Browsing by Author "Guven, Necip"

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Can Pirfenidone Prevent Tendon Adhesions? an Experimental Study in Rats
(Turkish Joint Diseases Foundation, 2023) Turkozu, Tulin; Guven, Necip; Altindag, Fikret; Tokyay, Abbas; Gokalp, M. Ata; Ismailov, Ulan; Akkol, Suna
Objectives: In this experimental study, we aimed to investigate the effectiveness of oral pirfenidone (PFD) treatment on preventing tendon adhesion and tendon healing in rats. Materials and methods: A total of 21 rats were assigned into three groups including seven rats in each group. In Group 1 (sham group), no surgical procedure was performed. In Group 2 (control group), tendon repair was performed following right achillotomy. In Group 3 (treatment group), the rats also underwent tendon repair after right achillotomy. Additionally, 30 mg/kg of oral PFD was initiated from the postoperative Day 1 and administered via gavage for 28 days. At the end of the study, tendon healing and fibrosis levels in the tendon repair site were compared macroscopically, histopathologically, and immunohistochemically among the groups. Results: Macroscopically, moderate and severe adhesions were observed in four and three rats, respectively in the control group, while no adhesion was found in four rats and filmy adhesions were observed in three rats in the treatment group (p<0.01). Microscopically, there was moderate adhesions in three rats and severe adhesions in four rats in the control group, while three rats had no adhesions and four rats had slight adhesions in the treatment group (p<0.01). Microscopically, tendon healing was good in six rats and fair in one rat in the control group, while five rats showed excellent tendon healing and two rats showed good tendon healing in the treatment group (p<0.01). Immunohistochemically, expressions of collagen I (p<0.01), collagen III (p<0.001), vascular endothelial growth factor (VEGF) (p<0.001), and proliferating cell nuclear antigen (PCNA) (p<0.001) significantly decreased in the treatment group compared to the control group. Conclusion: Our study results indicated that PFD decreased collagen synthesis and prevented the formation of peritendinous adhesion in rats; however, it did not impair tendon healing.
Clinical Results of Decortication With Bone Grafting Method Versus Extracorporeal Shock Wave Treatment in Long-Bone Pseudoarthrosis
(int Scientific information, inc, 2023) Gokalp, Mehmet Ata; Unsal, Seyyid Serif; Guner, Savas; Turkozu, Tulin; Guven, Necip
Background: Despite advanced treatment methods, the treatment of pseudoarthrosis still poses a significant challenge for orthopedists. In this study, we aimed to assess the clinical results of decortication and bone grafting and ex-tracorporeal shock wave treatment (ESWT) in long-bone pseudoarthrosis.Material/Methods: Between 2007 and 2015, 68 fractures of 66 patients treated for long-bone pseudoarthrosis were evaluated retrospectively. ESWT was used in 36 extremities and decortication and iliac bone grafting was used in 32. The treatment results of these patients were evaluated and compared with rates in the literature. Results: The mean patient age was 43.9 years (range, 21-69). The mean interval between the occurrence of the frac-ture and treatment with bone grafting or ESWT was 8.6 months and the mean interval between the procedure and achievement of union was 6.9 months. The patients were followed up for a mean period of 25.2 months. After the mean follow-up period, bone union had occurred in all 32 patients (100%) in the decortication and bone grafting group and in 28 (78%) of the 36 patients in the ESWT group (P=0.023).Conclusions: This study shows that extracorporeal shock wave treatment should be considered the first option in treatment of pseudoarthrosis as it is a non-invasive method and also provides good rates of union. In patients that do not heal with ESWT, decortication and bone grafting remains the criterion standard therapy.
