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Objective: The aim of this study was to explore the alterations in levels of pro-inflammatory and catabolic mediators followingvertebral fusion in a rabbit model of intervertebral disc degeneration.Methods: In this study, 24 female New Zealand albino rabbits (aged 4 to 5 months and weighing 3 to 3.5 kg) were used. All theanimals were randomly categorized into four groups, and dorsal spinal exposure of all lumbar vertebrae was routinely performedin each group. While disc degeneration was created in groups B, C, and D, spinal fusion was added to disc degeneration in groupsC and D. Disc degeneration was typically created by puncturing the discs with an 18-gauge needle under the guidance of C-armimaging. Fusion was achieved with posterior/posterolateral decortication and iliac bone grafts. The rabbits in groups A, B, and Cwere euthanized, and the discs were removed in the first week after the surgery. The rabbits in Group D were sacrificed, and thediscs were harvested at 5 weeks after the surgery. The levels of Interleukin (IL)-1β, IL-6, Nitric Oxide (NO), MatrixMetalloproteinase (MMP)-3, MMP-13, and Tissue Inhibitor of Metalloproteinases-1 (TIMP-1) in the discs were analyzed usingenzyme-linked immunosorbent assay kits.Results: Significant increase was observed in the protein levels of both pro-inflammatory and catabolic mediators in discdegeneration groups (Group B, C, and D) compared to Group A. In the fusion groups (Group C and D), these increasedmediators decreased, compared to non-fusion group (Group B), (IL1-β P = 0.017, TIMP-1 P = 0.03, NO P = 0.03). However,there was no statistically significant difference in mediator levels between the short- and long-term fusion (Group C versus D).Conclusion: The results of this study have shown that a significant decrease in pro-inflammatory and catabolic mediators may beexpected after vertebral fusion whereas there may be no significant difference between the first and fourth week of fusionsurgery. These findings may contribute to clarifying the mechanism of action of vertebral fusion in the treatment of low backpain.
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Objectives: The aim of this study was to translate The Self-Reported Foot and Ankle Score (SEFAS) into Turkish and to determinethe validity and reliability of the translated version in patients shoulder pain.Material and Methods: The Turkish version of the Shoulder Rating Questionnaire (SRQ-T) was applied to patients aftertranslation from English into Turkish. Patients with various shoulder pain complaint were included into the study if theywere over 18 years. The patients with mixed-type pain, cancer pain, headache, substance abuse, severe depression, andfibromyalgia syndrome were excluded. The musculoskeletal and neurological examinations of the patients were performed.The Turkish version of the Shoulder Rating Questionnaire (SRQ-T) and Disabilities of arm, shoulder, hands-T (DASH-T) wereapplied to all patients.Results: 122 patients were included in the study, and then patients are divided into two groups: Group 1, working group (n = 72);Group 2, non- working group (n = 50). The reliability and consistency of SRQ-T for all the samples were acceptable with aCronbach’s coefficient of 0.979. The test-retest method was used to determine reliability of the scale. Cronbach’s alpha wasmeasured pre-assessment and post- assessment; the values were 0.815 and 0.770, respectively. The correlation analysis wasdetermined for all the samples and calculated as 0.780. Also, the test-retest method with Wilcoxon Signed Rank Test was used todetermine reliability of the SRQ- T and its domains in group 1 and group 2.Conclusion: The Turkish version of the SRQ-T seems to be a valid and reliable self-administered questionnaire to evaluate theshoulder pain in Turkish patients.Level of Evidence: Level II, Diagnostic Study
