Publications by authors named "Nobuo Adachi"

282 Publications

Decreased Muscle-to-Fat Mass Ratio Is Associated with Low Muscular Fitness and High Alanine Aminotransferase in Children and Adolescent Boys in Organized Sports Clubs.

J Clin Med 2021 May 24;10(11). Epub 2021 May 24.

Sports Medical Center, Hiroshima University Hospital, Hiroshima 734-8551, Japan.

Decreased muscle-to-fat mass ratio (MFR) is associated with pediatric nonalcoholic fatty liver disease (NAFLD) and may reduce muscular fitness. Regular exercise in sports clubs has not led to reductions in obesity in children and adolescents; they may have decreased MFR. Decreased MFR could cause reduced muscular fitness, which may put them at risk for NAFLD development. We investigated whether MFR is related to muscular fitness and serum alanine aminotransferase (ALT), to determine whether MFR could be used to screen for NAFLD in children and adolescent boys belonging to sports clubs. Altogether, 113 participants (aged 7-17 years) who underwent body composition, laboratory, and muscular fitness measurements during a medical checkup were divided into tertiles according to their MFR. Lower extremity muscular fitness values were significantly decreased in the lowest MFR tertile ( < 0.001); conversely, serum ALT levels were significantly increased ( < 0.01). Decreased MFR significantly increased the risk of elevated ALT, which requires screening for NAFLD, after adjusting for age, obesity, muscular fitness parameters, and metabolic risk factors (odds ratio = 8.53, 95% confidence interval = 1.60-45.6, = 0.012). Physical fitness and body composition assessments, focusing on MFR, can be useful in improving performance and screening for NAFLD in children and adolescents exercising in sports clubs.
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http://dx.doi.org/10.3390/jcm10112272DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8197240PMC
May 2021

Quantifying Bone Marrow Edema Adjacent to the Lumbar Vertebral Endplate on Magnetic Resonance Imaging: A Cross-Sectional Study of Patients with Degenerative Lumbar Disease.

Asian Spine J 2021 May 20. Epub 2021 May 20.

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

Study Design: Cross-sectional study.

Purpose: We aimed to quantitatively assess bone marrow edema (BME) on magnetic resonance imaging (MRI) for patients with degenerative lumbar diseases.

Overview Of Literature: BME adjacent to a sclerotic endplate of the lumbar spine, detected using T2-weighted fat-saturated MRI, is closely associated with low back pain in patients with degenerative lumbar diseases. However, currently, there no quantitative evaluation methods for BME adjacent to the vertebral endplate.

Methods: Patients with degenerative lumbar diseases, whose MRIs detected BME, were enrolled. On a T2-weighted fat-saturated MRI, BME appeared as a high-intensity region adjacent to the vertebral endplate. We calculated the contrast ratios (CRs) of BME and normal bone marrow using the signal intensities of BME, normal bone marrow, and the spinal cord. On computed tomography, we calculated Hounsfield unit (HU) values in the same area as BME, the sclerotic endplate, and normal bone marrow to assess bone density.

Results: There were 16 men and 14 women, with an average age of 73.5 years. The mean CRs of BME and normal bone marrow were -0.015±0.056 and -0.407±0.023, respectively. BME's CR was significantly higher than that of normal bone marrow (p<0.01). The HU values in the same area as BME, the sclerotic endplate, and normal bone marrow were 251.9±24.6, 828.3±35.6, and 98.1±9.3, respectively; these values were significantly different from each other (p<0.01).

Conclusions: The CR on MRI is a useful quantitative assessment tool for BME in patients with degenerative lumbar diseases.
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http://dx.doi.org/10.31616/asj.2020.0648DOI Listing
May 2021

A larger side-to-side difference in anterior knee laxity increases the prevalence of medial and lateral meniscal injuries in patients with ACL injuries.

Knee Surg Sports Traumatol Arthrosc 2021 May 10. Epub 2021 May 10.

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

Purpose: The objective of this study was to investigate factors that influence the prevalence of medial and lateral meniscal injuries at the time of anterior cruciate ligament (ACL) reconstruction in patients with ACL injuries.

