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In a Turkish League Against Rheumatism (TLAR) project, evidence-based recommendations for the management of knee osteoarthritis (OA) was developed for the first time in our country in 2012 (TLAR-2012). In accordance with developing medical knowledge and scientific evidence, recommendations were updated. The committee was composed of 22 physical medicine and rehabilitation specialists (4 have rheumatology subspeciality also) and an orthopaedic surgeon. Systematic literature search were applied on Pubmed, Embase, Cochrane and Turkish Medical Index for the dates between January the 1st 2012 and January the 29th of 2015. The articles were assessed for quality and classified according to hierarchy for the level of evidence, and the selected ones sent to committee members electronically. They were asked to develop new recommendations. In the meeting in 2015, the format of the recommendations was decided to be patient-based and considering the grade and the severity of the disease. By the discussion of the each item under the light of new evidences, the final recommendations were developed. Each item was voted electronically on a 10-cm visual analogue scale (VAS) and the strength of recommendation (SoR) was calculated. In the light of evidences, totally 11 titles of recommendations were developed; the first 7 were applicable to each patient in every stages of the disease, remaining were for defined specific clinical situations. The mean SoR value of the recommendations was between 7.44 and 9.93. TLAR-2012 recommendations were updated in a new format. We think that, present recommendations will be beneficial for the physicians who manage, as well as the patients who suffer from the disease.

The biological response of the muscles around the knee in chronic ligamentous instability was investigated in an animal study. There were four groups of 6- to 9-month-old adult New Zealand albino rabbits (2500-3300 g). The animals were divided into groups according to the ligament that was surgically sectioned: group A anterior cruciate ligament (ACL), group B medial collateral ligament (MCL), group C both ACL and MCL, and group D served as the control group undergoing no surgical intervention. Three months after surgery, biopsy specimens of the vastus lateralis, rectus femoris, biceps femoris, extensor digitorum longus, and gastrocnemius muscles of the rabbits were obtained. Electron-microscopic cross-sections of the biopsy specimens were evaluated using the new predetermined atrophy parameters. Atrophy was found in the biopsy specimens of the quadriceps muscles in groups A and C (p<0.005). Unimportant changes were seen in the hamstrings, extensor digitorum longus, and gastrocnemius muscles (p>0.05). Only in the group undergoing MCL dissection were no changes observed in the muscles (p>0.05). It is concluded that ACL lesions affect the biomechanics of the knee negatively and this situation causes atrophy, especially in the quadriceps muscle. An MCL lesion alone does not cause an important problem in the surrounding musculature, probably because of its spontaneous healing capacity. New criteria for assessment of atrophy in the muscles employing electron-microscopic evaluation are suggested.

