Publications by authors named "Nobuo Adachi"

334 Publications

Comparison of the mechanical properties and mechanical damages to tendon tissue in three suspensory fixation techniques.

Asia Pac J Sports Med Arthrosc Rehabil Technol 2022 Oct 31;30:1-8. Epub 2022 Jul 31.

Dept. of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Background: Anterior cruciate ligament (ACL) injury is the most common traumatic injury to the knee joint. Suspensory fixation has become popular in ACL reconstruction because of its high primary stability, less invasiveness, and surgical convenience. There are two common types of suspensory fixation devices: those with fixed-length and those with adjustable-length loops. Owing to structural differences and differences in initial tensioning techniques, it is expected that mechanical property and damage to the tendons will vary from device to device; however, no literature has examined this so far. The main purpose of this study was to evaluate the damage caused to the tendon by three different suspensory fixation devices. An effective mechanical test was carried out as a prerequisite.

Methods: First, the mechanical properties of simple loop device (SLD) as fixed-length loop device, first-generation, and second-generation adjustable devices (AD1 and AD2) as adjustable-length loop devices were tested (isolated device testing). Second, each device was tested using bovine extensor tendons (specimen testing). Cyclic testing included 2000 cycles; the devices were subsequently displaced until failure, and the ultimate tensile strength was determined using isolated device testing. Six samples of 3 devices were used in each testing experiment. After specimen testing, the surface structure of the tendon was evaluated quantitatively using optical coherence tomography (OCT) and our original histological scoring system.

Results: During isolated device testing, SLD demonstrated the least cyclic displacement, followed by AD1 and AD2. The highest ultimate tensile strength was observed in AD2, followed by SLD and AD1. In specimen testing, the least cyclic displacement was observed in SLD, followed by AD1 and AD2. Histologically, AD1 demonstrated a significantly lower score, with damaged surface morphology, than SLD and AD2. OCT values were significantly higher, with a more disturbing tendon surface structure, in AD1 than in SLD and AD2.

Conclusions: The first-generation adjustable loop device exhibited greatest graft tissue damage at the suspensory site in a clinically relevant setting. The thinner adjustable loop mechanism may have elevated graft damage by frictional stresses during loop adjustment or by repetitive tensioning stresses.
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http://dx.doi.org/10.1016/j.asmart.2022.05.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9343929PMC
October 2022

Knee adduction moment is correlated with the increase in medial meniscus extrusion by dynamic ultrasound in knee osteoarthritis.

Knee 2022 Aug 2;38:82-90. Epub 2022 Aug 2.

Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Background: An increase in medial meniscus extrusion (MME) due to abnormal biomechanical stress leads to knee osteoarthritis (OA) progression. MME evaluation during walking is a key method of detecting dynamic changes in the meniscus, and in combination with motion analysis, can provide a deeper understanding of the mechanisms involved in the increase of MME.

Objective: To validate the feasibility of MME dynamic evaluation in combination with a motion analysis system based on the correlation between the increase in MME and biomechanical factors.

Methods: Twenty-three knees from 23 patients with mild to moderate knee OA were analysed in this study. The medial meniscus during walking was evaluated by ultrasound. The increase in MME was calculated as the difference between the minimum and maximum MME during walking. A three-dimensional motion analysis system was synchronised with the ultrasound and then, biomechanical factors such as knee moment and ground reaction force were evaluated.

Results: The wave patterns of the mediolateral and vertical components of ground reaction forces and knee adduction moment were similar to those in the MME based on a high cross-correlation coefficient (>0.8). The increase in MME was significantly correlated with the peak value of the knee adduction moment (r = 0.54, P = 0.0073) but not with the mediolateral and vertical components of the ground reaction force.

Conclusion: The findings show that knee adduction moment is correlated with an increase in MME during walking and indicates the validity and feasibility of the dynamic evaluation of MME in combination with a motion analysis system.
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http://dx.doi.org/10.1016/j.knee.2022.07.011DOI Listing
August 2022

Clinical Outcomes of Osteochondral Fragment Fixation Versus Microfracture Even for Small Osteochondral Lesions of the Talus.

Am J Sports Med 2022 Jul 28:3635465221109596. Epub 2022 Jul 28.

Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Background: The bone marrow stimulation (BMS) technique is performed for osteochondral lesions of the talus (OLTs) with a lesion size of <100 mm. The lesion defect is covered with fibrocartilage, and the clinical outcomes deteriorate over time. In contrast, the osteochondral fragment fixation can restore the native articular surface. The difference in clinical outcomes between these procedures is unclear.

Purpose: To compare the clinical outcomes of BMS and osteochondral fragment fixation for OLTs and examine the characteristics of patients with poor clinical outcomes of BMS.

Study Design: Cohort study; Level of evidence, 3.

Methods: In total, 62 ankles in 59 patients with OLTs were included. BMS was performed for 26 ankles, and fixation was performed for 36 ankles. Clinical outcomes, including the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Scale and bone marrow edema (BME) as identified on magnetic resonance imaging, were compared between the 2 groups. On computed tomography scans, the lesion location was compared with or without BME in each group.

Results: The AOFAS scores in the fixation group (97.3 ± 4.3 points) were significantly higher than those in the BMS group (91.3 ± 7.7 points), even when the lesion size was <100 mm ( < .05). When comparing the ankles with or without BME in each group, the AOFAS scores at the final follow-up were significantly lower for the ankles with BME (88.6 ± 7.8 points) than for those without BME (95.0 ± 6.1 points) in the BMS group ( < .05). Lesions with BME in the sagittal plane were located more centrally than those without BME in the BMS group. In the fixation group, there were no significant differences in AOFAS scores and location of the lesion in ankles with or without BME.

Conclusion: The clinical outcomes of osteochondral fragment fixation are superior to those of BMS in OLTs, even for lesions sized <100 mm. Fixation is recommended even for small lesions, especially for more centralized lesions in the medial and lateral sides of the talus.
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http://dx.doi.org/10.1177/03635465221109596DOI Listing
July 2022

The role of the oblique medial osteotomy angle during osteochondral fragment fixation in patients with a posteromedial osteochondral lesion of the talus.

J Orthop Sci 2022 Jul 18. Epub 2022 Jul 18.

Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan.