Methods: Patients with ACL injuries at 9 institutions were enrolled in this multicentre study. Age, sex, duration between injury and surgery, pivot shift test grade, anterior knee laxity determined using the Kneelax 3 arthrometer, and other variables were assessed by logistic regression analysis. Meniscal conditions were evaluated via arthroscopy.

Results: In all, 830 patients were enrolled. The prevalence of medial and lateral meniscal tears was 32.0% (266 knees) and 26.5% (220 knees), respectively. Significant factors that influenced the prevalence of medial meniscal injuries were age [odds ratio (OR) 1.03; P = 0.000], side-to-side differences in instrumented anterior knee laxity before surgery (OR 1.12; P = 0.002), duration between injury and surgery (≥ 12 months) (OR 1.86; P = 0.023), and pivot shift test grade (OR 1.36; P = 0.014). Significant factors of lateral meniscal injury were side-to-side differences in anterior knee laxity before surgery (OR 1.12; P = 0.003) and the male sex (OR 1.50; P = 0.027).

Conclusion: Greater anterior knee laxity, age, a longer duration between injury and surgery, and a higher pivot shift test grade predicted medial meniscal injury. Greater anterior knee laxity and the male sex predicted lateral meniscal injury. In patients with ACL injuries, the importance of side-to-side differences in anterior knee laxity should be rediscovered from the viewpoint of meniscal conditions.

Level Of Evidence: Level III.
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http://dx.doi.org/10.1007/s00167-021-06601-zDOI Listing
May 2021

Three-dimensional analysis of thumb motion recovery after carpal tunnel release.

J Hand Surg Eur Vol 2021 May 9:17531934211014700. Epub 2021 May 9.

Department of Orthopedic Surgery, Hiroshima University, Minami-ku, Hiroshima, Japan.

This study quantified recovery of thumb motion in patients with carpal tunnel syndrome after carpal tunnel release using three-dimensional motion analysis with a retroreflective surface-based marker method. Eighteen hands from 14 patients who underwent carpal tunnel release for idiopathic carpal tunnel syndrome were included. The angular movements of the three joints of the thumb, the path length of the thumb tip and the area enclosed by the perimeter path of the thumb tip were measured during circumduction. The range of joint movement, including abduction/adduction of the trapeziometacarpal joint, and flexion/extension of the interphalangeal and metacarpophalangeal joints and the path length of the thumb tips, improved significantly 1 year after surgery. The quantification of thumb kinematics helps to better understand motor dysfunction in carpal tunnel syndrome, assess the severity of the condition and decide on treatment. IV.
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http://dx.doi.org/10.1177/17531934211014700DOI Listing
May 2021

Tensiomyographic changes of muscle contractile properties in individuals with lower-limb amputation: A pilot study.

Prosthet Orthot Int 2021 Mar 26. Epub 2021 Mar 26.

Department of Sports Medical Center, Hiroshima University Hospital, Hiroshima, Japan Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Background: Individuals with a unilateral lower-limb amputation (LLA) rely heavily on their intact limb during daily physical activities. However, there is limited research on the resultant effects of this over-reliance on contractile properties of muscles in the intact limb.

Objective: To compare the muscle contractile properties of the intact limb among individuals with a unilateral LLA to those of age-matched able-bodied individuals, using tensiomyography.

Study Design: This is a cross-sectional, observational study.

Methods: Nine men with a unilateral LLA and 10 able-bodied men (control) were included. Tensiomyography measures were obtained for 5 muscles: gastrocnemius lateralis (GL) and medialis (GM), rectus femoris, vastus lateralis (VL), and vastus medialis. Contraction time (Tc), delay time (Td), maximal displacement (Dm), and velocity of deformation (Vd) for each muscle were compared between groups.

Results: Tc and Td for the GL and GM muscles were lower for the LLA than the control group (GL: P = .03, r = -0.51, P < .01, r = 0.67; GM: P = .02, r = 0.53, P = .07, r = 0.54, respectively). Dm and Vd of the VL were significantly smaller in the LLA than the control group (P < .01, r = 0.73, P < .01, r = 0.23, respectively).

