Publications by authors named "Kengo Shimozaki"

28 Publications

  • Page 1 of 1

Skeletal muscle metabolism on whole-body positron emission tomography during pitching.

J Int Soc Sports Nutr 2021 Mar 6;18(1):21. Epub 2021 Mar 6.

Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-0934, Japan.

Background: Electromyography (EMG) has been used for evaluating skeletal muscle activity during pitching. However, it is difficult to observe the influence of movement on skeletal muscle activity in deep-lying regions of the trunk and extremities using EMG. An alternative method that may be used is the measurement of glucose metabolism of skeletal muscle using positron emission tomography-computed tomography (PET-CT). This technique is a reliable measure of muscle metabolism, demonstrating a high correlation with the intensity of muscle activity. This study aimed to evaluate whole-body skeletal muscle metabolism during pitching using PET-CT.

Methods: Ten uninjured, skilled, adult pitchers, who were active at college or professional level, threw 40 baseballs at maximal effort before an intravenous injection of 37 MBq of F-fluorodeoxyglucose (FDG). Subsequently, additional 40 balls were pitched. PET-CT images were obtained 50 min after FDG injection, and regions of interest were defined within 72 muscles. The standardized uptake value (SUV) of FDG by muscle tissue per unit volume was calculated, and the mean SUV of the pitchers was compared with that of a healthy adult control group who did not exercise before the measurements. Statistical analysis was performed using a t-test, and P < 0.05 was considered statistically significant.

Results: Whole-body PET images showed a significant increase in glucose metabolism in the muscle groups of the fingers and toes in both the throwing and non-throwing sides. Additionally, asymmetric increases in glucose metabolism were observed in the muscles of the thigh.

Conclusions: This is the first study to evaluate whole-body muscle metabolism during pitching using PET-CT. Our findings would be useful in determining the training required for pitchers, and can be further applied to other sporting activities that involve throwing.
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http://dx.doi.org/10.1186/s12970-021-00418-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7937262PMC
March 2021

Clinical study of anatomical ACL reconstruction using a rounded rectangular dilator.

BMC Musculoskelet Disord 2021 Jan 7;22(1):38. Epub 2021 Jan 7.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, 920-0934, Kanazawa, Japan.

Background: The aim of this study was that to compare clinical results between the rounded rectangular femoral tunnel ACL reconstruction (RFTR) and the conventional round femoral tunnel ACL reconstruction using a hamstring tendon. The hypothesis was that ACL reconstruction performed using the rounded rectangular dilator technique was better than that performed using the conventional round femoral tunnel technique in terms of clinical results and bone tunnel enlargement.

Methods: We conducted retrospective study. After exclusions, 40 patients were included in the conventional anatomical single-bundle ACL reconstruction (ASBR) group and 40 patients were included in the RFTR group. The evaluation items were knee stability, Lysholm knee score, IKDC subjective score at 2 years after surgery and bone tunnel enlargement.

Results: The RFTR group had a larger femoral tunnel area (average area, 53.1 ± 4.0 mm vs. 46.1 ± 7.0 mm; P < 0.01), better anteroposterior stability, and higher Lysholm scores than the ASBR group (average side-to-side difference for anterior tibial translation, 0.6 ± 0.8 mm vs. 1.6 ± 1.4 mm; P < 0.01; average Lysholm score, 98.5 ± 2.1 vs. 97.5 ± 3.5; P < 0.01). Further, bone tunnel enlargement ratio was significantly lower in the RFTR group (73 ± 38% vs. 107 ± 41%; P < 0.01).

Conclusions: We designed and developed an original rounded rectangular dilator to perform a novel ACL surgery. This technique can create a larger bone tunnel and improve clinical results than the conventional round anatomical single-bundle ACL reconstruction.
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http://dx.doi.org/10.1186/s12891-020-03913-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7791683PMC
January 2021

Usefulness of lateral femoral cutaneous nerve block in combination with femoral nerve block for anterior cruciate ligament reconstruction: a prospective trial.

Arch Orthop Trauma Surg 2021 Mar 2;141(3):455-460. Epub 2021 Jan 2.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-0934, Japan.

Introduction: The study aimed to compare the combination of femoral nerve block (FNB) with interspace between the popliteal artery and the capsule of posterior knee (IPACK) block (IPACK group) with the combination of FNB with lateral femoral cutaneous nerve (LFCN) block (LFCN group) for postoperative pain control in patients undergoing anterior cruciate ligament (ACL) reconstruction. We hypothesized that the lower pain scores and decreased suppository use would be noted in patients administered a combination of FNB and IPACK block.

Materials And Methods: A non-randomized prospective controlled clinical trial was conducted. The IPACK and LFCN groups included 40 patients each. The patients received IPACK block and LFCN block alternately. Thirty minutes prior to the surgery and after administration of general anesthesia, patients received an ultrasound-guided FNB and IPACK block or LFCN block. After ACL reconstruction, the visual analog scale pain scores were recorded at 30 min, 4 h, 8 h, 12 h, 24 h, 48 h, and 72 h after the surgery. The administration and use of analgesic suppositories were assessed. These measures were compared among the treatment types at each time-point using the Welch's t-test.

Results: Suppository use was significantly less in the LFCN group than in the IPACK group. The pain scores were significantly lower in the LFCN group at 30 min, 4 h, 48 h, and 72 h after the surgery.

Conclusion: The combination of FNB with LFCN block during ACL reconstruction significantly reduces pain in the early postoperative period compared to a combination of FNB with IPACK block.

Level Of Evidence: Prospective control trial, Level II.
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http://dx.doi.org/10.1007/s00402-020-03724-9DOI Listing
March 2021

Flexibility of infrapatellar fat pad affecting anterior knee pain 6 months after anterior cruciate ligament reconstruction with hamstring autograft.

Sci Rep 2020 12 7;10(1):21347. Epub 2020 Dec 7.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.

