Researcher: Birsel, Olgar
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Birsel, Olgar
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Publication Metadata only Functional outcomes and complications following scapulothoracic arthrodesis in patients with facioscapulohumeral dystrophy(Lippincott Williams and Wilkins (LWW), 2020) Ersen, Ali; Atalar, Ata Can; N/A; Eren, İlker; Birsel, Olgar; Oflazer, Piraye; Demirhan, Mehmet; Faculty Member; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; 168021; 202021; N/A; 9882Background: Facioscapulohumeral dystrophy (FSHD) is an autosomal-dominant myopathy characterized by facial and shoulder girdle muscle weakness with scapular winging. Scapulothoracic arthrodesis is a successful treatment approach for patients with Methods: We retrospectively reviewed the records of 40 patients (64 shoulders) in whom scapulothoracic arthrodesis was performed. To achieve fusion, multiple multifilament cables were used together with autologous bone and allograft bone. Preoperative and postoperative shoulder elevation and abduction; Disabilities of the Arm, Shoulder and Hand (Quick version, qDASH) scores; and pulmonary function were compared. Recorded complications were classified as pulmonary or scapular. Results: The mean age of the patients at the time of the operation was 25.4 years (range, 15 to 60 years), and the mean duration of follow-up was 71.2 months (range, 12 to 185 months). When the preoperative values were compared with those at the latest follow-up, significant improvement was noted in terms of elevation (from a mean [and standard deviation] of 60.6 degrees +/- 17.2 degrees to 123.7 degrees +/- 26.7 degrees; p < 0.001), abduction (from 52.7 degrees +/- 15.8 degrees to 98.8 degrees +/- 20.3 degrees; p < 0.001), and qDASH scores (from 34.7 +/- 11.4 to 13.3 +/- 13.1; p < 0.001). The overall complication rate was 26.6%. There were 7 pulmonary complications (4 pneumothoraxes, 2 pleural effusions, and 1 major atelectasis), and 5 chest tube placements were required. Ten complications (including 3 rib fractures, 1 brachial plexus palsy, 2 cases of implant irritation, 2 nonunions, 1 delayed union, and 1 scapular fracture) were related to the scapular fixation, and 7 revision procedures were required. Scapulothoracic fusion was achieved in all patients but 1, who had a scapular fracture. Pulmonary function tests were performed for 19 patients, and no difference was observed between preoperative and postoperative results. Conclusions: Scapulothoracic arthrodesis with use of multifilament cables is a successful surgical technique with high fusion rates and low morbidity. Pulmonary complications are common but resolve with careful attention.Publication Metadata only A novel shoulder disability staging system for scapulothoracic arthrodesis in patients with facioscapulohumeral dystrophy(Elsevier Masson SAS, 2020) N/A; Eren, İlker; Birsel, Olgar; Çakmak, Özgür Öztop; Aslanger, Ayça Dilruba; Eraslan, Serpil; Kayserili, Hülya; Oflazer, Piraye; Demirhan, Mehmet; Faculty Member; Faculty Member; Faculty Member; Doctor; Researcher; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; N/A; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; 168021; 202021; 299358; N/A; N/A; 7945; N/A; 9882Background: Scapulothoracic arthrodesis (STA) is a well-established surgical technique to provide scapular stabilization in patients with facioscapulohumeral dystrophy (FSHD). There is no staging or scoring systems available to guide surgical decision. The aim of this study was to develop a staging system to evaluate the shoulder disability in patients with FSHD to guide surgical decision making and assess its reliability among surgeons. Methods: Fifty-seven shoulders of 29 patients (15 male, 14 female) with an average age of 34.5 years (13–73) were included. Six stages of the disease were defined to create a system consisting of shoulder elevation, deltoid function and scapular winging. Patients were assessed by two independent orthopaedic surgeons who were blind to each other. Statistical analyses included mean and standard deviation for descriptive variables, Pearson's correlation and Cohen's Kappa for inter and intra observer agreement. Results: Measurement of elevation showed excellent correlation in both inter- and intraobserver assessment. There was substantial agreement on deltoid function and moderate agreement on scapular winging. Decision on stage showed excellent agreement on inter observer and substantial agreement on intra observer assessment. Surgical decision using the stage showed excellent agreement on both inter and intra observer assessment. Conclusion: This novel staging system has an excellent inter observer agreement on FSHD patients’ shoulder disability. This would provide surgeons a beneficial tool to define patient groups that would have negatively or positively affected from STA. © 