The global burden of symptomatic knee osteoarthritis (KOA) continues to grow, driving clinical interest in biological treatment options. Stromal vascular f

Purpose: The ideal number of sutures for epineural nerve repair is still unclear. Increased number of sutures increases secondary damage and inflammation to the nerve tissue, which negatively affects nerve regeneration. When the number of sutures decreases, the strength of the nerve repair site decreases and nerve endings are fringed, which also negatively affects nerve regeneration. Therefore, each additional suture is not only beneficial but also detrimental. The aim of this study was to find out the ideal number of sutures for nerve repair. Methods: Seventy rats were randomly divided into 5 groups. One of the groups was used as a control group, and right sciatic nerves of the rats in other 4 groups were repaired by using 2, 3, 4, or 6 epineural sutures, respectively, after nerve transection. Biomechanical assessment was performed on the nerves collected from these rats at 5 days of follow-up. Functional and histological analyses were evaluated after 12 weeks of follow-up. Results: It was found that an increase in the number of sutures enhances resistance to tensile force in general. However, there was no significant biomechanical difference between the 6-sutured group in which the most sutures were used and the 4-sutured group. In functional examinations, overall successful results were obtained in the group with 4 sutures. In histological examinations, there was no statistical difference between the control group, 2-sutured groups, and 4-sutured groups in terms of connective tissue index. However, it was observed that the group with 6 sutures had a higher connective tissue index than the control group and groups with 2 and 4 sutures. In terms of regeneration index, it was found that repair with 4 sutures was superior to repair with 2 and 6 sutures. No difference was found between any of the suture groups according to the diameter change index. Conclusions: These results indicate that repair with 4 sutures is the best method of epineural repair that provides both strength and regeneration. These findings will contribute to both the repair of clinically similar nerves and the standardization of rat nerve studies.

Bennett fractures are intra-articular fractures of the first metacarpal, typically resulting from axial loading. The optimal surgical method for fixation remains a topic of ongoing debate. This study aims to evaluate and compare the biomechanical properties of different fixation techniques. Four fixation models were analyzed: the Lag Screw (LS) model, the Plate-screw (PS) model, and two K-wire models (Kw1 and Kw2). The biomechanical stability of each model was assessed by measuring the total displacement at the fracture line and the maximum von Mises stresses (MvMs) on the fixation materials. Measurements revealed that the LS model exhibited the highest total displacement of 2,184 mm, while the PS model showed the least displacement at 0,069 mm. Among the K-wire models, Kw1 had a total displacement of 0,408 mm, while Kw2 displayed 0,146 mm. Notably, the MvMs values at the fracture line were highest in the LS model (623,95 MPa for the large fragment surface) and lowest in the Kw2 model (16,237 MPa). The PS model demonstrated the lowest stresses on the fixation materials, highlighting its biomechanical advantage. Furthermore, the assessment of joint-level displacement indicated that the Kw1 model had the greatest displacement (0,156 mm), while the PS model maintained remarkable stability, recording a stable 0 mm displacement. The PS model demonstrated superior biomechanical stability, making it the most suitable fixation method among those studied. While the Kw2 model showed promising results with low total displacement values, further studies are necessary to establish its clinical efficacy.

Individuals seeking information about platelet-rich plasma (PRP) treatment for knee osteoarthritis, a controversial topic, may turn to YouTube. However, the quality and content adequacy of these videos should be questioned. This study analyzed YouTube videos related to PRP to evaluate their quality and content. The primary aim was to assess these videos’ quality and content, while the secondary aim examined the relationship between video quality/content and video characteristics, information sources, and themes. A total of 250 videos related to PRP treatment for knee osteoarthritis were identified through YouTube searches, and 68 of them were included in the study. The number of views, number of days since upload, view ratio, video duration, number of comments, the source of the information presented in the video, and the overall theme of the video were recorded. The quality and content of the videos were evaluated using the DISCERN, Journal of the American Medical Association, Global Quality Score, and PRP scoring systems. Median scores for video quality and adequacy were: DISCERN: 48 (range: 19–76), Journal of the American Medical Association: 2 (range: 1–4), Global Quality Score: 3.5 (range: 1–5), and PRP score: 6 (range: 2–10). Video quality and content positively correlated with the number of views, view ratio, duration, and comments. Videos in which patients provided the information had the lowest scores in terms of quality and content. While sports medicine physicians generally achieved higher scores, no difference was found between orthopedic surgeons and other specialized physicians. This study has shown that YouTube videos related to PRP treatment for knee osteoarthritis are not of low quality. The positive correlation between video characteristics, such as the number of views and comments, and quality suggests that the YouTube algorithm may prioritize higher-quality content, potentially enabling individuals to access better videos. Physicians provided higher-quality content compared with patients, although differences were observed among medical specialties. This finding suggests that the quality of informative content on PRP may vary depending on the expertise of the content creator. Despite certain limitations, YouTube may serve as a useful resource for individuals seeking information about PRP treatment. However, for the most reliable information, academic sources with an editorial process should be consulted.

