Objective: The aim of this study was to evaluate glenohumeral morphologic differences and their correlation between glenohumeral 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 the patients were categorized into two groups: 50 patients with Anl (23 female, 28 male; mean age = 29 ± 7.4) and 50 patients with RCT (28 female, 22 male). Two separate control groups were then formed, one of which included contralateral shoulders of patients in the AnI group, and the other consisted of contralateral shoulders of patients in the RCT group. The x-ray and MRI scans 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 Acromion Angulation (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; and AA, 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 moderate correlation 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 correlation was found between AI and GI in the AnI group (r = 0.22, P = 0.001). The inter- and intra-observer intraclass correlation coefficients 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 0.72 and 0.77 for AA. Conclusion: The results of this study have shown that lower AI, GI, and antevert GV may be associated with AnI. Investigating CSA, AI, and GV could be useful for diagnostic evaluation of patients with AnI. Level of Evidence: Level III, Diagnostic Study Cite this article as: Karahan N, Yılmaz B, Öztermeli A, et al. Evaluation of critical shoulder angle and acromion index in patients with anterior shoulder instability and rotator cuff tear. Acta Orthop Traumatol Turc 2021; 55(3): 220-6.

Background: The objective of this study was to evaluate the efficacy of subacromial injections of collagenase and corticosteroid in rats with experimentally induced adhesive capsulitis. Method: Thirty adult Wistar albino male rats were distributed into 3 groups of 10 rats each after stabilization of their shoulders for 3 weeks: the first group received a single dose of 0.002 mg (0.25 mL) subacromial collagenase; the second group received a single dose of 1.60 mg (0.25 mL) subacromial steroid, and the third group received a single dose of 0.25 mL subacromial saline solution. One week later, we investigated shoulder range of motions, collagen content of the shoulder, and joint cartilage structure. Results: There was no statistically significant difference in the cartilage damage between the groups (p > 0.05). Fibrosis measurements were significantly lower in the collagenase group than in the steroid and saline groups. There was no significant difference in fibrosis between the steroid and saline groups (p > 0.05). Abduction measurements were significantly higher in the collagenase group than in the steroid and saline groups (p < 0.001). No significant difference in the abduction measurements was observed between the saline and steroid groups (p > 0.05). Conclusion: We observed that subacromial injections of collagenase Clostridium histolyticum effectively treated adhesive capsulitis. The results suggest that this treatment could be considered for use in patients with an intact rotator cuff.

Tendons play an important role in the movement by transmitting the contraction force produced by the muscles to the bone they hold, and their contribution to stability to the joints is extremely important. Tendons generally have a very complex structure; they are actually heavily composed of connective tissue and have a small number of cells and rich extracellular matrix, similar to other connective tissue structures. The tendons are mainly composed of three parts: the tendon itself, the muscle-tendon junction, and the bone insertion. The simplest classification for the tendons classified according to their shapes, settlements, and anatomical structures is the classification made according to their shapes. Tendons can be classified in many ways according to their location, but the most logical one is the tendon classification in relation to the functions they see as intraarticular and extraarticular. According to their anatomy, the tendons can also be classified as sheathed or synovial-coated or unsealed or paratenon-coated. According to their functions, tendons can be classified as energy storage or positional tendons.

Objective The purpose of this study was to investigate different treatment methods employed by orthopedic surgeons for open tibial fracture in adults. Methods Survey of 12 questions regarding treatment of open tibial fracture was conducted with 285 orthopedics and traumatology specialists in Turkey in personal interviews and using web-based technique. Results Of all survey participants, 99.6% responded that tetanus prophylaxis is necessary emergency procedure in cases of adult open tibial diaphysis fracture. In addition, 96.5% considered antibiotics administration necessary, 85.6% also selected irrigation with saline, 55.4% included debridement, and 45.3% temporary fixation. Only 4 (1.3%) respondents did not use aminoglycoside antibiotics. While 29.8% of those surveyed preferred external fixator as a definitive treatment method, 75.8% use intramedullary nail and 13.7% preferred plate method. Conclusion A wide variation was observed among orthopedics and traumatology specialists in Turkey regarding treatment of open tibial diaphysis fracture in adults. Data obtained from this study together with the available literature may be useful to further develop therapeutic approaches. ER - Keywords Antibiotics Debridement Fixation Open fractures Tibia

Objective: The aim of this study was to investigate whether collagenase clostridium histolyticum (CCH) reduces intra-articular fibrotic adhesion formation in a rat model of arthrofibrosis. Methods: A total of 24 male Wistar rats (7 months old, weighing 220 –275 g) were randomly and equally assigned to one of two groups: the collagenase group and the control group (n = 12 each). In each group, a partial capsulotomy, and synovectomy were performed in knee. After a partial capsulotomy and synovectomy were performed in each group, the collagenase group received intra-articular CCH of 0.008 mg in 0.1 mL saline solution while the control group received the equal volume of intra-articular saline solution alone. After 6 weeks of surgery, the rats were sacrificed by decapitation, and the following outcome measures were collected. Knee range of motion (ROM) was measured using with a goniometer under 20 g force. Adhesion formation was rated using the macroscopic visual scoring system after the knee joint was exposed through a lateral parapatellar approach. Histological evaluation was performed on samples including connective tissue and fibrotic adhesions, and fibroblast cell numbers were measured performed per square. Levels of interleukin 1 (IL-1) and fibroblast growth factor (FGF) were assayed by ELISA from the intra-articular fluid. Results: The macroscopic visual scoring system was significantly lower in the collagenasegroup (median = 1, range = 0–2) than in the control group (median = 2, range = 1–3)(< 0.001).ROMwas significantly higher in the collagenase group (102° ± 12.1°) than in the control group (77° ±8.94°) (P <0.001). The number of fibroblasts obtained from the scar tissue were considerably lower in the collagenase group (mean = 16.5 ± 2.74) compared tothe control group (mean = 30.1± 4.89) (P < 0.001). Levels of IL-1 andFGF were significantly lower in the collagenase group (mean = 18.6 ng/l ± 4.39,mean = 36.3 ng/l ± 2.03; respectively) compared to the control group (mean = 31.7ng/l ± 3.75, mean = 38.7 ng/l ± 2.19; respectively) (P < 0.001). Conclusion: Evidence from this study has revealed that CCH injection can inhibit the development ofarthrofibrosis, decreasing the precursor inflammatory cytokines (IL-1 and FGF-1) and histologic fibrosis in a rat knee arthrofibrosis model. Level of Evidence: Level IV, Therapeutic study Cite this article as: Karahan N, Kaya M, Yılmaz B, et al. The effect of collagenase clostridium histolyticum on adhesion reduction in a rat knee arthrofibrosis model. [published online ahead of print, 2021 September 17] Acta Orthop Traumatol Turc; 10.5152/j.aott.2021.20364. 55(5): 385–390..