Background: Medial malleolar osteotomy has been widely performed for posteromedial osteochondral lesions of the talus (OLT) to expose the lesion. In osteochondral fragment fixation, bioabsorbable pins should be inserted as perpendicular as possible to obtain the rigid fixation. However, the exposure of the lesion may depend on the osteotomy angle, which affects the pin insertion angles. This study aimed to analyze the relationship between pin insertion and osteotomy angles in the medial malleolar osteotomy.

Methods: Twenty-four ankles of 23 patients were included. The malleolar bisector angle which was calculated from radiographs and actual osteotomy angles were measured on radiographs, and the pin insertion and osteotomy angles were measured using MRI. The intersection angle was defined by the tangential line of the tibial plafond and medial malleolar articular facet, and the bisector of this angle was defined as the malleolar bisector angle. The relationship between pin insertion and osteotomy angles was analyzed.

Results: There was no significant difference between the actual osteotomy (55.7° ± 6.6°) and malleolar bisector angles (57.4° ± 4.3°) on the radiograph. There was a significant correlation between pin insertion and osteotomy angles (rs = 0.601). The pin insertion angle (54.3° ± 5.9°) in the lower actual osteotomy angle than the malleolar bisector angle was smaller than those in the higher actual osteotomy angle (63.4° ± 8.2°).

Conclusions: This study showed the osteotomy angle affected pin insertion angle. The osteotomy angle should not be smaller than the malleolar bisector angle at medial malleolar osteotomy to insert pins as perpendicular as possible for fixation of posteromedial OLTs.
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http://dx.doi.org/10.1016/j.jos.2022.06.016DOI Listing
July 2022

The role of substance P on maintaining ligament homeostasis by inhibiting endochondral ossification during osteoarthritis progression.

Connect Tissue Res 2022 Jul 20:1-11. Epub 2022 Jul 20.

Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Purpose: Osteoarthritis (OA) is characterized by the degeneration of various tissues, including ligaments. However, pathological changes such as chondrogenesis and ossification in ligaments during OA are still unclear. Substance P (SP), a neuropeptide, has various functions including bone metabolism. This study aimed to analyze the expression and function of SP in OA ligaments, and the therapeutic potential of SP agonists in OA mice.

Materials And Methods: Expressions of SP, SOX9, and MMP13 were histologically analyzed in the posterior cruciate ligament (PCL) in humans with OA and Senescence-accelerated mouse-prone 8 (SAMP8) mice as a spontaneous OA model. The effect of SP agonists on chondrogenesis was evaluated using human ligament cells. Finally, SP agonists were administered intraperitoneally to destabilized medial meniscus (DMM) mice, and the PCL was histologically evaluated.

Results: In PCL of humans and mice, the expression of SP, SOX9, and MMP13 was upregulated as OA progressed, but their expression was downregulated in severe degeneration. SP and SOX9 were co-expressed in chondrocyte-like cells. In ligament cells, SP agonists downregulated SOX9, RUNX2, and COL10A1. On evaluating chondrogenesis in ligament cells, pellet diameter was reduced in those treated with the SP agonists compared to those untreated. Administration of SP agonists ameliorated PCL degeneration in DMM mice. The Osteoarthritis Research Society and ligament scores in mice with SP agonists were significantly lower than those without SP agonists.

Conclusions: SP plays an important role in maintaining ligament homeostasis by inhibiting endochondral ossification during OA progression. Targeting SP has therapeutic potential for preventing ligament degeneration.
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http://dx.doi.org/10.1080/03008207.2022.2099847DOI Listing
July 2022

Stepwise decision making for CFL repair in addition to arthroscopic ATFL repair yields good clinical outcomes in chronic lateral ankle instability regardless of the remnant quality.

J Orthop Sci 2022 Jul 6. Epub 2022 Jul 6.

Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan.

Background: Although arthroscopic anterior talofibular ligament (ATFL) repair for chronic lateral ankle instability (CLAI) has been widely performed, there are several issues such as the efficacy of the isolated ATFL repair for the ATFL and calcaneofibular ligament (CFL) injury and the influence of the poor remnant on the clinical outcomes to be discussed. This study aimed to evaluate clinical outcomes of the arthroscopic ATFL repair with the stepwise decision regarding the requirement of CFL repair and the influence of remnant qualities on clinical outcomes.

Methods: Forty-four ankles underwent arthroscopic surgery to repair the lateral ankle ligament for CLAI. After arthroscopic ATFL repair, CFL repair was performed if instability remained. Clinical outcomes including the Karlsson-Peterson (KP) scores, Japanese Society for Surgery of the Foot (JSSF) scale, and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were assessed at the final follow-up. ATFL remnants were classified into excellent, moderate, and poor according to the arthroscopic findings, and the clinical outcomes of each remnant group were compared.

Results: Twenty-five ankles were required for CFL repair after ATFL repair. K-P score was significantly improved from 66.1 ± 5.3 to 94.8 ± 6.5 points (p < 0.01). JSSF scale was significantly improved from 70.5 ± 4.5 to 95.9 ± 6.0 points (p < 0.01). The SAFE-Q was also significantly improved on all subscales. There were no significant differences in clinical outcomes among excellent, moderate, and poor remnants.

Conclusions: Stepwise decision for CFL repair in addition to arthroscopic ATFL repair gave satisfactory clinical outcomes in CLAI regardless of the remnant quality.
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http://dx.doi.org/10.1016/j.jos.2022.06.010DOI Listing
July 2022

Posterior wall blowout on computed tomography after anterior cruciate ligament reconstruction.

J Orthop Sci 2022 Jul 3. Epub 2022 Jul 3.

Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Background: During anterior cruciate ligament (ACL) reconstruction, even when a posterior wall of the femoral bone tunnel is identified, computed tomography (CT) occasionally demonstrates a breach of the posterior femoral cortex of the femoral bone tunnel, i.e., posterior wall blowout, after ACL reconstruction (posterior wall blowout-like phenomenon). This study aimed to investigate the influence of the posterior wall blowout-like phenomenon on clinical outcomes after ACL reconstruction using hamstring tendon.

Methods: A total of 105 patients who underwent CT examination two weeks after ACL reconstruction were enrolled. A cortical suspension device was used for femoral side fixation in all cases. Posterior wall was identified in all cases during the surgery. The side-to-side difference in anterior knee laxity, pivot shift test, Lysholm knee score, the International Knee Documentation Committee (IKDC) subjective form, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were evaluated one year after the surgery. A second CT examination was performed 6-12 months after the surgery, if a posterior wall blowout-like phenomenon was identified in the first CT examination.

