Objectives The aim of this study was to evaluate how fatty atrophy (FA) of the hip abductors in operated and non-operated hips affected the functional outcome following arthroplasty. Methods Forty-four hips of 22 patients (8 males and 14 females; mean age: 60?±?14.4 (range: 24–84)) who matched the inclusion criteria and willing to participate in the study were retrospectively evaluated. The mean follow-up was 13.8?±?2.3 (range: 10–18) months Magnetic resonance imaging (MRI) and Harris Hip Score (HHS) were used to evaluate muscle degeneration and functional outcome after unilateral THA through a posterolateral approach. The FA grade was evaluated using Goutallier grading system. Non-operated hips of subjects were used as the control. Age, duration after the operation, gluteal muscle FA, and the relationships with HHS were evaluated. Results FA was more evident in the operated hip (p??0.05), whereas there was a positive correlation with the contra-lateral hip (p?Conclusion Following THA, there was marked FA in the operated hip compared to that in the contralateral hip. In these cases, degree of FA in the replaced hip did not correlate with patients' age. Fatty atrophy of the gluteus minimus precedes that of gluteus medius. FA of the contralateral gluteus minimus and patient age are strongly correlated with lower HHS. Level of evidence: Level IV, diagnostic study. Level of evidence Level IV, diagnostic study. ER -

Objective The aim of this study was to define a quantitative parameter to indicate which cases of plantar fasciitis will benefit from local corticosteroid injection or ESWT and to compare the efficacy of two different treatment modalities. Methods Seventy patients (mean age: 49.10; range: 41–58) with chronic plantar fasciitis unresponsive to conservative treatment for 3 months were treated with either betamethasone injection or extracorporeal shock wave therapy (ESWT). Correlation between AOFAS scores, fascia thickness, duration of symptoms, age and calcaneal spur length were assessed. Results Degree of fascial thickening (mean 4.6 mm for all patients) did not influence baseline AOFAS scores (r = -0.054). Plantar fascia thickness significantly decreased in both groups after treatment (1.2 mm for steroid, 1.2 mm for ESWT) (p < 0.01 for both groups). Percentage of change in AOFAS scores (68% for steroid and 79% for ESWT, p = 0.069) and fascial thickness (24% for steroid and 26% for ESWT, p = 0.344) were similar between two groups. Functional recovery was not correlated with baseline fascial thickness (r = 0.047) or degree of fascial thinning after treatment (r = -0.099). Percentage of change in AOFAS scores was correlated only with baseline AOFAS scores (r = -0.943). Conclusions Plantar fascia thickness increases significantly in plantar fasciitis and responds to treatment. Both ESWT and betamethasone injection are effective in alleviating symptoms and reducing plantar fascia thickness in chronic plantar fasciitis. However, the only predictive factor for functional recovery in terms of AOFAS scores is patients' functional status prior to treatment. Measuring of plantar fascia is not helpful as a diagnostic or prognostic tool and MRI imaging should be reserved for differential diagnosis. Level of evidence Level III, Therapeutic study. ER -

Objective Whether surgical or conservative treatment is more effective in allowing patients to return to physical activity after anterior cruciate ligament (ACL) injury is controversial. We sought to compare mid-term outcome measures between isolated ACL tear patients who underwent reconstruction followed by closed kinetic chain exercises and those who underwent neuromuscular training only. Methods We retrospectively evaluated patients with ACL tears who underwent post-surgery CKC strength training after ACL reconstruction (Group A), and patients who only underwent neuromuscular training (Group B) with a minimum follow-up time of 5 years. Surgical techniques, rehabilitation, assessment of subjective knee function, one-leg hop test, assessment of joint position sense, muscle strength, and the health profile of the patient were evaluated. Results Overall, 43 patients were included in Group A (mean age, 32.56 ± 4.89; Tegner activity scale, 5) and 39 patients in Group B (31.67 ± 7.27; 5). Patients in both groups returned to their regular physical activity level after a similar time frame (Group A: average, 12 months; Group B, average, 13.4 months). The mean Lysholm knee score was 88.52 ± 7.65 in Group A and 86.21 ± 13.72 in Group B. Mean distances for the one-leg hop test for Group A were 135.21 ± 31.66 and 145.36 ± 42.10 mm in the reconstructed and uninjured knees, respectively. In Group B, the mean hop distances were 132.47 ± 28.13 and 147.89 ± 21.45 mm in the rehabilitated and uninjured knees, respectively. No statistical difference was observed between the groups for any of the parameters evaluated, including assessment of subjective knee function, one-leg hop test, assessment of joint position sense, muscle strength, and the health profile. Conclusion Our data suggest that early surgical reconstruction may not be a prerequisite to returning to recreational physical activities after injury in patients with ACL tears. Level of evidence Level IV, therapeutic study. ER - Keywords Anterior cruciate ligament Anterior cruciate ligament reconstruction Functional performance tests Knee joint Neuromuscular joint facilitation Proprioception

