Browsing by Author "Unal, Yunus Can"

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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.
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.
Virtual Reality Headset Versus Traditional Training in Orthopedic Surgery: a Comparative Study on Real Surgical Performance in Total Knee Arthroplasty
(Lippincott Williams & Wilkins, 2024) Unal, Yunus Can; Adanas, Cihan; Kaya, Sehmuz; Ozkan, Sezai; Ismailov, Ulan
Is it possible for a low-volume surgeon to enhance their surgical skills without performing actual surgeries by utilizing virtual reality headsets and emerging technologies? It has been observed that the time spent by surgical assistants in the operating room decreased after the post-shift leave regulation. In the literature, the use of virtual reality simulations as a support tool in surgical training is recommended. Although the efficacy of virtual reality surgical simulations in surgeries such as arthroscopy and laparoscopy has been proven, there are limited studies on their effect in open surgeries. In this study, 20 orthopedic and traumatology residents with no experience in primary total knee arthroplasty were divided into 2 groups. One group was prepared for surgery using surgical simulation with virtual reality headsets, while the other group was prepared for surgery with traditional methods. The actual surgical performance of the participants was evaluated with the Objective Structured Scale of Technical Skills (OSATS) surgical skills scale. It was observed that the virtual reality group was more successful in the "Time and Motion" and "Surgical Functioning and Fluency" criteria. Virtual reality surgical simulations are useful tool in surgical training and can contribute to the development of surgeons' skills. However, more research is needed on how to integrate these simulations into training programs and in which areas they are most effective.