This study aimed to identify factors affecting anterior knee pain (AKP) after anterior cruciate ligament reconstruction (ACLR) with hamstring tendon autograft using ultrasonography. Forty-two patients were evaluated by ultrasound, 6 months after ACLR. The thickness of the superficial part of the infrapatellar fat pad was measured, as well as the thickness change ratio between the two angles. Color Doppler evaluated the rate of blood flow in the fat pad. AKP was assessed with the Kujala Scale. The correlations between AKP and age, body mass index, the thickness change ratio, and the grade of increased blood flow were examined. Independent variables showing significant correlations with AKP were used for multiple linear regression analysis. There were significant correlations between AKP and age (r = - 0.68), body mass index (r = - 0.37), the thickness change ratio of the fat pad (r = 0.73) and the grade of increased blood flow (r = - 0.42), respectively. Age and the thickness change ratio of the fat pad affected the AKP score (R = 0.56). After ACLR, older age and a decrease in the thickness change ratio of the superficial area of the infrapatellar fat pad appear to affect post-operative AKP after 6 months.
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http://dx.doi.org/10.1038/s41598-020-78406-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7721795PMC
December 2020

Partial resection of the infrapatellar fat pad during anterior cruciate ligament reconstruction has no effect on clinical outcomes including anterior knee pain.

Arch Orthop Trauma Surg 2020 Nov 22;140(11):1751-1757. Epub 2020 Jun 22.

Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.

Background: Anterior knee pain (AKP) is a major complication that occurs after anterior cruciate ligament reconstruction (ACLR), even when hamstring tendon (HT) grafts are used. Damage to the infrapatellar fat pad (IPFP) during arthroscopy can cause AKP. The purpose of this study was to evaluate the influence of IPFP preservation on clinical outcomes, including AKP, in patients who underwent ACLR with HT autografts using the inside-out technique.

Methods: Forty-two patients who underwent primary ACLR with HT autografts were prospectively assessed for 2 years after surgery. They were randomly selected to undergo treatment with as much intercondylar IPFP preservation as possible or with intercondylar IPFP resection to confirm the ACL origin on the femoral and tibial sides, especially the femoral footprint in deep flexion of the knee joint. The total IPFP volume was calculated using sagittal MR images before and 6 months after surgery. The patients completed a subjective knee score questionnaire and were assessed for patellar tendon tenderness and pain with the half-squat test or single-leg hop test at 6 months and 2 years postoperatively.

Results: There were no differences in the patient characteristics, including age, sex, BMI, time from injury to surgery, and meniscus tear. The difference in the total size of the IPFP preserved was significant (P = 0.004). However, there were no significant differences in the subjective knee scores. Moreover, there were no differences in the clinical assessment parameters between the IPFP preservation and resection groups.

Conclusions: The size of the IPFP decreased more in the resection group than in the preservation group at 6 months after surgery. However, partial IPFP resection, which was used to better visualize the origin of the ACL, had no effect on the clinical outcomes, including AKP.

Level Of Evidence: Level II.
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http://dx.doi.org/10.1007/s00402-020-03520-5DOI Listing
November 2020

Autologous Adipose-Derived Stem Cell Sheet Has Meniscus Regeneration-Promoting Effects in a Rabbit Model.

Arthroscopy 2020 10 15;36(10):2698-2707. Epub 2020 Jun 15.

Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa University, Kanazawa, Japan.

Purpose: This study investigated meniscal regeneration-promoting effects of adipose-derived stem cell (ADSC) sheets in a rabbit meniscal defect models.

Methods: ADSCs were extracted from the interscapular fat pad adipose tissue of 42 mature female Japanese white rabbits. Once cells reached confluence at the third passage, the culture medium was supplemented with ascorbic acid. Within a week, the cells in culture formed removable sheets, which were used as ADSC sheets. Cell death (CD) sheets were created by killing ADSCs by freezing to investigate the need for viable ADSCs in ADSC sheets. The anterior half of the medial meniscus from the anterior root to the posterior edge of the medial collateral ligament was removed from both limbs. An autologous ADSC or CD sheet was transplanted to one knee (ADSC sheet or CD sheet group). The contralateral limb was closed without transplantation following meniscal removal (control group). Rabbits were euthanized 4 and 12 weeks after transplantation to harvest the entire medial menisci. The meniscal tissue area, transverse diameter on the inside of the medial collateral ligament, and histologic score were compared between the 3 groups.

Results: The area and transverse diameter of regenerated tissues were larger in the ADSC sheet group than in the control group at 4 and 12 weeks. Further, the histologic score in the ADSC sheet group (8) was significantly greater than that in the control group (4.5) at 4 weeks (P = .02) and greater than that in the CD sheet group (9) (ADSC = 12.5, P = .009) and control group (6) (ADSC = 12.5, P = .0003) at 12 weeks.

Conclusions: Transplantation of the ADSC sheet into the meniscal defect increased the volume and improved the histologic score of the regenerated meniscal tissue. ADSC sheets may have meniscal regeneration-promoting effects in a rabbit model with meniscal defects.

Clinical Relevance: ADSC sheets do not require a scaffold for implantation in the rabbit model, and this evidence suggests that some tissue regeneration occurs at the site of a surgically created meniscal defect.
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http://dx.doi.org/10.1016/j.arthro.2020.06.004DOI Listing
October 2020

Intraoperative fluoroscopy shows better agreement and interchangeability in tibial tunnel location during single bundle anterior cruciate ligament reconstruction with postoperative three-dimensional computed tomography compared with an intraoperative image-free navigation system.

Knee 2020 Jun 13;27(3):809-816. Epub 2020 Mar 13.

Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan.

Background: Fluoroscopy and navigation systems provide an accurate and reproducible method of guiding anatomical tunnel positioning during anterior cruciate ligament reconstruction (ACLR). The aim was to evaluate the differences in tibial tunnel location assessed by both an intraoperative navigation system and fluoroscopy, validated using a one-week postoperative three-dimensional computed tomography (3DCT).

Methods: The tibial tunnel location in a consecutive series of 35 patients who received a single-bundle ACLR was evaluated by intraoperative navigation system, fluoroscopic image and compared with postoperative 3DCT position. The location to the anterior-posterior (AP) and medial-lateral (ML) direction were compared between all three methods.

