Objective: The aim of this study was to investigate the effects of anterior cruciate ligament reconstruction performed by preserving remnant tissue on proprioception and to assess the effects it has on isokinetic quadriceps and hamstring muscle strength, as well as on range of motion and functional scores. Methods: A prospective study was conducted with 44 patients who underwent either anterior cruciate ligament reconstruction with remnant preservation (study group, n=22) or with remnant excision (control group, n=22) with the use of a 4-strand hamstring allograft. The mean follow-up time was 20.2 ± 1.4 months after surgery. Using an isokinetic dynamometer, proprioception was evaluated with passive joint position perception at 150, 450, and 600, and quadriceps femoris, and hamstring muscle strength were evaluated at speeds of 900, 1800, and 2400 per second. Range of motion was measured using a goniometer. Functional outcomes were assessed using International Knee Documentation Committee subjective knee evaluation score and Lysholm knee scoring questionnaires. Results: It was only at 15° of knee flexion that there was a statistically significant difference in proprioception; the median of the difference in the amount of deviation from the target angle between the healthy knee and the operated side was 1.7 (range, 0.7-20.7) in those with remnant preserved, and 2.7 (range, 1-26) in those with remnant excised (P=.016). At 2400/s speed, the mean quadriceps femoris strength was 77.2 ± 24.3 Nm in those with remnant preserved and 67.6 ± 24.2 Nm in those with remnant excised. (P=.048) There was no difference between the 2 groups in terms of range of motion, International Knee Documentation Committee, and Lysholm knee scoring. (P > .05) Conclusion: The present study has demonstrated that better proprioception and higher quadriceps femoris muscle strength can be obtained by remnant-preserving anatomical single-bundle anterior cruciate ligament reconstruction using a hamstring autograft. Level of Evidence: Level II, Therapeutic study. Cite this article as: Igdir V, Gencer B, Dogan O, Caliskan E, Orhan A, Demir Ozbudak S. The effects of remnant-preserving anterior cruciate ligament reconstruction on proprioception: A prospective comparative study. Acta Orthop Traumatol Turc., 2023;57(3):109-115.

There is no consensus in the literature on nonoperative treatment of displaced and multipart fractures of proximal humerus as those are normally treated operatively. Our aim was to compare the functional results of nonoperative management and open reduction internal fixation with the proximal humerus internal locking system of 2-, 3-, and 4-part proximal humerus fractures, among themselves and with a healthy control group. Between 2014 and 2018, 92 proximal humerus fractures constituting a nonoperative group (n = 47) and an operative group (n = 45) together with healthy control subjects (n = 45) were analyzed in a tertiary care referral center. The American Shoulder and Elbow Surgeons (ASES) shoulder score and visual analog scale (VAS) pain score were used for subjective functional analysis. Range of motion and muscle strength were analyzed objectively for all patients and healthy control subjects. In 2-part fractures, VAS scores and hand grip strength were determined as lower in the nonoperative group (p = 0.033 and p = 0.034, respectively). In 3- and 4-part fractures, there was no difference between the two groups in terms of ASES and VAS scores. Patients who underwent surgery had more muscle strength than those in the nonoperative group, but only arm extensor and forearm flexor muscle strengths were statistically significant for 3-part fractures. In cases of 4-part fractures, objective functional results were similar between the two groups. With insufficient functional results and high complication rates in surgery, nonoperative management is still the preferred choice for proximal humerus fractures, especially in case of multipart fractures.

Objective: The aim of this study was to measure the cartilaginous coverage of the acetabulum using magnetic resonance imaging (MRI) and to analyze its effect on the timing and necessity of secondary operations in residual acetabular dysplasia (RAD). Methods: The MRI results of 33 children (30 girls and 3 boys) aged between 5 and 9 years who were operated on unilaterally via a posteromedial limited approach were compared with the radiographical findings of acetabular dysplasia at follow-up. The acetabular index (AI) and the center-edge (CE) angles were measured. MRI was used to measure the osseous acetabular index (OAI), cartilage acetabular index (CAI), and cartilaginous center-edge angles (CCE). The Children's Hospital's Oakland Hip Evaluation Score (CHOHES) was used for the assessment of clinical and functional results. The Severin scoring system was used to evaluate the radiographic results. The Mann-Whitney U test and Spearman correlation tests were used for statistical analysis. Results: In all, 30 (90.9%) girls and 3 (9.1%) boys with an average age of 7.4 years (range: 5e9 years) and a mean follow-up period of 6.1 years (range: 4e8 years) were included. While there was a significant difference between non-dislocated hips and operated hips in 3 measurements (AI, Wiberg CE, and Ogata CE) using X-rays (p < 0.05), no significant difference was found in the MRI measurements (OAI, CAI, and CCE) (p > 0.05). The CAI values were lower than the AI measured on X-ray (p ¼ 0.035). The mean CCE was higher than the mean CE (p ¼ 0.022). The mean CHOHES score was 83.1 (range: 52e100) and the score of 62% patients was above 90. There was no significant difference in terms of CHOHES score according to age at the time of operation (p ¼ 0.43). Three (9.1%) patients were Severin class I, 8 (24.3%) patients were class II, 12 (36.3%) patients were class III and 10 (30.3%) patients were class IV. There was no correlation between preoperative hip dislocation and Severin score (p ¼ 0.056). No significant difference was found between the ambulatory and non-ambulatory groups in terms of Severin classification (p ¼ 0.063). Conclusion: Cartilaginous acetabulum should be taken into account in RAD measurements. MRI may be a more appropriate option for the evaluation of acetabular cartilaginous coverage in the evaluation of RAD and the decision to perform surgery, though X-rays are currently the most used method. The results revealed no effect on functional or radiological scores as a result of being of walking age. Level of study: Level III, Diagnostic Study.

In this retrospective study, we evaluated the efficiency of minimal invasive intralesional extended curettage in the treatment of osteoid osteomas of the extremities in children. Forty-seven children (29 males, 18 females; mean age 10.5 years; range 4–19 years) with osteoid osteoma of the extremities underwent minimal invasive intralesional extended curettage. The exact localization of the nidus was determined preoperatively by thin-section (1–1.5 mm) computed tomography scans, and complete excision of the nidus was performed using a modified burr-down technique. None of the procedures required bone grafting or internal fixation. The median follow-up duration was 59 months (range, 12–136 months). Histopathological confirmation of osteoid osteoma was achieved in all procedures. All patients experienced immediate and complete relief of lesional pain after surgery. Preoperative (a day before surgery) and postoperative (at the time of discharge) mean visual analogue scale scores, questioning the pain derived from osteoid osteoma, were 7.7±1.2 and 0.3±0.6, respectively, confirming complete removal of the nidus. Early motion of the involved extremities and mobilization of the patients were achieved within 2 days. The children resumed normal function within 3 weeks. Postoperative complication or recurrence was not encountered in any of the patients. Even though percutaneous radiofrequency thermoablation is accepted as the treatment of choice for extraspinal osteoid osteomas, this technique requires a regional reference institution. Minimal invasive intralesional extended curettage can be performed in conventional institutions, even those not specialized in bone tumor surgery, by orthopedic surgeons with high success and low morbidity rates, in addition to rapid functional recovery.