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Closed lumbar hernia surgery is performed by piercing the skin without opening the skin. The spinal cord is reached through the natural hole we call the foramen by using normal anatomical pathways and the intervals between the muscles. A nerve emerges from the foramina, the hernia that presses on the nerve is reached with the help of a tube by piercing the skin without damaging that nerve. The hernia is removed with the help of the camera image, without damaging another anatomical structure inside, in the surgery performed with the camera. What is the difference between closed lumbar hernia surgery and other lumbar hernia surgeries? Closed surgery is surgery performed by piercing the skin without opening the skin. Any anatomical structure is not damaged. Arthroscopy performed on joints in orthopedic surgery is an example of closed surgery. Since these surgeries are performed without cutting the skin, the bleeding is not more than a teaspoon. An optical device, namely a camera, is absolutely used. In the camera-guided surgery, without damaging another anatomical structure inside, a direct diagnosis and treatment for the ailment is performed. Is closed lumbar hernia surgery more comfortable than other surgeries, is there any difference with the old system, how is the healing process? Surgery means opening a wound. To treat a tissue, it is necessary to open a wound. In modern surgery, the wound is minimized and the problem is reached directly. In all endoscopic surgery, laparoscopy, arthroscopy, closed lumbar hernia surgery and neck hernia operations, the lesion and problematic area are reached with a minimum of wound and the disease is treated. Therefore, there is a rapid recovery, because no harm can be done. Since a place is not cut and no tissue is removed, the patient can get rid of his discomfort and return to work immediately, even walking from the operating table.

Enemy of the Feet in Summer Vacation SLIPPERS BETWEEN FINGERS Finger protrusion increases Hallux Valgus. Yes, it looks aesthetically pleasing! What should we pay attention to, there must be arch reinforcement in the flip-flops, if possible, the types that prevent the foot from going forward should be preferred with the comb bone band. In foot anatomy, the internal muscles that support the arch adhere to the ossicles called sesamoid between the joint beam and the toe. Flip-flops and shoes are mostly designed flat and without arc reinforcement. Hallux Valgus As the load on the inner muscles of the foot increases, the sesamoid slides outward with the additional load between the toes, while the thumb comb bone inward somersaults (pronation), and the thumb joint adapts to this turn by sliding outward. As the comb bone turns inside, the joint relationship is disrupted with the outward sliding of the joint, a protrusion (bunion) occurs on the inner side, and the joint wears out over time and the deformity becomes permanent. Avoid such slippers that make up all components of Hallux Valgus (valgus-bunion-pronation) ... Stay healthy.

Cartilage tissue is a metabolically active tissue. Healthy cartilage has an intercellular substance (matrix) rich in glucosaminoglycan glycoproteins, which hold a high amount of water in its hyaline cartilage structure. It is not a tissue that has the ability to repair itself, except for superficial losses. Since the cartilage cell is not capable of regeneration, the losses can be covered up to 1 mm by matrix production, without cellular migration, which is not the case for the cartilage cell. This type of healing is the healing of hyaline cartilage without scarring. In superficial losses, if the injury does not reach the subchondral tissue, hyaline healing is achieved without the need for any cellular migration. In full-thickness injuries, we see that a non-cartilaginous tissue plays a role in the defect filled with fibrin and mesenchymal cells after cartilage repair and bleeding. In this case, the repair tissue is in the form of fibrocartilage scar tissue. Scar tissue is a rough, non-slippery tissue on the cartilage surface. It acts like a dead tissue with no active metabolism. The healing margin is uncertain and raised from the surface. The rough surface leads to a situation requiring intervention, which constantly wears and wears, resulting in a painful joint. Hyaline cartilage provides a smooth and smooth surface as well as providing lubricity, which is one of the basic functions of cartilage. Fibrocartilage, on the other hand, serves as a filling function as a scar tissue and prepares the ground for the inflammatory response with PDGF and TGF-ß mediators released from mesenchymal cells, which have an important place in the physiopathology