Results: The tibial tunnel locations were 46.7 ± 4.5%, 44.5 ± 1.9%, and 43.6 ± 2.4% in ML direction, and 42.8 ± 7.6%, 37.9 ± 3.8%, and 37.9 ± 3.7% in AP direction using an intraoperative navigation system, fluoroscopic image and postoperative 3DCT, respectively. Significant differences between the navigation system and fluoroscopic image (ML, P = 0.001; AP, P = 0.006), and the navigation system and 3DCT (ML, P = 0.001; AP, P < 0.001) were seen. However, there was no significant difference between fluoroscopy and 3DCT (ML, P = 0.315; AP, P = 0.999). There was a significant lack of agreement for analyses measured using a navigation system and 3DCT. Fluoroscopy and 3DCT demonstrated an acceptable agreement (ML, r = -0.21, P = 0.232; AP, r = 0.04, P = 0.826).

Conclusions: A tibial tunnel location assessed by intraoperative fluoroscopy shows better agreement and interchangeability with one-week postoperative 3DCT validation during single-bundle ACLR compared with an intraoperative image-free navigation system.
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http://dx.doi.org/10.1016/j.knee.2020.02.017DOI Listing
June 2020

Partial lateral meniscus anterior root injuries during anatomical single-bundle anterior cruciate ligament reconstruction are likely to occur in women with small skeletons.

Knee Surg Sports Traumatol Arthrosc 2020 Nov 14;28(11):3517-3523. Epub 2020 Feb 14.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan.

Purpose: This study aimed to investigate the occurrence and characteristics of lateral meniscus anterior root injuries during anatomical single-bundle anterior cruciate ligament (ACL) reconstruction.

Methods: Between 2011 and 2018, 70 women who had ACL injuries without lateral meniscal tears underwent anatomical single-bundle ACL reconstruction. Using computed tomography, the anatomical relationship between the predicted lateral meniscus anterior root insertion and the tibial tunnel was retrospectively assessed, and the patients were divided into partial lateral meniscus anterior root injury and intact groups. The demographic characteristics, the distances between bony landmarks, the tibial tunnel sizes, and lateral meniscal extrusion assessed by magnetic resonance imaging were compared between the two groups.

Results: Thirteen of the 70 patients had suspected partial lateral meniscus anterior root injuries. Patient height was significantly shorter in the injury group than in the intact group (157.7 ± 6.4 vs. 161.4 ± 5.4 cm: p = 0.03); the distance from the apex to the bottom of the slope of the medial intercondylar ridge was significantly shorter in the injury group than in the intact group (15.1 ± 1.9 vs. 16.7 ± 1.4 mm: p = 0.001).

Conclusions: Partial lateral meniscus anterior root injury during anatomical single-bundle ACL reconstruction was suspected in 18% of cases. Patient height and the distance between bony landmarks were significantly shorter in the injury group than in the intact group. Surgeons should understand that even a slight deviation of the tibial tunnel position can lead to partial lateral meniscus anterior root injury in patients with small skeletons.

Level Of Evidence: IV.
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http://dx.doi.org/10.1007/s00167-020-05896-8DOI Listing
November 2020

Comparison of muscle activity, strength, and balance, before and after a 6-month training using the FIFA11+ program (part 2).

J Orthop Surg (Hong Kong) 2020 Jan-Apr;28(1):2309499019891541

Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.

Background: Sports injury prevention training programs have been reported to be effective in decreasing the incidence of injuries. The aim of this study was to evaluate the effects of a 6-month training period, using part 2 of the FIFA11+ program (the Fédération Internationale de Football), on the activation and strength of core and lower limb muscles and on static and dynamic balance performance.

Study Design: Case series; level of evidence, 4.

Methods: Eight college male soccer players, aged mean 20.4 ± 0.5 years old, completed the FIFA11+ program at least three times per week for 6 months. The following variables were measured both before and after the 6-month training program: activities of more than 30 muscles (core and lower limb muscles), measured using the standardized uptake values of 18F-fluorodeoxyglucose on positron emission tomography; isokinetic strength of the knee flexor and extensor and hip abductor muscles, measured at 60° s; static balance over a 60-s period, measured using a gravicorder; and dynamic balance, measured using the star excursion balance test.

Results: Training improved the activity levels of core (obliquus externus abdominis and erector spinae) and lower limb (tibialis anterior) muscles ( ≤ 0.03), corrected the between-limb difference in the activation of the semimembranosus and improved dynamic balance, with a greater training effect on the nondominant limb ( ≤ 0.02). Training also improved the knee flexor force of the nondominant lower limb ( = 0.02).

Conclusion: Routine performance of the FIFA11+ program can improve the activation of core and lower limb muscles, with a concomitant improvement in dynamic balance. These improvements could be beneficial in lowering the risk of sports-related injuries.
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http://dx.doi.org/10.1177/2309499019891541DOI Listing
December 2020

No superiority of dextrose injections over placebo injections for Osgood-Schlatter disease: a prospective randomized double-blind study.

Arch Orthop Trauma Surg 2020 Feb 11;140(2):197-202. Epub 2019 Nov 11.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.

Purpose: Osgood-Schlatter disease (OSD) is a traction apophysitis of the tibial tuberosity. Patellar tendinopathy and deep infrapatellar bursitis have recently been shown to contribute to pain in patients with OSD. We compared the effects of dextrose injection and saline injection.

Methods: We performed a clinical trial from April 2012 to January 2016 and included 49 knees from 37 boys and 1 girl (mean age, 12.3 ± 1.1 years) for whom conventional conservative therapy for > 1 month was ineffective. They were randomly assigned to receive double-blind injections of 1% lidocaine (1 mL) with 20% dextrose (1 mL; dextrose group) or 1% lidocaine (1 mL) with saline (1 mL; saline group). Injections were administered monthly for 3 months by a single investigator. The Victorian Institute of Sport Assessment (VISA) score was used to evaluate anterior knee pain.

Results: Overall, 43 knees were included; 6 knees were lost to follow-up. The mean pre-injection VISA scores in the dextrose and saline groups were 58.7 ± 18.3 and 63.4 ± 16.4, respectively. No significant differences were found between the two groups at any time point. The mean VISA score before injections significantly increased at the 1-month follow-up in both groups (P < .01). The injection had no adverse effects.

Conclusions: We were not able to show the efficacy of dextrose injections compared to that of saline.

