of four different local injection modalities in the treatment of plantar fasciitis. Methods: In a prospective randomized multicenter study of plantar fasciitis, 100 patients were divided into four equal groups and were treated using four different methods of local injection: group A was treated with 2 mL of autologous blood alone; group B, an anesthetic (2 mL of lidocaine) combined with peppering; group C, a corticosteroid (2 mL of triamcinolone) alone; and group D, a corticosteroid (2 mL of triamcinolone) combined with peppering. The outcome was defined by using a 10-cm visual analog scale and modified criteria of the Roles and Maudsley score 3 weeks and 6 months after the injection and compared with the pretreatment condition. Results: The successful results in all of the groups after injections were higher than those in the pretreatment condition (P = .000). In groups C and D, in which local corticosteroid injections were used, excellent results were obtained, with superior effect in the group in which peppering was used (P < .05). Conclusions: In the treatment of plantar fasciitis, combined corticosteroid injections and peppering is effective and produces better clinical results. (J Am Podiatr Med Assoc 99(2): 108-113, 2009)
