Person: UÇAN, VAHDET
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Publication Open Access Comparison of Small-diameter-hole and Traditional Microfracture in Cartilage Repair and the Effect of Adding a Hyaluronic Acid-based Acellular Matrix Scaffold: An Animal Study(2021-03-01T00:00:00Z) UÇAN, VAHDET; YILDIZ, FATİH; ELMADAĞ, Nuh Mehmet; UZER, GÖKÇER; GÜZEL, YUNUS; TOK, OLGU ENİS; Mukaddes, E.; UÇAN, VAHDET; YILDIZ, FATİH; ELMADAĞ, NUH MEHMET; UZER, GÖKÇER; TOK, OLGU ENİS; EŞREFOĞLU, MUKADDESObjective: Since, there is no standardized technique for the treatment of focal cartilage defects that can recreate original cartilage tissue; researchers continue to explore and evaluate various treatment modalities. This study compared post-operatke healing of cartilage defects after treatment with small-diameter-hole microfracture (SDHM) technique with that of traditional microfracture technique. The effects of the hole density and augmentation with hyaluronic acid-based acellular matrix (HA-based AM) on cartilage healing were also investigated. Methods: Articular cartilage defects measuring 5 mm in diameter and 3 mm in depth were created in each femoral trochlear groove of 21 New Zealand rabbits. Rabbits were assigned to seven groups comprising six knees each. The rabbits were sacrificed 12 weeks later, and the regenerated cartilage was harvested for histological evaluation using the Wakitani scoring system. Results: All defects were filled with regenerated tissue macroscopically. Group I (14; range 10-14 points) had significantly higher Wakitani score than in groups VI (6; range 1-11 points) and VII (5; range 3-10 points) (p=0.043 and p=0.016, respectively). No significant differences were observed among the other groups. Augmentation with HA-based AM did not contribute to cartilage healing. Conclusion: Improved cartilage healing was observed with increasing SDHM density than with traditional microfracture technique. SDHM combined with HA-based AM implantation did not improve the quality of the regenerated cartilage.Publication Open Access Do Techniques for Hill-Sachs Remplissage Matter in Terms of Functional and Radiological Outcomes?(2021-06-01T00:00:00Z) Pulatkan, Anil; KAPICIOĞLU, Mehmet; UÇAN, VAHDET; Masai, Mustafa Ngeiywo; Ozdemir, Bulent; Akpinar, Sercan; Bilsel, Kerem; KAPICIOĞLU, MEHMET; UÇAN, VAHDET; BİLSEL, İSMAIL KEREMBackground: Different techniques are used for the remplissage procedure, including the double-pulley and mattress suture techniques. Both techniques have shown good results; however, it is unclear if one technique is superior. Hypothesis: The remplissage procedure using the double-pulley technique with 2 anchors would have superior functional and radiological outcomes compared with the mattress suture technique with a single anchor. Study Design: Cohort study; Level of evidence, 3. Methods: This study included patients with anterior shoulder instability who were treated using arthroscopic Bankart repair combined with remplissage between 2012 and 2017. A structured questionnaire was used to gather information on the following metrics: Instability Severity Index Score, hyperlaxity, Sugaya index, presence of a Hill-Sachs defect, number of dislocations before surgery, sports participation, radiological measurement of the Hill-Sachs lesion, postoperative range of motion in both shoulders, Rowe score, Walch-Duplay score, American Shoulder and Elbow Surgeons score, and Filling Index Score of Remplissage grade according to magnetic resonance imaging scans at the last follow-up. Results: There were 41 patients included with a mean age of 30 +/- 7 years who underwent the Hill-Sachs remplissage procedure using the double-pulley technique with 2 anchors (n = 21; group DA) or the mattress suture technique with a single anchor (n = 20; group SA). At the final follow-up, there were no significant differences between the groups regarding the Instability Severity Index Score (P = .134), the Sugaya index (P = .538), sports participation (P = .41), the radiological measurement of the Hill-Sachs lesion (P = .803), or the Rowe score (P = .182). However, there were significant differences between the groups in the Walch-Duplay score (P = .012), American Shoulder and Elbow Surgeons score (P = .005), and Filling Index Score of Remplissage grade (P = .015), favoring group DA, as well as differences in external rotation in a neutral position (external rotation loss: 9 degrees +/- 3 degrees [group SA] vs 12 degrees +/- 3 degrees [group DA]; P = .003) and at 90 degrees of abduction (external rotation loss: 8 degrees +/- 3 degrees [group SA] vs 11 degrees +/- 3 degrees [group DA]; P = .006), favoring group SA. Conclusion: In the remplissage procedure, the double-pulley technique provided better filling of the lesion and improvement in functional scores, but external rotation was limited compared with the mattress suture technique.Publication Open Access Comparison of Single and Double Incision Repair Techniques in Distal Biceps Tendon Rupture(2022-08-01T00:00:00Z) KAPICIOĞLU, Mehmet; Pulatkan, Anil; UÇAN, VAHDET; TEZGEL, OKAN; Bilsel, Kerem; KAPICIOĞLU, MEHMET; UÇAN, VAHDET; TEZGEL, OKAN; BİLSEL, İSMAIL KEREMObjective: The purpose of this study was to compare the complications and functional outcomes of single versus doubleincision repair techniques for the treatment of distal biceps