Level Of Evidence: Randomized controlled trial. Level I.
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http://dx.doi.org/10.1007/s00402-019-03297-2DOI Listing
February 2020

Internal Oblique Muscle Strain on the Side of the Dominant Arm in a Representative Handball Player.

Curr Sports Med Rep 2019 Oct;18(10):358-360

Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, JAPAN.

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http://dx.doi.org/10.1249/JSR.0000000000000640DOI Listing
October 2019

Investigation of extrusion of the medial meniscus under full weight-loading conditions using upright weight-loading magnetic resonance imaging and ultrasonography.

J Orthop Sci 2020 Jul 5;25(4):652-657. Epub 2019 Oct 5.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan.

Background: Meniscal morphology under full weight-loading conditions is currently unknown. This study aimed to evaluate extrusion in the medial meniscus between unloaded and upright-loaded conditions in healthy adults using upright magnetic resonance imaging (MRI) and ultrasonography and to investigate the relationship between MRI and ultrasonography in upright-loaded conditions.

Methods: Eighteen healthy adult volunteers (13 men and 5 women) participated in the study. MRI and ultrasonography were performed with patients in the supine, double-leg upright (DLU), and single-leg upright (SLU) positions. Medial, anterior, and posterior extrusions of the medial meniscus against the tibial edge were evaluated and compared across the three positions. Medial extrusion correlations between MRI and ultrasonography were examined. Demographic data and hip-knee-ankle (HKA) angles were measured and correlated with changes in the medial extrusion. The medial meniscal extrusions detected via MRI and ultrasonography were compared across the three positions. Correlations were examined using Pearson's correlation coefficients.

Results: Negative correlations were found between the change in medial extrusion of the medial meniscus and HKA angle (MRI: r = -0.52, ultrasonography: r = -0.51). Although no significant differences among the three conditions were observed for the anterior and posterior extrusions of the medial meniscus, the medial extrusion of the medial meniscus was significantly greater in DLU and SLU positions than that in the supine position for MRI and ultrasonography (P < 0.05). Positive correlations for the medial extrusion of the medial meniscus were found between MRI and ultrasonography in all three positions (supine: r = 0.74, DLU; r = 0.71, SLU; r = 0.61).

Conclusions: Although no significant differences in anterior and posterior extrusions of the medial meniscus were seen across the studied positions, the medial meniscus was found to undergo significant medial extrusion during upright weight-loading conditions. The strong correlation between MRI and ultrasonography highlighted the usefulness of ultrasonography.

Level Of Evidence: Level IV.
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http://dx.doi.org/10.1016/j.jos.2019.09.009DOI Listing
July 2020

Relationship between the deep flexion of the knee joint and the dynamics of the infrapatellar fat pad after anterior cruciate ligament reconstruction via ultrasonography.

J Phys Ther Sci 2019 Jul 9;31(7):569-572. Epub 2019 Jul 9.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Japan.

[Purpose] A sufficient flexion angle of the knee joint after knee surgery leads to higher quality of their life; therefore, here we investigated the relationship between the dynamics of the infrapatellar fat pad and seiza-style sitting via ultrasonography. [Participants and Methods] Twenty-eight patients were enrolled 3 months post-operatively after anterior cruciate reconstruction. They were divided into a "possible" group and "impossible" group, according to whether they could sit in the seiza style. The thickness of the superficial part of the infrapatellar fat pad was measured at 10° and 90° knee flexion on reconstructed knees in the sitting position via ultrasound evaluation. Images were taken to capture the patella apex and tibial tuberosity. The thickness of the superficial part of the infrapatellar fat pad was measured, and the thickness change ratio was calculated. The characteristics of each group were compared. [Results] The superficial part of the infrapatellar fat pad was significantly thinner in the possible group at a 10° knee flexion. The thickness change ratio of the infrapatellar fat pad was significantly greater in the possible group. [Conclusion] The thickness of the infrapatellar fat pad at a 10° knee flexion and the thickness change ratio of the infrapatellar fat pad could affect the possibility of sitting in the seiza style.
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http://dx.doi.org/10.1589/jpts.31.569DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6642903PMC
July 2019

Incidence of injury in young handball players during national competition: A 6-year survey.

J Orthop Sci 2020 Jul 4;25(4):677-681. Epub 2019 Jul 4.

Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa-city, 920-8641, Japan.

Background: An updated injury surveillance of young handball players is needed because of the increased risk of injury in recent handball games with increased intensity. This study examined acute injuries in young handball players during games.

Methods: We retrospectively assessed the injuries occurring during 6 national competitions, including 550 games from 2013 to 2018, held in March of each year. All players were 13 or 14 years old.

Results: In total, 169 injuries were reported. The number of match injuries per 1000 player hours was 26.5. The injury incidence in boys was higher than that in girls (p = 0.001). No significant differences were found in injury incidence according to the position and date during the tournament (p = 0.108 and 0.483, respectively). Of all injuries, 43.2% were in the lower extremities and 20.7% affected the upper extremities. Most injuries occurred in the head/face (n = 53, 31.4%), followed by the ankle/foot (n = 41, 24.3%), knee (n = 23, 13.6%), and wrist/hand (n = 22, 13%). The most common injury type was sprain (n = 64, 37.9%), followed by contusion (n = 50, 30.0%) and wound (n = 35, 20.7%). In field players, ankle sprain was the most frequent diagnosis, followed by head/face wound and contusion. In contrast, contusion was the main cause of injury in goalkeepers, followed by wound on the head/face.

Conclusions: Preventive measures focussing on sprains in the lower extremity and improved skill in ball-handling technique should be considered to prevent head/face and wrist/hand injuries, especially in boys.

Study Design: Retrospective cohort study.
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http://dx.doi.org/10.1016/j.jos.2019.06.011DOI Listing
July 2020

Ultrasound-guided injection and the pie crust technique for the treatment of symptomatic bipartite patella.

J Med Ultrason (2001) 2019 Oct 1;46(4):497-502. Epub 2019 Jul 1.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.

Purpose: This study aimed to investigate the results of a new treatment procedure (ultrasound-guided injection and the "pie crust" technique for lengthening of capsular tendon structures) for symptomatic bipartite patella.