Background: Scaphoid nonunion remains a challenging injury with no clear consensus on treatment. Surgical options, such as bone grafting procedures, are available for the treatment of scaphoid nonunions. While open grafting provides direct visualization, it is theoretically believed to lead to several problems due to the complex ligamentous structure responsible for wrist stability and challenges in the vascular supply of the scaphoid. On the other hand, despite its technical challenges, arthroscopic grafting is thought to avoid complications by preserving surrounding tissues. Questions/purposes: (1) Do patients undergoing bone grafting via arthroscopy for scaphoid nonunion report better function than patients undergoing an open procedure? (2) Do patients undergoing bone grafting via arthroscopy for scaphoid nonunion demonstrate better objective outcomes, such as ROM, extremity strength, and bony union? Methods: Between January 2012 and January 2022, we operated on 141 patients with scaphoid nonunion. The following patients were excluded from this study: 33 patients with scaphoid nonunion advanced collapse and arthritis, 18 patients with proximal pole fractures, 5 patients with previous surgeries, 16 patients with avascular necrosis, and 8 patients with the radius used as a graft source. In total, 28 patients underwent open grafting, and 33 patients underwent arthroscopic grafting; for both groups, the iliac crest was used as the graft source. Two patients with nonunion were observed in each treatment group, and they were excluded from the study. Results from the remaining 26 patients treated with open grafting and 31 patients treated with arthroscopic grafting (totaling 57 patients) were analyzed. The decision to treat patients with open or arthroscopic methods was not based on a particular reason. In our clinic, we initially preferred open grafting for treating nonunion of the scaphoid. Subsequently, we began to prefer arthroscopic methods for the treatment of these injuries. Twenty patients in the arthroscopic group had additional ligamentous injuries, which were simultaneously treated arthroscopically. All patients in both groups had at least 1 year of follow-up, but 48% of patients treated arthroscopically and 42% of those treated with open approaches were lost before 2 years of follow-up. The remaining patients had follow-up periods longer than 24 months. Our primary analysis was performed at 1 year, and we did a secondary analysis at 2 years. We compared the Patient-Rated Wrist Evaluation (PRWE), QuickDASH, and VAS scores of the patients. We also compared ROM and grip and pinch strength in patients’ contralateral wrists. We used predefined, evidence-based thresholds for the minimum clinically important differences for these outcome measures. Results: According to the 1-year functional analysis, we found no clinically important difference between the open surgery group and the arthroscopic surgery group in terms of PRWE score (median [IQR] 19 [25] versus 8 [9], difference of medians 11; p = 0.001), QuickDASH (median 14 [23] versus 7 [11], difference of medians 7; p = 0.004), and VAS scores (median 2 [2] versus 1 [1], difference of medians 1; p = 0.02). At 1 year, there were no differences in objective measurements, including grip strength (median 81 [16] versus 85 [14], difference of medians 4; p = 0.60), pinch strength (median 82 [18] versus 81 [15], difference of medians 1; p = 0.85), and ROM (flexion-extension median 83 [22] versus 85 [13], difference of medians 2; p = 0.74; radial deviation-ulnar deviation median 80 [36] versus 85 [14], difference of medians 5; p = 0.61). In the 2-year analysis, no clinically important difference was observed in terms of PRWE score, and no differences were found in terms of QuickDASH, VAS, strength tests, and ROM between the open and arthroscopic groups. No difference was observed in the union rates between the open group and the arthroscopic group (93% [26 of 28] versus 94% [31 of 33], OR 1.19 [95% CI 0.16 to 9.06]; p = 0.86). Conclusion: In comparing open surgical procedures with arthroscopic techniques for the treatment of scaphoid nonunions, the present study revealed no differences in functional outcomes and objective measures such as ROM and strength tests at both the 1-year and 2-year follow-up visits. Although technically more challenging, arthroscopy provides a potential advantage, such as addressing concomitant ligament injuries simultaneously. However, patients did not perceive a difference between the two surgical methods. In future studies, investigating long-term outcomes in a larger population will contribute to better elucidating this issue. Level of Evidence: Level III, therapeutic study.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.