This study aims to improve the diagnostic reliability of syndesmosis injuries through evaluation of radiological measurements in the Turkish population and to provide mean reference values to prevent malreduction and overcompression during the treatment. This retrospective study was performed between January 2018 and May 2018. The bilateral anteroposterior (AP) and lateral radiographs of 100 patients (60 males, 40 females; mean age 42.9 years; range, 23 to 72 years) who presented at our polyclinic were analyzed. Tibiofibular overlap (TFO), tibiofibular clear space (TFCS) and medial clear space (MCS) measurements were performed on the AP radiographs. The lateral radiographs were evaluated in respect of the anterior tibiofibular interval (ATFI), posterior tibiofibular interval (PTFI), and anterior tibiofibular ratio (ATFR) for syndesmosis reduction assessment. The lower and upper limits, mean and median values of the measurements were recorded. The measurements on the AP radiographs were determined to be as TFO: 7.9±2.4 mm (4-13), TFCS: 3.8±0.9 mm (2.2-6), MCS: 3.3±0.4 mm (2.7-4.5), and superior clear space: 3.3±0.3 mm (2.7-3.8). According to the measurements on the AP radiographs, the TFCS did not show any difference in terms of the variables of age, gender and side (p=0.070, p=0.219 and p=1.0, respectively). These measurements on the AP radiographs showed a high statistical consistency in terms of side (p=0.72, p=1.0, p=0.900 and p=0.920, respectively). The measurements on the lateral radiographs were as ATFI: 12.8±2.4 mm (8-18), PTFI: 6.1±2.9 mm (3-15) and ATFR: 0.4±0.1 (0.28-0.5). According to the measurements on the lateral radiographs, the ATFR did not show any difference in terms of the variables of age, gender and side (p=0.750, p=0.570 and p=0.848, respectively). The lateral measurements indicated statistical consistency in terms of side (p=0.400, p=0.260 and p=0.848, respectively). On the AP radiographs, TFCS was found to be reliable and the intraoperative evaluation of its high consistency with the opposite extremity is appropriate to avoid overcompression. The evaluation of ATFR on lateral radiographs was found to be reliable and evaluation is recommended to avoid intraoperative malreduction.

Objectives: Metal anchors (MA), commonly used in the early stages of rotator cuff surgical treatment development, are associated with a high risk of complications, especially in osteoporotic bone. As an alternative to rigid anchors, all-suture anchors (ASA) have been introduced for the medial row, offering promising clinical outcomes and favorable biomechanical studies. We aimed to compare the clinical outcomes of MAs and ASAs in either single-row or in medial-row suture bridge techniques in arthroscopic rotator cuff repair. Our hypothesis was that in cases where ASA was used for at least 12 months of follow-up, more favorable results would be obtained as compared to rigid anchors, and intraoperative complications such as anchor pullout would be encountered less. Methods: In this retrospective cohort analysis, we reviewed patients who underwent arthroscopic rotator cuff repair between January 2020 and December 2022. Surgeries were performed by two senior surgeons in a single tertiary center. Patients who had undergone revision surgery, had a history of previous shoulder surgeries, had massive rotator cuff tears, and partial-thickness tears; or had concomitant subscapularis tears were excluded. Preoperative and postoperative scores, including Constant–Murley (CM), Disabilities of the Arm, Shoulder, and Hand (DASH), and visual analog scale (VAS), were compared. The minimum follow-up period was 12 months. Clinical assessment of shoulder range of motion included forward flexion, abduction, internal rotation, and external rotation. Intraoperative anchor-related complications were compared. All patients underwent the same surgical technique and postoperative rehabilitation protocol. Results: A total of 142 patients (89 females, 53 males; mean age: 57.4 years) were included in the study, with 67 patients in the ASA group and 75 in the MA group. The sex distribution and mean age were similar between groups. The ASA group had 15 traumatic tears, while the MA group had 13 (p < 0.05). The mean follow-up period was 21.6 months (range 12–40 months). Preoperative CM scores were statistically better in the ASA group, but this difference was not clinically relevant (p < 0.046). The mean CM score was 75.64, the mean DASH score was 8.57, and the mean VAS was 1.38 at the postoperative period in the MA group. The mean CM score was 78.40, the mean DASH score was 9.75, and VAS was 1.59 at the postoperative period in the ASA group. Seven cases experienced anchor pullout in the MA group, and thread breakage occurred in one patient of each group (p = 0.014). The mean age of the patients with anchor pullout was significantly higher (p = 0.002). This finding was not hypothesized in the initial study design but emerged during post-hoc analysis and highlights the importance of considering bone quality in elderly patients. Conclusions: The clinical outcomes of rotator cuff repairs using all-suture anchors or metal anchors are comparable. However, ASA use may offer an advantage in elderly patients by reducing the risk of anchor pullout. Further studies assessing tendon integrity and bone quality and incorporating long-term follow-up periods are recommended to support and validate the present findings.

Pathology in any segment of the spine-pelvis-lower extremity may impair the global postural balance, leading to compensatory alterations in other parts. The aim of this study was to compare the pelvic movements of patients suffering from knee osteoarthritis with patients who underwent total knee arthroplasty and healthy controls.