2020 Elsevier Masson SASPublication Metadata only Long-term outcomes after arthroscopic transosseous-equivalent repair: clinical and magnetic resonance imaging results of rotator cuff tears at a minimum follow-up of 10 years(Mosby-Elsevier, 2021) Koyuncu, Özgür; Fox, Michael A.; N/A; N/A; N/A; N/A; N/A; Büyükdoğan, Kadir; Aslan, Lercan; Eren, İlker; Birsel, Olgar; Demirhan, Mehmet; Doctor; Faculty Member; Faculty Member; Doctor; Faculty Member; N/A; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; N/A; N/A; N/A; N/A; N/A; 145301; 168021; 202021; 9882Purpose: The objective of this study was to evaluate the long-term functional outcomes and structural integrity of medium to massive rotator cuff tears at 10-12 years of follow-up after arthroscopic transosseous-equivalent (TOE) repair. Methods: This was a retrospective study of a consecutive series of patients who underwent primary arthroscopic TOE repair of medium- to massive-sized degenerative rotator cuff tears performed by a single surgeon between January 2007 and August 2009. Patients were examined at a minimum follow-up of 10 years, and magnetic resonance imaging (MRI) was performed to assess tendon integrity. The Constant score (CS), American Shoulder and Elbow Surgeons score, and pain level documented using a visual analog scale were compared between intact repairs and recurrent defects. Univariate analysis was performed to identify factors related to recurrent defects. Results: A total of 102 patients met the inclusion criteria, and 79 shoulders in 76 patients (74.5% of eligible patients) with a mean age at surgery of 55 +/- 8 years (range, 40-72 years) were available for clinical evaluation at a mean follow-up time of 10.9 years (range. 10-12 years). The mean anteroposterior tear size was 3.1 +/- 1.1 cm, and there were 41 medium (52%), 26 large (33%), and 12 massive (15%) tears. MRI was performed in 72 shoulders in 69 patients (91% of available shoulders) and revealed that 13 shoulders had recurrent defects (Sugaya stages 4 and 5). During the follow-up period, 3 patients underwent revision surgery, and the overall recurrent defect rate was 21.3%. A clinically meaningful improvement was observed in all outcome measures at the final follow-up regardless of tendon integrity. Patients with intact repairs showed superior outcomes compared with those with recurrent defects; however, only the overall CS met the threshold for clinical relevance. A significant linear correlation was observed between the Sugaya classification and all outcome scores except the CS pain subscale; however, the strength of correlation was weak. The presence of diabetes (odds ratio [OR], 8.6; 95% confidence interval [CI], 2.25-33.2; P = .002), tear size (OR, 2.08; 95% CI, 1.16-3.46; P= .012), and tear refraction (OR. 4.07: 95% CI, 1.11-14.83; P = .033) were associated with recurrent defects in the univariate analysis. Conclusion: Arthroscopic TOE repair of rotator cuff tears provided improved clinical outcomes with a recurrent defect rate of 21.3% at 10-12 years after surgery. Future research focusing on tendon healing is needed as repair integrity on MRI correlates with clinical outcomes. (C) 2021 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.Publication Metadata only Management of scapular dysfunction in facioscapulohumeral muscular dystrophy: the biomechanics of winging, arthrodesis indications, techniques and outcomes(Bioscientifica Ltd, 2022) N/A; N/A; Eren, İlker; Gedik, Cemil Cihad; Kılıç, Uğur; Abay, Berk; Birsel, Olgar; Demirhan, Mehmet; Faculty Member; Researcher; Doctor; Undergraduate Student; Faculty Member; Faculty Member; School of Medicine; School of Medicine; N/A; School of Medicine; School of Medicine; School of Medicine; N/A; N/A, Koç University Hospital; N/A; N/A; N/A; 168021; 327612; N/A; N/A; N/A; 9882center dot Facioscapulohumeral muscular dystrophy (FSHD) is a common hereditary disorder which typically results in scapular winging due to wasting of the periscapular muscles affected by this condition.center dot Scapulothoracic arthrodesis (STA) is the current surgical treatment for FSHD patients with severe winging and preserved deltoid muscle. center dot There are several different techniques in the literature such as multifilament cables alone and cable or cerclage wires combined with single or multiple plates. We prefer cables without plates as it provides independent strong fixation points and strongly recommend utilization of autograft.center dot The functional results of studies report that regardless of the technique used, shoulder elevation and thus quality of life is improved, as shown with outcome scores.center dot There are several complications associated with STA. Pulmonary complications are common and usually resolve spontaneously. Meticulous surgical technique and effective postoperative analgesia may reduce the incidence. Scapular complications which