Methods: We retrospectively investigated patient outcomes following the treatment of symptomatic type III bipartite patella with our new technique. Fifteen knees in 14 boys (mean age, 13.0 ± 1.7 years) were included. The procedure involved the injection of 1% lidocaine (2 mL) and triamcinolone acetonide (5 mg) between the patella and fragment. We then punctured 10 sites from one skin puncture to extend lateral capsular tendon structures. The patients were clinically assessed using the Victorian Institute of Sports Assessment (VISA) score before and 1 week, 1 month, and 3 months after the procedure. Patients were also evaluated for complications.

Results: The average VISA score was 45.7 ± 4.7 before treatment, 70.6 ± 7.3 at 1 week post-treatment, 84.4 ± 16.6 at 1 month post-treatment, and 88.6 ± 18.3 at 3 months post-treatment. The VISA score improvement from before the procedure to 1 week after the procedure was significant (P < 0.01). There were no complications in any of the patients, who returned to sports at a mean of 4.2 ± 2.1 weeks after the procedure. However, two patients (three knees) had poor results and could not return to action; thus, they underwent surgical treatment 4 months after the ultrasonographic procedure.

Conclusions: This novel method is a potential treatment option for the management of symptomatic bipartite patella in outpatient clinics.
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http://dx.doi.org/10.1007/s10396-019-00960-4DOI Listing
October 2019

Lateral meniscus posterior root tear in anterior cruciate ligament injury can be detected using MRI-specific signs in combination but not individually.

Knee Surg Sports Traumatol Arthrosc 2020 Oct 28;28(10):3094-3100. Epub 2019 Jun 28.

Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.

Purpose: The purpose of this study was to evaluate (1) the diagnostic value of using single and multiple magnetic resonance imaging (MRI) findings for lateral meniscus posterior root tear (LMPRT) detection in anterior cruciate ligament (ACL) injury and (2) the influence of time from ACL injury to MRI assessment on LMPRT detection. Finally, we investigated the relationship between LMPRT and bone bruising.

Methods: In all, 231 knees with ACL injury, 32 with LMPRT, were retrospectively assessed. Cases were evaluated for LMPRT based on the cleft, ghost, and truncated triangle signs, used individually or in combination. To assess the influence of the timing of the MRI assessment on LMPRT detection, we also evaluated the overall sensitivity, specificity, and accuracy in cases in which MRI was performed within 2 weeks of injury. The number of condyles with bone bruising was assessed and then compared between patients with and without LMPRT.

Results: Although the sensitivity and specificity of the three signs individually were 34.4-65.6% and 94.0-97.0%, when at least one of these signs was positive, the sensitivity and specificity were 84.4% and 90.5%, respectively. However, the diagnostic value of each sign when MRI was performed within 2 weeks of injury was lower than the overall value. There was a significant difference in the number of condyles with bone bruising between the LMPRT (3 ± 1) and non-LMPRT (2 ± 2) groups.

Conclusions: Although the sensitivity of each sign for LMPRT was low, LMPRT could be detected adequately if these signs were used in combination. Therefore, surgeons should detect LMPRT using these three signs in combination, not individually.

Level Of Evidence: IV.
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http://dx.doi.org/10.1007/s00167-019-05599-9DOI Listing
October 2020

Aspergillus terreus spondylodiscitis following an abdominal stab wound: a case report.

J Med Case Rep 2019 Jun 5;13(1):172. Epub 2019 Jun 5.

Department of Orthopaedic Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa City, Ishikawa, 920-8641, Japan.

Background: Aspergillus terreus, a saprophytic fungus, is recognized as an emerging pathogen in various infections in humans. However, bone and joint involvement is uncommon. To the best of our knowledge, only seven cases of spondylodiscitis caused by Aspergillus terreus have been reported previously in humans. We report a case of a patient with Aspergillus terreus spondylodiscitis following an abdominal stab wound.

Case Presentation: A 74-year-old Japanese man with no particular medical history fell from a ladder and sustained a left abdominal stab wound from an L-shaped metal peg. Computed tomography showed the trace of the L-shaped metal peg from the left abdomen to the left rib and left kidney. The scan also showed an anterolateral bone avulsion of the left side of the T12 vertebral body, as well as fractures of the L1 left transverse process and the left 10th-12th ribs. He was hospitalized and treated with conservative therapy for 6 weeks. He was readmitted to the hospital with complaints of sudden back pain, numbness of both legs, and inability to walk 13 weeks after the fall. Magnetic resonance imaging findings were typical of spondylodiscitis. Gadolinium-enhanced T1-weighted magnetic resonance imaging indicated increased signal intensity at T11-T12 vertebral bodies and severe cord compression and epidural abscess at T11-T12 associated with infiltration of soft paravertebral tissues. On the seventh day after admission, he underwent partial laminectomy at T11 and posterior fusion at T9 to L2. The result of his blood culture was negative, but Aspergillus terreus was isolated from the material of T11-T12 intervertebral disc and vertebral bodies. His Aspergillus antigen was positive in a blood examination. Histological examination showed chronic suppurative osteomyelitis. On the 35th day after admission, he underwent anterior fusion at T11 and T12 with a rib bone graft. For 5 months, voriconazole was administered, and he wore a rigid corset. Posterior partial laminectomy at T11 and anterior fusion at T11 and T12 resulted in a good clinical course. The patient's neurological dysfunction was completely recovered, and his back pain disappeared. Two years after the operation, computed tomography was performed and showed bone fusion at T11 and T12. Magnetic resonance imaging revealed no evidence of increased signal intensity at T11-T12 vertebral bodies and severe cord compression and epidural abscess at T11-T12.

Conclusions: To our knowledge, this is the first report of spondylodiscitis caused by Aspergillus terreus after an abdominal penetrating injury. The histological finding of chronic suppurative osteomyelitis and the radiological findings strongly suggested direct inoculation of Aspergillus terreus.
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http://dx.doi.org/10.1186/s13256-019-2109-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6549268PMC
June 2019

The characteristic findings of an inverted-type discoid lateral meniscus tear: a hidden tear pattern.

BMC Musculoskelet Disord 2019 May 17;20(1):223. Epub 2019 May 17.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan.