brachii tendon rupture Methods: Between 2012 and 2018, patients with distal biceps brachii tendon rupture who were treated with a single or doubleincision repair technique were included in this retrospective study. Range of motion (ROM) and Mayo elbow performance scores (MEPS) were evaluated. Results: Seventeen patients with a mean age of 45.6±6.4 years (range: 34-58 years) who underwent single (n=9) and double (n=8) incision techniques were included in this study. The mean followup was 33±10.5 months (range: 24-62 months). Preoperative and postoperative ROM and MEPS were similar between two groups (p>0.05). In the single incision repair technique group, 3 patients had lateral antebrachial cutaneous nerve (LACN) palsy and 1 patient was re-operated due to re-rupture. In the double incision repair technique group, 1 patient had posterior interosseous nerve (PIN) palsy and 1 patient had hematoma that did not require surgical drainage. No significant differences were detected in terms of complications (p=0.62). Conclusion: Good functional results were obtained after both single and double incision techniques for the treatment of distal biceps brachii tendon rupture. Both single and double incision techniques were reliable however LACN was at risk in single incision technique and PIN in double incision technique.Publication Open Access Unicompartmental knee arthroplasty combined with high tibial osteotomy in anteromedial osteoarthritis: A case report(2021-01-01T00:00:00Z) UÇAN, VAHDET; Pulatkan, Anil; TUNCAY, İBRAHİM; UÇAN, VAHDET; TUNCAY, İBRAHİMIntroduction and importance: Anteromedial osteoarthritis (AMOA) is a common knee pathology. However, the best treatment of AMOA remains unclear. Unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) are surgical options for AMOA patients who do not benefit from conservative treatment. We aimed to show an unusual treatment option where UKA and HTO are performed simultaneously. Case presentation: We present a 52-year-old man with AMOA secondary to spontaneous osteonecrosis of the knee (SONK) and metaphyseal tibial varus malalignment, who was successfully treated with a combined UKA and HTO. His functional scores were excellent at the 5-year follow-up. Clinical discussion: Advanced SONK that causes AMOA can be treated with osteochondral autograft transplantation (OAT), HTO, UKA, or total knee arthroplasty (TKA). Although good results have been reported selecting appropriate patients for all of these methods, the best treatment method remains unclear. Conclusion: Although HTO and UKA are alternative treatments for AMOA, successful results can be obtained using both in individual cases.Publication Open Access Use of cement combined grafting in upper and lower extremity benign bone tumors(2020-01-01T00:00:00Z) Pulatkan, Anil; Ucan, Vandet; TOKDEMİR, SEVİL; ELMALI, NURZAT; GÜRKAN, Volkan; UÇAN, VAHDET; TOKDEMİR, SEVİL; ELMALI, NURZAT; GÜRKAN, VOLKANObjectives: This study aims to investigate the effectivity of cement combined demineralized bone matrix (DBM) treatment on new bone formation in the cortical window as well as to evaluate the effect of new bone formation on functional outcomes. Patients and methods: Thirty-two benign bone tumor patients (15 males, 17 females; median age 38 years; range, 12 to 68 years), who were treated with cement combined DBM between February 2010 and December 2014, were evaluated retrospectively. Patient characteristics were recorded as age, gender, tumor localization, histological diagnosis, Enneking stage, tumor size, size of the cortical window, usage of prophylactic fixation, time to return to work, Musculoskeletal Tumor Society (MSTS) functional score, tumor relapse, and new bone formation on the cortical window in the computed tomography scans after one year of surgery. Results: Median tumor volume was 17.2 cm 3 (range, 2.8 to 139.6 cm 3 ), median area of the cortical window was 8.3 cm 2 (range, 1.6 to 28.4 cm 2 ), and median postoperative one-year MSTS score was 84.5 (range, 66 to 97). MSTS scores were significantly worse with the usage of prophylactic fixation (p<0.001). There was a statistically significant difference between the usage of prophylactic fixation and cortical window size (p=0.013). There was a low-level negative correlation in terms of age and bone formation on the cortical window (p=0.046, r= -0.356) and mid -level negative correlation between cortical window size and functional scores (p=0.001, r= -0.577). Conclusion: Application of cement combined with DBM procedure is an effective, alternative, and biological treatment in bone tumors that provides immediate stability and stimulates new bone formation on the cortical window.Publication Open Access Results of the Local Steroid Injections in the Simple Bone Cyst(2020-01-01T00:00:00Z) UÇAN, VAHDET; Pulatkan, Anil; ERDEM, Ahmet Can; KAPICIOĞLU, Mehmet; GÜRKAN, Volkan; UÇAN, VAHDET; ERDEM, AHMET CAN; KAPICIOĞLU, MEHMET; GÜRKAN, VOLKANObjective: Steroid injections represent one of the simple treatment alternatives for simple bone cysts (SBC). The aim of this study was to evaluate the results of local steroid injections in the treatment of SBC. Methods: Seventeen patients (11 males, 6 females; mean age 12.4 years; range=2 to 39 years) with SBC were treated with injection of methylprednisolone acetate (MPA) with the use of the two-needle