are associated with the fixation may be encountered in the early or late period, which are related to the learning curve of the surgeon.center dot In conclusion, STA is a reliable solution to a major problem in FSHD patients that helps them maintain their activities of daily living until a cure for the disease is found. A successful result is strongly dependent on patient selection, and a multidisciplinary team of neurologists, geneticists and orthopaedic surgeons is required to achieve good results.Publication Metadata only Patients without re-dislocation in the short term after arthroscopic knotless Bankart repair for anterior shoulder instability may show residual apprehension and recurrence in the long term after 5 years(Elsevier, 2022) N/A; N/A; N/A; N/A; N/A; N/A; Eren, İlker; Büyükdoğan, Kadir; Yürük, Batuhan; Aslan, Lercan; Birsel, Olgar; Demirhan, Mehmet; Faculty Member; Doctor; Researcher; Faculty Member; Faculty Member; Faculty Member; School of Medicine; N/A; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; 168021; N/A; 327613; 145301; 202021; 9882Hypothesis: The aim of this study was to report the long-term results, residual instability, and recurrence rate of arthroscopic Bankart repair surgery without a re-dislocation event in the first 5 years. Methods: We performed a retrospective analysis of Bankart repairs performed in a single center, by a single surgeon, with a minimum of 5 years' follow-up. Patients without a re-dislocation in the first 5 years of surgery were included. Patients who underwent open repair, those who underwent revision surgery, and those with critical glenoid bone loss were excluded. A total of 68 shoulders in 66 patients (51 male and 15 female patients) were included. Patients were analyzed in 2 domains: (1) failures defined as re-dislocation and (2) failures defined as apprehension and re-dislocation combined (residual instability). Clinical outcomes were assessed using shoulder range of motion, the American Shoulder and Elbow Surgeons score, and the Western Ontario Shoulder Instability Index (WOSI) score. Pain, residual apprehension, re-dislocations, and additional surgical procedures were recorded. Results: The mean age of patients was 31.16 (range, 16-60 years), and the mean follow-up duration was 8.42 +/- 2.1 years. The median number of dislocations was 3 (range, 1-20), and the median time from first dislocation to surgery was 16 months (interquartile range, 3-100.5 months). Five patients reported re-dislocations (7.4%) with a mean period of 6.54 +/- 2.5 years (range, 5-10.8 years). Seven patients without re-dislocations and 2 patients with re-dislocations reported residual apprehension. Mean shoulder elevation and mean external rotation were 161.3 degrees +/- 12.4 degrees and 39.2 degrees +/- 11 degrees, respectively. The mean visual analog scale, American Shoulder and Elbow Surgeons, and WOSI scores were 0.5 +/- 1.4, 91 +/- 11.9, and 88 +/- 12.1, respectively. Age was similar in patients with stable shoulders and those with shoulders with re-dislocation or residual instability. The WOSI score was lower in patients with re-dislocation and residual instability (P = .030 and P = .049, respectively). Conclusions: Arthroscopic Bankart repair is a successful surgical option for anterior shoulder instability. The 7.4% re-dislocation rate after 5 years indicates there may be a deterioration of capsulolabral repair in certain patients. The long-term failure pattern may be underestimated in short- to mid-term projections. (C) 2021 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.Publication Metadata only Önder Kılıçoğlu: a guiding light that faded too soon(Aves, 2022) Ozturkmen, Yusuf; Aktekin, Cem Nuri; Berk, Haluk; N/A; Birsel, Olgar; Faculty Member; School of Medicine; 202021N/APublication Open Access Arthroscopic knotless separate layer transosseous equivalent repair of delaminated rotator cuff tears(Elsevier, 2019) Koyuncu, Özgür; Fox, Michael A.; N/A; Büyükdoğan, Kadir; Eren, İlker; Birsel, Olgar; Demirhan, Mehmet; Doctor; Faculty Member; School of Medicine; N/A; N/A; N/A; 9882Delamination of rotator cuff tears presents a challenge for surgeons. Recognizing and repairing such a complex tear pattern often require innovative approaches to achieve an anatomic restoration of footprint. In this Technical Note, we described our preferred method that anatomically repairs both layers of delaminated rotator cuff tear separately in a knotless transosseous equivalent technique. Two sutures are placed to the articular layer in a cinch stitch configuration. Then, closed-loop end sutures are passed through both layers while keeping the closed-loop end at the working portal. The free ends of cinch stitches are loaded to anchors with a preloaded fiber tape loop, which is placed to the medial row while approximating the articular layer onto its footprint. Fiber tapes are then shuttled through