of arthritis. Closure of the cartilage defect may be in the form of excessive scar tissue and this tissue may create a mechanical barrier. Osteophyte (bone protrusion-horn) formations are the hard osseous healing tissue of mesenchymal cells with stem cell characteristics, which are involved in the formation of fibrocartilage tissue. Therefore, in addition to the acute inflammatory response, the problems in the late period will be the healing tissue that disrupts the mechanical barrier. Unfortunately, this condition is painless following the recovery of the acute situation after trauma. DIAGNOSIS Whether the cartilage injury is traumatic, infection or aging, the diagnosis of the cartilage problem is very difficult after the acute condition (swelling, pain, feeling of being stuck) has disappeared. Examination and analysis of limitations in the patient’s daily life are of great importance in early diagnosis. Magnetic resonance imaging (MRI) is insufficient in the diagnosis of superficial lesions without contrast (arthrography). Findings found close to normal such as increased fluid in MRI reports; tripping, difficulty in climbing/descending stairs are sometimes very obvious, but they may not be innocent. In cases suggesting a mechanical problem, even if the history of the harvest and the findings of the examination do not support the findings of the MRI examination, “Diagnostic Arthroscopy” should not be avoided. TREATMENT Cartilage lesions that do not create mechanical barriers can be treated with recessive methods such as anti-inflammatory drugs, ice, and rest when it is sure that the body is within its healing capacity. Physical therapy is very effective in returning the patient to his normal life quickly. This should not exceed 3 weeks. Hyaluronic acid injection (viscosupplementation) and oral intake of glucosaminoglycan drugs (at least 6 months) during cartilage healing complete the treatment. Viscosupplementation has a mechanical and chemical contribution to the regulation of the metabolism of the cartilage matrix. In this respect, it is combined after arthroscopy treatment. If the complaints have not completely disappeared, arthroscopic surgery is the gold standard in cases that cause mechanical obstruction or cannot heal spontaneously. Arthroscopic Surgical Treatment It can be Diagnostic, Excisional or Reconstructive. Diagnostic Arthroscopy is used in the early diagnosis of the cause of joint complaints despite radiological criteria. During arthroscopy, joint examination is performed; Meniscus tears, cartilage softening, cartilage tears, joint mouse (free parts) and ligament lesions are detected and promptly intervened. The intervention may include simple procedures such as removal of the lesion (excision-debridement) or complex applications in the form of repair (reconstructive). Simple Arthroscopy (Excision-Debridement) These are procedures such as meniscus tear, removal of cartilage pieces and plica cutting. The healing potential of hyaline cartilage should be used in superficial cartilage lesions. The parts that are about to break off from the mechanical barrier surface should be taken out and the cartilage should be protected as much as possible. When a cartilage lesion is detected, innocent folds that may be the cause are investigated and the cause is eliminated. Arthroscopic Repair: It covers meniscus repair, ligament repair and cartilage transplantation. If the cartilage loss involves a single surface and has not severely damaged the opposite surface, repair is required if it is a full-thickness injury. In this case, it can be done by providing autologous (own cartilage) from another donor (allograft, xenograft). In addition to arthroscopic applications such as mosaicplasty, there are cartilage transfer surgeries performed by opening the joint. Considering the advantages of hyaline cartilage healing, similar mechanical problems may be encountered if the tissue formed in cartilage transfers is not aligned with the surface. The hyaline cartilage implanted with the appropriate technique allows the defect to enter the superficial healing process and reshape. Carbon fiber filler, which is another method used for the closure of the cartilage defect, aims to stimulate the formation of a smooth surface hyaline matrix while preventing excessive development of fibrocartilage tissue. However, since the cartilage surface formed after the method does not provide the expected lubricity, such methods are rarely applied. In conclusion, arthroscopic treatment is the indisputable gold standard in the diagnosis and treatment of cartilage lesions. However, planning by considering cartilage healing physiology during treatment directly affects patient satisfaction and treatment success.