Conclusions: Men with a unilateral LLA seem to have slower deformation of the gastrocnemius muscles and higher stiffness of the VL than able-bodied controls. These findings may be indicative of an overuse of the intact limb as a compensation for the unilateral LLA. The confirmation of these findings in a larger sample size is required to translate these findings to practice.
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http://dx.doi.org/10.1097/PXR.0000000000000011DOI Listing
March 2021

Autologous meniscus fragments embedded in atelocollagen gel enhance meniscus repair in a rabbit model.

Bone Joint Res 2021 Apr;10(4):269-276

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

Aims: Meniscal injuries are common and often induce knee pain requiring surgical intervention. To develop effective strategies for meniscus regeneration, we hypothesized that a minced meniscus embedded in an atelocollagen gel, a firm gel-like material, may enhance meniscus regeneration through cell migration and proliferation in the gel. Hence, the objective of this study was to investigate cell migration and proliferation in atelocollagen gels seeded with autologous meniscus fragments in vitro and examine the therapeutic potential of this combination in an in vivo rabbit model of massive meniscus defect.

Methods: A total of 34 Japanese white rabbits (divided into defect and atelocollagen groups) were used to produce the massive meniscus defect model through a medial patellar approach. Cell migration and proliferation were evaluated using immunohistochemistry. Furthermore, histological evaluation of the sections was performed, and a modified Pauli's scoring system was used for the quantitative evaluation of the regenerated meniscus.

Results: In vitro immunohistochemistry revealed that the meniscus cells migrated from the minced meniscus and proliferated in the gel. Furthermore, histological analysis suggested that the minced meniscus embedded in the atelocollagen gel produced tissue resembling the native meniscus in vivo. The minced meniscus group also had a higher Pauli's score compared to the defect and atelocollagen groups.

Conclusion: Our data show that cells in minced meniscus can proliferate, and that implantation of the minced meniscus within atelocollagen induces meniscus regeneration, thus suggesting a novel therapeutic alternative for meniscus tears. Cite this article:  2021;10(4):269-276.
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http://dx.doi.org/10.1302/2046-3758.104.BJR-2019-0359.R2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076997PMC
April 2021

Pharmacological Targeting of Heme Oxygenase-1 in Osteoarthritis.

Antioxidants (Basel) 2021 Mar 9;10(3). Epub 2021 Mar 9.

Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima 7348551, Japan.

Osteoarthritis (OA) is a common aging-associated disease that clinically manifests as joint pain, mobility limitations, and compromised quality of life. Today, OA treatment is limited to pain management and joint arthroplasty at the later stages of disease progression. OA pathogenesis is predominantly mediated by oxidative damage to joint cartilage extracellular matrix and local cells such as chondrocytes, osteoclasts, osteoblasts, and synovial fibroblasts. Under normal conditions, cells prevent the accumulation of reactive oxygen species (ROS) under oxidatively stressful conditions through their adaptive cytoprotective mechanisms. Heme oxygenase-1 (HO-1) is an iron-dependent cytoprotective enzyme that functions as the inducible form of HO. HO-1 and its metabolites carbon monoxide and biliverdin contribute towards the maintenance of redox homeostasis. HO-1 expression is primarily regulated at the transcriptional level through transcriptional factor nuclear factor erythroid 2 (NF-E2)-related factor 2 (Nrf2), specificity protein 1 (Sp1), transcriptional repressor BTB-and-CNC homology 1 (Bach1), and epigenetic regulation. Several studies report that HO-1 expression can be regulated using various antioxidative factors and chemical compounds, suggesting therapeutic implications in OA pathogenesis as well as in the wider context of joint disease. Here, we review the protective role of HO-1 in OA with a focus on the regulatory mechanisms that mediate HO-1 activity.
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http://dx.doi.org/10.3390/antiox10030419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001640PMC
March 2021

Histopathological and Radiographic Features of Osteolysis After Fixation of Osteochondral Fragments Using Poly-L-Lactic Acid Pins for Osteochondral Lesions of the Talus.

Am J Sports Med 2021 05 29;49(6):1589-1595. Epub 2021 Mar 29.