Results: Two weeks after the surgery, 16 of the 105 patients showed a posterior wall blowout-like phenomenon. Twelve of the 16 cases demonstrated a regenerated posterior femoral cortex of the femoral bone tunnel on their second CT images. There were no significant differences between the posterior wall blowout-like phenomenon group and the normal posterior wall group in terms of a side-to-side difference in anterior knee laxity (0.4 ± 1.5 mm and 0.1 ± 1.6 mm, respectively), pivot shift test, Lysholm knee score, IKDC score, and KOOS at one year after surgery. The length and diameter of the femoral bone tunnel were not significantly different between the two groups.

Conclusions: Posterior wall blowout-like phenomenon after ACL reconstruction using a cortical suspension device did not negatively influence clinical outcomes.

Level Of Evidence: III - retrospective comparative clinical study.
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http://dx.doi.org/10.1016/j.jos.2022.06.002DOI Listing
July 2022

Dynamic response of medial meniscus extrusion to the lateral wedge insole is correlated with immediate pain reduction in knee osteoarthritis patients: real-time ultrasonographic study.

J Med Ultrason (2001) 2022 Jul 5. Epub 2022 Jul 5.

Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Purpose: To investigate the effect of lateral wedge insole (LWI) on medial meniscus extrusion (MME) observed during dynamic evaluation with ultrasound and its correlation with the alteration in knee pain in patients with knee osteoarthritis (OA).

Methods: This cohort study included 25 participants with knee OA. The medial meniscus was imaged during walking in video mode using ultrasonography. The degree of increase in MME (ΔMME) was calculated as the difference in the value of the maximum and minimum MME. The intensity of knee pain was evaluated immediately after the walking trial using the visual analogue scale (VAS). These measurements were performed with and without the LWI. The participants were categorised into the responder group, which was identified by the constant reduction in the VAS, and the non-responder group.

Results: MME, ΔMME, and knee pain during walking were significantly lower with the LWI than without the LWI (p < 0.01). The reduction in ΔMME with the LWI in the responder group was significantly higher than that in the non-responder group (p < 0.01).

Conclusions: Our findings showed that MME and knee pain during walking decreased with LWI use, especially in patients whose reduction in knee pain was characterised by inhibition in the increase in MME observed during dynamic evaluation with ultrasound.
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http://dx.doi.org/10.1007/s10396-022-01234-2DOI Listing
July 2022

Comparison of the electrophysiological characteristics of tight filum terminale and tethered cord syndrome.

Acta Neurochir (Wien) 2022 Aug 5;164(8):2235-2242. Epub 2022 Jul 5.

Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Purpose: This study aims to characterize tight filum terminale (TFT) in motor evoked potential (MEP) testing by comparing TFT patients with both tethered cord syndrome (TCS) patients and healthy subjects.

Methods: Fifty TFT patients, 18 TCS patients, and 35 healthy volunteers participated in this study. We recorded MEPs following transcranial magnetic stimulation from the bilateral abductor hallucis muscles as well as compound muscle action potentials and F-waves evoked by electrical stimulation of the tibial nerve from the bilateral abductor pollicis brevis muscles. The peripheral conduction time (PCT) was calculated from the latency of the compound action potential and F-wave. Furthermore, the central motor conduction time (CMCT) was calculated by subtracting PCT from MEP latency.

Results: TFT and TCS patients had a significantly longer MEP latency than healthy subjects. PCT in TFT patients was significantly longer than those in TCS patients or healthy subjects. Using the cutoff values for PCT, we were able to diagnose patients with TFT patients with a sensitivity of 72.0% and a specificity of 91.4%.

Conclusion: Prolonged PCT in the MEP test may be a useful indicator for TFT and suggests that MEP may be used as an adjunct diagnostic tool for TFT.
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http://dx.doi.org/10.1007/s00701-022-05298-4DOI Listing
August 2022

Percutaneous Intervertebral-Vacuum Polymethylmethacrylate Injection for Foraminal Stenosis with Degenerative Lumbar Scoliosis.

World Neurosurg 2022 Jul 3. Epub 2022 Jul 3.

Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hiroshima, Japan.

Background: Percutaneous intervertebral-vacuum polymethylmethacrylate injection (PIPI) is a minimally invasive procedure for low back pain in elderly patients with degenerative lumbar scoliosis (DLS). Patients with DLS often have radiculopathy as a result of foraminal stenosis in addition to low back pain. The purpose of this study was to evaluate the clinical and radiologic results of PIPI for foraminal stenosis with radiculopathy in elderly patients with DLS.

Methods: We included patients with de novo DLS aged 65 years or older who underwent PIPI. The presence of an intervertebral vacuum on computed tomography and bone marrow edema on magnetic resonance imaging was required for inclusion. The intersegmental radiologic parameters on plain radiographs and computed tomography and the extent of bone marrow edema on magnetic resonance imaging were measured. The clinical outcomes were evaluated using the visual analog scale (VAS) and Oswestry Disability Index (ODI).

Results: We enrolled 40 patients with DLS who underwent PIPI. There were 16 men and 24 women, and the mean age was 79.0 ± 6.3 years. The mean foraminal height and extent of bone marrow edema showed a significant increase and reduction, respectively, after PIPI (P < 0.05). VAS score for radiculopathy and ODI significantly improved after PIPI (P < 0.01). The minimum clinically important differences in VAS score for radiculopathy and ODI at the final follow-up were 73.9% and 63.6%, respectively.

Conclusions: PIPI is a minimally invasive procedure not only for low back pain but also for radiculopathy in elderly patients with DLS. It leads to intervertebral stabilization and indirect decompression of the foramen.
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http://dx.doi.org/10.1016/j.wneu.2022.06.125DOI Listing
July 2022

Tendon-Specific Dicer Deficient Mice Exhibit Hypoplastic Tendon Through the Downregulation of Tendon-Related Genes and MicroRNAs.

Front Cell Dev Biol 2022 14;10:898428. Epub 2022 Jun 14.

Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Tendon is a fibrous connective tissue, that is, transmitting the forces that permit body movement. However, tendon/ligament biology is still not fully understood and especially, the role of miRNAs in tendon/ligament is sparse and uncharacterized in models. The objectives of this study were to address the function of DICER using mice with tendon/ligament-specific deletion of ( conditional knockout; cKO), and to identify key miRNAs in tendon/ligament. cKO mice exhibited hypoplastic tendons through structurally abnormal collagen fibrils with downregulation of tendon-related genes. The fragility of tendon did not significantly affect the tensile strength of tendon in cKO mice, but they showed larger dorsiflexion angle in gait compared with Control mice. We identified two miRNAs, miR-135a and miR-1247, which were highly expressed in the Achilles tendon of Control mice and were downregulated in the Achilles tendon of cKO mice compared with Control mice. miR-135a mimic increased the expression of tendon-related genes in injured Achilles tendon-derived fibroblasts. In this study, cKO mice exhibited immature tendons in which collagen fibrils have small diameter with the downregulation of tendon-related genes such as transcriptional factor, extracellular matrix, and miRNAs. Thus, DICER plays an important role in tendon maturation, and miR-135a may have the potential to become key miRNA for tendon maturation and healing.
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http://dx.doi.org/10.3389/fcell.2022.898428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9241168PMC
June 2022

Distributional patterns of subchondral bone density and histopathological features of the first tarsometatarsal joint in hallux valgus feet.

BMC Musculoskelet Disord 2022 Jun 14;23(1):569. Epub 2022 Jun 14.

Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551, Japan.

Background: Hypermobility of the first tarsometatarsal (TMT) joint is frequently identified in patients with hallux valgus (HV); however, its association with the development of osteoarthritis in the first TMT joint in such patients remains unknown. The purpose of this study was to clarify the distribution of subchondral bone density of the first TMT joint via computed tomography (CT) using Hounsfield units (HU).

Methods: Patients were divided into three groups: the osteotomy (20 feet; 20 women, mean age: 61.8 years), arthrodesis (23 feet; two men, 21 women, 71.2 years), and control group (patients without HV deformity who had undergone CT scans of the foot; 13 feet; seven men, six women, 29.7 years). The HU ratios were calculated, which were defined as the HU value of each subdivision of the subarticular spongiosa of the first TMT joint [dorsomedial (DM), dorsolateral (DL), plantomedial (PM), and plantolateral (PL)] divided by the HU values of the entire joint surface. The ratios for the osteotomy, arthrodesis, and control groups were compared. The degradation of the articular cartilage in the first TMT joint was histologically graded in the arthrodesis group. Tukey-Kramer multiple comparison analysis was conducted to compare the HU ratios among the three groups, and the histological grade in each subdivision.

Results: The arthrodesis group demonstrated high HU ratios in the DM area of the medial cuneiform, and significantly lower HU ratios in the PL area of the first metatarsal. Lower HU ratios in the DL area were observed in both the osteotomy and the arthrodesis group when compared to that in the medial cuneiform of the control group. The histological evaluation indicated nearly normal articular cartilage for all subdivided areas in both the medial cuneiform and the first metatarsal in patients with severe HV.

Conclusions: Although high subchondral bone density was identified in the DM area of the medial cuneiform in severe HV, only mild degradation was histologically observed in the articular cartilage of the first TMT joint. Our findings suggest that the indications for arthrodesis of the first TMT should be reconsidered based on the severity of the degenerative changes in the first TMT joint.
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http://dx.doi.org/10.1186/s12891-022-05523-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9195286PMC
June 2022

Associations between implant alignment or position and patient-reported outcomes after total hip arthroplasty.

Clin Biomech (Bristol, Avon) 2022 Jul 5;97:105701. Epub 2022 Jun 5.

Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.

Background: We aimed to evaluate the associations between implant alignment/position and patient-reported outcomes following total hip arthroplasty using CT-based simulation software.

Methods: We reviewed hips of 137 patients (27 males, 110 females, mean age: 67.3 years old) who underwent total hip arthroplasty. Radiographic evaluations were based on the software for evaluation of the parameters related to implant alignment/position and femoral/3-dimensional offset using post-operative CT data. Pre-operative and one-year post-operative patient-reported outcomes using Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire scores were evaluated.

Findings: The total and movement scores of normal combined anteversion and stem anteversion angle groups were significantly higher than those of lower and higher groups. The pain and movement scores of decreased femoral offset group were significantly lower than those of restored and increased femoral offset group. There were no significant differences in all scores in cup inclination and anteversion angle, stem coronal alignment, and 3-dimensional femoral offset among groups. Moreover, investigation of the associations between combined anteversion angle/stem anteversion/femoral offset and movement scores revealed that combined anteversion angle and stem anteversion were significantly associated with the movement that needs deep hip flexion and occasionally deep abduction, and high femoral offset was also associated with the movement that needs deep hip flexion.

Interpretation: Surgeons should consider the stem anteversion, stem sagittal alignment, and combined anteversion, in addition to the femoral offset to achieve patient's post-operative satisfaction, although the surgeon may have a relatively larger choice for the implant positioning, especially on the cup side.
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http://dx.doi.org/10.1016/j.clinbiomech.2022.105701DOI Listing
July 2022

Quantitative evaluation of the vertical mobility of the first tarsometatarsal joint during stance phase of gait.

Sci Rep 2022 06 2;12(1):9246. Epub 2022 Jun 2.

Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan.

We determined how the in vivo mobility of the first tarsometatarsal (TMT) joint can be quantified during gait. Twenty-five healthy participants (12 females) with no history of foot disorders were included. Non-invasive ultrasound (US) with a three-dimensional motion analysis (MA) system was used to evaluate the kinematic characteristics of first TMT joint during stance phase of gait. US probe was positioned longitudinally above the first TMT joint and adjusted to its proximal dorsal prominence. Gait analysis was conducted by the MA system starting with the activation of B-mode US video at 80 frames per second and 60-mm depth for simultaneous capture. During stance phase, the first metatarsal was translated dorsally with respect to the medial cuneiform, returning to a neutral level at toe-off in all subjects. During middle stance phase, the medial cuneiform was stable in males but displaced in the plantar direction in females and was the primary contributor to the differences in sagittal mobility observed between groups. Quantitatively measuring sagittal mobility of the first TMT joint could be useful for the early detection of foot abnormalities. The dynamic characteristics of the medial cuneiform during gait in healthy females may be associated with a high prevalence of hallux valgus.
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http://dx.doi.org/10.1038/s41598-022-13425-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9163033PMC
June 2022

Effects of limited previously acquired information about falling height on lower limb biomechanics when individuals are landing with limited visual input.