Objectives: Knee osteoarthritis (OA) is a common disease which causes pain, disability and great socioeconomic burden as a result. Turkish League Against Rheumatism (TLAR) initiated a project to prepare national, \"evidence-based recommendations for the management of knee osteoarthritis\" supported by expertopinion in order to assist the physicians who are interested in knee OA in their daily clinical practice. Materials and methods: The expert committee was composed of 25 academicians, 23 of whom were physical medicine and rehabilitation (PM&R) specialists (three also had rheumatology subspeciality) and two were orthopedic surgeons. At the first meeting, the previous guidelines were discussed, and 2008 Osteoarthritis Research Society International (OARSI) recommendations were decided to be taken as the fundamental template for national recommendations. Databases of the Pubmed, Embase, Cochrane, and Turkish Medical Index were used to search the literature, and this was carried out for the period between 2009-2010 for international publications since studies up to 2009 were present in the 2010 OARSI update. No limit was applied for searching of national publications. The selected relevant publications were graded according to evidence level and quality, and were sent to the members who were then asked to suggest propositions according to their experiences, knowledge, and review of the literature. After amalgamation and editing of new proposals, Delphi rounds were started. After five Delphi rounds, the propositions on which the members were in consensus, were discussed with regard to evidence and the \"strength of recommendation\" was determined by measuring on visual analog scale (VAS) for each proposal at the final meeting. Results: Nineteen propositions (one for general principles, nine for nonpharmacologic treatments, seven for pharmacologic treatments, and two for surgical treatments) were accepted as the \"TLAR Evidence-Based Recommendations for the Management of Knee OA\" in consensus as a result of Delphi rounds. Conclusion: Evidence-based recommendations for the management of knee OA were developed by TLAR for the first time in our country. The recommendations should be updated regularly according to new evidence and insights. It is expected that physicians who are interested in knee OA will benefit greatly from this report in their daily clinical practice. Key words: Knee osteoarthritis; TLAR; treatment guideline. Amac: Diz osteoartriti (OA) sik gorulen ve neden oldugu agri ve sakatlik sonucunda sosyoekonomik yuk bindiren bir hastaliktir. Turkiye Romatizma Arastirma ve Savas Dernegi (TRASD) OA tedavisi ile ugrasan hekimlere gunluk klinik uygulamalarinda yardimci olmak amaciyla, uzman gorusleri ile desteklenmis, ulusal \"diz osteoartrit tedavisinde kanita dayali onerileri\" hazirlamak icin bir proje baslatmistir. Gerec ve yontemler: Uzmanlar komitesi 23'u fiziksel tip rehabilitasyon (FTR) uzmani (ucu ayrica romatoloji yan dal uzmani) ikisi ise ortopedi ve travmatoloji uzmani olan 25 akademisyenden olusturulmustur. ilk toplantida konu ile ilgili onceden yayinlanmis rehberler uzerinde tartisilmis ve 2008 Osteoarthritis Research Society International (OARSI) onerilerinin ulusal oneriler icin temel sablon olarak kullanilmasina karar verilmistir. Literatur taramasi icin Pubmed, Embase, Cochrane ve Turk Tip Dizini veritabanlari kullanilmis olup, uluslararasi taramalar icin, 2009 yilina kadar yayinlanmis calismalarin 2010 OARSI guncellemesinde yer almasindan dolayi, 2009-2010 yillarini kapsayacak bir sure kisitlamasi yapilmistir. Ulusal yayinlarin taranmasi icin tarih sinirlamasi yapilmamistir. Konuyla ilgili calismalar arasindan secilen makaleler kanit duzeyi ve kalite acisindan derecelendirilmis, uzmanlar kurulu uyelerine gonderilerek kendilerinden mevcut kanitlar ve kendi bilgi ve deneyimleri isiginda tedavi onerileri hazirlamalari istenmistir. Hazirlanan oneriler bir araya getirilmis, duzeltmeler yapilmis, sonrasinda Delphi turlari baslatilmistir. Bes Delphi turu sonunda, uzerinde gorus birligi saglanan oneriler son toplantida kanitlar isiginda tartisilmis ve vizuel analog skala (VAS) uzerinden degerlendirilerek her bir oneri icin \"oneri gucu\" belirlenmistir. Bulgular: Delphi turlari sonucunda, uzerinde gorus birligi saglanmis olan 19 oneri (biri genel prensip, dokuzu nonfarmakolojik, yedisi farmakolojik ve ikisi cerrahi tedaviler ile ilgili olmak uzere) \"TRASD Diz Osteoartriti Kanita Dayali Tedavi Onerileri\" olarak kabul edilmistir. Sonuc: TRASD tarafindan, ulkemizde diz OA'si ile ilgili ilk kanita-dayali tedavi onerileri olusturulmustur. Bu onerilerin yeni kanitlar ve gorusler isiginda duzenli olarak guncellenmesi gerekmektedir. Bu onerilerin, diz OA'si ile ilgilenen hekimlerin gunluk pratiklerine katkisi olacagi beklenmektedir. Anahtar sozcukler: Diz osteoartriti; TRASD; tedavi rehberi.

The results of external fixation of 57 open fractures of the tibia are presented. We applied external fixation following the debridement, reposition, and stabilization of the fracture, with minimal osteosynthesis by Kirschner wires or screws. In case of infection, we treated pseudarthrosis by posterior grafting. The duration of the application of external fixation was five to 24 weeks (average: 13.5 weeks). The results show that the application of external fixation in the treatment of open fractures has many advantages.