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

Background: Fixation of osteochondral fragments is a potential option for treating an osteochondral lesion of the talus (OLT) involving large lesions in the remaining articular cartilage surface. Bioabsorbable devices, especially those made of poly-L-lactic acid (PLLA), can be used for the fixation of an OLT. Postoperative osteolysis surrounding the PLLA pins is occasionally observed; however, the significance of osteolysis remains unknown.

Purpose: To elucidate the association between osteolysis surrounding the PLLA pins, histopathological findings in subchondral bone, and preoperative Hounsfield unit (HU) values at the pin fixation site.

Study Design: Case Series; Level of evidence, 4.

Methods: This retrospective analysis included 20 patients with OLT (11 men and 9 women; mean age, 20.9 years; 1 bilateral case). Tissue from the osteochondral fragment was collected intraoperatively using a bone biopsy needle for histological evaluation. The fragment was fixed through the biopsy hole using a PLLA pin. Osteolysis surrounding the PLLA pin was assessed at 1 year postoperatively using magnetic resonance imaging (MRI). Histopathological scores were assigned based on trabecular bone loss, empty lacunae, inflammatory granulation tissue, cartilage-like tissue, and the presence of osteoclasts. The HU values around the pin insertion site, detected on the postoperative MRI scans, were measured using the region of interest based on the preoperative coronal and sagittal computed tomography (CT) images.

Results: Osteolysis was observed postoperatively in 9 ankles (42.9%). Histopathological evaluation revealed that the osteolysis group had a significantly higher pathological score than the nonosteolysis group (10.2 vs 6.3; < .001). Lower HU values were identified in the osteolysis group on preoperative coronal and sagittal CT images ( < .05). The histopathological score negatively correlated with preoperative HU values (Pearson = -0.46; = .037).

Conclusion: Intraoperative biopsy of the OLT allowed for histopathological evaluation of the same site as that of the PLLA pin fixation. Our findings suggest that preoperative subchondral trabecular deterioration is associated with the incidence of postoperative osteolysis surrounding the PLLA pin. Additionally, low preoperative HU values in subchondral bone under OLT may serve as a predictor of osteolysis surrounding the PLLA pin.
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http://dx.doi.org/10.1177/03635465211001758DOI Listing
May 2021

The evaluation of degeneration of posterior cruciate ligament using CT Hounsfield unit in knee osteoarthritis.

BMC Musculoskelet Disord 2021 Mar 26;22(1):309. Epub 2021 Mar 26.

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

Background: Posterior cruciate ligament (PCL) degeneration is often seen in knee osteoarthritis (OA); however, there is no established method for its evaluation. The purpose of this study is to investigate whether the Hounsfield unit (HU) using computed tomography (CT) could be a useful scale to evaluate the degeneration of PCL in knee OA.

Methods: Knee OA treated with total knee arthroplasty (21 patients, 21 knees) and non-osteoarthritic knees (21 patients, 21 knees) were retrospectively observed and studied. All PCLs in the knees were analyzed using CT. The PCL in the sagittal section was divided into three regions: proximal, middle, and distal sections. The HU value of the PCL at each area was measured. In osteoarthritic knees, tissues from the PCL were collected and histologically graded. The correlation between the radiological classification by Kellgren and Lawrence and the histological grade was analyzed. The average CT HU values for each degenerative grade were also calculated and compared.

Results: The HU values in OA and non-OA were 70.7 and 88.4 HU (p < 0.05) at the proximal region, 75.7 and 85.3 HU (p < 0.05) in the central region, and 82.3 and 86.5 HU (p > 0.05) in the distal region, respectively. The degeneration of PCL was graded as follows: one, three, and 17 mild, moderate, and severe cases at the proximal portion, and 16, 4, and one mild, moderate, and severe cases at the distal portion, respectively. The radiological classification and the grade of degeneration were not correlated in either the proximal (r = 0.047, p = 0.84) or the distal (r = - 0.21, p = 0.35) portions. The HU value was 84.5, 72.1, and 70.6 HU for mild, moderate, and severe grades, respectively (mild versus moderate: p < 0.05, mild versus severe: p < 0.05, moderate versus severe: p > 0.05).