Objectives: To evaluate the results and complications of femoral neck fractures treated with internal fixation with three screws with an average follow-up of three years.\r\nMethods: Thirty seven patients operated upon between June 2000 and May 2005 for fractures of the femoral neck with three screws were identified as the study population. The final results of 26 patients (11 male, 15 female, with an average age of 39.8, range 16-69) that had a minimum of two year follow-up (average 37 months, range 24-64 months) were evaluated. Those patients that had additional fractures were not included in the evaluation. Preoperatively based on Garden classification four patients (15%) were Type I, eight patients (31%) were type 2, six patients (23%) were type three and eight patients (31%) were type 4. Functional results were evaluated according to the UCLA hip score. \r\nResults: The average time to union was 5.5 months (range 3-12 months). One patient did not achieve union and a total hip replacement was done in the 15th postoperative month. Four patients had avascular necrosis (AVN) of the femoral head. The incidence of AVN in patients who had an operation within 24 hours of fracture was 9.5% while 40% in patients operated later than that. In patients with AVN one required a total hip replacement, another required treatment with bipolar hemiarthroplasty, the other two patients did not require further operations. One patient underwent bipolar hemiarthroplasty after screw pullout occurred on the 35th postoperative day. Fifteen patients (58%) had excellent results, five (19%) had good, 5 (19%) had moderate results and one (4%) had a poor result.\r\nConclusion: Operative treatment with internal fixation using three screws in femoral neck fractures in the first 24 hours after a fracture gives favourable results in young patients that are too young to be considered for arthroplasty.

Objective: This study aimed to compare the effects of 24-h continuous femoral nerve block (CFNB) and periarticular infiltration analgesia (PIA) on postoperative pain and functional results in the first 6 weeks after total knee arthroplasty (TKA). Methods: Sixty patients who underwent unilateral TKA were included in this study. The patients were divided into two groups: Group A received CFNB and Group B received PIA. Each patient received 0.25% levobupivacaine and 1:100,000 epinephrine as infiltration to the posterior capsule. A patient-controlled analgesia (PCA) device was used for all patients, and 24-h tramadol usage by patients was recorded. We measured maximum range of motion (ROM), pain using a visual analog scale (VAS), 2-min walk test (2MWT), and the scores of Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Knee Society Score (KSS). Results: Compared with Group B, Group A had lower postoperative opioid usage (p<0.05), less pain at rest (p<0.05), less pain with passive motion (p<0.05), less pain with movement and after active movement (p<0.05), and superior passive and active ROM (p<0.05). Group A also had better 2MWT results at 24 and 48 h after surgery (p<0.05), and superior WOMAC and KSS results at 6 weeks after surgery. Conclusion: As long as it is applied with infiltration analgesia to the posterior capsule, CFNB is an effective and safe analgesia method resulting in better postoperative patient comfort and greater ROM. Furthermore, it produces better results in the early postoperative period with a favorable side effect profile. Özet Amaç: 24 saat devamlı femoral sinir bloğu (DFSB) ve periartiku¨ler infiltrasyon analjezisinin (PİA) total diz artroplastisi (TDA) sonrası ağrı ve ameliyat sonrası erken dönem (6 hafta) fonksiyonel sonuçlara olan etkisinin karşılaştırılmasıdır. Çalışma planı: Tek taraflı TDA yapılan 60 hasta çalışmaya alınarak, iki farklı çalışma grubu oluşturuldu. Grup A, DFSB uygulanan hastalardan, grup B, PİA uygulanan hastalardan oluşmakta idi. Tu¨m hastaların diz eklemi arka kapsu¨lu¨ne, %0.25 levobupivakain ve 1:100,000 epinefrin içeren solu¨syon uygulandı. Tu¨m hastalara hasta-kontrollu¨ analjezi (PCA) cihazı takıldı ve 24 saatlik tramadol kullanımı kaydedildi. Maksimum hareket açıklığı (ROM), ağrı ve fonksiyonel durum, görsel ağrı skalası (VAS), iki dakika yu¨ru¨me testi, Western Ontario ve McMaster Üniversiteleri Osteoartrit İndeksi (WOMAC) ve Diz Cemiyeti Değerlendirme (KSS) testleri ile değerlendirildi. Bulgular: B grubu ile karşılaştırıldığında, A grubundaki hastaların opioid kullanımı daha az (p<0.05), ameliyat sonrası istirahatte ağrı kontrolu¨ daha iyi idi (p<0.05). Aktif ve pasif hareket ile daha az ağrı (p<0.05) oluşurken, aktif ve pasif hareket ile daha iyi hareket açıklığı var idi (p<0.05). Grup A’nın ameliyat sonrası iki dakika yu¨ru¨me testi sonuçları daha iyi (p<0.05), WOMAC ve KSS sonuçları da ameliyat sonrası altıncı haftada daha u¨stu¨n idi. Çıkarımlar: DFSB diz eklemi arka kapsu¨lu¨ne infiltrasyon analjezisi ile uygulandığı takdirde, du¨şu¨k yan etki profili ile ameliyat sonrası daha iyi hasta konforu ve daha fazla hareket açıklığı sağlayan etkili ve gu¨venilir bir analjezi metodur. Bu özet, makalenin henüz redaksiyonu tamamlanmamış haline aittir ve bilgi verme amaçlıdır. Yayın aşamasında değişiklik gösterebilir.