Comparison of Long-Term Clinical and Radiologic Outcomes of Aperfix and Fixed Loop Device Fixation in Anterior Cruciate Ligament Reconstruction: a Retrospective Study
(Lippincott Williams & Wilkins, 2025) Kaya, Sehmuz; Guven, Necip; Unal, Yunus Can; Ozkan, Sezai; Adanas, Cihan; Turkozu, Tulin; Gokalp, Mehmet Ata
Anterior cruciate ligament reconstruction aims to improve knee stability and range of motion. The AperFix system consists of polymer components, and fixed-loop fixation is an established endoscopic technique. Our aim in this study was to compare the long-term clinical and radiological results of AperFix and fixed-loop fixation and to prove that the long-term results of the AperFix fixation method are at least as good as those of the fixed loop device. This retrospective study included 109 patients who underwent primary anterior cruciate ligament reconstruction using single bundled hamstring tendon grafts. Patients under 16 years of age, patients with incomplete follow-up, bilateral or other ligament injuries, inflammatory arthropathy, previous knee surgery, or concurrent meniscal treatment were excluded. Participants were divided into 2 groups according to femoral fixation methods: AperFix fixation (group 1, n = 55) and fixed loop device fixation (group 2, n = 54). All operations were performed by senior surgeons under general or spinal anesthesia. Postoperative rehabilitation started on day 1 and allowed patients to resume normal activities at 6 months. Outcomes were evaluated during follow-up, including knee range of motion, clinical scores [Lysholm, Cincinnati, Tegner, and International Knee Documentation Committee] and radiographic measurements of femoral tunnel width and length. Measurements were performed by 2 orthopedic surgeons to ensure reliability. This study evaluated 109 patients (55 in group 1, 54 in group 2) and found no statistically significant differences in demographic variables such as age, sex, body mass index, follow-up duration, or side distribution. Clinical outcomes, including anterior drawer test, Lachman test results, knee flexion-extension degrees, and Lysholm, Cincinnati, Tegner, and International Knee Documentation Committee scores, were similar between the groups (P > .05). Complications occurred in 8 cases (rerupture, infection, and deep vein thrombosis), with no significant correlation to the fixation method used (P = .506). Radiographic analysis revealed no significant differences in femoral tunnel width or length between the groups (P > .05). In our current study, no meaningful disparity was found between the AperFix and fixed loop device methods in terms of long-term clinical outcomes. As there are no long-term studies on the results of AperFix fixation in the literature, more studies on this subject are needed.
The Effect of Theranekron on Femur Fracture Healing in an Experimental Rat Model
(Turkish Joint Diseases Foundation, 2022) Guven, Necip; Ozkan, Sezai; Turkozu, Tulin; Koc, Serap; Keles, Omer Faruk; Yener, Zabit; Karasu, Abdullah
Objectives: The aim of this study was to investigate the radiological, biomechanical, histopathological and immunohistochemical effects of Theranekron on fracture healing in an experimental rat model. Materials and methods: Forty-eight male albino Wistar rats were used. Four groups were formed, with 12 rats in each of Theranekron groups 1 and 2, and control groups 1 and 2. After a fracture was created in the right femur of the rats included in the study, fixation was performed with an intramedullary Kirschner wire. Theranekron was administered subcutaneously to Theranekron groups 1 and 2 at a dose of 0.3 mg/kg on days 0, 5 and 10. After radiographic analysis of the femurs of Theranekron group 1 and control group 1 rats at four weeks of the study was performed, both groups were divided into two equal subgroups (six femurs in each group). Histopathological and immunohistochemical examinations were performed in one subgroup and biomechanical examination in the other subgroup. At the end of six weeks, the rats in Theranekron group 2 and control group 2 were evaluated after applying the same procedure as in the fourth week. Results: When the mean radiological scores of the Theranekron and control groups were compared, a statistically significant difference was found in favor of the Theranekron group at four and six weeks (p=0.028 and p=0.006, respectively). At four weeks, statistically significant higher biomechanical forces were obtained in the Theranekron group compared to the control group (p=0.030). In the histopathological evaluation, the inflammation value of the control group at four weeks was statistically significantly higher than the Theranekron group (p=0.027). The angiogenesis, osteoblast proliferation, and bone formation values of the Theranekron group were significantly higher than the control group (p=0.014, p=0.014, and p=0.005, respectively). At six weeks, the bone formation values of the Theranekron group were statistically significantly higher than the control group (p=0.021). The difference between the Theranekron group and the control group scores of the immunohistochemical evaluation were statistically significantly different at four and six weeks (p=0.006 and p=0.011, respectively). Conclusion: Theranekron may play a role in accelerating fracture healing by reducing acute inflammation process in the early period of fracture union, increasing fracture strength, angiogenesis, osteoblast proliferation, and bone formation.
