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    Anterior cruciate ligament reconstruction using a hamstring graft: a retrospective comparison of tunnel widening upon use of two different femoral fixation methods
    (Springer, 2015) Mermerkaya, Musa Ugur; Atay, Ozgur Ahmet; Kaymaz, Burak; Bekmez, Senol; Karaaslan, Fatih; Doral, Mahmut Nedim
    To compare femoral and tibial tunnel widening (TW) in patients undergoing anterior cruciate ligament (ACL) reconstruction using an interference screw (IS), or an EndoButton-Continuous Loop(A (R)) on the femoral side, and an IS/staple on the tibial side. Between 2006 and 2009, at a single institution, 72 patients who underwent arthroscopic ACL reconstruction with quadrupled hamstring tendon grafting were retrospectively reviewed. Fixation was performed, and with the EndoButton-Continuous Loop(A (R)) device (Group I (TM)) in 48 patients (mean age 29.1 +/- A 7.3 years) with a bioabsorbable IS (Group I (TM) I (TM)) in 24 patients (mean age 28.5 +/- A 8.4 years) on the femoral side. Evaluation included standardized anteroposterior (AP) and lateral radiography. The diameters of tunnels at the last follow-up visit (at a median time of 17 months postoperatively) were compared to those noted on radiographs taken 1 day postoperatively. The two groups were similar in terms of age and gender distribution, the operated side, the size of the tunnel created, and the follow-up period (n.s.). Femoral TW at the proximal and middle levels (on both AP and lateral views) in Group I (TM) I (TM) was significantly greater than in Group I (TM) (p < 0.050 for all comparisons). No significant difference in femoral TW at the distal level was evident between the groups, and tibial TW at all levels was similar in both groups (n.s.). Femoral TW is less after EndoButton-Continuous Loop(A (R)) fixation and not reduced after IS fixation. Surgeons should be aware of TW when selecting a fixation device for hamstring graft. Therapeutic, retrospective comparative study, Level III.
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    Assessment of Calcaneal Morphology and Radiological Parameters in Haglund's Syndrome
    (Galenos Publ House, 2022) Buyukdogan, Kadir; Aslan, Lercan; Kaymaz, Burak; Yilmaz, Onur; Ayik, Gokhan; Mermerkaya, Musa Ugur
    Objective: To compare the radiological parameters of the normal population with the patients with Haglund's syndrome (HS) and to seek a correlation between pain scores and radiological parameters in patients with HS.Methods: Thirty-one patients surgically treated for HS (Haglund group) and 36 healthy subjects free of hindfoot pathology seen in consultation for any other foot pathologies (control group) were included in the study. Demographic data of the patients were acquired, and radiological measurements such as; Fowler Philip Angle (FPA), lateral talus-first metatarsal angle (LTFMA), and Calcaneal pitch angle (CPA) were recorded. The visual analog scale (VAS) and the American Orthopaedic Foot & Ankle Society (AOFAS) scores of the patients in the Haglund group were assessed.Results: Mean CPA, FPA, and LTFMA in the Haglund group were 23.88 +/- 4.6, 58.16 +/- 5.7, and 4.92 +/- 1.88, respectively, and the same recordings in the control group were 21.16 +/- 4.81, 59.1 +/- 4.3, and 4.25 +/- 2.57, respectively. CPA differences between Haglund and control groups were statistically significant (p=0.021). The average values of the VAS and AOFAS scores of the patients in the Haglund group were 8.45 +/- 1.06 and 47.4 +/- 7.58, respectively. There was no correlation between the scores and the radiological measurements of patients in the Haglund group.Conclusion: Radiological assessments are widely debated. Many studies support our results that measurements defined for the morphology of calcaneus are not associated with the Haglund's disease severity. Increase in the CPA is found to be related to HS. This may be explained by the extension of the calcaneus to irritate the Achilles tendon and cause heel pain.
