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Öğe Comparison of a New Radiographic Technique with MRI Measurements for Tibial Tunnel Evaluation in ACL Reconstruction(Mdpi, 2025) Yucel, Mucahid Osman; Dalaslan, Rasit Emin; Saglam, Sonmez; Karaduman, Zekeriya Okan; Arican, Mehmet; Akar, Bedrettin; Tural, VolkanBackground/Objectives: The correct angular placement of the tibial tunnel is crucial to ensure graft tension, maintain knee stability, and ensure optimal clinical outcomes after anterior cruciate ligament (ACL) reconstruction. While 3D imaging methods such as MRI and CT are the gold standard for evaluating tunnel positioning, their routine use is limited by cost, availability, and time constraints. In clinical practice, 2D radiographs are more accessible but lack established reliability in accurately estimating tunnel angles. The aim of this study was to convert 2D radiographic angular measurements used in the evaluation of patients undergoing anterior cruciate ligament reconstruction into 3D values with a simple method and to compare these measurements with three-dimensional angles calculated using conventional MRI and CT. Methods: This retrospective study included 38 patients who underwent anatomic anterior cruciate ligament reconstruction. Postoperative radiographs and MR images were analyzed to determine the tibial tunnel angles. The angles calculated from 2D radiographs were statistically analyzed for their correlation with the actual 3D angles measured by MRI. Results: The analysis showed a strong correlation between tibial tunnel angles from radiographs and MRI, with minimal, non-significant differences. This suggests that radiographs can provide a reliable estimate of tibial tunnel angles. Conclusions: These findings suggest that radiographs can predict tibial tunnel angles in ACL reconstruction as accurately as MRI. This method can guide the correct tunnel angle and facilitate postoperative evaluation. Further studies are needed to confirm these results across various populations and techniques.Öğe Distal Radius Eklem İçi Kırıklarının El Bilek Fiksatörü ile Tedavisinde Radio-Ulnar Açıdaki Değişikliklerin El Bilek Skorlamasına Etkisi(Düzce Üniversitesi, 2023) Akar, Bedrettin; Yücel, Mücahid OsmanAmaç: Bu çalışmada kapalı repozisyon ve penning tipi dinamik el bilek fiksatörü ile tedavi edilen radiusun distal intra-artiküler kırıkları (RDIK)’nda radyolojik ölçüm ile değerlendirilen radial inklinasyon (RI) açısının klinik sonuçlara olan etkisinin değerlendirilmesi amaçlandı.Gereç ve Yöntemler: 2012 ve 2020 yılları arasında RDIK nedeniyle kapalı redüksiyon ve dinamik el bilek fiksatörü uygulanan 120 hastanın dosyaları geriye dönük olarak incelendi. Hastaların post operatif 2., 6. ve 10. haftalarda radyolojik olarak el bileği ön/arka grafilerinden RI açıları ölçülerek, açısal değerlerdeki farklılıkların, Mayo el bilek skorlaması (MEBS) kriterlerine göre klinik sonuçlara olan etkisi araştırıldı.Bulgular: AO kırık sınıflamasına göre, 77 (%64,2) hastanın tip C1, 43 (%35,8) hastanın ise tip C2 kırığı vardı. Hastaların 69 (%57,7)’u kadın ve 51 (%42,3)’i erkek olup ortalama yaş 50,08±15,36 yıldı. Fiksatörler altıncı haftada çıkarıldı. Post op 10. haftada ölçülen RI açıları, 83 (%69,1) hastada 20°-30°, 32 (%26,6) hastada 10°-19° ve 5 (%4,3) hastada ise 0°-9° idi. MEBS’e göre, 39 (%32,5) hasta mükemmel, 76 (%63,3) hasta iyi ve 5 (%4,2) hasta ise orta olarak değerlendirildi. RI değerleri ile MEBS arasında pozitif yönde istatistiksel olarak anlamlı bir korelasyon gözlendi (r=0,369; p lt;0,001).Sonuç: Kapalı redüksiyon ile dinamik bilek fiksatör uygulaması basit ve minimal invaziv bir yöntemdir ve IFDR tedavisinde başarılı klinik ve fonksiyonel sonuçlar sağlar. Optimal RI açılarının klinik ve fonksiyonel sonuçlarda etkili olduğunu düşünüyoruz.Öğe Effect of potential risk factors on renal functions in simultaneous bilateral total knee arthroplasty(Frontiers Media Sa, 2024) Akar, Bedrettin; Ugur, Fatih; Yucel, Mucahid Osman; Aytug, FerhanObjective This retrospective study investigated the risk factors leading to a decrease in Renal glomerular filtration rate (eGFR) and the development of acute kidney injury (AKI) during the early postoperative period in patients undergoing simultaneous bilateral total knee arthroplasty (SBTKA).Methods SBTKA was performed on 862 patients between 2014 and 2021 in a single center, by a single surgeon. The risk factors affecting the development of AKI were analyzed by monitoring the changes in pre-and postoperative serum creatinine (Scr) levels and eGFR values. RIFLE criteria were used to evaluate the kidney functions of the patients, who were followed up for an average of 6 months.Results While there was no decrease in eGFR or AKI in 818 patients postoperatively, eGFR decreased and AKI of different stages developed in 44 patients, according to the RIFLE criteria. Of the 44 patients with AKI, 31 had Risk, 9 had Injury, 3 had Failure, and one had Loss of kidney function. Two patients with American Society of Anaesthesiologists (ASA) class IV died due to deepening of postoperative renal dysfunction.Conclusion We found that the direct risk factors in SBTKA in terms of eGFR decrease and AKI development include long operation time, increased need for blood transfusion, and diabetic nephropathy, while increased body mass index (BMI) is an indirect risk factor. When planning for a SBTKA, we presume that a thorough analysis of these factors will decrease AKI risk.