If the spinal canal stenosis occurs congenitally, it requires open surgery at an early age. The canal stenosis that occurs with aging is very different and physiological. After proving that the stenosis of the spinal canal was at the disc level and that there was no canal stenosis at the lamina level, we claimed that there was no need for a screwing (fusion) attempt between the laminectomy used in open surgery and the ring that had to be performed as a result. After proving that the stenosis of the spinal canal was at the disc level and that there was no canal stenosis at the lamina level, we claimed that there was no need for a screwing (fusion) attempt between the laminectomy used in open surgery and the ring that had to be performed as a result. In spine endoscopy, we can easily reach the foramen tract, which we use to remove the lumbar hernia, and open the canal stenosis in a 6 mm hole. In this way, our patients can stand up after 2 hours and get rid of the pain. Moreover, this surgery can be performed awake with local anesthesia without the need for anesthesia.

Arthroscopy is the visualization of the joint with an optical device scope. While visualizing the intra-articular structures, they are examined and radiologically invisible cartilage problems and tears of intra-articular structures can be revealed. For example, while peripheral separation of the meniscus can be missed during mri, it can be diagnosed on arthroscopy. Mri is proficient in surface injuries of cartilage tissue, and arthroscopy can be performed even for diagnostic purposes, despite normal Mri examination in knee pain that does not heal. The main purpose of arthroscopy is to eliminate the cause revealed during diagnosis, and repair / reconstructive treatments are performed simultaneously. With advanced suture materials, patients with anterior cruciate ligament repair can be pressed the next day. Shoulder dislocations, rotator muscle repairs can return to normal life immediately. Tears in the elbow and wrist joints are repaired, and treatment-resistant conditions such as tennis elbow can be corrected. Compression caused by ankle sprain can be eliminated and joint wear can be prevented by removing stuck in the hip bone. Open surgical techniques have largely been removed from our practice as the gold standard in arthroxopia joint surgery. Scope wound is 5-7 mm, completion of the entire surgical procedure through 2-3 holes, almost no need for surgical wound care, very little bleeding, ensures very rapid healing. It has been with the contribution of arthroscopic methods in the orientation of modern surgery to minimally invasive treatments.

Epiduroscopy is the endoscopic visualization of epidural structures. Epiduroscopy, which can be applied under local anesthesia, is among the interventional surgical methods. Prophylactic antibiotics should be administered in sterile operating room conditions. Epiduroscopy provides imaging of the spinal canal area with a thin camera that can move in all directions. The patient should be placed face down in the frog position. Under fluoroscopy, using an 18-g needle, the needle is directed vertically and the guide wire is advanced. The surgical procedure should be decided while proceeding in the canal. Epiduroscopy is for diagnostic purposes and is applied to find the source of pain of unknown origin. Thanks to the epiduroscopy method, medication can be applied to the desired area of ​​the spinal cord when necessary. (Hyalurinidase collagenase preoperative epidural catheter is applied) In which situations is the epiduroscopy method applied? Back pain due to surgery Low back pain that does not respond to conservative treatments Axial back pain accompanying root pain Spinal canal stenosis Neck hernia accompanying radiculopathy Erpidural adhesions Epidural Fibrosis (after invasive procedures) Except those; Epiduroscopic discectomy, mass excisions or biopsy purposes can be applied. Recovery process after epiduroscopy: What is epiduroscopy?

