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    Lesion size and varus malalignment are the major determinants leading to poorer clinical outcomes after combined microfracture treatment for focal cartilage lesions during anterior cruciate ligament reconstruction
    (SPRINGER, 2021) Sofu, Hakan; Gümüşsuyu, Gürkan; Guler, Olcay; Ucpunar, Hanifi; Duman, Serda; Camurcu, Yalkin
    The purposes of this study were to evaluate the clinical effects of microfracture (MFX) performed for Outerbridge grade 3 or 4 focal cartilage lesion during the same surgery with arthroscopic anterior cruciate ligament (ACL) reconstruction and to analyze the major determinants of these potential effects on the clinical outcome. The clinical and radiographic data of 119 patients were evaluated. The mean follow-up time was 32.6 +/- 6 months. Isolated arthroscopic ACL reconstruction was performed in 70 patients (Group 1), whereas MFX for Outerbridge grade 3 or 4 chondral lesion during ACL surgery was performed in 49 patients (Group 2). Visual analogue scale (VAS) score, Lysholm knee score, and Tegner activity scale were the instruments used as outcome measures to evaluate the clinical status of the patients. Routine X-ray and MRI were also performed for all patients pre-operatively as well as at the latest follow-up visit. Lineer regression analysis was performed to determine major factors predicting the poorer clinical outcome. Clinical outcomes were similar between isolated ACL reconstruction and combined procedure. On the other hand, according to lineer regression analysis, cartilage lesion size > 2 cm(2) and > 5 degrees of varus alignment were detected as the major determinants leading to poorer outcomes in combined ACL reconstruction and MFX. Level of evidence: III - Retrospective Comparative Study.
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    Should orthopedic surgeons consider reducing the negative effects of Outerbridge grade 2 patellofemoral chondral lesion on early postoperative recovery during anterior cruciate ligament reconstruction
    (Springer-Verlag France, 2019) Sofu, Hakan; Çamurcu Yalkın; Issin, Ahmet; Üçpunar Hanifi; Özcan Seçkin; Duman, Serda
    Purpose: The purpose of this study was to comparatively evaluate the effectiveness of intra-articular PRP and HA injections applied as the treatment of Outerbridge grade 2 chondral lesions in patellofemoral joint during arthroscopic ACL reconstruction. Methods: The clinical and radiographic data of 61 patients between 18 and 45 years of age were evaluated. The patients were separated into three groups. Hyaluronic acid injection was applied in 22 knees (Group 1), PRP injection was applied in 18 knees (Group 2), and 21 knees did not have any specific treatment except ACL reconstruction (Group 3). All patients were followed clinically at least for 12 months. Clinical examination of the operated knee, visual analogue scale (VAS) score, Lysholm knee score, and Tegner activity scale were the outcome measures. Routine X-ray and MRI were also performed for all patients at 12-month postoperative follow-up visit. Results: Although the mean VAS and Lysholm scores at 3-month follow-up were better in Group 1 and 2 than Group 3, the efficacy of intra-articular PRP on healing process regarding progression of the mean VAS and Lysholm scores through 6- and 12-month follow-ups was significantly better and longer than HA. No statistically significant differences were detected according to Tegner activity scale between the groups at 3 and 6 months; however, Group 2 had better activity level than both Group 1 (p < 0.001) and 3 (p < 0.001) at the end of 12 months after surgery. Conclusion: Intra-articular PRP injection applied as the treatment of concomitant Outerbridge grade 2 chondral lesion in patellofemoral joint during ACL reconstruction revealed better and durable clinical outcomes via decreasing the potentially negative effects of chondral pathology on postoperative healing with respect to HA injection. Level of evidence: III—retrospective comparative study. © 2018, Springer-Verlag France SAS, part of Springer Nature.