Conclusions: In knee OA, a lower HU value in the PCL indicates the progression of degeneration. The CT HU value could be a useful measurement to predict the grade of PCL degeneration.
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http://dx.doi.org/10.1186/s12891-021-04177-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004421PMC
March 2021

Long-term outcome of targeted therapy for low back pain in elderly degenerative lumbar scoliosis.

Eur Spine J 2021 Mar 17. Epub 2021 Mar 17.

Department of Orthopaedic Surgery, Spine Center, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi, Hiroshima, 738-8503, Japan.

Purpose: Treatment of low back pain (LBP) associated with elderly degenerative lumbar scoliosis (DLS) remains controversial. We have developed percutaneous intervertebral-vacuum polymethylmethacrylate injection (PIPI) targeting to the intervertebral vacuum as a minimally invasive surgery. The present study compared the long-term clinical outcomes of PIPI to that of nonoperative treatment.

Methods: Patients with de novo DLS, aged ≥ 65 years, who had LBP with visual analog scale (VAS) of ≥ 50 for ≥ 6 months with intervertebral vacuum on computed tomography and bone marrow edema (BME) on magnetic resonance imaging were included. The clinical outcomes were evaluated using VAS and the Oswestry Disability Index (ODI) at baseline, 1, 6, 12, 24 months, and at the final follow-up. The course of BME was also evaluated.

Results: One hundred and one patients underwent PIPI and 61 received nonoperative treatment. The mean follow-up duration after PIPI and nonoperative treatment was 63.7 ± 32.4 and 43.9 ± 20.9 months, respectively. VAS and ODI after PIPI were significantly improved compared to post-nonoperative treatment. BME decreased substantially in the PIPI group and it was significantly correlated with VAS and ODI improvement. Following PIPI, LBP recurred in 28 patients (35%). LBP recurrence was identified at the same level of PIPI in 10 patients, at the adjacent level of PIPI in 11 patients, and at the non-adjacent level of PIPI in seven patients. Eighteen patients underwent additional PIPIs, and both VAS and ODI were significantly improved after additional PIPIs.

Conclusion: Bone marrow lesions of the endplate are strongly associated with the presence of LBP. PIPI can be considered as an effective, safe and repeatable treatment for LBP in elderly DLS patients.
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http://dx.doi.org/10.1007/s00586-021-06805-4DOI Listing
March 2021

Effectiveness of measuring tension during arthroscopic rotator cuff repair.

J Exp Orthop 2021 Mar 16;8(1):21. Epub 2021 Mar 16.

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

Purpose: Arthroscopic rotator cuff repair (ARCR) for relatively small rotator cuff tears (RCTs) has shown promising results; however, such surgery for larger tears often results in failure and poor clinical outcomes. One cause of failure is over-tension at the repair site that will be covered with the tendon stump. Reports on the clinical outcomes using ARCR with tension ≤ 30 N are lacking. This study aimed to evaluate ARCR outcomes and failure rates using less tension (30 N) and to assess the prognostic factors for failure.

Methods: Our study group comprised of 118 patients who underwent ARCR for full-thickness RCTs with full tendon stump coverage of the footprint with a tension of ≤ 30 N, measured using a tension meter; no additional procedures, such as margin convergence or footprint medialisation, were performed. The failure rate was calculated, and the prognostic factor for failure was assessed using multivariate regression analyses.

Results: There were seven cases of failure in the study group. Postoperatively, flexion and internal rotation ranges of motion, acromiohumeral interval, muscle strength, and clinical results improved significantly. Using multivariate regression analyses, intraoperative concomitant subscapularis tendon lesion and pre-operative infraspinatus tendon retraction, assessed using radial-sequence magnetic resonance imaging, were significantly correlated with post-ARCR failure using less tension (p = 0.030 and p = 0.031, respectively).

Conclusion: ARCR is likely to succeed for RCTs that can be extracted using tension ≤ 30 N. However, cases with more severe subscapularis tendon lesions and those with high infraspinatus tendon retraction may show surgical failure.