Experimental Evaluation of Timing and Preference of Surgical Intervention for Crush Syndrome in Disaster Scenarios: Fasciotomy or Amputation? a Rat Model Study
(BMC, 2025) Kaya, Sehmuz; Unal, Yunus Can; Guven, Necip; Dundar, Abdulrahim; Keles, Omer Faruk; Basbugan, Yildiray
Background Crush syndrome is a severe condition caused by the systemic effects of rhabdomyolysis due to prolonged muscle compression. Common in disasters like earthquakes, it poses life-threatening risks, including acute renal failure, hyperkalemia, and metabolic acidosis. Although surgical interventions such as fasciotomy and amputation are critical in its management, the optimal timing and criteria remain unclear. This study investigates the impact of surgical intervention timing on crush syndrome outcomes, providing guidance through the first experimental rat model evaluating fasciotomy and amputation post-injury. Methods Forty-eight Wistar albino rats were divided into six groups. Rhabdomyolysis was induced experimentally, followed by amputation or fasciotomy at 0, 12, or 24 h. The control group underwent rhabdomyolysis induction without surgery. Weekly urine samples were collected during the study, and blood, muscle, and kidney tissues were examined biochemically and histopathologically at the experiment's end. Data analysis focused on the systemic and tissue-specific effects of intervention timing. Results Early intervention groups (0 h) demonstrated minimal muscle inflammation and necrosis, preserved muscle fiber arrangement, and more pronounced regeneration. Late interventions (12 and 24 h) were associated with intense inflammation, necrosis, edema, and hemorrhage in muscle tissue. Immediate amputation (0 h) limited toxic metabolite effects, reducing kidney inflammation and damage. Late interventions showed increased interstitial nephritis and inflammatory cell infiltration in kidney tissue. Biochemical analyses revealed that urinary myoglobin levels decreased and renal function was preserved in the early intervention groups. Conclusions The timing of surgical intervention is critical in managing crush syndrome. Early amputation and fasciotomy minimized necrosis and inflammation in muscle tissue, supported tissue regeneration, and reduced systemic complications by preventing toxic metabolite accumulation in the kidneys. Early amputation particularly showed superior renal protection and lower systemic complication risks compared to late interventions. These findings highlight the importance of timely surgical action and provide valuable insights for developing effective treatment strategies in disaster settings. However, the descriptive nature of the study and the fact that the data obtained from the experimental model cannot be directly applied to clinical practice should be taken into account. Therefore, the findings should be supported by future clinical trials.
The Impact of Early Weight-Bearing on Results Following Anterior Cruciate Ligament Reconstruction
(Bmc, 2024) Kaya, Sehmuz; Unal, Yunus Can; Guven, Necip; Ozcan, Can; Dundar, Abdulrahim; Turkozu, Tulin; Gokalp, Mehmet Ata
Introduction Anterior cruciate ligament (ACL) ruptures are common injuries that typically affect young, physically active individuals and may require surgical reconstruction. Studies have shown that the long time success of ACL reconstruction depends on the surgical technique and the postoperative rehabilitation strategy. However, there is still no consensus on the content of rehabilitation programs. Hence, additional research is required to elucidate the significance of early weight-bearing in the rehabilitation process following ACL reconstruction. The aim of this article is to examine the impact of weight-bearing on the clinical results of ACL reconstruction.Materials and methods We retrospectively reviewed patient records who had undergone arthroscopic reconstruction using a semitendinosus-gracilis tendon graft for anterior cruciate ligament rupture between January 2018 and December 2020. The study included the data of 110 patients. The patients were split into two groups: Group 1 underwent early weight-bearing, while Group 2 followed a non-weight-bearing regimen for three weeks. We assessed the patients using the anterior drawer test, Lachman test, range of motion, Lysholm knee scale, Cincinnati scale, Tegner scale, International Knee Documentation Committee (IKDC) form and clinical records. Analytical tests were conducted to compare the results.Results The complication rates did not show a significant difference between the groups. Group 1 had higher frequencies of positive anterior drawer and Lachman tests. The Lysholm and Cincinnati knee scores of patients in Group 1 were notably lower than those of patients in Group 2. Additionally, the Tegner activity scores and IKDC scores of patients in Group 1 were also meaningfully lower than those of patients in Group 2. In Group 1 patients, there was no notable relationship observed between body mass index (BMI) and the results of the anterior drawer test (ADT) or Lachman test. However, patients with a BMI of 25 or higher in Group 1 showed a decrease in postoperative IKDC scores. In Group 2 patients, no significant relationship was identified between BMI and either the ADT or the Lachman test outcome.Conclusion Based on current literature and current rehabilitation guidelines following ACL reconstruction, the decision to initiate early weight-bearing is based on a limited number of studies with low levels of evidence. In our study, we found that patients who followed a non-weight-bearing regimen for 3 weeks after surgery had better mid-term results than those who were allowed to bear weight early. It appears that further prospective studies on this topic are needed to update rehabilitation guidelines in the next.