Failed Low Back Surgery Syndrome is generally omitted or neglected foraminal strictures. Correct diagnosis, correct surgical indication, good surgical technique and equipment are very important in order to minimize the occurrence of this syndrome. What is Failed Low Back Surgery Syndrome? The fact that the back problem has not been resolved even though it has been treated with revision surgery at least once, the conservative treatments for at least 6 months are insufficient or the patient is not satisfied. What are the Symptoms of Failed Low Back Surgery Syndrome? The recurrence of the previous complaints of the patient, does not decrease or increase at all. How Is It Diagnosed? The diagnosis of Failed Low Back Surgery is a multidisciplinary decision. Evaluating all the pre-treatment examinations of the patient together with the physicians who treat other disciplines makes it easier to reach the correct diagnosis. Patient compliance is required. In order to find the source of pain, the target should be determined well with temporary injection treatments. How Is It Treated? If it is thought that the problem in the treatment is caused by the methods used in the old treatment, for example, if there is an infection and implant failure, this situation should be resolved first. It is possible to remove or renew the implant. It is appropriate to avoid a new open surgery in the minimally invasive approach. Often omitted or neglected foramen nerve compression is emphasized. After determining the target and level, the cause of pain is removed with foraminoscopy. How Long Does Endoscopic Surgery Take? Endoscopic surgery can take 1-2 hours. Although the optimal time is 30-45 minutes, it increases the time to differentiate the nerve tissues due to the intervention of the anatomy deformed tissues. What is the Recovery Process After the Surgery? In the procedures performed under local anesthesia, we confirm that the pain has passed on the operating table. The patient can get off the table without pain. However, under general anesthesia, we remove the patients after eating 4 hours after the effect of anesthesia is over. The painful process can mimic the old in the inflammatory phase after 72 hours. Similar pain occurs in the first ten days, but gradually decreases. When the exercises are started 3 weeks after the operation, new pain may develop. Due to the pain, coping with neuropathic symptoms or even psychological support may be required. Mesotherapy-acupuncture helps the physical therapy process. Although this situation is not seen in some patients, both patient groups start to work to regain their belief in the treatment in a few months. Patients should be returned to normal life within 6 months. The problem is completely resolved in the following months and 2 years. How Much is the Surgery Fee? It is determined according to the hospital and patient budget.

Before details of Hallux Valgus Surgery, let's briefly answer the question of Hallux Valgus - what is the big toe bone protrusion. What is Hallux Valgus? It is the outward curvature of the big toe. However, there are actually three components of the scallop, which include pronation and joint bursitis. It is often accompanied by an inverting of the comb bone (varus). It should be kept in mind that metatarsus primus varus (MPV) causes hallux valgus along with it. Most of the preventable hallux valgus disorders at a young age are MPV. The patient complains of deformity, as well as swelling of the thumb joint and the bad appearance of the protrusion. Since the joint axis is distorted, the joint pains increase with movement and the width is restricted as a result of wear over time. A stiff thumb (hallux rigidus) may develop. Thumb extension disappears. Hallux Valgus Surgery How is Hallux Valgus Treated? Night splints, bursitis treatment, and appropriate shoes may be beneficial before the deformity progresses. Surgical treatment should not be delayed in case of malalignment (metatarsus primus varus, disruption of the joint connection). Medial capsulorrhaphy and lateral release, bursectomy and bunionectomy are applied in soft tissue entrances. Violation of the joint border, which we call the sulcus while removing the bunion, disrupts the joint functions, causing postoperative dissatisfaction and a stiff thumb. In this respect, bunionectomy is very critical and should not be exaggerated in such a way that it does not exceed filing. In metatarsus primus varus where the alignment is disturbed, or in bone curvatures, corrective osteotomies are made on the metatarsal and phalanx bones to correct angular problems and make the joint compatible. At Which Stage Is Hallux Valgus Surgery Required? Surgical treatment should not be delayed in case of malalignment (metatarsus primus varus, disruption of the joint connection). Misalignment should be corrected immediately, joint harmony should be ensured and wear should be prevented. In cases where there is no malalignment, if orthoses to correct soft tissue do not help and frequent bursitis painful joints occur, surgery is a valid solution. What Are The Surgery Options - How Is It Done - How Long Does It Take? It is in the form of soft tissue surgeries and bone surgeries. Soft tissue surgeries; It includes lateral release, medial capsulorrhaphy, and bursectomy. Bone surgeries are osteotomies that correct the alignment. Osteotomies correct bone axis disorders, provide alignment, and create joint harmony. Soft tissue surgeries are also performed along with it. The operation time may vary between 30-90 minutes. What is the Recovery Process After the Surgery? A 3 to 6-week healing period includes the time that special shoes or slippers should be worn. A plaster cast may be required in bone surgery. In cases where bone fixation is rigid, it is possible to press early or to give weight to the heel. However, the possibility of not being able to step should be taken into account. Will It Repeat After Surgery? Recurrence may occur after soft tissue surgeries. New osteotomy is rarely required in bone surgery. How Much is the Surgery Fee? It depends on the type of surgery and the use of materials. Pricing is made according to the hospital class determined according to the patient's budget.