Level Of Evidence: LEVEL IV Retrospective case series.
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http://dx.doi.org/10.1186/s40634-021-00341-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7966668PMC
March 2021

Quantitative Analysis of Deltoid Ligament Degradation in Patients With Chronic Ankle Instability Using Computed Tomographic Images.

Foot Ankle Int 2021 Mar 11:1071100721997070. Epub 2021 Mar 11.

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

Background: Rotational ankle instability (RAI) is associated with the faster onset of severe ankle osteoarthritis via dysfunction of the anterior talofibular ligament, calcaneofibular ligament, and deltoid ligament. No specific clinical examination is available for RAI, and diagnostic imaging has limitations in evaluating ligament degradation. This study investigated the deltoid ligament degeneration using Hounsfield unit (HU) values on computed tomography (CT) images.

Methods: Patients were enrolled in this retrospective analysis if they had undergone magnetic resonance imaging (MRI) and CT scans of the ankle. The chronic ankle instability (CAI) group comprised 20 ankles with CAI (9 men, 11 women; mean age, 28.7 years) and the control group comprised 28 ankles (16 men, 12 women, mean age, 41.3 years). The average HU values of the deep posterior tibiotalar ligament (dPTL) that constitutes the deltoid ligament were measured on coronal CT images, and MRI results were used as a reference. All patients were subdivided based on the MRI findings of dPTL injury such as fascicular disruption, irregularity, and the loss of striation.

Results: A strong negative correlation was identified between age and HU values for all patients (Spearman ρ = -0.63; < .001). The mean HU values of the dPTL for participants aged <60 years were 81.0 HU for the control group (21 ankles) and 69.5 HU for the CAI group ( = .0075). No significant differences in the HU values were observed for the dPTL among the MRI subgroups.

Conclusion: In addition to the conventional imaging examination such as stress radiographs and MRI, HU measurements of CT images could be useful for quantitatively and noninvasively evaluating degenerative changes in the deltoid ligament for CAI patients to assist the diagnosis of RAI.

Level Of Evidence: Level III. case-control study.
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http://dx.doi.org/10.1177/1071100721997070DOI Listing
March 2021

The relevance of whole or segmental body bioelectrical impedance phase angle and physical performance in adolescent athletes.

Physiol Meas 2021 Apr 12;42(3). Epub 2021 Apr 12.

Hiroshima University Hospital Sports Medical Center, Hiroshima City, Hiroshima, Japan.

. The physical condition of athletes can be assessed easily and quantitatively using objective indicators. Bioelectrical impedance measures the phase angle (PA), representing hydration and cell function, and is a potential clinical indicator of physical condition. This study aimed to investigate the association between PA and physical performance in adolescent athletes.. Overall, 170 adolescent athletes underwent a sports medical check-up, including body composition measurements and physical performance tests. Whole-body and segmental PAs (arm and leg) were determined based on body composition values. Isometric grip power and knee isokinetic muscle strength were measured as parameters of muscle strength. Counter movement jump height and squat jump height were measured as jump parameters. Associations between PA and each muscle strength or jump parameters were analysed using Pearson product-moment correlation coefficient or Spearman's rank correlation coefficient.. Whole-body and upper limb PAs were highly correlated with grip power (= 0.70-0.80). Whole-body and lower limb PAs were correlated with knee isokinetic muscle strength (= 0.43-0.59). Whole and all segmental PAs were correlated with counter movement jump height (= 0.46-0.57) and squat jump height (= 0.42-0.52).. PA can be used to monitor physical condition and sports performance in adolescent athletes. Segmental PAs can help assess the condition of the corresponding body part.
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http://dx.doi.org/10.1088/1361-6579/abed35DOI Listing
April 2021

Evaluation of the degenerative pattern of PCL in osteoarthritis patients using UTE-T2 mapping.

Asia Pac J Sports Med Arthrosc Rehabil Technol 2021 Apr 17;24:35-40. Epub 2021 Feb 17.

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

Background: The posterior cruciate ligament (PCL) is one of the essential stabilizers of the knee joint and it was demonstrated that its degenerative change related to the knee osteoarthritis (OA). We aimed to evaluate signal of the PCL in OA patients in comparison with healthy young and elderly volunteers using the ultra-short echo timeenhanced (UTE)-T2∗ mapping, and to validate these findings with histology.