Insall-Salvati Index Is Associated With Anterior Cruciate Ligament Tears in Men: a Case-Controlled Study
(Sage Publications Ltd, 2022) Guven, Necip; Ozkan, Sezai; Turkozu, Tulin; Yokus, Adem; Adanas, Cihan; Gokalp, Mehmet Ata; Tokyay, Abbas
Purpose Many factors in the etiology of anterior cruciate ligament (ACL) tears, predisposing factors related to knee morphology have also been reported. This study aimed to determine whether the Insall-Salvati (IS) index, which measures patella height, is a predisposing risk factor for ACL tears. Methods The IS index, patellar length (PL), and patellar tendon length (PTL) values of patients (study group) that underwent arthroscopic reconstruction for ACL tears obtained by preoperative magnetic resonance imaging (MRI) were compared with the index values in the preoperative MRIs of patients that underwent knee arthroscopy for reasons besides ACL tears. In addition, the anterior tibial translation (ATT) of both groups was also measured and compared on MRI images. The MRI findings of the subjects included in both study groups were arthroscopically confirmed. Results The mean ages of the study group (n = 120) and control group (n = 90) were 29.1 +/- 8.2 years and 31.8 +/- 9.8 years, respectively. There was a statistically significant difference between the study and control groups in terms of the PL and PTL values (p = 0.016 and p = 0.001, respectively). The IS index was statistically significantly higher in the study group with ACL tears (p = 0.009). The ATT was 8.61 +/- 4.68 mm in the study group and 3.80 +/- 1.92 mm in the control group. The ATT results of both groups were evaluated, and it was found that the study group was significantly higher than the control group (p = 0.001) Conclusions As a result of our current study, we observed higher IS index values in patients with ACL tears than in patients without ACL tears. It should be kept in mind that patella alta, which is associated with a high IS index as one of the factors of knee morphology associated with ACL tears, may play a role in the etiology of ACL tears.
The Outcomes of Acetabular Fractures Treated Surgically and Factors Affecting the Result The Results of Acetabular Fractures
(derman Medical Publ, 2018) Guven, Necip; Gokalp, Mehmet Ata; Unsal, Seyyid Serif; Turkozu, Tulin; Guner, Savas
Aim: The aim of this study was to evaluate the radiological and clinical outcomes of surgically treated acetabular fractures. Material and Method: A total of 30 patients with acetabular fracture who had presented to the Orthopedics and Traumatology Department of Yuzuncu Yil University Medical Faculty between January 2009 and December 2013 and undergoing surgery were included in the study. The number of males was 25 (83.3%), and the number of females was 5 (16.7%). The ages of the patients varied between 18 and 68 (mean: 40) years. The indications for surgery were: more than 3 mms of dislocation in one of the three X-Rays obtained (antero-posterior, obturator oblique and iliac oblique), intra-articular piece of the fracture and posterior instability. Results: 20 (66.7%) and 10 (33.7%) patients had acetabular fractures in the right and left hips, respectively. The most common cause of trauma was falling from a height. According to the classification of Letournel, 18 patients (60%) had complex and 12 patients (40%) had simple fractures. 13 patients (43.5%) had additional traumatic hip dislocation. Following the surgical intervention, 13 patients (43.3%) had anatomical reduction and 4 (13.3%) had poor reduction. The patients were followed-up for a mean duration of 28 months. According to the radiological criteria of Matta, 13 patients (43.3%) had excellent, 11 (36.6%) had good, 4 (13.3%) had moderate, and 2 (6.6%) had poor outcomes. According to the clinical recovery criteria of Merle d'Aubigne and Postel, 7 patients (23.3%) had very good, 15 (50%) had good, 4 (13.3%) had moderate, and 4 (13.3%) had poor outcomes. Discussion: It was concluded that the quality of reduction affected the clinical and radiological outcomes, and that this effect depended on the simple or complex nature of the fracture. Successful and satisfactory results may be obtained by selecting the correct incision method for the fracture type, advanced surgical experience and careful post-operative patient follow-up.