Clin Biomech (Bristol, Avon) 2022 06 7;96:105661. Epub 2022 May 7.

Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.

Background: Inhibitions in the acquisition of accurate information about the environment can affect control of the lower extremities and lead to anterior cruciate ligament injury. This study aimed to clarify the effects of limited prior knowledge of the height of the fall, as well as limited visual input, on lower limb and trunk motion and ground reaction force during landing.

Methods: Twenty healthy university students were recruited. Drop landings from a 30-cm platform were measured under three conditions: (1) unknown, without prior knowledge of the height of the fall and without visual input; (2) known, with prior knowledge of the height of the fall and without visual input; and (3) control, with prior knowledge of the height of the fall and visual input.

Findings: In the unknown condition, the peak ground reaction force for the vertical and posterior directions was significantly higher than that in the known and control conditions; leg and knee stiffness, ankle joint work, and joint flexion motion of the knee, ankle, and trunk after landing were decreased as well. In the known condition, there were no significant differences in leg and knee stiffness and vertical ground reaction force compared to the control condition.

Interpretation: The results of this study indicate that the risk of anterior cruciate ligament injury during landing increases when individuals have limited visual input and prior knowledge of the height of the fall. This finding suggests that an accurate perception of the surrounding environment may help prevent anterior cruciate ligament injuries.
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http://dx.doi.org/10.1016/j.clinbiomech.2022.105661DOI Listing
June 2022

Evaluation of intervertebral disc degeneration using T2 signal ratio on magnetic resonance imaging.

Eur J Radiol 2022 Jul 13;152:110358. Epub 2022 May 13.

Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Purpose: Intervertebral disc degeneration is assessed clinically by magnetic resonance imaging (MRI). Although some quantitative evaluation methods for MRI under special imaging conditions have been reported, they are widely and generally difficult to use. The aim of this study is to determine if intervertebral disc degeneration can be assessed using the ratio of MRI T2 values of the disc to the spinal cord T2 values.

Methods: Signal ratio was calculated using the T2 signal intensity of the disc and the spinal cord on MRI under common conditions for a new assessment of disc degeneration. T2-weighted images of 100 patients undergoing MRI twice within a year under different imaging conditions, 1.5 T or less and 3.0 T, were used for the assessment. The T2 signal intensity was measured at the center of the discs at L2-3, L3-4, L4-5, L5-S1 and the spinal cord at T12 level. Signal ratio was calculated using these T2 signal intensity values. The ratio of the difference between the first and second values to the mean of the first and second values was calculated to confirm the equivalence of MRI assessments of disc degeneration in the same patient under different imaging conditions.

Results: The equivalence of values between the first MRI and the second MRI in the signal ratio was significantly higher than that in the T2 signal intensity. In addition, the signal ratio was negatively correlated with age and were significantly associated with Pfirrmann grade.

Conclusions: By using the signal ratio, disc degeneration can be evaluated by MRI even under different imaging conditions.
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http://dx.doi.org/10.1016/j.ejrad.2022.110358DOI Listing
July 2022

Authors' Reply to Letter to the Editor.

J Foot Ankle Surg 2022 May-Jun;61(3):674-675

Professor, Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

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http://dx.doi.org/10.1053/j.jfas.2022.01.015DOI Listing
May 2022

Radiographic Factors for Adjacent Vertebral Fractures and Cement Loosening Following Balloon Kyphoplasty in Patients with Osteoporotic Vertebral Fractures.

Spine Surg Relat Res 2022 11;6(2):159-166. Epub 2021 Oct 11.

Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hatsukaichi, Japan.

Introduction: Balloon kyphoplasty (BKP) is a minimally invasive surgical approach for the treatment of osteoporotic vertebral fractures (OVF). Some risks have been reported after treatment with BKP; therefore, it is necessary to determine when BKP does not work. Thus, in this study, we aim to clarify the radiographic predictors of secondary vertebral fractures and cement loosening after BKP for OVF.

Methods: This study enrolled patients with single-level OVF at the thoracolumbar junction (T11-L2) who underwent BKP for the first time between January 2011 and March 2014. The clinical outcomes were evaluated using the visual analog scale (VAS) and a modified Oswestry Disability Index (ODI) at 1 week and 1, 3, 6, and 12 months after surgery. Radiographic assessments were performed preoperatively and within 1 year after BKP using plain radiography and computed tomography.

Results: The 85 patients who met the inclusion criteria underwent BKP. The average age of participants (21 men, 64 women) was 77.8 years (range, 57-92 years). Postoperative VAS and ODI scores were all significantly better than preoperative scores. Polymethyl methacrylate (PMMA)-cement leakage was observed in 18 patients (21.2%) but was asymptomatic in all cases. Secondary vertebral fractures were detected in 20 patients (23.5%), including adjacent levels in 15 patients (17.6%) and non-adjacent levels in 5 patients (5.9%). Rostral bridging osteophyte formation was found to be significantly associated with the occurrence of adjacent vertebral fractures (odds ratio 12.746; =0.010). PMMA-cement loosening was observed in three patients (3.5%). A high prevalence (100%) of bridging osteophytes, vacuum clefts, and spinous process fractures was observed in patients with PMMA-cement loosening. PMMA-cement loosening was found in 3 out of 10 patients with all three of these factors.

Conclusions: Rostral bridging osteophyte formation was determined to be a risk factor for both adjacent vertebral fractures and PMMA-cement loosening.

Level of Evidence: 3.
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http://dx.doi.org/10.22603/ssrr.2021-0112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8995113PMC
October 2021

Spinous Process Fractures in Osteoporotic Vertebral Fractures: A Cross-Sectional Study.

Spine Surg Relat Res 2022 30;6(2):139-144. Epub 2021 Jun 30.

Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Introduction: The purpose of this study was to assess radiological features and clinical scores of osteoporotic vertebral fracture (OVF) accompanied by spinous process fracture (SPF).

Methods: We included painful patients with single-level OVF with intravertebral cleft. SPF was detected using magnetic resonance imaging (MRI) and/or computed tomography (CT). The plain radiographs of the vertebral fractures were evaluated based on the wedging angle of the fractured vertebrae and vertebral instability. We investigated the clinical parameters of age, gender, visual analog scale (VAS) score for low back pain (LBP), Oswestry Disability Index (ODI), and the period from the onset of acute fracture.