Background: The purpose of this study was to reveal the clinical history and physical and magnetic resonance imaging (MRI) findings of patients with an inverted-type discoid lateral meniscus (DLM) tear compared with those with a symptomatic and torn discoid meniscus without inverted tear patterns.

Materials And Methods: Between 2014 and 2016, 12 patients underwent arthroscopic partial meniscectomy for an inverted-type DLM tear (inverted group). We age-matched these patients with 12 controls who were extracted from many normal DLM tear cases in the same period (non-inverted group). The assessment items were traumatic history with the onset of pain, the mean duration between the appearance of symptoms and surgery, preoperative knee range of motion (ROM), positive findings on the McMurray test, knee locking or catching, and characteristic MRI findings. These items were compared between the two groups using χ and Student's t-tests.

Result: All patients in the inverted group had clear trauma with the onset of pain during sports or daily life activities, and 7 of the 12 patients with a non-inverted type of DLM tear had clear trauma. There was a significantly higher rate of traumatic history in the inverted group than in the non-inverted group (P = 0.03). The mean duration between the appearance of symptoms and surgery, preoperative knee ROM, positive findings on the McMurray test, and knee locking or catching were not significantly different between the inverted and non-inverted groups. On MRI, the diagnosis ratio of DLM was significantly higher in the non-inverted group (9/12 cases) than in the inverted group (3/12 cases, P = 0.04). Nine of the 12 inverted-type patients had the characteristic findings of an inverted-type DLM tear, including a duplicated or enlarged posterior horn and blunting of the inner rim, on the sagittal plane of an MRI.

Conclusion: Patients with inverted-type DLM tears had clear trauma and infrequently had the characteristic MRI findings that are observed in patients with normal DLM tears. Physicians should suspect that an inverted-type DLM tear is present during diagnosis and focus on the posterior horn to find the inverted sign on the MRI sagittal plane.

Level Of Evidence: Level III.
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http://dx.doi.org/10.1186/s12891-019-2618-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6524316PMC
May 2019

Use of ultrasonography to evaluate the dynamics of the infrapatellar fat pad after anterior cruciate ligament reconstruction: a feasibility study.

J Med Ultrason (2001) 2019 Jan 19;46(1):147-151. Epub 2018 Nov 19.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.

Purpose: There has been no specific study on the quantitative morphological changes that occur in the infrapatellar fat pad (IPFP) after anterior cruciate ligament (ACL) reconstruction. We used ultrasonography to evaluate the dynamics of the IPFP in knees after ACL reconstruction using the contralateral knees as controls.

Methods: We enrolled 31 patients 3 months after they underwent ACL reconstruction. The thickness of the superficial part of the IPFP was measured using longitudinally oriented ultrasound images of the anterior part of both knees at 90° and 10° flexion. We then used these data to calculate the ratio of the change in thickness.

Results: At 90° knee flexion, the superficial part of the IPFP was significantly thinner in the reconstructed knees (9.3 ± 3.4 mm) than in the contralateral knees (11.8 ± 4.6 mm). The thickness change ratio was significantly smaller in the reconstructed knees (188.6 ± 64.7%) than in the contralateral knees (249.7 ± 73.8%).

Conclusion: When assessed 3 months after ACL reconstruction, the thickness of the superficial part of the IPFP at 90° knee flexion and the thickness change ratio of the IPFP were both significantly lower in the reconstructed knees than in the contralateral knees.
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http://dx.doi.org/10.1007/s10396-018-0917-7DOI Listing
January 2019

Response to Macchi et al. "Letter to the Editor 'Histopathological study of the infrapatellar fat pad in the rat model of patellar tendinopathy: A basic study'".

Knee 2019 01 7;26(1):281. Epub 2018 Nov 7.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.

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http://dx.doi.org/10.1016/j.knee.2018.10.007DOI Listing
January 2019

Incidence rates and characteristics of abnormal lumbar findings and low back pain in child and adolescent weightlifter: A prospective three-year cohort study.

PLoS One 2018 29;13(10):e0206125. Epub 2018 Oct 29.

Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Takara-machi, Kanazawa-shi, Ishikawa-ken, Japan.

Purpose: The purpose of this three-year cohort study was to assess the incidence rates and characteristics of abnormal lumbar findings and low back pain (LBP) in child and adolescent weightlifting athletes using magnetic resonance imaging (MRI) and medical questionnaires. This study evaluated subclinical sports injuries, which in turn may help prevent competition-specific injuries and improve performance levels.

Materials And Methods: Between 2014 and 2016, twelve participants who had been competing in weightlifting events for at least 2 years were enrolled in this study. The mean age of the participants at the start of this study was 11.4 ± 2.0 years, and there were 6 boys and 6 girls. Annual medical questionnaire surveys and lumbar examinations using MRI were performed during the 3-year follow-up. The incidence rates and variations of LBP and abnormal MRI findings were evaluated.

Results: At the start of this study, there were no positive findings of LBP, and abnormal lumbar findings on MRI were observed in only 2 participants. At the 2-year follow-up, 1 participant had LBP, and 8 of 12 participants had abnormal lumbar findings. In the final year, only 3 participants had LBP; however, abnormal lumbar findings were observed on MRI in 11 participants. Among these, lumbar spondylolysis was observed in 4 participants, lumbar disc protrusion or extrusion in 2 participants, and lumbar disc degeneration in 9 participants.

Conclusion: This prospective 3-year cohort study of 12 child and adolescent weightlifters revealed abnormal lumbar findings in 11 participants at a high rate on MRI examination. Children and adolescents undergoing resistance training at the competition level could potentially have irreversible changes in the lumbar vertebra without symptoms.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206125PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205614PMC
March 2019

Evaluation of dynamic change in regenerated tendons in a mouse model.

J Exp Orthop 2018 Sep 21;5(1):37. Epub 2018 Sep 21.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.

Background: Using the film model method, the process whereby a substance called tendon gel is secreted from transected tendon ends and changed into a tendon after application of a traction force is known. The objective of this study was to investigate the association between mechanical properties in the early stages of tendon regeneration and time by using the film model method.

