Background:This study investigates the effect of microfracture as a bone marrow-stimulating(BMS) technique on rotatory cuff(RC) healing using a chronic RC tear model.Methods:Chronic retracted RC tendon tear model was created in the subscapularis(SSC) tendons of 20 New Zealand rabbits, bilaterally. The tendons were repaired after eight weeks using a single-row configuration with suture anchors. In right shoulders, tendons were repaired in a standard fashion(control group). In left shoulders, microfractures were performed on the SSC footprint before repair(microfracture group). The animals were sacrificed 8 and 16 weeks after repair. The repaired tendons were tested biomechanically for their ultimate failure load, linear stiffness and elongation at failure. Gross and histological evaluation of the tendon-to-bone healing was evaluated.Results:In every sample, the SSC tendon was attached to its footprint on the lesser tuberosity. In microfracture group, collagen fibers were organized in relatively ticker bundles at both time intervals. The mean ultimate failure load of microfracture was significantly greater than that of control group at 8 (148.4+31 N vs. 101.4+26 N; p=0.011) and 16 (155+30 N vs. 114.9+25 N; p=0.017) weeks after repair, respectively. There were no significant differences between the two groups at each time interval for linear stiffness (15.9+2.7N/mm vs. 15.8+1.3N/mm, p=0.798 and 16.9+4.3N/mm vs. 17.1+3.6N/mm, p=0.848, respectively) and elongation at failure (4.7+1.1 mm vs. 4.7+1.3 mm, p=0.848 and 4.8+1.5 mm vs. 4.9+0.9 mm, p=0.749, respectively).Conclusions:The BMS technique of microfracture on the tuberosity of the repaired chronic rotator cuff tear promotes the dynamic tendon healing with significant ultimate force to failure and apparent microscopic findings.

ÖZ ABSTRACTSpina iliaka anterior superior (SİAS) avülsiyon kırıkları nadir ve acil servis değerlendirmesinde gözden kaçabilecek yaralanmalardır. SİAS, kalça fleksör kaslarından olan tensor fasia lata ve sartorius kaslarının başlangıç bölgesidir. Özellikle adölesanlarda topa vurma esnasında bu kasların kuvvetli kontraksiyonlarıyla avülsiyon kırıkları gözlemlenebilir. Olgumuz, 16 yaşında erkek sporcu, futbol oynarken topa vurma sonrası sol kalçasında ani ağrı başlayan, topallamaya neden olacak ağrı ve hareket kısıtlılığı nedeniyle acil polikliniğe başvurmuş ve fizik muayenede yumuşak doku travması olarak değerlendirilmiştir. Tarafımıza başvuran hastanın poliklinik kontrollerinde çekilen grafilerinde SİAS avülsiyon kırığı tanısı konuldu. Hastaya non-steroidal anti-enflamatuvar ilaç, tam yük vermeden koltuk değnekleriyle mobilizasyon ve soğuk uygulama ile yaklaşık 4 hafta konservatif tedavi uygulandı. Birinci ay kontrolünde tam ve ağrısız eklem hareket açıklığı olduğu ve palpasyonda ağrı olmadığı saptandı. SİAS avülsiyon kırıkları çoğunlukla konservatif olarak tedavi edilse de iyi fizik muayene yapılmadığında yumuşak doku travması ile karışabilmekte ve özellikle deplasman miktarı fazla olan kırıklar klinik sorunlara sebep olabilmektedir.Anahtar Sözcükler: Avülsiyon kırığı, pelvis, apofiz, spina iliaka anterior superior Spina iliaca anterior superior (SIAS) avulsion fracture is a type of injury that is rare and possible to be overlooked in emergency services. SIAS is the insertion area of the Tensor fascia lata and Sartorius muscles, which are two of the hip flexor muscles and forceful contractions of these muscles which can be observed while kicking a ball, can lead avulsion fractures of SIAS, especially among adolescents. In our case, a 16-year-old male athlete attended the emergency service with a movement restriction and severe pain causing limping that started as an instant pain in the left hip after kicking the ball during a soccer game. It was misdiagnosed as soft tissue injury and no radiological imaging was performed. After plain radiography of the hip was performed in control appointment, the patient was diagnosed as having SIAS avulsion fracture, and a complete and pain-free range of motion was achieved after a conservative treatment of nonsteroid anti-inflammatory drugs, three weeks rest along with cold therapy and walking with crutches without full weight bearing. Even though SIAS fractures are generally treated with conservative methods, they can be misdiagnosed as soft tissue injury in case of poor physical examination and especially displaced fractures may cause clinical problems.

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Discoid meniscus is an uncommon congenital anomaly, and it is rarely seen in the medial compartment of the knee. Literature about bilateral medial discoid meniscus pathology is also limited because one of the knees is usually asymptomatic, although the pathology bilaterally exists. The incidence of bilateral cases should be more than that in current literature because of a number of non-diagnosed cases. In this study, we discuss the approach for a patient with one-sided symptomatic bilateral medial discoid meniscus and present partial meniscectomy as a treatment method.