Results: MRI and/or CT indicated among 195 patients of OVF with LBP, 41 patients (20.5%) had SPFs. SPFs were observed one level above the fractured vertebral body in 35 patients (85.4%) and at the same level as the fractured vertebral body in 6 patients (14.6%). The prevalence of vertebral fracture of thoracic spine in the SPF-positive group was significantly greater than that in the SPF-negative group. There were no significant differences in age, gender, VAS, ODI, the time period from the onset of acute LBP, wedging angle, and vertebral instability between the presence or absence of SPFs.

Conclusions: SPFs occurred in 20.5% of patients with OVF and LBP. In addition, SPFs often occurred one level above the fractured vertebra, and SPFs with OVF tended to be located in the thoracic spine.
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http://dx.doi.org/10.22603/ssrr.2021-0066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8995117PMC
June 2021

Prevalence of Rotator Cuff Tears Among Older Tennis Players and Its Impact on Clinical Findings and Shoulder Function.

J Sport Rehabil 2022 Apr 23:1-7. Epub 2022 Apr 23.

Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima,Japan.

Context: Tennis is a noncontact sport playable at an individual's own pace. Thus, it is popular among the older adults. It is known that older adults often suffer from rotator cuff tears (RCTs), which may affect tennis activity. However, the prevalence and influence of RCTs on tennis play among older players are not well-known. This study aimed to evaluate the prevalence of RCTs in older tennis players and its impact on physical findings and shoulder function.

Design: A cross-sectional study.

Methods: Fifty-three tennis players (mean age: 70.7 y; range: 60-83 y) participating in a recreational-level tennis tournament were examined in this study. An ultrasonographic examination of both shoulders was performed to detect RCTs. Relationships between RCTs of the dominant shoulder and clinical findings, shoulder pain, and shoulder function including range of motion, shoulder strength, and Single Assessment Numeric Evaluation score, and Disability of the Arm, Shoulder and Hand-Sports Module score were assessed.

Results: RCTs were detected in 19 (36%) dominant shoulders and 6 (11%) nondominant shoulders. Asymptomatic RCTs were detected in 11 (58%) dominant shoulders and 5 (83%) nondominant shoulders. Increased crepitus and more positive results in the empty can test, and infraspinatus test were observed in the dominant shoulders with RCTs than in those without; however, there was no difference in shoulder pain, range of motion; strength; Single Assessment Numeric Evaluation score; and Disability of the Arm, Shoulder and Hand-Sports Module score between the players with and without RCTs.

Conclusions: One-third of the older tennis players in this study had RCTs in the dominant shoulder with some positive physical sign of an RCT. However, shoulder pain and shoulder function did not differ between the players with and without RCTs, suggesting that RCTs had a minor impact on the tennis performance in the participants of this study.
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http://dx.doi.org/10.1123/jsr.2021-0105DOI Listing
April 2022

Equivalent outcomes of ACL revision with over-the-top single and double-bundle reconstruction using hamstring tendon compared to anatomical single and double-bundle reconstruction.

J Exp Orthop 2022 Apr 13;9(1):33. Epub 2022 Apr 13.

Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan.

Purpose: In revision anterior cruciate ligament reconstruction (ACLR), our procedure of choice is the over-the-top route (OTTR) for cases where it is difficult to use a primary bone tunnel or to create a new bone tunnel due to the enlargement or malposition of the bone tunnel. Depending on the condition of the primary bone tunnel, we choose single (bone tunnel or OTTR) or double (bone tunnel or anteromedial (AM) bundle: OTTR /posterolateral (PL) bundle: bone tunnel) for femoral fixation. This study showed the results of single and double OTTR revision ACLR using the hamstring tendon.

Methods: Seventy-eight patients, who underwent revision ACLR using the hamstring tendon and who could be followed up for more than 2 year, were included in this study. The methods of revision ACLR were single in 54 cases (bone tunnel: 24 cases; OTTR method: 30 cases) and double in 24 cases (bone tunnel: 16 cases; OTTR for AM bundle and bone tunnel for PL bundle: eight cases). The cause of re-injury, the meniscus and cartilage injury, the reconstruction method, and the Lysholm score, Lachman test, Pivot-shift test, and the side-to-side difference in the tibial anterior translation were evaluated before and after surgery.

Results: There was no statistically significant difference in the Lyshom score, Lachman / Pivotshift test and side-to-side difference anterior translation of the tibia between the four groups.

Conclusions: The clinical results of single and double OTTR revision ACLR are equivalent to those of anatomic single and double bone tunnel procedures.
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http://dx.doi.org/10.1186/s40634-022-00472-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9008081PMC
April 2022

An association between excessive valgus hindfoot alignment and postural stability during single-leg standing in adolescent athletes.

BMC Sports Sci Med Rehabil 2022 Apr 11;14(1):64. Epub 2022 Apr 11.

Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551, Japan.

Background: Diminished balance is associated with the incidence of ankle and lower extremity injuries in adolescents. Although flexible flatfoot is a common foot condition in pediatric and adolescent populations, the association between balance control and foot morphology remain unclear in adolescent athletes.

Methods: Rearfoot angle in the double-limb standing position, body mass index (BMI), and isometric muscle strength related to the knee joint were retrospectively reviewed in 101 adolescent athletes (75 boys and 26 girls) with a mean age of 14.0 years (range 12-17). Postural stability during single-leg standing on static and dynamic platforms was investigated using Balance System SD in 119 feet without functional ankle instability. The participants were divided according to their rearfoot angle into control (less than 7°) and valgus (greater than or equal to 7°) groups. The measured parameters were compared between the control and valgus groups using Welch's t-test, and P values < 0.05 were considered statistically significant. Multiple regression analysis was conducted to identify the factors that significantly influenced postural control.

Results: The average rearfoot angle was 4.6° in all participants. An excessive valgus rearfoot angle was detected in 53 feet (26.2%). No significant difference was found between the groups in terms of BMI and isometric knee muscle strength. Although no statistical differences were observed in postural stability on the static platform between the control and valgus groups, the valgus group demonstrated poorer postural stability for single-leg standing on the dynamic platform. Multiple regression analysis revealed that BMI and rearfoot angle were significantly associated with a poor postural control on the dynamic platform.

