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    Can coracoacromial ligament degeneration be evaluated with preoperative MRI?
    (Sage Publications Ltd, 2024) Ozdemir, Faruk; Ayanoglu, Tacettin; Dagistan, Emine; Kalaycioglu, Oya; Celik, Ilhan; Kalfaoglu, Melike Elif; Kanatli, Ulunay
    Background Subacromial impingement syndrome is one of the most common causes of painful shoulder in the middle-aged and elderly population. Coracoacromial ligament (CAL) degeneration is a well-known indicator for subacromial impingement. Purpose To examine the relationship between CAL thickness on preoperative magnetic resonance imaging (MRI), arthroscopic CAL degeneration and types of rotator cuff tears. Material and Methods Video records of patients who underwent arthroscopic shoulder surgery between 2015 and 2021 were retrospectively scanned through the hospital information record system. In total, 560 patients were included in this study. Video records of the surgery were used to evaluate the grade of coracoacromial ligament degeneration and the type of cuff tear. Preoperative MRI was used to measure CAL thickness, acromiohumeral distance, critical shoulder angle, acromial index, and acromion angulation. Results Significant differences were observed between grades of CAL degeneration in terms of CAL thickness (P < 0.001). As CAL degeneration increases, the mean of CAL thickness decreases. According to the results of post-hoc analysis, the mean CAL thickness of normal patients was significantly higher than those of patients with full-thickness tears (P = 0.024) and massive tears (P <0.001). Patients with articular-side, bursal-side, and full-thickness tears had significantly higher CAL thickness averages than patients with massive tears. Conclusion This study showed that the CAL thickness decreases on MRI as arthroscopic CAL degeneration increases. High-grade CAL degeneration and therefore subacromial impingement syndrome can be predicted by looking at the CAL thickness in MRI, which is a non-invasive method.
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    Effect of the presence of cysts in the hip joint on hip arthroscopy
    (Turkish Joint Diseases Foundation, 2024) Ciceklidag, Murat; Ayanoglu, Tacettin; Kaptan, Ahmet Yigit; Vural, Abdurrahman; Kalaycioglu, Oya; Ozer, Mustafa; Kanatli, Ulunay
    Objectives: The aim of this study was to investigate whether the presence and size of fibrous cysts affected postoperative results in patients undergoing hip arthroscopy. Patients and methods: Between January 2010 and December 2019, a total of 261 patients (138 males, 123 females; mean age: 39.5 +/- 11.9 years; range, 18 to 66 years) who underwent hip arthroscopy with the diagnosis of cam-pincer-mixed-type femoroacetabular impingement (FAI) and labral pathologies were retrospectively analyzed. The study groups (impingements and labral pathologies) and the presence of cyst (or cyst size: <5 mm, 5-8 mm, >8 mm) were used as the fixed effects, and the analysis was adjusted for baseline age, sex, and preoperative scores. Pre- and postoperative modified Harris Hip Score (mHHS) and Visual Analog Scale (VAS) scores that were applied to all patients were used as an indication of clinical results. Results: The mean preoperative mHHS score of the patients with a cyst was significantly lower compared to the patients without a cyst (56.8 +/- 12.3 vs. 60.3 +/- 12.7, p=0.026). The mean change in the mHHS score and the mean percentage change in VAS score were significantly higher in the patients with a cyst compared to the patients without a cyst (mHHS score: 28.1 +/- 14.0 vs. 22.5 +/- 14.1, p=0.002; VAS score: 61.9 +/- 30.2 vs. 52.6 +/- 47.4, p=0.038). The increase in mHHS score over time for patients with a cyst was significantly higher than the patients without cysts in the pincer group (38.1 +/- 11.1 vs. 19.3 +/- 13.5, p<0.001). The patients with a cyst size of >8 mm had a significantly higher increase in the mHHS scores compared to the patients with a cyst size of <5 mm (29.5 +/- 12.9 vs. 23.5 +/- 13.8, p=0.043). Conclusion: Subchondral cysts in the femoral head and neck junction accompanied cam-type and mixed-type FAI, while subchondral cysts in the acetabulum accompanied pincer-type impingement. In all groups, the mean increase in mHHS scores and the mean decrease in VAS scores were higher in patients with subchondral cysts than in patients without cysts. In patients with subchondral cysts, if the lesion causing FAI is treated arthroscopically, it can positively affect the functional results.
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    Proprioception After Primary Repair of the Anterior Cruciate Ligament
    (Sage Publications Inc, 2024) Ciceklidag, Murat; Kaya, Ibrahim; Ayanoglu, Tacettin; Ayas, Inci Hazal; Ozer, Mustafa; Ataoglu, Muhammet Baybars; Kanatli, Ulunay
    Background: Primary repair of the anterior cruciate ligament (ACL) has some potential advantages over the reconstruction technique, which include but are not limited to better knee sensation due to preservation of the natural ACL tissue in patients compared with tendon graft. Proprioception is impaired after ACL injuries and the sense of the joint position is lost. Purpose/Hypothesis: The purpose of this study was to compare arthroscopic ACL primary repair and ACL reconstruction techniques clinically and functionally and analyze the differences in proprioception. It was hypothesized that primary repair would restore knee joint proprioception more successfully because the original tissue of the ACL is preserved. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 63 patients (34 underwent reconstruction and 29 underwent primary repair between 2017 and 2020) and 33 healthy controls, as well as the healthy knees of the operated groups, were evaluated between 24 and 48 months (mean, 29 months) postoperatively. Patients with proximal femoral avulsion tears and stump quality suitable for repair underwent primary repair, and those with tears outside these criteria underwent reconstruction using hamstring tendon autograft. Proprioception was evaluated using the active joint position sensation method during weightbearing, with a digital inclinometer used to measure differences between the target and achieved flexion angles of 15 degrees, 30 degrees, and 60 degrees. Results: At 15 degrees of knee flexion, the deviation angles for the healthy knee of the reconstruction and primary repair groups were significantly smaller than those of the control group (P < .001), but there was no statistically significant difference between the groups in terms of deviation angle at 30 degrees and 60 degrees of flexion. The deviation angle of the operated knees was statistically significantly larger in the reconstruction group than in the primary repair group at all angles. The deviation angles at 15 degrees, 30 degrees, and 60 degrees were 2.83 degrees, 2.66 degrees, and 2.66 degrees in the reconstruction group and 1.00 degrees, 1.00 degrees, and 1.33 degrees in the primary repair group, respectively (P < .001). There was no statistically significant difference between the reconstruction and primary repair groups in terms of clinical scores. Conclusion: Primary ACL repair can preserve proprioception in a well-selected patient group. In short-term follow-up, primary repair of the ACL in patients with proximal femoral avulsion tears and stump quality suitable for repair appears to be proprioceptively protective. Future studies are needed to clarify the long-term consequences of primary repair on proprioception in a larger population.