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1.  Arthroscopic inspection after the surgical treatment of patella fractures 
International Orthopaedics  2008;33(3):665-670.
After the treatment of patella fractures the only way to evaluate healing at the articular surface before implant removal is through arthroscopy. The purpose of this study was to examine the healing potential of the cartilage. Arthroscopy was performed in 18 patients at the time of implant removal. The mean age of the patients was 42.1 years. The time elapsed from the index surgery to the arthroscopy and implant removal surgery was 12.9 months. During the arthroscopy, we inspected articular step-off, cartilage loss, and joint surface irregularities. Cartilage irregularities were observed in 13 of the 18 patients. Five patients had well-healed cartilage at the patellar surface. Although none of the patients had displacement at final follow-up X-rays, step-off was detected in two patients during arthroscopy. Our observation showed that cartilage lesions did not correlate with clinical and radiological evaluation. Despite good knee scores, we observed surface irregularities, chondral lesions, and fibrillation in most of the cases implicating subsequent patellofemoral arthritis.
doi:10.1007/s00264-008-0548-5
PMCID: PMC2903096  PMID: 18414856
2.  Full recovery of muscle function after delayed primary repair of deltoid muscle detachment 
Detachment of the deltoid muscle and tendon is a rare complication that is reported to result in poor outcome after rotator cuff surgery. We performed a delayed primary repair of the detached deltoid in a 53-year-old female patient who underwent an open acromioplasty procedure. A successful result was achieved after surgical restoration of the deltoid muscle origin back to the acromion. At 25 months' follow-up the patient had recovered almost the full range of motion of the glenohumeral joint and was free of pain. Due to lack of literature on this rare condition, there are no well-defined treatment principles for the management of deltoid muscle detachments that develop as a complication of rotator cuff surgery. This paper describes a repair procedure for the management of deltoid muscle detachments. In addition, it discusses the importance of the guidelines that have to be followed during primary rotator cuff surgery.
doi:10.4103/0973-6042.44144
PMCID: PMC2840831  PMID: 20300324
Delayed repair; deltoid; muscle; rupture
3.  The influence of vertebral instability on peridural circulation and concomitant peridural fibrosis formation 
European Spine Journal  2005;15(6):959-964.
An animal model of vertebral instability was used to analyze the effect of chronic lumbar instability on the peridural vasculature and fibrosis formation. Fifty mature male domestic rabbits were divided into five equal groups. The vertebral instability was performed by excision of supra and interspinous ligaments between L2-L3 and L3-L4, excision of transverse and spinous processes and making bilateral laminectomies and facetectomies in groups I, II, III and IV. In group V only para vertebral muscle dissection was performed without vertebral instability. The simulation of the long term effects of overuse model on unstable spines (chronic instability) were performed with the use of Electrical Neuromuscular Stimulator to simulate cyclic flexion–extension movement in groups I, II. The rabbits in group I and III were sacrified for the histological evaluation at postoperative fifth day. The rabbits in groups I II, IV and V were sacrified at postoperative 21st day. There was no peridural venous endothelial injury or stasis but there was an increased amount of polymorph nuclear leukocytes in both group I (unstable-overuse) and group III (unstable-no overuse) after sacrification at postoperative fifth day. Peridural fibrosis and also vascular changes with different grades were seen in group II, VI and V after sacrification at postoperative 21th day. The grade of the venous changes and the mean amount of peridural scar formation were prominently higher in group II (unstable-overuse) than in group IV (unstable-no overuse) and V (control group). There was no difference between group IV and V for peridural scar formation and vascular changes. In conclusion, the instability of the lumbar spine with overuse could be a cause of peridural venous circulatory impairment, resulting in fibrosis formation.
doi:10.1007/s00586-005-0959-6
PMCID: PMC3489426  PMID: 16382309
Adhesion; Fibrosis; Instability; Peridural scar; Venous dilatation

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