Conclusions: Our findings suggest that excessive rearfoot valgus specifically contributes to the deterioration of postural stability in adolescent athletes, and that rearfoot alignment should be evaluated for the adolescent population to prevent sports-related lower extremity injury.
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http://dx.doi.org/10.1186/s13102-022-00457-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9004062PMC
April 2022

Incomplete Atypical Femoral Fracture Treated by Prophylactic Intramedullary Nail Fixation: A Case Series.

Cureus 2022 Feb 28;14(2):e22725. Epub 2022 Feb 28.

Orthopaedics, Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN.

Long-term bisphosphonate use may be associated with atypical femoral fractures. In this report, we describe three cases of bisphosphonate-associated incomplete atypical femoral fracture, treated by prophylactic intramedullary nail fixation. Patients with long-term intake of bisphosphonates must be carefully monitored; atypical femoral fracture should be suspected in the presence of symptoms such as thigh pain. Its early identification is important to avoid a complete fracture and invasive surgery, and prophylactic fixation is recommended for incomplete atypical femoral fractures.
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http://dx.doi.org/10.7759/cureus.22725DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8968090PMC
February 2022

The therapeutic capacity of bone marrow MSC-derived extracellular vesicles in Achilles tendon healing is passage-dependent and indicated by specific glycans.

FEBS Lett 2022 04 29;596(8):1047-1058. Epub 2022 Mar 29.

Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan.

The therapeutic potential of mesenchymal stem cell (MSC)-derived extracellular vesicles (EVs) for various diseases and tissue repair is attracting attention. Here, EVs from conditioned medium of human bone marrow MSCs at passage 5 (P5) and passage 12 (P12) were analysed using mouse Achilles tendon rupture model and lectin microarray. P5 MSC-EVs accelerated Achilles tendon healing compared with P12 MSC-EVs. Fucose-specific lectin TJA-II was indicated as a glycan marker for therapeutic MSC-EVs. The present study demonstrated that early passaged MSC-EVs promote Achilles tendon healing compared with senescent MSC-EVs. Glycans on MSC-EVs might provide useful tools to establish a quality control and isolation system for therapeutic MSC-EVs in regenerative medicine.
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http://dx.doi.org/10.1002/1873-3468.14333DOI Listing
April 2022

Evaluation of the flexion gap with a distal femoral trial component in posterior-stabilized total knee arthroplasty.

Knee Surg Relat Res 2022 Mar 10;34(1):10. Epub 2022 Mar 10.

Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Japan.

Purpose: A distal femoral trial component was manufactured, and flexion gap size and inclination were evaluated with or without the distal femoral trial component in total knee arthroplasty (TKA). This study aimed to evaluate the effect of the distal femoral trial component on flexion gap size and joint inclination in posterior-stabilized (PS)-TKA.

Materials And Methods: A total of 84 patients with medial osteoarthritis who underwent mobile-bearing PS-TKA using modified gap techniques were included in this retrospective study. The flexion gap size and inclination before and after setting the distal femoral trial component were evaluated and compared with the final gap size and inclination.

Results: The joint gap size and inclination were significantly lower in those with than in those without the distal femoral trial component (P = 0.005, P < 0.001). The final gap size and inclination were similar to the gap size and inclination with the distal trial component (P = 0.468, P = 0.158).

Conclusions: The joint gap size and medial tension in PS-TKA were significantly reduced after setting the distal femoral trial component. The flexion gap measured using the distal femoral trial component was similar to that when the final trial component was set. To more accurately perform the gap technique TKA, the flexion gap should be measured using the distal femoral trial component.
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http://dx.doi.org/10.1186/s43019-022-00142-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8908638PMC
March 2022

Accuracy of total knee arthroplasty using the modified gap technique based on the bone gap: an evaluation of the bone gap with a distal femoral trial component.

Arthroplasty 2021 Apr 5;3(1):17. Epub 2021 Apr 5.

Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Japan.

Background: In total knee arthroplasty (TKA) using the modified gap technique, the soft-tissue balance is measured after osteotomy of the distal femur and proximal tibia (conventional bone gap). However, after osteotomy, the flexion gap size during 90° knee flexion may be larger than that observed after implantation. The tension of the lateral compartment during 90° flexion may also be reduced after osteotomy of the distal femur. We manufactured a distal femoral trial component to reproduce the condition after implantation and prior to posterior condyle osteotomy. This study aimed to evaluate the effect of the trial component on the flexion gap.

Methods: This prospective study included 21 consecutive patients aged 78 years with medial osteoarthritis who underwent cruciate-retaining TKA between February 2017 and March 2018. The postoperative flexion gap size and inclination during 90° flexion were compared between cases with and without the trial component.

Results: The mean joint gap size with the trial component (13.4 ± 0.80 mm) was significantly smaller than that without the trial component (14.7 ± 0.84 mm). The mean gap inclination angle with the trial component (3.7° ± 0.62°) was significantly smaller than that without the trial component (5.5° ± 0.78°).

Conclusions: In the present study, the joint gap size and medial tension were significantly reduced after the trial component had been set. Accurate measurement of the soft-tissue balance is an important factor in the modified gap technique, and this method using a distal femoral trial component can offer better outcomes than those achieved with conventional methods.
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http://dx.doi.org/10.1186/s42836-021-00072-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8796463PMC
April 2021

Development of a rat model with lumbar vertebral endplate lesion.

Eur Spine J 2022 04 27;31(4):874-881. Epub 2022 Feb 27.

Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.

Purpose: Vertebral endplate lesion (EPL) caused by severe disc degeneration is associated with low back pain. However, there is no suitable animal model to elucidate the pathophysiology of EPL. This study aimed to develop a rat model of EPL and evaluate rat behavior and imaging and histological findings.

Methods: The L4-5 intervertebral discs of Sprague-Dawley rats were transperitoneally removed, except for the outer annulus fibrosus and cartilage endplate, in the EPL group. The L4-5 discs were not removed and simply exposed in the sham group. Changes around the vertebral endplate on magnetic resonance imaging (MRI) and computed tomography (CT) were evaluated. Additionally, pain-related behavioral and histological assessments were performed.

Results: In the EPL group, a low-signal area around the vertebral endplate was observed on T1-weighted and T2-weighted fat-saturated MRI at 8 weeks or later after surgery. In the same group, CT showed osteosclerosis around the vertebral endplate at 12 weeks after surgery. The sham group did not show abnormal imaging features on the MRI and CT. Behavioral evaluation showed that the EPL group had a significantly longer grooming time than the sham group. Conversely, the 12-week postoperative locomotion time and the 1- and 12-week postoperative standing times were significantly shorter in the EPL group than in the sham group. Histological evaluation showed a high degree of vertebral endplate degeneration and an increased number of osteoclasts and proportion of nerve fibers expressing calcitonin gene-related peptide in the EPL group compared to those in the sham group.