Method: Adult male ddY mice, closed colony mice established and maintained in Japan, were prepared for each experimental group. The study animals were 30 mice and were divided into three groups of 10 mice each. Ten specimens of tendon gel secreted from the transected tendon ends were collected on days 10, 15, and 20 postoperatively. While a traction force of 0.00245 N was applied to these specimens, the process of tendon gel changing into a tendon was video recorded for 24 h, and the length of extension was measured over time. Regenerated tendons were stained with hematoxylin and eosin for histological examination. Healing site was studied histologically according to the our maturity score with reference to the Bonar's scale.

Results: The day 10 specimens gradually stretched for 12 h after the start of pulling and transformed into tendons. In contrast, the day 15 and 20 specimens stretched immediately after the start of pulling and transformed into tendons. The day 10 specimens stretched significantly more than the day 15 and 20 specimens (mechanical strain; 0.43 ± 0.26%, 0.03 ± 0.02%, and 0.03 ± 0.01%, respectively)Statistically significant differences were observed in the day 10 specimens than in the day 15 and 20 specimens. (P < 0.017). Using our maturity scores, the day 15 and 20 specimens were more mature than the day 10 specimens. (1.6 ± 0.68, 3.9 ± 0.54, and 4.8 ± 0.64, respectively) Statistically significant differences were observed in the day 10 specimens than in the day 15 and 20 specimens (P < 0.017).

Conclusion: Tendon gel physiologically and histologically matures on or after day 15 and becomes stronger dynamically in mechanical strength after day 15 than after day 10.
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http://dx.doi.org/10.1186/s40634-018-0152-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6150864PMC
September 2018

Histopathological study of the infrapatellar fat pad in the rat model of patellar tendinopathy: A basic study.

Knee 2019 Jan 24;26(1):14-19. Epub 2018 Aug 24.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.

Background: Patellar tendinopathy is difficult to successfully treat. This study aimed to characterize the pathological changes of the infrapatellar fat pad (IPFP) in patellar tendinopathy (PT), and to investigate the influence of PT on the development of fibrotic changes in the IPFP.

Methods: Forty male Wistar rats were randomly divided into PT (n = 20) and control groups (n = 20). Bacterial collagenase I (patellar tendinopathy group) or saline (control) was injected, intratendinous, into the patellar tendon. Rats were sacrificed at week 12. The whole knee joint was sagittally sectioned and stained with hematoxylin-eosin and Masson's trichrome. The IPFP samples were graded according to cellularity, fibrosis, and vascularity. The whole IPFP and blue-stained area was measured. Mann-Whitney U tests were used to compare the between-group differences of each score and quantitative value.

Results: Scores for cellularity were three (2-3) and 0 (0-1) in the PT and control groups, respectively (P < 0.01). Mean scores for fibrosis were two (1-3) and 0 (0-1) in the PT and control groups, respectively (P < 0.01). Mean scores for vascularity were two (2-3) and one (1-1) in the PT and control groups, respectively (P < 0.01). There was a significant difference in the total score between the PT and control groups (seven (5-8) and two (1-3), respectively) (P < 0.01). Average percentages of the fibrous area of the IPFP were 38.2 ± 26.5% and 11.2 ± 3.9% in the patellar tendinopathy and control groups, respectively (P < 0.01).

Conclusion: The IPFP in the patellar tendinopathy group showed greater cellularity, fibrosis, and vascularity than the control group.
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http://dx.doi.org/10.1016/j.knee.2018.07.016DOI Listing
January 2019

No difference in the graft shift between a round and a rounded rectangular femoral tunnel for anterior cruciate ligament reconstruction: an experimental study.

Arch Orthop Trauma Surg 2018 Sep 16;138(9):1249-1255. Epub 2018 May 16.

Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa University, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.

Introduction: We developed a novel technique of creating a rounded rectangular femoral bone tunnel for anatomical, single-bundle, autologous hamstring tendon anterior cruciate ligament (ACL) reconstruction. Although this tunnel has many advantages, its non-circular shape has raised concerns regarding excessive graft shift within the bone tunnel. This study aimed to compare the graft shift between round and rounded rectangular tunnels using a graft diameter tester for simulating the femoral bone tunnel.

Materials And Methods: Seven semitendinosus tendon grafts harvested from fresh-frozen cadavers were prepared by removing all excess soft tissue. The two ends of a double-fold hamstring tendon were sutured using a baseball stitch and then looped over a TightRope (Arthrex Co., Ltd., Naples, Florida, USA) to make a fourfold graft. The diameter of the graft was standardized to 8 mm using a round graft diameter tester. A round and an original rounded rectangular graft diameter tester were used for simulating the respective femoral bone tunnels. The graft was inserted into the tunnel, with the TightRope positioned on the outside of the tunnel. The distal end of the graft was tensioned to 40 N at an angle of 75° to reproduce the most severe graft bending angle. Digital photographs of the tunnel aperture taken at each simulated tunnel and the range of graft shift in the simulated tunnel were analyzed by ImageJ software. Statistical analyses were performed using the Tukey test. P < 0.05 was considered to be significant.

Results: There were no significant differences between the round and the rounded rectangular tunnel groups (P > 0.05) in terms of graft shift, gap area, and graft shift ratio.

Conclusion: In a simulated ACL reconstruction, there is no difference in the graft shift between a round and a rounded rectangular bone tunnel.
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http://dx.doi.org/10.1007/s00402-018-2958-1DOI Listing
September 2018

Greater body mass index and hip abduction muscle strength predict noncontact anterior cruciate ligament injury in female Japanese high school basketball players.

Knee Surg Sports Traumatol Arthrosc 2018 Oct 6;26(10):3004-3011. Epub 2018 Mar 6.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.

Purpose: This 3-year prospective study assessed risk factors for noncontact anterior cruciate ligament (ACL) injuries in female Japanese high school basketball players. Players suffering noncontact ACL injuries were assumed to demonstrate poorer hip abductor, knee flexor, and knee extensor muscle strength, as well as static balance, than those without injuries.

Methods: One hundred and ninety-five new female high school basketball players underwent baseline examinations for various parameters during their first year of high school. After the baseline data were collected, all ACL injuries occurring over the subsequent 3 years were recorded. The assessment parameters between the noncontact ACL injury group and the control group were compared.