Optimizing muscle activation through exercise variation is critical for enhancing performance and reducing injury risk. This cross-sectional study examined how trunk position (neutral vs. flexion) and surface stability (ground-based vs. suspension-based) influence lower extremity and trunk muscle activation during the Bulgarian Split Squat (BSS). Twenty-one trained female athletes (mean ± SD: age 20.3 ± 2.5 years; height 165.9 ± 5.8 cm; body weight 58.5 ± 5.7 kg) participated in the study. Surface electromyography was used to assess activation of eight lower extremity and trunk muscles: gluteus medius (GMed), gluteus maximus (GMax), vastus lateralis (VL), rectus femoris (RF), vastus medialis (VM), semitendinosus (ST), biceps femoris (BF), and erector spinae (ES) during four BSS variations. Suspension-based BSS resulted in significantly greater activation of the ES (p = 0.046), while trunk flexion increased activation in the GMax, BF, and RF muscles (p < 0.05). Suspension-based BSS is particularly effective for targeting trunk stabilizers like the ES, while trunk flexion enhances posterior chain muscle activation, especially GMax and BF. These variations can be strategically applied in strength training and rehabilitation to meet specific neuromuscular goals. In practice, the findings may guide individualized programming for enhancing performance or preventing injuries in female athletes. ClinicalTrials.gov identifier NCT06112015, registered on 01/11/2023.

Total hip arthroplasty (THA) effectively reduces pain and restores function in hip osteoarthritis, yet discrepancies often remain between patient-reported outcomes (PROMs) and actual physical performance. This study investigated whether PROMs are associated with, and can independently predict, performance-based mobility and balance after THA. Fifty patients (mean age 64 ± 7 years; 56% female) who underwent unilateral primary THA at least 12 months earlier were included. Assessments comprised the Oxford Hip Score (OHS), the 12-Item Short Form Health Survey (SF-12), and visual analog scales for rest and activity-related pain. Performance-based tests included the Timed Up and Go (TUG), Four Square Step Test (FSST), and 4-Meter Gait Speed (4MGS). Pearson correlation and multivariate linear regression analyses were conducted controlling for demographic and clinical variables. Activity-related pain demonstrated moderate correlations with TUG and FSST and a strong correlation with 4MGS, while OHS showed moderate negative correlations with TUG and FSST and a strong negative correlation with 4MGS. SF-12 physical scores correlated with TUG and 4MGS, whereas rest pain was not associated with any performance measure. Regression analyses revealed that OHS and activity-related pain were consistent independent predictors of all three performance tests, while age and comorbidities significantly predicted FSST outcomes. These findings suggest that PROMs, particularly OHS and activity-related pain, are closely related to objective performance measures and may independently predict postoperative mobility and balance after THA. Combining PROMs with performance-based tests can provide a more comprehensive assessment, facilitating individualized rehabilitation strategies and early identification of patients at risk of poor functional recovery

Background/Objectives: Unstable intertrochanteric femur fractures (IFFs) in geriatric patients are associated with high rates of morbidity and mortality due to poor bone quality, multiple comorbidities, and limited functional capacity. This study aimed to compare the clinical outcomes of cementless bipolar hemiarthroplasty (BHA) performed via a transtrochanteric approach and proximal femoral nailing (PFN) in elderly patients with unstable IFFs. Methods: This retrospective comparative study included 131 patients aged ≥70 years who underwent surgery for AO/OTA 31-A2 and 31-A3 unstable fractures between January 2021 and July 2025 were retrospectively reviewed. 64 patients received cementless BHA and 67 underwent PFN. Eligible patients were ambulatory prior to fracture (independently or with a cane/walker); patients with pathological fractures/malignancy, alternative procedures (cemented or posterolateral BHA, total hip arthroplasty, tumor prosthesis, or other osteosynthesis methods), incomplete records, or <6 months of follow-up were excluded. Demographics, perioperative variables, mechanical complications, revision requirement, time to mobilization, and 1- and 6-month mortality rates were analyzed. Primary outcomes were mortality and perioperative clinical parameters. Results: The two groups were comparable in age, sex, ASA scores, and fracture patterns. Intraoperative blood loss and transfusion requirements were significantly higher in the BHA group (both p < 0.001). Mobilization was observed earlier in patients treated with BHA (1 [1,2] vs. 3 [2,3] days; p < 0.001). Mechanical complications were more frequently observed after PFN, which was associated with a higher revision requirement (17.9% vs. 4.7%; p = 0.018). Operative time, hospital stay, and 1- and 6-month mortality rates showed no significant differences between the groups. Conclusions: In geriatric patients with unstable IFFs, cementless BHA performed via a transtrochanteric approach may be considered a viable surgical option with appropriate patient selection, taking into account its association with earlier mobilization and the observed mechanical complication profile. PFN offers advantages of reduced blood loss and lower transfusion needs. Surgical decision-making should be individualized based on fracture morphology, bone quality, and the patient’s overall medical condition. Given the heterogeneity of unstable fractures within the AO/OTA classification and the retrospective nature of the present study, larger, multicenter prospective investigations incorporating functional outcomes are warranted to further clarify optimal treatment strategies.