Meniscus tears are detected by examination, and the treatment is meniscus surgery. What is Meniscus Surgery? The meniscus is a fibrous cartilage-like structure found in the knee joint structure. Its task is to ensure the harmony of the joint surfaces and to maintain stability. In cases where the limits of joint movement are forced (excessive stretching and rotational movement), it tears. There are two meniscus structures, outer and inner, in the knee. One is a crescent (inner) and firmly adhered to the walls, the other is a little more rounded but partially adherent and mobile (outer). Since the inner meniscus is adhered to the surrounding environment, it is frequently injured in trauma and gives rapid symptoms, external meniscus tears are less common, but diagnosis is more difficult because it does not cause pain. Meniscus surgeries are performed with arthroscopic surgery today. Before arthroscopic surgery, meniscus structures were completely removed (meniscectomy). The counterpart of meniscectomy surgery in arthroscopic surgery is partial meniscectomy. In partial meniscectomy, only the tear area is removed, never the entire meniscus is touched. As the canal meniscus tissue continues to function, joint functions do not deteriorate, wear does not occur, and daily life is quickly returned. In arthroscopic meniscus surgery, if the tear is close to the capsule with high blood supply, it can be repaired with stitches. Meniscus transplantation (taken from another person, allograft) is possible in cases where the entire menicus is damaged or disappeared. When it comes to menicus surgery; Only the removal of the tear (partial meniscectomy) is performed. The procedure of removing the entire meniscus (total meniscectomy) is now abandoned. Arthroscopic meniscus repair means arthroscopic meniscus transplantation. What are the Meniscus Symptoms? In meniscus diseases, there are complaints such as pain, stuck and locking during joint movements. If the discomfort is due to trauma, swelling due to bleeding (hemarthrosis) may occur at first, and then swelling may occur due to the increase in joint fluid. While the temperature increase accompanies pain and swelling for the first time, the signs of inflammation disappear over time. Mechanical findings; stuttering and locking continues. Locking; the knee remains bent and cannot be opened. How is the meniscus diagnosed? Meniscus tears are detected by examination. MR imaging is very useful as a diagnostic method. Some meniscus tears may not signal on MRI when they sit in place, or tears close to the capsule we call peripheral may be missed. What is the Meniscus Treatment Process? The treatment of meniscus tears is surgery. It may be possible for peripheral meniscal tears to heal spontaneously with rest, but the rate of re-rupture is very high. When a tear is detected, arthroscopic surgery should be performed early, without causing abrasion due to friction in the joint. At Which Stage Is Meniscus Surgery Required? It should be done at the stage of meniscus tear. In this way, joint wear can be prevented, repairable tears are repaired within the first 72 hours, and the chance of recovery is much higher than neglected / delayed tears. What are the surgery options, how is it done, how long does it take? In joint surgery, removing or repairing the meniscus by arthroscopic method is the gold standard. Open surgery has been largely abandoned. How is the Recovery Process After the Surgery? After the operation, it is pressed immediately and full movement can be given. In meniscus repairs, it may be necessary to give partial weight with crutches or not to press for a while, depending on the strength of the suture material. Will It Repeat After Surgery? The remaining meniscus can rupture again. If the risks causing the tear are not eliminated, a new tear may develop. The area treated with arthroscopic surgery does not recur. How Much is the Surgery Fee? The cost of surgery depends on the type of surgery and the use of materials. Pricing is made according to the patient’s budget and the hospital class.

