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    The Buford complex: Prevalence and relationship with labral pathologies
    (Mosby, 2021) Özer, Mustafa; Kaptan, Ahmet Yiğit; Ataoğlu, Muhammet Baybars; Çetinkaya, Mehmet; Ayanoğlu, Tacettin; İnce, Bülent; Kanatlı, 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 labral 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.
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    Is it the subcoracoid impingement or the subacromial impingement that tears the subscapularis tendon? A comparison of the MRI findings of the operated and healthy shoulders of the patients
    (Scientific and Technological Research Council Turkey, 2023) Çetinkaya, Mehmet; Kaptan, Ahmet Yiğit; Ulucaköy, Coşkun; Orhan, Özlem; Topal, Murat; Ayanoğlu, Tacettin; Kanatlı, Ulunay
    Background/aim: The purpose of this study is to investigate whether the etiological factors accepted as causes of idiopathic subscapularis tears are true or not when the comparison is made with the opposite side healthy shoulder of the patients who underwent arthroscopic repair for an isolated subscapularis tear. Materials and methods: Sixteen patients who underwent shoulder arthroscopy between February 2016 and January 2018 and were diagnosed with isolated subscapularis tear were evaluated. The coracohumeral distance (CHDax), coracoid overlap (CO), and tuberculum minus cysts (TMC) were evaluated on the axial images of the MRI studies while the acromiohumeral distance (AHDsag), CHDsag, and subscapularis tendon slip number (STSN) on the sagittal oblique images and the AHDcor and SLAP lesion on the coronal oblique images. Degeneration of the coracoacromial ligament was evaluated during arthroscopy. Results: The mean CHDsag (11.26–10.08), CHDax (10.63–9.98), CO (14.2–15.43), AHDsag (8–7.66), and AHDcor (7.65–7.68) measurements (operated side-healthy side, respectively) were statistically similar (p > 0.05). No statistically significant difference was found between TMC and STSN in healthy and operated shoulders (p > 0.05). There was mild coracoacromial ligament fraying in 4 (25%) and obvious coracoacromial ligament fraying in 8 (50%) which indicated subacromial impingement in 75% of the patients. Conclusion: The parameters of the coracoid process did not reveal any significant difference between the operated (for an isolated subscapularis tear) and opposite-side healthy shoulders of the patients. However, coracoacromial ligament degeneration was present in 75% of the patients
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    The middle glenohumeral ligament: A classification based on arthroscopic evaluation
    (Mosby-Elseiver, 2022) Kaptan, Ahmet Yiğit; Özer, Mustafa; Alim, Ece; Perçin, Ali; Ayanoğlu, Tacettin; Öztürk, Burak Yağmur
    Background: Although middle glenohumeral ligament (MGHL) variations have been shown in the literature, their clinical effect and relationship with intra-articular pathologies have yet to be revealed, except for the Buford complex. This study was designed to classify MGHL and to reveal its relationship with clinical pathologies. Methods: A total of 843 consecutive shoulder arthroscopies were evaluated retrospectively, and a classification system was proposed for MGHL with regard to its structure and its relation to the anterior labrum. The associations of each MGHL type with superior labrum anterior-posterior (SLAP) lesions, subscapularis tears, and anterior instability were investigated. Results: MGHL variations were grouped into 6 types according to the classification. A significant difference in favor of type 6 MGHL (Buford complex) was observed in the distribution of SLAP lesions (P < .001). There was no significant difference between MGHL types and the distribution of anterior instability history (P = .131) and subscapularis tears (P = .324). Conclusion: SLAP lesions accompany type 6 MGHLs (Buford complex) significantly more frequently than other types. There is also a negative relation between the anterior instability and thicker MGHL variants. (C) 2021 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.
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    Recurrent anterior shoulder instability in patients 40–60 years old. Accompanying injuries and patient outcomes of arthroscopic repair
    (Elsevier, 2020) Eren, Toygun Kağan; Aktaş, Erdem; Kaptan, Ahmet Yiğit; Ayanoğlu, Tacettin; Ulucaköy, Coşkun; Kanatlı, Ulunay
    Background: Accompanying injuries are frequently seen in middle aged patients with recurrent instability. The aim of this study was to elucidate the associated injuries, report patient outcomes of the following arthroscopic instability surgery regarding 40–60 years old patients with recurrent shoulder instability. Methods: Patients that underwent arthroscopic instability surgery due to recurrent shoulder instability between February 2008 and November 2015, and which were 40–60 years old were included and evaluated retrospectively. Minimum follow-up duration was 24 months. Anterior-inferior labral injuries and accompanying pathologies such as rotator cuff tears and SLAP lesions were documented. Postoperative patient-reported outcome evaluation was made using Oxford Shoulder Instability Score. Results: Among 355 patients that underwent arthroscopic instability surgery, 88 patients which had pathology of recurrent instability were in the range of 40–60 years old. Patients who had previous shoulder surgery or fracture (n = 8) epileptic seizure history (n = 3), neurologic deficit (n = 2) were excluded from the study. 75 patients were included with a mean follow-up 69 ± 23 months (32–125). The percentage of middle-aged and elderly (40–60 years old) was 24.8% among recurrent shoulder instability patients. 44% had isolated Bankart lesion whereas 56% revealed multiple pathologies. Bankart + SLAP lesions were found in 32%, whereas Bankart + Rotator Cuff tears in 26.7% (13 isolated supraspinatus, 4 supraspinatus + subscapularis, 1 isolated subscapularis full-thickness and 2 partial-thickness supraspinatus tears). The mean Oxford Shoulder Instability Score was 38.4 ± 5.2 (26–48). The scores of patients which were treated with labrum and rotator cuff repair (median 42, range 30–48) were significantly better than the patients who were treated with isolated labrum repair (median 39, range 20–46) (p = 0.015). There was no difference regarding patients with or without SLAP repair (median 39 vs 39 and range 30–48 vs 20–48, respectively) (p = 0.702). Conclusions: Arthroscopic repair of capsulolabral lesions is a safe and successful technique in 40–60 years old patients. Furthermore, the presence of repaired rotator cuff tears led to even superior results. Accompanying SLAP lesions did not affect the results. Study design: Retrospective Case Series. Level of evidence: 4, Retrospective Case Series.
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    Should we replace the patella during total knee replacement?
    (Turkish Joint Diseases Foundation, 2023) Atik, O. Şahap; Hangody, Laszlo Rudolf; Sarıkaya, Baran; Ayanoğlu, Tacettin; Kaptan, Ahmet Yiğit
    Joint arthroplasties are the procedure of choice that have been increasingly adopted in conditions leading to joint damage, such as severe osteoarthritis (OA), rheumatoid arthritis, and avascular necrosis.[1-3]