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Objective: The aim of this study was to evaluate glenohumeral morphologic differences and their correlation betweenglenohumeral instability and rotator cuff pathology.Methods: Two-hundred radiographs and 100 MRI scans of 100 patients in whom the diagnosis of Anterior Shoulder Instability(Anl) or Rotator Cuff Tear (RCT) was arthroscopically verified were retrospectively identified and included in the study. All thepatients were categorized into two groups: 50 patients with Anl (23 female, 28 male; mean age = 29 ± 7.4) and 50 patients withRCT (28 female, 22 male). Two separate control groups were then formed, one of which included contralateral shoulders ofpatients in the AnI group, and the other consisted of contralateral shoulders of patients in the RCT group. The x-ray and MRIscans were examined by an orthopedic surgeon and a radiologist. The Acromial Index (AI) and the Critical Shoulder Angle (CSA)were measured on true anteroposterior shoulder radiographs; Glenoid Inclination (GI), Glenoid Version (GV), and AcromionAngulation (AA) were measured on MRI.Results: In the AnI group, the measurements were as followed: AI, 0.66 ± 0.03; CSA, 33 ° ± 2.85; GI, 3.4° ± 6.2; GV, 4.1 ± 4.3; andAA, 12.9 ± 8.3. In the RCT group, AI 0.71 ± 0.04; CSA, 36° ± 2.69; GI, 9.1 ± 5; GV, 6.7 ° ± 5.7; and AA, 14.3° ± 8.7. A moderatecorrelation was found between CSA and GI (r = 0.41, P = 0.001) and between AI and GI (r = 0.42, P = 0.014). A weak correlationwas found between AI and GI in the AnI group (r = 0.22, P = 0.001). The inter- and intra-observer intraclass correlationcoefficients were respectively 0.81 and 0.84 for AI, 0.88 and 0.92 for CSA, 0.72 and 0.76 for GI, 0.69 and 0.73 for GV, and 0.72and 0.77 for AA.Conclusion: The results of this study have shown that lower AI, GI, and antevert GV may be associated with AnI. InvestigatingCSA, AI, and GV could be useful for diagnostic evaluation of patients with AnI.Level of Evidence: Level III, Diagnostic Study
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Objective: The aim of this study was to systematically review whether the altered central pain modulation has a significantinfluence on post-surgical outcomes in patients undergoing shoulder surgery due to musculoskeletal disorders.Methods: A systematic search of MEDLINE, PEDro, and EMBASE was conducted without time restriction, includingobservational prognostic studies. Quality in Prognostic Studies Tool was adopted for critical appraisal, and a qualitativesynthesis was undertaken. Two authors independently performed study selection, data extraction, and risk of biasassessment; any disagreement was resolved by a third author. A review protocol is published in the PROSPERO registry(CRD42019122303). The data regarding the potential predictors and outcome measures were obtained from the studies.Results: 11 prospective cohort studies were appraised. Overall, 952 patients were included with a sample size that ranged from 20to 314. Studies included both arthroscopy and open surgery and presented low to moderate ROB. The prognostic factorsinvestigated were depression, psychological distress, anxiety, catastrophizing, fear avoidance beliefs, self-efficacy andquantitative sensory testing. Only avoidance behaviors and self-efficacy were significantly related to post-surgical pain andfunction at 12 months after surgery.Conclusion: Fear avoidance beliefs and inadequate coping strategies seem to be the most correlated factors with the worst painand function scores. Surgeons and physical therapists should look for patients with signs of altered central pain modulationbefore surgery as they might be at risk of unfavorable outcome.Level of Evidence: Level II, Therapeutic Study