Before giving information about wrist triangular complex problems and arthroscopic treatment, let's briefly talk about the wrist. Our wrist consists of a complex structure connected to each other like eight beads to which the two bones of the forearm (Radius and Ulna) are articulated. This extremely flexible structure, which enables us to resist various strains in daily life, completes the functions of our hands by moving in almost all directions. I compare the architecture of the forearm bones to the sticks used in Far Eastern dishes. While the ulna hinge acts as a joint in the elbow, a radius in the wrist functions similarly. While the radius in the elbow rotates around itself like a shaft, it makes the same situation as ulna on the wrist, they literally cross each other. In this way, they give our hands a unique function that can perform the movements we use in daily life, such as turning keys, screwing, and opening the door handle. As it turns out, in reality the elbow and wrist joints complement each other in this way, but unfortunately they also share their questions. For example, if we have suffered an elbow joint fracture, the key turning function of our wrist is likely to be impaired. Similarly, an injury that causes shortness of the wrist may cause early calcification by causing strain in the elbow joint. This is why, in recent years, the importance of anatomical correction (near-real correction) in wrist fractures, before shortness can be accepted. If shortness occurs, the little finger side of the wrist (Ulna) faces more strains than anticipated in the load distribution. This situation will cause the really complex bone-joint-ligament structure, which we call the Triangular Complex (TAC), to be susceptible to injury. Check out the figures to see this brief briefing. The TAK structure on the wrist allows the ulna, which is shorter than the radius, to join the joint, supports the wrist bones, enables rotational movements. TAK is at risk in wrist sprains. In addition to bone injury, TAK injury is very common in fractures. It can be directly injured, torn or indirectly squeezed between the ulna-wrist bones approaching the joint due to the shortening of the radius bone (abutment syndrome). Arthroscopic Treatment In Arthroscopic Treatment, we can simply divide TAC injuries into rupture and compression. TAC ruptures can be divided into simple wrist looseness-dislocation (instability) and those that do not. Wrist tightness or abutment disease manifests itself with the limitation of joint motion in which pain is at the forefront. We can observe these gates with arthroscopic joint surgery. This procedure can be performed by using a special sling device with the help of a scope with a diameter of about 1.2 mm and only numbing the arm. In the absence of arthroscopy, we opened the joint for treatment and often could not benefit our patients at the macro level. Today, using HD optical cameras and advanced equipment, we can correct the dislocations with extremely practical repair methods, and we can remove the jams with the micromotor, laser and radiofrequency devices we operate inside. Get rid of living with painful joints, Join Life….

What are Knee Replacement Surgeries? Knee Replacement Surgery,In short, it is the modification of the joint surface. Prosthesis is the material that replaces lost joint surfaces. It can be applied to people who have completely lost the joint surface, have painful joints (knee pain), and whose movements are restricted to a certain level. If the movement is too restricted, it cannot be applied. There is no age limit, it can be applied to anyone with these complaints. Surgery can be performed on patients with knee pain regardless of age and weight. Losing weight reduces the load on the joints, and in this case, the life of the prosthesis is also prolonged. If the joint has completely lost its function, knee replacement surgeries (resurfacing surgeries) are one of the important operations we have. How long is the Knee Replacement Surgery? The duration of a joint surgery is approximately one hour. Two joint surgeries can be performed at the same time. Two knee surgeries can be performed in one and a half to two hours. Anesthesia is applied depending on the patient's preference. How long is the recovery period after Knee Replacement Surgery? Minimally invasive surgeries are an important factor in increasing the healing process and causing less damage. The surgery is performed at the muscle joints, the areas we call cleavage. Surgeries performed in this way provide faster recovery. The patient will be able to stand up and press the next day. Since the healing process is very fast, the patient can feel better and return to his normal life in 1 week, more painlessly.