Öğe Short-Term Clinical Evaluation of Tibial Tunnel Angle and Position in Anatomical Anterior Cruciate Ligament Reconstruction(Mdpi, 2025) Yucel, Muecahid Osman; Dalaslan, Rasit Emin; Saglam, Soenmez; Arican, Mehmet; Karaduman, Zekeriya Okan; Akar, BedrettinBackground and Objectives: This study aimed to evaluate the influence of the angle and position of the tibial tunnel in the coronal and sagittal planes on short-term postoperative clinical outcomes following arthroscopic anterior cruciate ligament reconstruction (ACLR). Materials and Methods: This retrospective study included 40 patients who underwent anatomical ACLR between 1 January 2023 and 31 December 2023 and had a follow-up period of at least 4 months. The angle of the tibial tunnel on the AP radiograph and both the angle and anteroposterior position on the lateral radiograph were measured. Clinical evaluations were conducted using the Visual Analogue Scale (VAS), the International Knee Documentation Committee (IKDC) score, and the Lysholm Knee Score, along with measurements of knee flexion and extension, to assess short-term outcomes at 1, 2, and 4 months postoperatively. Results: In patients whose tibial tunnels were positioned at 40-50 degrees in the coronal plane, Lysholm scores were significantly higher at the 2nd and 4th months compared to other angles. In the sagittal plane, a tunnel angle between 30 degrees and 40 degrees was associated with significantly increased IKDC scores at both the 2nd and 4th months. Additionally, tunnels with an anterior-posterior ratio of 0.4-0.6 in the sagittal plane were associated with limitations in flexion and extension at the 4th month. There was no significant difference in VAS scores between the groups. Conclusions: Our findings suggest that optimizing the tibial tunnel angle in both the coronal and sagittal planes may play a crucial role in early postoperative knee function. Specifically, tibial tunnels placed between 40 degrees and 50 degrees in the coronal plane and 30 degrees and 40 degrees in the sagittal plane were associated with higher functional scores. However, tunnels positioned with an anterior-posterior ratio of 0.4 to 0.6 were linked to greater joint motion limitation. These findings indicate that angular and positional optimization of the tibial tunnel may have contributed to improved functional recovery following ACL reconstruction.Öğe Significance of Preoperative Multidisciplinary Assessment with 30-Second Sit-to-Stand and Timed Up-and-Go Tests in Predicting Postoperative Outcomes(Mdpi, 2025) Yucel, Mucahid Osman; Saglam, Sonmez; Dalaslan, Rasit Emin; Arican, Mehmet; Karaduman, Zekeriya Okan; Akar, Bedrettin; Celik, MucahitBackground/Objectives: Evaluating basic daily activities like sitting, standing, and walking is crucial for predicting preoperative risks and postoperative recovery. These functional abilities can be assessed through patient history or measured using objective tests. For this purpose, the 30-Second Sit-to-Stand (30STS) Test and Timed Up-and-Go (TUG) Test are frequently used in clinical settings. However, few studies have evaluated their effectiveness in anesthesia and orthopedics. In this study, we aimed to assess the applicability of these tests across clinical disciplines. Methods: A total of 43 patients who underwent total knee arthroplasty (TKA) surgery between January and December 2023 with American Society of Anesthesiologists (ASA) scores of 2-3 were retrospectively evaluated. The 30STS, TUG, and VAS scores were recorded preoperatively and on postoperative days 90-180. Results: The preoperative 30STS and TUG scores showed no statistically significant difference between the ASA 2-3 groups, but the ASA 2 group demonstrated a more pronounced performance improvement in both tests during the first 90 days postoperatively. The correlation tests revealed a strong positive relationship with the TUG Test and a moderate positive relationship with the 30STS and VAS scores. Conclusions: The correlation between the preoperative and postoperative results of the 30STS and TUG Tests suggests that preoperative tests can predict post-operative functional performance. However, the lack of a significant statistical relationship between the preoperative tests and ASA scores indicates that these tests may not be sufficiently useful for assessing the functional capacity. The better test outcomes in the ASA 2 patients indicate that combining these assessments with anesthetic evaluations may improve postoperative functional predictions, thereby promoting a multidisciplinary approach.