technique. The cysts were localized in the proximal humerus (n=6), the calcaneus (one patient had bilateral lesions) (n=2), proximal femur (n=7) and the tibia (n=2). Pathological fractures occurred in three patients before steroid injection. These three patients with pathological fractures were treated with injection of MPA after fractures healed. Each patient received a maximum of four injections at eight week intervals, each consisting of 40-160 mg of MPA. The patients were followed up with plain radiographs obtained in the first month, third month, sixth month, and at the end of a year. After the first year, patients were followed up with plain radiographs once a year. The mean follow-up duration was twenty two months (range=3 to 48 months). Cyst healing was assessed according to the modified Neer classification. Results: Treatment with MPA resulted in complete recovery in ten cysts (55%) and recovery with residual lesions in three cysts (17%). Three cysts (17%) did not respond to steroid treatment and two patients (11%) developed recurrence. The results were satisfactory (72%) in patients with complete recovery and partial recovery with residual lesions, and unsatisfactory in five patients (28%). The patients with recurrence were treated with curettage and grafting or cementation. No procedure-related complications were encountered. Conclusion: Our findings suggest that, the treatment with local steroid injection in SBC provides satisfactory results, thus this treatment with low morbidity can be applied to these patients before aggressive treatment.Publication Open Access A Novel External Fixator Designed for a More Comfortable and Secure Hip Arthroscopy(2022-01-01T00:00:00Z) Pulatkan, Anil; UÇAN, VAHDET; YILDIZ, FATİH; TUNCAY, İBRAHİM; UÇAN, VAHDET; YILDIZ, FATİH; TUNCAY, İBRAHİMObjective: To evaluate the functional results of a novel external fixator (EF) designed for joint distraction and prevention of traction table-related hip arthroscopy complications Methods: After obtaining promising results in a cadaveric study, 21 hips of 20 patients underwent EF-assisted arthroscopic hip surgeries for femoroacetabular impingement (FAI) and/or labral tear treatments. Patients were operated on a standard operating table in the supine position. A novel EF was used to distract the joint for central hip arthroscopy. The time needed for EF application and joint distraction and the amount of joint distraction were recorded. Preoperative functional scores were retrospectively compared to the postoperative 5-year follow-up results using the Harris Hip and Western Ontario and McMaster Universities Index scores. Results: All patients underwent peripheral and central arthroscopy. The mean time for EF application and joint distraction was 19 min (range: 8-21). The mean amount of joint distraction was 13.2 mm (range: 12-18). None of the arthroscopic procedures had to be converted to open surgery. Functional results of all patients were improved at the 5-year follow-up (p<0.01). Only one patient required hip arthroscopy revision due to residual FAI. No other major or minor complication was found that is related to the EF or arthroscopy itself. Conclusion: Mid-term outcomes following EF-assisted hip arthroscopy demonstrate significant improvement in the functional outcomes without traction table-related complications. EF can be used as an alternative to traction table to maintain adequate hip distraction in arthroscopic hip surgery. In addition to the rotation, a novel designed EF allows hip joint flexion during distraction contrary to traction table.Publication Open Access Comparison of Intravenous, Intra-articular, and Combined Tranexamic Acid Use in Primary Total Knee Arthroplasty without a Tourniquet and a Drain(2020-04-01T00:00:00Z) Binlaksar, Ruwais; Ali, Jotyar; UZER, GÖKÇER; YILDIZ, FATİH; UÇAN, VAHDET; TUNCAY, İBRAHİMObjective: We assessed the effect of tranexamic acid (TXA) route of administration on the estimated blood loss (EBL) in patients undergoing primary total knee arthroplasty (TKA) without tourniquet and drain use. Methods: One hundred fifty three patients who underwent primary TKA with use of TXA, between December 2012 and February 2016 were evaluated retrospectively. The patients were divided into three groups according to the route of TXA use: group I, 2 g of intravenous (IV; n=50); group II, 2 g of intraarticular (IA, n=50); and group III, 1 g of IV and 1 g IA combined use (n=53). We recorded the body mass indexes, the platelet counts, haemoglobin, haematocrit levels, prothrombin time, partial thromboplastin time, and international normalised ratio, preoperatively and at 1st and 7th days, postoperatively. EBL was calculated using Meunier's formula. Results: On the first day, the mean EBLs for groups I to III were 286.3 +/- 128.8 mL, 342.7 +/- 176.0 mL, and 379.7 +/- 228.9 mL, respectively (p=0.029 for group I vs. group III). On 7th day postoperatively, they were calculated as 823 +/- 619.3 mL, 1175.1 +/- 970.5 mL, and 1092.2 +/- 766.7 mL (p=0.073) During the first 90 days postoperatively, we did not see any symptomatic thromboembolic complications, delayed haemorrhage, or surgical site or periprosthetic infections. Conclusion: IV, IA or combined uses of TXA are effective and safe for reducing blood loss and transfusion requirements in primary TKA without a tourniquet and drain.