Joint pain is one of the main reasons for outpatient treatment for musculoskeletal problems. While MRI (Magnetic Resonance Imaging), one of the advanced diagnostic methods, increases the options for the treatment of joint cartilage lesions, its effect on the accuracy of the options and the decision of timing is limited. Early diagnosis and adequate treatment can prevent the irreversible loss of cartilage tissue. Cartilage tissue is a metabolically active tissue. Except for superficial losses, it does not have the ability to repair itself. Since cartilage cells do not have regeneration capability, losses can only be covered up to 1 mm by cellular migration and matrix production. In superficial losses, if the injury does not reach the subchondral tissue, there is no cellular migration. After hemorrhage in full-thickness injuries, we see that fibrin and mesenchymal cells play a role in shaping. In this case, the repair tissue becomes firocartilage like cicatricial tissue. The hyaline cartilage provides a smooth and smooth surface as well as providing belt fluidity, one of the basic functions of cartilage. Fibrocartilage functions as a filler as a scar tissue and prepares the basis for the inflammatory response with PDGF, TGF- (3 mediators released from mesenchymal cells, which have an important place in arthritis physiopathology. If the cartilage defect creates a mechanical obstacle and the arthroscopic treatment is delayed, the healing may result in the form of excess scar tissue. This will increase the friction and wear and make the treatment unsuccessful. It is a hard osseous healing tissue caused by mesenchymal cells with pluripotent cell characteristics to increase osteophyte formations despite the relief of pain over time, therefore, in addition to acute inflammatory response, the problems in the late period will be in the form of a healing tissue that creates a mechanical obstacle and disrupts lubricity. Viscosupplementation provides the migration of chondral cells and accelerates the formation of new cartilage as well as a mechanical effect in the closure of superficial defects. However, its application alone is controversial in cases where there is a mechanical obstacle. Despite conservative options, the aim in arthroscopic surgery should be to provide acceptable lubricity of cartilage lesions without causing erosion on the opposite surface over time. In superficial cartilage lesions, this procedure can be applied to a simple debridement, and in more severe lesions, to cartilage transfer. Simple debridement is based on cellular migration and matrix filling healing, unstable fragments, chondromalastic foci are cleaned and regeneration is given to healthy layers. Although the cartilage healing is hyaline, regional thinning develops and the irregularity continues. Although the belt-like mechanics of the injury area deteriorates due to thinning, the opposite surface wear is prevented. Cartilage transfer is the process of removing cartilage osteochondral graft from a smooth area. When the healing is completed, the surface is covered with hyaline cartilage. Correct treatment of timely, correctly defined cartilage lesion means preservation of long-term joint function. In the treatment, the right option should be determined immediately by targeting eradication. How sensitive and effective is MRI in this choice? Although the answer seems to be in favor of MRI with the developing technology, its sensitivity in superficial lesions is not yet sufficient. Detection of cartilage lesions The problem in diagnosing cartilage injuries or degenerations is that the main complaint and the way pain occurs during daily activity are quite similar to meniscal lesions. Provocation maneuvers during physical examination can often be painful in condylar lesions. In case MRI examination and physical examination findings do not match, which is inevitable in differential diagnosis and treatment planning, the presence of a superficial cartilage lesion should be revealed by questioning the short-term conservative response. Arthroscopic joint examination of pain that does not decrease despite conservative treatment or recurs at the end of treatment is the gold standard in early detection of cartilage lesions. Although rare, cartilage lesions can be reported as cruciate ligament injuries on MRI. In this case, if it cannot be distinguished due to the clinical painful knee, the large cartilage lesion can be missed by the decision of conservative ligament repair (Figure 1). MRI methods and difficulties in the diagnosis of cartilage lesions It is often seen that no special classification is used except for recording the presence of cartilage lesions, facial discontinuity and irregularity, and subchondral edema reported by MRI. Therefore, even if it is possible for the clinician to suspect the presence of a superficial cartilage lesion with a good physical examination, it may not be possible to confirm the lesion. Clinically compatible results and sensitivity of MRI are reduced under 1 Tesla power. Sensitivity to cartilage lesions