both layers of tendon with the help of a previously placed closed-loop suture. Finally, the lateral row anchors are placed while fiber tapes are tensioned in a cross-bridge configuration. We believe that this technique may facilitate uneventful healing of delaminated rotator cuffs by providing the biomechanical properties of transosseous equivalent repair.Publication Open Access Comment on “Bosworth and modified Phemister techniques revisited. A comparison of intraarticular vs extraarticular fixation methods in the treatment of acute Rockwood type III acromioclavicular dislocations”(Elsevier, 2019) N/A; Demirhan, Mehmet; Birsel, Olgar; School of Medicine; 9882; N/APublication Open Access Turkish version of the patient-based Constant-Murley Score: its cross-cultural adaptation, validity, reliability and comparison with the clinician-based version(Bayçınar Tıbbi Yayıncılık ve Reklam Hizmetleri, 2022) Mısırlıoğlu, Tuğçe Özekli; Eren, İlker; Taşkıran, Özden Özyemişçi; Günerbüyük, Caner; Birsel, Olgar; Canbulat, Nazan; Demirhan, Mehmet; Faculty Member; Teaching Faculty; Faculty Member; Faculty Member; School of Medicine; 168021; 133091; 380939; 202021; 58534; 9892Objectives: the aim of this study was to translate, cross-culturally adapt the patient-based Constant-Murley Score (p-CMS), assess its validity, reliability, and compare it with the clinician-based CMS (c-CMS). Patients and methods: this cross-sectional study included a total of 51 shoulders of 46 patients (22 males, 24 females; mean age: 49 +/- 10 years; range, 29 to 70 years) with shoulder pain between December 2015 and July 2016. After translation of p-CMS, each participant was asked to complete the final Turkish version of the p-CMS. The c-CMS was assessed by a physiatrist who was blinded to the p-CMS. Retest of the p-CMS was performed in patients (n=15) who did not receive any treatment between two visits (Days 3 to 5). Results: a total of 51 shoulders (n=5 bilateral shoulder pain) were tested. Strength, subjective, objective, and total scores were significantly different between the p-CMS and c-CMS (p<0.001). Pain scores of the c-CMS and p-CMS revealed similar results with 95% limits of agreement of -3.81 and 4.81. Weighted kappa statistics demonstrated that the levels of agreement ranged between 0.343 and 0.698 in subjective and between 0.379 and 0.515 in objective components. For test-retest reliability of the p-CMS, intraclass correlation coefficient values ranged between 0.838 and 0.995. Conclusion: the Turkish version of the p-CMS has internal consistency and test-retest reliability to evaluate shoulder function in Turkish patients with shoulder pathologies. Considering the differences in test protocols and scoring methods of c-CMS and p-CMS, their interchangeable use is not supported.Publication Open Access The effect of shear-wave elastography on functional results and muscle stiffness in patients undergoing non-selective and selective open kinetic chain exercises(Bayçınar Tıbbi Yayıncılık, 2019) Botanlıoğlu, Hüseyin; Zengin, Gökhan; Aydıngöz, Önder; Güven, Mehmet Fatih; Erginer, Rıfat; Kaynak, Gökhan; Ustabaşıoğlu, Fethi; Gülşen, Fatih; N/A; Birsel, Olgar; School of MedicineObjectives: this study aims to assess the effect of shear-wave elastography (SWE) on vastus medialis obliquus (VMO) and vastus lateralis (VL) muscle performances and functional outcomes of patients with patellofemoral pain syndrome (PFPS) undergoing non-selective open kinetic chain exercises (NSOKCE) and selective open kinetic chain exercises (SOKCE). Patients and methods: this randomized-controlled clinical trial included a total of 40 patients with PFPS (20 males, 20 females; mean age 46.5 +/- 9.8 years, range, 27 to 65 years) and 40 healthy controls (20 males, 20 females; mean age 36.3 +/- 11.2 years, range, 23 to 71) between February 2013 and August 2014. The participants in each group were randomized into subgroups according to NSOKCE or SOKCE for six weeks. The VMO and VL muscles were assessed with the SWE, thigh circumferences were measured, and the Visual Analog Scale (VAS) and Lysholm Knee Scale (LKS) scores were obtained. Results: the OKCE alleviated pain, improved LKS scores, and increased the thigh circumference in PFPS patients. While the healthy controls were able to increase the resting muscle tone of their VMO, the patients with PFPS failed in their both knees. Similarly, resting as well as contracted VMO and VL muscles' functions were improved significantly by both NSOKCE and SOKCE in the healthy controls. The NSOKCE improved the VAS scores in the PFPS group. The increase in the muscle mass of the affected sides of PFPS patients were more evident with NSOKCE. Conclusion: Our study results show that NSOKCE planning can be preferred over SOKCE, thanks to its contribution to pain improvement and increase in the thigh circumference in the conservative treatment of PFPS.