The Role of Deadlifts in Distal Biceps Brachii Tendon Ruptures: an Alternative Mechanism Described With Youtube Videos
(Sage Publications inc, 2021) Kapicioglu, Mehmet; Bilgin, Emre; Guven, Necip; Pulatkan, Anil; Bilsel, Kerem
Background: The classic injury mechanism of a distal biceps brachii tendon rupture (DBBTR) is eccentric loading to the flexed elbow when the forearm is supinated. Purpose: To determine alternative mechanisms of a DBBTR in powerlifting sports, particularly in deadlift competitions, with the use of YouTube videos. Study Design: Descriptive epidemiology study. Methods: A search on YouTube was performed using the search terms "distal biceps tendon rupture" and "distal biceps tendon injury" combined with "competition," "deadlift," and "powerlifting." The videos underwent an evaluation for accuracy by 3 surgeons according to predetermined criteria. Type of sports activity, participant sex, side of the injury, and arm positions at the time of the injury were recorded. Results: Among the videos reviewed, 35 injuries were found appropriate for an evaluation. All participants were male. The majority of the injuries (n = 25) were observed during the deadlift. Only in 1 deadlift injury were both forearms in supination. In the remaining deadlift injuries (n = 24), all elbows were in extension, with 1 forearm in supination and the other in pronation. Among the deadlift injuries in the mixed-grip position, all ruptures occurred in a supinated extremity: 25% (n = 6) of ruptures occurred on the right side, and 75% (n = 18) of ruptures occurred on the left side; this was a significant difference (P = .014). Conclusion: We described an alternative mechanism for a DBBTR, namely, eccentric loading to an extended elbow when the forearm is supinated during the deadlift. As all the ruptures occurred in a supinated extremity, holding the bar with both forearms in pronation may prevent or decrease the risk of ruptures during the deadlift.
Treatment and Management of Complications in Pediatric Forearm Fractures
(Galenos Publ House, 2021) Tokyay, Abbas; Ozkan, Sezai; Guven, Necip; Turkozu, Tulin; Adanas, Cihan; Gokalp, Mehmet Ata
BACKGROUND/AIMS Forearm diaphyseal fractures are common in children. While closed reduction and casting are sufficient in most patients, surgical treatment is required in some cases. The aim of this study is to determine the possible causes of complications occurring in patients with intramedullary fixation with nail (IMN), as well as to evaluate the management of complications and their final results. MATERIAL and METHODS Between January 2017 and January 2020, 53 children under the age of 16 who had forearm fractures and surgically treated with IMN were included in the study. Demographic data of the patients, type of surgery, surgical technique, postoperative care, complications, and treatment modalities of complications were evaluated. RESULTS The mean age of 53 patients (41 boys and 12 girls) included in this study was 10.5 +/- 2.4 years. The average follow-up period of all our patients was 23.4 months (12-34 months). Complications in our study were seen in 14 (26.4%) patients. These complications included pintrack infection in six (11.3%), refracture in four (7.5%), injury of superficial branch of radial nerve in Iwo (3.7%), extensor pollicis bogus rupture in one (1.8%), and pin migration in one (1.8%) patient. CONCLUSION As a result of the treatment and management of these complications, mild hypesthesia persisted along the superficial branch of the radial nerve in only one case, and all other complications were fully recovered. Successful management of complications can be achieved with close follow-up and appropriate treatment.