increases in proportion to magnet power. Digital software support STIR imaging, spin echo T1 / T2 cartilage-specific sequence and gradient settings increase sensitivity, so a wide range of sensitivity between 18-80% is reported in the literature. MR-arthrography is useful in detecting the suspicious lesion after a good physical examination, which is not frequently used, but has not found its place in practice. Detection of superficial erosions is difficult, and the possibility of focal focuses outside of the sections is quite strong. Reaching the surface in the presence of MRI subchondral edema Some side lesions may reveal false positivity in 14%. In addition, false-negative rate has been reported to be higher (16-30%), although it varies depending on sensitivity. When degenerative cartilage lesions are widespread and superficial, they may not be demonstrated by MRI even though they are responsible for a significant part of the findings (Figure 2). Although MRI sensitivity is claimed to be 100% in full-thickness lesions, it may not give any MRI findings (Figure 3). Cartilage in small joints such as ankles Detection of dac lesions can be much more misleading. A full-thickness lesion cannot be detected on MRI scans, and extensive talus edema may be false negative (Figure 4). Fragmented flap-style cartilage injuries, which are clinically extremely noisy, often do not show MRI findings (Figure 5). Similarly, extensive-superficial chronic subchondral inflammation can be missed in lesions whose process is over (Figure 6). 54-year-old female patient, diffuse superficial degenerated cartilage loss and softening 43-year-old male patient with complete focal cartilage lesion without MRI findings and peripheral meniscal separation in return 41-year-old male patient, a full-thickness cartilage lesion on the articular surface of the ankle tibia distal end without MRI findings 34-year-old female patient with MRI findings non-giving flap-style cartilage defect A 34-year-old female patient, an explosive superficial chronic cartilage lesion in the medial femoral condyle. Arthroscopy efficacy Arthroscopic diagnostic approach should be among the options of the clinician under the guidance of physical examination in cases of joint pain that does not resolve despite conservative treatment. Arthroscopic diagnosis can explain the clinic by revealing the cartilage softening with dynamic examination as well as video imaging, even if there is no superficial loss. Arthroscopic classifications of cartilage lesions should reveal the topography of the lesion as a focal, large or kissing lesion and should be able to convey sufficient information depending on whether its depth is superficial, moderate or full. However, we could not use a practical and generally accepted classification that defines both features in our clinic. Surface changes Maintaining the habit of defining Outerbridge's popularized cartilage lesions at 4 degrees, we preferred to characterize them topographically as focal, large and kissing lesions. Discussion Irle et al. He found 100% efficiency and sensitivity of MRI in injuries extending to the subchondral region, but insufficient in superficial lesions. Similarly, Ochi et al. Increasingly determined the sensitivity in softening, fragmentation, erosion and full thickness lesions as 14.3%, 57.3%, 75% and 100%. Potter et al., In a series of 600 cases, obtained more sensitive results by using the MRI spin echo technique in arthroscopic images according to the Outerbridge classification. In this study, sensitivity was 87%, specificity was 94% and accurate diagnosis was 92%. On the other hand, they found false positive 15% and false negativity 14%. Spiers et al. A prospective study of 58 patients found inadequate physical examination efficacy in terms of MRI in terms of meniscal lesions. In this series, it is significant to emphasize that MRI reduces diagnostic arthroscopy by 29% at the stage of diagnosis and the sensitivity is reported as 68%. Bradella et al. Reported a sensitivity of 64-80% in cartilage lesions. Although Friemert et al found increased sensitivity with the STIR technique in addition to the spin echo technique, the increase in sensitivity in superficial cartilage lesions is not significant. In the study of Macarini et al, it is highly specific to emphasize that the sensitivity may change according to the localization of the cartilage lesion. The similarity between the cartilage injury in the medial femoral condyle and the anterior cruciate ligament rupture in our series is a good example of this study. Emphasizing that the sensitivity may change to magnet power and echo-gradient choices, these studies reveal the importance of clinical evaluation. Result Treatment of superficial cartilage losses, whether traumatic or degenerative, should relieve pain and increase functional capacity by creating a slippery joint surface. In conservative treatment, symptoms rapidly regress as long as the lesion remains within the regeneration limits of the tissue. 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