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    Effects of boric acid on the healing of Achilles tendons of rats
    (Springer, 2016) Kaymaz, Burak; Golge, Umut Hatay; Ozyalvach, Gulzade; Komurcu, Erkam; Goksel, Ferdi; Mermerkaya, Musa Ugur; Doral, Mahmut Nedim
    Tendinous lesions are among the most frequent pathologies encountered in sportsmen. The objectives of new treatments are to improve the healing process and reduce the recovery time. Boron plays an important role in the wound repair process by increasing components of extracellular matrix and angiogenesis. This animal study aimed to investigate the effect of boric acid on healing of the Achilles tendon. The right Achilles tendons of 40 rats were completely sectioned, and the rats were randomly divided into five groups. Each group consisted of eight rats. Groups 1 and 2 were oral boric acid groups with the doses of 4 and 8 mg/kg/day boric acid, respectively. Group 3 was the local boric acid group (8 mg/kg boric acid intratendinous injection). Group 4 was administered both oral and local boric acid (8 mg/kg/day orally and 8 mg/kg boric acid intratendinous injection), and group 5 was the control group with no boric acid application. At the end of the fourth week, all the rats were killed and histopathological examination of the Achilles tendon repair site was made. Histopathological examination of the tissue sections revealed more properly oriented collagen fibres, more normal cellular distribution of tenocytes and more properly organized vascular bundles in group 1 and group 2, which were the groups administered oral boric acid. Pathological sum scores of groups 1 and 2 were less than those of the other groups, and the differences between the oral boric acid groups (group 1 and group 2) and the other three groups (groups 3, 4 and 5) were statistically significant (p = 0.001). As boric acid is safe and toxicity even after very high doses is unusual, oral boric acid may be used as an agent to improve the healing process of tendon injuries. However, biomechanical tests should also be performed to show the effect of boric acid on strength and endurance of the tendon before it can be used in clinical practice.
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    Scintigraphic evaluation of the osteoblastic activity of rabbit tibial defects after HYAFF11 membrane application
    (BMC, 2016) Mermerkaya, Musa Ugur; Doral, Mahmut Nedim; Karaaslan, Fatih; Huri, Gazi; Karacavus, Seyhan; Kaymaz, Burak; Alkan, Erkan
    Background: An unfavorable condition for bone healing is the presence of bone defects. Under such conditions, a material can play a role to cover fractured or defective bone. Technological advances now allow for the use of such material. Hyalonect (R) (Fidia Advanced Biopolymers SLR, Italy), a novel membrane comprising knitted fibers of esterified hyaluronan (HYAFF11) can be used to cover fractured or grafted bone and can also serve as a scaffold to keep osteoprogenitor cells in place. The aim of this study was to compare osteoblastic activity by the use of scintigraphic methods in defective rabbit tibias during early-phase bone healing with or without a hyaluronan-based mesh. Methods: Two groups (A and B) of New Zealand albino rabbits were used; each group included 10 animals. Operations on all rabbits were performed under general anesthesia. We also resected 10-mm bone segments from each animal's tibial diaphysis. After resection, tibias with defects were fixed using Kirschner wires. In group A, no hyaluronan-based mesh was used. In group B, tibial segmental defects were enclosed with a hyaluronan-based mesh. The rabbits were followed up for 4 weeks postoperatively, after which bone scintigraphic studies were performed on each animal to detect and compare osteoblastic activity. Results: The mean count in the fracture side of the hyaluronan-based mesh group was significantly higher compared to that of the group A (p = 0.019). However, there was no significant difference between group B and control rabbits with respect to the mean count on the intact bone side (p = 0.437). The bone defect (fracture)/intact bone mean count ratio was significantly higher in group B compared to group A (p = 0.008). Conclusions: A hyaluronan-based mesh plays a role in promoting osteoblastic activity. Hyalonect r is suitable for restoring tissue continuity whenever the periosteal membrane is structurally impaired or inadequate. Our results demonstrated that, during early-phase bone healing, osteoblastic activity was increased in bone defect sites when a hyaluronan-based mesh was also used. The most important aspect of this study concerns its scintigraphy-based design. This study is the first to use a scintigraphic method to demonstrate the effectiveness of hyaluronic acid-based material for bone healing.