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Objective: Progranulin (PGRN) is a growth factor that has antiinflammatory, immunosuppressive, and chondroprotective effects.It blocks Tumor Necrosis Factor-α (TNF-α) signal pathway by binding its receptor. Recently, it has been claimed that PGRN maybe overexpressed in patients with Osteoarthritis (OA). However, these patients tend to be obese and obesity also may be one ofthe factors that affect PGRN levels. The aim of this study was to compare the PGRN levels of patients with Knee OA (KOA) withthat of healthy controls by eliminating the effect of obesity and to evaluate PGRN-to-Tumor Necrosis Factor-α (TNF-α) ratio inKOA, both of which were investigated first in literature by this study.Methods: A total of 80 individuals (40 patients with KOA and 40 healthy controls) were included in this study. The patients andcontrols were divided into two groups according to their Body Mass Indexes (BMI): nonobese (BMI between 18.5 and 24.9) andobese (BMI of 30 or higher). Each of the groups included 20 subjects and had an equal number of men and women. Blood sampleswere obtained from all participants, and the serum PGRN and TNF-α levels were measured using commercial ELISA kits.Results: There was no difference among groups in terms of age (P = 0.416) and gender distribution. There was no statisticaldifference among study groups with regard to serum PGRN levels. Serum TNF-α levels were significantly higher in obesecontrols (P < 0.001) and nonobese patients (P = 0.003) compared to that of nonobese healthy controls. Correspondingly, serumPGRN-to-TNF-α ratio was considerably lower in obese controls (P < 0.001) and nonobese patients (P < 0.001) by comparison withthat of nonobese healthy controls.Conclusion: We determined that both obesity and KOA increased serum TNF-α levels and concordantly decreased serum PGRNto-TNF-α ratio. The results of the study suggest that the activation of the PGRN pathway and/or the inhibition of the TNFαpathway may be essential in terms of the reestablishment of the disrupted inflammatory balance in patients with KOA.Level of Evidence: Level III, Diagnostic study
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Objective: This study aimed to determine the effectiveness of calcium phosphate cementing in the surgical treatment of Sanders type IIand III calcaneal fractures using screw fixation with sinus tarsi approach.Methods: In this retrospective study, 85 feet of 84 patients (74 males, 10 females; mean age 43 [17-61] years) in whom screw fixation was performed using the sinus tarsi approach for Sanders type II or III calcaneal fractures were included. The mean follow-up was 28 (14-39) months.Patients were categorized into 2 groups on the basis of whether calcium phosphate cement (CPC) was used. Group 1 had 37 patients withCPC (38 calcaneal fractures) and group 2 had 47 patients without CPC (47 calcaneal fractures). In the clinical assessment, the American Orthopedic Foot Ankle Society (AOFAS) hind foot score and the Maryland Foot Score (MFS) were used at the final follow-up. In the radiologicalassessment, Bohler’s angle on plain radiograph and posterior facet step-off on computed tomography were measured pre-and postoperatively.Results: At the final follow-up, the mean Bohler’s angle was 26.2° (20°-33°) in group 1 and 26° (17°-30°) in group 2 (P = 0.85). The meanposterior facet step-off was 1.6 (0-5) mm in group 1 and 1.5 (0-5) mm in group 2 (P = 0.85). The mean AOFAS score was 83.8 (59-100) ingroup 1 and 85.8 (60-100) in group 2 (P = 0.5). The mean MFS was 86.3 (66-100) in group 1 and 87.7 (66-100) in group 2 (P = 0.62).Conclusion: Evidence from this study have shown that CPC may have no significant effect on clinical and radiological outcomes in thesurgical treatment of Sanders type II and III calcaneal fractures using screw fixation with sinus tarsi approach.Level of Evidence: Level IV, Therapeutic Study
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Objective: This study aimed to determine the effects of tamoxifen on sciatic nerve crush injury in a rat model using histopathological,histomorphometric, and immunohistochemical approaches.Methods: In this study, 24 male Sprague-Dawley rats aged of 5 to 7 weeks and weighing between 300 g and 400g were used. The ratswere randomly divided into 3 groups: control (group C), sciatic nerve injury (group SNI), and sciatic nerve injury with tamoxifen (groupSNT). The sciatic nerve crush injury model was performed using the De Koning’s crush force method. In group C, only a skin incisionwas made and then the skin was sutured. In group SNI, the injury model was performed but no treatment was applied. In group SNT, theinjury model was executed, and then 40 mg/kg/day tamoxifen