Results: Of the 195 players, 24 were excluded due to pre-existing injuries present during the initial examination, quitting the basketball club during the follow-up period, or missing data. The remaining 171 players were observed for 3 years; unilateral noncontact ACL injuries were occurred in 12 players. Significantly lower general joint laxity and greater hip abductor strength were observed in the ACL injury group than in the control group. Body mass index (BMI) and hip abductor strength were significantly greater in the ACL injury group than in the control group, based on logistic regression analysis.

Conclusions: Greater BMI and hip abductor muscle strength were independent risk factors for noncontact ACL injuries in female Japanese high school basketball players. Although performing complete screens may be difficult, attention should be given to ACL injuries, particularly in highly competitive players with strong muscles.

Level Of Evidence: III.
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http://dx.doi.org/10.1007/s00167-018-4888-4DOI Listing
October 2018

Two-dimensional motion analysis of dynamic knee valgus identifies female high school athletes at risk of non-contact anterior cruciate ligament injury.

Knee Surg Sports Traumatol Arthrosc 2018 Feb 24;26(2):442-447. Epub 2017 Aug 24.

Department of Orthopaedic Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.

Purpose: Female athletes are at greater risk of non-contact ACL injury. Three-dimensional kinematic analyses have shown that at-risk female athletes have a greater knee valgus angle during drop jumping. The purpose of this study was to evaluate the relationship between knee valgus angle and non-contact ACL injury in young female athletes using coronal-plane two-dimensional (2D) kinematic analyses of single-leg landing.

Methods: Two hundred ninety-one female high school athletes newly enrolled in basketball and handball clubs were assessed. Dynamic knee valgus was analysed during single-leg drop jumps using 2D coronal images at hallux-ground contact and at maximal knee valgus. All subjects were followed up for 3 years for ACL injury. Twenty-eight (9.6%) of 291 athletes had ACL rupture, including 27 non-contact ACL injuries. The injured group of 27 knees with non-contact ACL injury was compared with a control group of 27 randomly selected uninjured knees. The relationship between initial 2D movement analysis results and subsequent ACL injury was investigated.

Results: Dynamic knee valgus was significantly greater in the injured group compared to the control group at hallux-ground contact (2.1 ± 2.4 vs. 0.4 ± 2.2 cm, P = 0.006) and at maximal knee valgus (8.3 ± 4.3 vs. 5.1 ± 4.1 cm, P = 0.007).

Conclusion: The results of this study confirm that dynamic knee valgus is a potential risk factor for non-contact ACL injury in female high school athletes. Fully understanding the risk factors that increase dynamic knee valgus will help in designing more appropriate training and interventional strategies to prevent injuries in at-risk athletes.

Level Of Evidence: Prognostic studies, Level II.
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http://dx.doi.org/10.1007/s00167-017-4681-9DOI Listing
February 2018

Thoracic spondylolisthesis and spinal cord compression in diffuse idiopathic skeletal hyperostosis: a case report.

J Med Case Rep 2017 Apr 1;11(1):90. Epub 2017 Apr 1.

Department of Orthopaedic Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa City, Ishikawa, 920-8641, Japan.

Background: Diffuse idiopathic skeletal hyperostosis has long been regarded as a benign asymptomatic clinical entity with an innocuous clinical course. Neurological complications are rare in diffuse idiopathic skeletal hyperostosis. However, if they do occur, the consequences are often significant enough to warrant major neurosurgical intervention. Neurological complications occur when the pathological process of ossification in diffuse idiopathic skeletal hyperostosis extends to other vertebral ligaments, causing ossification of the posterior longitudinal ligaments and/or ossification of the ligamentum flavum. Thoracic spondylolisthesis with spinal cord compression in diffuse idiopathic skeletal hyperostosis has not previously been reported in the literature.

Case Presentation: A 78-year-old Japanese man presented with a 6-month history of gait disturbance. A magnetic resonance imaging scan of his cervical and thoracic spine revealed anterior spondylolisthesis and severe cord compression at T3 to T4 and T10 to T11, as well as high signal intensity in a T2-weighted image at T10/11. Computed tomography revealed diffuse idiopathic skeletal hyperostosis at T4 to T10. He underwent partial laminectomy of T10 and posterior fusion of T9 to T12. The postoperative magnetic resonance imaging revealed resolution of the spinal cord compression and an improvement in the high signal intensity on the T2-weighted image.

Conclusions: We report the first case of thoracic spondylolisthesis and spinal cord compression in diffuse idiopathic skeletal hyperostosis. Neurosurgical intervention resulted in a significant improvement of our patient's neurological symptoms.
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http://dx.doi.org/10.1186/s13256-017-1252-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5376279PMC
April 2017

Ipsilateral Medial and Lateral Discoid Meniscus with Medial Meniscus Tear.

J Orthop Case Rep 2016 Sep-Oct;6(4):9-12

Department of Orthopaedic Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa-Shi, Ishikawa-Ken 920-8641, Japan.

Introduction: Discoid meniscus is a well-documented knee pathology, and there are many cases of medial or lateral discoid meniscus reported in the literature. However, ipsilateral concurrent medial and lateral discoid meniscus is very rare, and only a few cases have been reported. Herein, we report a case of concurrent medial and lateral discoid meniscus.

Case Report: A 27-year-old Japanese man complained of pain on medial joint space in his right knee that was diagnosed as a complete medial and lateral discoid meniscus. In magnetic resonance imaging, although the lateral discoid meniscus had no tear, the medial discoid meniscus had a horizontal tear. Arthroscopic examination of his right knee similarly revealed that the medial discoid meniscus had a horizontal tear. In addition, the discoid medial meniscus also had an anomalous insertion to the anterior cruciate ligament, and there was also mild fibrillation of the medial tibial cartilage surface. We performed arthroscopic partial meniscectomy for the torn medial discoid meniscus but not for the asymptomatic lateral discoid meniscus. The latest follow-up at 18 months indicated satisfactory results.

Conclusion: We report a rare case of ipsilateral medial and lateral discoid meniscus with medial meniscus tear. The medial discoid meniscus with tear was treated with partial meniscectomy, whereas the lateral discoid meniscus without tear was only followed up.
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http://dx.doi.org/10.13107/jocr.2250-0685.546DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5288636PMC
February 2017
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