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    A new modified pararectus approach and visualization: an anatomical study
    (Springer, 2023) Atlıhan, Doğan; Aydın, Mahmud; Çapkın, Sercan; Sürücü, Serkan; Günaydın, Fatih; Acar, Halil İbrahim
    Introduction: The aim of our study was to visualize all the windows used in the pararectus approach with detailed cadaver images to facilitate better understanding of orthopedic surgeons and, in addition, was to modify the incision used in the pararectus approach to a more cosmetic bikini incision. Materials and methods: In total, 20 cadavers fixed in 10% formalin were used in this study. Of these cadavers, 14 were male and six were female, with a mean age at death of 57 (42-82 years). The four windows were defined as follows in all the cadavers: pubic, quadrilateral, sacroiliac, and iliac windows. Results: The most important structure at risk in the pubic window was the corona mortis, as it was observed in 12 (60%) cadavers. In men, the spermatic cord was an important structure at risk in the pubic window. The obturator vessels and nerves were the structures at most risk in the quadrilateral window due to their close location with the quadrilateral surface. The obturator nerve on the medial side and at the entrance of the pelvis through the linea terminalis and lumbosacral truncus were the structures at most risk close to the sacroiliac joint in the sacroiliac window.
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    Evaluation of bilateral acromiohumeral distance on magnetic resonance imaging and radiography in patients with unilateral rotator cuff tears
    (Springer Science and Business Media Deutschland GmbH, 2022) Sürücü, Serkan; Aydın, Mahmud; Çapkın, Sercan; Karahasanoğlu, Rıdvan; Yalçın, Mazhar; Atlıhan, Doğan
    Introduction The aim of this study was to evaluate the difference in the acromiohumeral distance (AHD) between the shoulders with full-thickness rotator cuff tear and contralateral healthy shoulders of the same patients on magnetic resonance imaging (MRI) and radiograph. Materials and methods We included 49 patients with unilateral full-thickness rotator cuff tears. The mean age of the patients (29 women and 20 men) was 54.57 +/- 7.10 years. The shoulders were divided into those with a full-thickness rotator cuff tear and healthy shoulders. The mean AHDs on radiograph and MRI were calculated by two radiologists experienced in the musculoskeletal system. Shoulders with rotator cuff tears on coronal plane and sagittal MRI were divided into 3 (Patte I, II, III) and 4 subgroups (S: superior, AS: anterosuperior, PS: posterosuperior, APS: anteroposterosuperior), respectively. The relationship between the groups and the subgroups was statistically investigated. Results The mean AHDs on radiograph were 6.93 and 9.11 mm and on MRI were 5.94 and 7.46 mm in the patient and control groups, respectively. The mean AHDs were 6.47, 6.03, and 4.95 mm in Patte I, II, and III, respectively. The difference between the subgroups was statistically significant. According to the sagittal plane topography, the mean AHDs (mm) were 6.39, 6.44, 5.8, and 4.6 mm in the superiorly, anterosuperiorly, posterosuperiorly, and anteroposterosuperiorly localized lesions, respectively. The relationship between S and AS was not statistically significant, and those between S and PS, AS and PS, S and APS, and PS and APS were significant. Conclusions In patients with unilateral full-thickness rotator cuff tear, AHD narrowing was observed on the tornekler side after evaluating the bilateral acromiohumeral distance on MRI and radiograph. AHD was significantly reduced by increasing the degree of supraspinatus tendon retraction in the coronal plane MRI and by the posterosuperior and anteroposterosuperior location of the rotator cuff tear in the sagittal plane MRI.
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    The effect of biceps tenotomy on superior humeral migration in arthroscopic repaired full-thickness supraspinatus tears
    (Elsevier B.V., 2023) Aydın, Mahmud; Çapkın, Sercan; Sürücü, Serkan; Karahasanoğlu, Rıdvan; Yılmaz, Murat
    Lesions of the long head of the biceps (LHB) tendon are a prevalent injury that frequently coexists with rotator cuff injuries. This study aimed to assess the effect of supraspinatus (SST) repair with concurrent LHB tenotomy on superior migration of the humeral head. The acromiohumeral distance (AHD) was determined via ultrasound to evaluate the superior migration of the humeral head. Methods: The study population was retrospectively recruited from patients who underwent unilateral arthroscopic repair of isolated degenerative full-thickness SST tears between January 2017 and December 2019. Patients were divided into 2 subgroups based on whether they underwent LHB tenotomies during arthroscopy. While 37 patients underwent arthroscopic single-row SST repair, the other 33 patients underwent arthroscopic single-row SST repair with LHB tenotomy. The subject group consisted of people who had undergone arthroscopic shoulder surgery. Contralateral shoulders without rotator cuff injuries were included in the control group. The AHD and SST thicknesses of patients were examined via the ultrasound in both groups and subgroups. Results: The mean age in the SST repair group was 55.52 ± 4.58 years (range, 46-63 years), whereas it was 58.24 ± 3.98 (range, 52-73 years) in the SST repair + LHB tenotomy group. In the SST repair group, 57.6% of patients were female and 42.4% were male, whereas 56.8% and 43.2% were in the SST repair + LHB tenotomy group, respectively. The mean body mass index was 28.06 ± 1.31 kg/m2 (range, 25.7-31.2 kg/m2) in the SST repair group and 28.95 ± 1.79 kg/m2 in the SST repair + LHB tenotomy group. Groups were not different for sex, surgery side, dominant side, tear size, and follow-up time; however, the SST repair + LHB tenotomy group had significantly higher mean age and body mass index than the SST repaired group. The mean AHD value and SST thickness were significantly less in both the rotator cuff repair group and the rotator cuff repair + LHB tenotomy group compared to the healthy shoulder. The mean AHD value was significantly lower in the SST repaired + LHB tenotomy group than in the SST repair group (P = .02). Conclusion: The AHD was narrowed in patients who underwent LHB tenotomy and radiologically demonstrated the depressor effect of the LHB tendon on the humeral head. As a secondary outcome, we demonstrated that regardless of tenotomy, AHD could not be restored in patients who underwent arthroscopic single-row SST repair.