was given for 4 weeks by intraperitoneal methods. At the end of 4 weeks,all animals were killed using high doses of an anesthetic. Approximately, 2-cm sciatic nerve samples were obtained for histopathological,histomorphometric, and immunohistochemical analyses using the old skin incision.Results: In the histopathological examination, vascular congestion and density of vacuolization were significantly lower in group SNTthan in group SNI (p<0.05). In the histomorphometric examination, the mean sciatic nerve diameter was 306±62 µm in group C, 510±42µm in group SNI, and 204±23 µm in group SNT. A significant difference was observed in the sciatic nerve diameter measurements amongthe 3 groups (p<0.05). In pairwise comparisons, the mean sciatic nerve diameter was significantly lower in group SNT than in group SNI(p=0.00002). Sciatic nerve diameter measurements of both groups were found to be significantly higher than group C (p<0.05). The meanepineurium thickness was 17±0.8 µm in group C, 32±2.5 µm in group SNI, and 17±0.8 µm in group SNT. A significant difference wasobserved in the epineurium thickness measurements among the 3 groups (p<0.05). In pairwise comparisons, the epineurium thicknesswas significantly higher in group SNI than in groups SNT and C (p<0.05). In the immunohistochemical analysis, S100 immunoreactivitywas found significantly higher in group SNI than in the other 2 groups (p<0.05).Conclusion: The histomorphometric, histopathological, and immunohistochemical data obtained from this study have shown that tamoxifen has a beneficial effect on sciatic nerve crush injury in the experimental rat model.
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Objective: This study aimed to determine the effects of the number of total siblings, younger siblings, and complex clubfoot deformity onthe brace compliance and recurrence in the management of children with clubfoot deformity using the Ponseti technique.Methods: The data from 91 children, including 22 girls and 69 boys (total 130 idiopathic clubfeet), seen from 2016 to 2019 were prospectivelycollected and retrospectively reviewed. The deformity was unilateral in 52 (57.1%) children (32 right, 20 left) and bilateral in 39 (42.9%). Themean age at presentation was 2 (range, 1–30) weeks, and the mean follow-up was 21.5 (range, 12–36) months. All the clubfeet were treated according to the Ponseti method. After removing the cast, a foot abduction brace (Dennis Brown splint) was worn. A complex clubfoot deformitywas identified in 12% (n=11) children. At the follow-up, the Pirani score, recurrence status, and brace compliance were recorded. Recurrentdeformity was defined as any deformity recurrence requiring manipulation, recasting, or surgical treatment. Brace compliance was assessedper the parents’ report.Results: The median number of children in a family was 3 (range, 1–12). A total of 53 (58.2%) parents had up to 3 children, and 38 (41.8%)parents had more than 3 children. Of the patients, 22 (24.2%) had younger siblings and 25 (26.4%) had a family history of clubfoot. A totalof 58 feet (44.6%) in 40 children (43.9%) developed recurrence. Brace non-compliance was the main risk factor for recurrence, increasingthe recurrence rate 32-fold compared with that of compliant parents (odds ratio [OR], 32.67, 95% confidence interval [CI], 10.02–106.49;p=0.001). The rate of non-compliance with brace use was 51.6% (n=47). Brace non-compliance was significantly associated with having ayounger sibling (OR, 3.9; 95% CI, 1.36–11.2; p=0.011) and having a complex deformity (OR, 11.62; 95% CI, 1.42–95.1; p=0.022) but was notassociated with the total number of children (OR, 1.61; 95% CI, 0.7–3.73; p=0.265).Conclusion: Our study shows that having new siblings in the first years of the Ponseti treatment may increase the brace non-complianceby minimizing the attention paid to the children with clubfeet by their parents. Nonetheless, complex clubfoot deformity may promotebrace compliance by increasing the parents’ interest during the treatment process.Level of Evidence: Level IV, Therapeutic Study
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