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    Aperture fixation instead of transverse tunnels at the patella for medial patellofemoral ligament reconstruction
    (Springer, 2012) Hapa, Onur; Aksahin, Ertugrul; Ozden, Raif; Pepe, Murad; Yanat, Ahmet Nedim; Dogramaci, Yunus; Bozdag, Ergun
    Medial patellofemoral ligament (MPFL) reconstruction is an effective option for the treatment of recurrent patellar instability. Most techniques utilize the passage of a tendon graft through tunnels at the patella with the risk of patellar fracture. The purpose of this study was to investigate the strength of the recent MPFL reconstruction techniques (transverse tunnel, interference screw, anchor, and docking technique). Thirty-six saw bones were divided into four groups (transverse tunnel, interference screw, anchor fixation, and docking technique) with nine patellae in each. Patella-tendon constructs were pre-loaded to 10 N and cyclically loaded for 20 cycles from 2 to 30 N under load control at a rate of 5 N/sec. The construct was then tested to failure at a constant displacement rate of 6 mm/sec. Ultimate load (N), stiffness (N/mm), and failure mode were recorded for each specimen. The docking group had lower ultimate load [106 (SD 41) N] and stiffness [14 (SD 2) N/mm] values than the other groups tested (P = 0.007). The anchor group had lower stiffness [21 (SD 6) N/mm] values than the tunnel group [28 (SD 3) N/mm (P = 0.01)] and the interference screw group [31 (SD 6) N/mm, (P = 0.004)]. There was no significant difference in the ultimate load between anchor [299 (SD 116) N], tunnel [304 (SD 140) N], and interference screw groups [241 (SD 103) N] (n.s.). Aperture fixation techniques, especially interference screw fixation, were as strong as the technique utilizing tunnels in the patella for MPFL reconstruction.
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    Biomechanical Comparison of Tibial Eminence Fracture Fixation With High-Strength Suture, EndoButton, and Suture Anchor
    (W B Saunders Co-Elsevier Inc, 2012) Hapa, Onur; Barber, F. Alan; Suner, Ganim; Ozden, Raif; Davul, Serkan; Bozdag, Ergun; Sunbuloglu, Emin
    Purpose: To biomechanically compare anterior cruciate ligament (ACL) tibial bony avulsion fixation by suture anchors, EndoButtons (Smith & Nephew, Andover, MA), and high-strength sutures subjected to cyclic loading. Methods: Type III tibial eminence fractures were created in 49 ovine knees, and 7 different types of repairs were performed. Each repair group contained 7 specimens. The repair groups were as follows: No. 2 FiberWire (Arthrex, Naples, FL); No. 2 UltraBraid (Smith & Nephew); No. 2 MaxBraid (Arthrotek, Warsaw, IN); No. 2 Hi-Fi (ConMed Linvatec, Largo, FL); No. 2 OrthoCord (DePuy Mitek, Raynham, MA); Ti-Screw suture anchor (Arthrotek); and titanium EndoButton. These constructs were cyclically loaded (500 cycles, 0 to 100 N, 1 Hz) in the direction of the native ACL and loaded to failure (100 mm/min). Endpoints included ultimate failure load (in Newtons); pullout stiffness (in Newtons per millimeter); cyclic displacement (in millimeters) after 100 cycles, between 100 and 500 cycles, and after 500 cycles; and mode of failure. Bone density testing was performed in all knees. Results: Bone density was not different among the groups. The EndoButton group had a higher ultimate failure load than the FiberWire, UltraBraid, Hi-Fi, and suture anchor groups (P < .05). The MaxBraid and OrthoCord groups had higher failure loads than the suture anchor group (P < .05). The MaxBraid group also had a higher failure load than the Hi-Fi group (P < .05). Stiffness was not statistically different for the various tested constructs. After 100 cycles, the EndoButton group had less displacement than the FiberWire, UltraBraid, MaxBraid, and Hi-Fi groups (P < .05). The suture anchor group had less displacement than the Hi-Fi and FiberWire groups (P < .05). The displacements of the different tested constructs between 100 and 500 cycles and total displacements after 500 cycles were not statistically different. The predominant failure mode was suture rupture. Conclusions: Under cyclic loading conditions in an ovine model, EndoButton fixation of tibial eminence fractures provided greater initial fixation strength than suture anchor fixation or fixation with various high-strength sutures except for OrthoCord. Clinical Relevance: During initial cyclic loading of ACL tibial eminence fractures, the strength of the repair construct should be taken into consideration because conventional suture repair even with ultrahighmolecular-weight polyethylene sutures may not provide enough strength.
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    Effects of montelukast on tendon healing in a murine model
    (Springer, 2017) Gideroglu, Kaan; Cakici, Husamettin; Hapa, Onur; Ozturan, Kutay E.; Bozdag, Ergun; Yilmaz, Fahri; Saglam, Ibrahim
    Background Tendon injury induces a local inflammatory response characterized by the production of pro-inflammatory cytokines. The aim of this study is to investigate the effects of montelukast sodium on the healing of tendons through histological and biomechanical evaluations. Methods Forty-eight female Wistar albino rats were randomly assigned to an experimental group that received montelukast sodium (n = 24) and a control group (n = 24) that did not. Tendon injury was created in the Achilles tendon. The experimental group was injected intraperitoneally (IP) with 1 ml of 1 mg/kg montelukast sodium solution once a day prior to the surgery and during the experimental research. The control group was injected with saline solution. Two weeks later, eight rats in each group underwent a histological evaluation. In the fourth week, eight rats underwent a histological evaluation and the other eight rats went through a biomechanical evaluation. Results Based on the histological evaluation in the second week, it was observed that the severity of the inflammation was less in the experimental group that received montelukast sodium (p < 0.05). In terms of the formation of collagen, no significant difference was observed between the groups in the second and fourth weeks. Tendon breaking loads were 33.2 +/- 10.95 and 38.8 +/- 10.90 N for the montelukast group and the control group, respectively. However, the difference between the groups was found to be statistically insignificant (p > 0.05). Conclusions There was no negative effect on the healing of tendons due to injection of montelukast sodium. In addition, observing less inflammation in the experimental group in the earlier phase suggests that montelukast sodium may help in preventing tendon adhesion after reconstructive treatment.