Conclusion: Our rat EPL model showed pain-related behavioral patterns and an increased expression of pain-related neuropeptide. This model could contribute to the study of the pathophysiology of EPL and will help in the treatment of low back pain in the future.
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http://dx.doi.org/10.1007/s00586-022-07148-4DOI Listing
April 2022

Characteristics of Chronic Ankle Instability Requiring Both Anterior Talofibular and Calcaneofibular Ligament Repair.

J Foot Ankle Surg 2022 Jan 21. Epub 2022 Jan 21.

Professor, Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Chronic ankle instability (CAI) leads to the ankle osteoarthritis (OA), and ligament repair is performed to restore ankle stability. However, anterior talofibular ligament (ATFL) repair alone is not sufficient to stabilize the ankle in some cases, which additionally require calcaneofibular ligament (CFL) repair. This study aimed to explore characteristics of CAI that necessitated the repair of both ATFL and CFL. Forty-three patients (44 ankles) with CAI treated operatively were retrospectively reviewed. After ATFL repair, patients with residual ankle instability revealed by the varus stress under fluoroscopy additionally underwent CFL repair. Preoperative condition and intraoperative findings of the combined ATFL and CFL repair (AC) (n = 24) and only ATFL repair (A) (n = 20) groups were compared. The ankle activity score of group AC was significantly higher (p < .05) than that of group A. OA changes at the medial gutter were observed in 62.5% (15/24) in the group AC and 20% (4/20) in group A. Chondral/osteochondral lesions were seen in 66.7% (16/24) in the group AC and 20% (4/20) in group A. The remnant quality in group AC was inferior to that of group A. CAI that necessitated both ATFL and CFL repair exhibited characteristic findings such as high ankle activity score, high rate of chondral/osteochondral lesions and/or OA changes, and poor quality of ATFL remnants compared to those in CAI that required only ATFL repair. The repair of both ATFL and CFL should be considered in CAI which exhibit these characteristics to ensure complete correction of the instability.
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http://dx.doi.org/10.1053/j.jfas.2022.01.009DOI Listing
January 2022

Analysis of Anastomotic Venous Factors in Traumatic Lower Extremity Injuries Reconstructed by Free Flap.

Cureus 2022 Jan 5;14(1):e20978. Epub 2022 Jan 5.

Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN.

Background Venous thrombosis has been shown to be the most frequent cause of free flap failure in traumatic lower extremity injuries. However, the roles of various anastomotic venous factors, including venous anastomosis (end-to-end (ETE) or end-to-side (ETS)), venous outflow (one vein or two veins), and recipient venous selection (deep or superficial vein), remain unclear. This retrospective study aims to investigate factors contributing to microvascular complications in patients with lower extremity Gustilo type IIIB/IIIC injuries reconstructed by free flap with a focus on the three abovementioned venous factors. Methods A total of 44 flap treatment outcomes of 41 patients with these injuries from 2015 to 2020 were assessed according to the three venous factors (type of anastomosis, venous outflow, and vein selection). Results The average patient age was 52 years, with the majority (75.6%) being male. Eight patients (18.2%) returned to the operating room due to venous thrombosis, and five patients (11.4%) experienced total flap failure. The following factors were suspected to have contributed to venous thrombosis: vein size mismatch (n = 2) and recipient vein insufficiency possibly due to post-traumatic vessel disease (PTVD) (n = 6). End-to-side (ETS) anastomoses showed lower venous thrombosis rates than end-to-end (ETE) anastomoses (6.3% versus 25%, p = 0.22), two-vein outflows had lower rates than one (8.3% versus 30%, p = 0.07), and deep veins had the lowest thrombosis rates (7.7%), whereas superficial veins had the highest (38.5%). Conclusion The key venous factors in preventing venous thrombosis include using as many two-vein ETS anastomoses as possible to deep recipient veins.
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http://dx.doi.org/10.7759/cureus.20978DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8820499PMC
January 2022

Evaluation of subscapularis tendon tears of the anterosuperior aspect using radial-sequence magnetic resonance imaging.

JSES Int 2022 Jan 28;6(1):97-103. Epub 2021 Sep 28.

Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Background: Magnetic resonance imaging (MRI) is widely used to diagnose subscapularis tendon tears; however, it is difficult to assess the anterosuperior aspect of these tears. Radial-sequence MRI can reveal the fiber components of the anterosuperior aspect, from perpendicular, by overcoming the partial volume effect. We aimed to classify the insertion of subscapularis tendon tears on radial-sequence MRI and determine the effectiveness of radial-sequence MRI for subscapularis tendon tear assessments.

Methods: We retrospectively investigated 196 patients (mean age, 66.7 ± 9.0 years; 118 men, 78 women) who underwent 1.5 T MRI before arthroscopic rotator cuff repair. Radial-sequence MRI findings of the anterosuperior aspect insertion of the subscapularis tendon were classified into five grades, and intraoperative findings compared with preoperative conventional MRI and radial-sequence MRI. We calculated sensitivity, specificity, accuracy, and positive and negative predictive values. Interobserver and intraobserver reliability for radial-sequence MRI classification was calculated using kappa (κ).

Results: Conventional MRI sensitivity of subscapularis tendon tears was 45.3%; specificity, 95.8%; accuracy, 82.1%; positive predictive value, 80.0%; and negative predictive value, 82.5%. Radial-sequence MRI sensitivity was 92.5%; specificity, 88.1%; accuracy, 89.3%; positive predictive value, 74.2%; and negative predictive value, 96.9%. Sensitivity ( < .001), accuracy ( = .04), specificity ( = .02), and negative predictive values ( < .001) in radial-sequence MRI were significantly higher than those in conventional MRI. Intraobserver and interobserver reliabilities for radial-sequence MRI classification were κ = 0.78 and 0.65, respectively, corresponding to high reproducibility, and defined as good.

Conclusion: We provide evidence that radial-sequence MRI is an effective tool to evaluate subscapularis tendon tears, especially before surgery.
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http://dx.doi.org/10.1016/j.jseint.2021.08.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8811407PMC
January 2022
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