Methods: Thirty asymptomatic volunteers, 13 young people (younger group) and 17 elderly people (elder group), and 27 patients who had undergone total knee arthroplasty (OA group) were enrolled in this study. UTE-T2∗ maps of PCL were obtained from all participants. The PCL was divided into proximal, middle, and distal parts and the UTET2∗ values obtained from each part were compared among the groups. In OA group, the sacrificed PCLs were evaluated histologically in each part corresponding to the part of UTE-T2∗ maps and compared.

Results: The UTE-T2∗ values in OA group were significantly higher than those in other groups except in distal part. In elder group, the UTE-T2∗ values were significantly higher than those in younger group only in the proximal part. Moreover, in OA group, the UTE-T2∗ values in proximal and middle parts were significantly higher than those in distal part. There was a moderate correlation between the UTE-T2∗ values and histological scores.

Conclusions: The specific signal intensity pattern of the PCL in patients with OA was demonstrated using UTE-T2∗ mapping, and these findings were related to histological degenerated status of the PCL.
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http://dx.doi.org/10.1016/j.asmart.2021.01.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899951PMC
April 2021

Extraskeletal Ewing sarcoma attached to the ulnar nerve: A case report.

Int J Surg Case Rep 2021 Mar 23;80:105676. Epub 2021 Feb 23.

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

Introduction: Extraskeletal Ewing sarcoma (EES) of the extremity is uncommon, and only a small number of reported cases have been devoted to the upper-extremity.

Presentation Of Case: A 65-year-old woman presented with a recurrent EES, a highly malignant tumor, involving the ulnar nerve at the right elbow region which was initially suspected as a benign soft tissue tumor, schwannoma, thus marginal excision had been performed. Due to its malignant behaviour, we treated the recurrent lesion with wide excision and reconstruction combined with chemotherapy. Histological evaluation revealed a monotonous small round cells appearance.

Discussion: EES of the extremity involving the ulnar nerve is fairly uncommon. The tumor was often smaller in the adult than in the child population which was consistent with the present case, thus may mimic a benign tumor. Because of the overlapping histopathological features of EES with other tumors, other investigations such as immunohistochemistry and cytogenetic studies must be performed to allow definitive diagnosis. The result of our study was negative for the EWSR1-FLI-1 and CIC-DUX4 fusion gene, however, other less frequent translocations could be found in this case which does not exclude the diagnosis of Ewing sarcoma family.

Conclusion: Few cases of EES involving the ulnar nerve have been previously reported. The correct diagnosis of EES involving the ulnar nerve has become particularly important in order to enable the initiation of comprehensive management that have the potential to reduce disease progression and the avoidance of improper and potentially harmful surgical therapy.
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http://dx.doi.org/10.1016/j.ijscr.2021.105676DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920869PMC
March 2021

Three-dimensional analysis of the cortical contact state of short and conventional stems in different stem positions in total hip arthroplasty.

Clin Biomech (Bristol, Avon) 2021 Mar 20;83:105297. Epub 2021 Feb 20.

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

Background: Despite the increasing use of short cementless stems in total hip arthroplasty, their potential benefits have yet to be confirmed. We evaluated the cortical contact state of short and conventional stems in different femoral canal types and stem positions using a CT-based 3-dimensional templating software.

Methods: We reviewed 153 hips in 153 patients, grouped according to femoral canal type-normal (68), champagne-flute (41), and stove-pipe canal (44). We investigated the influence of stem position on the contact state by evaluating three situations of stem anteversion (original anteversion, +5°anteverted, and +5°retroverted), three stem positions, neutral +2°extended, and +2°flexed positions using Taperloc Complete Microplasty stem.

Findings: The contact values of all zones between both stems in all canal types exhibited no significant differences. The values in zones 1, 2, 6, and 7 of both stems in 5° retroverted and anteverted, 2° extended and flexed positions were not significantly different compared to those of the neutral position. However, the values in zones 3, 4, and 5 of both stems were significantly greater compared to those of the neutral position in 2° extended and flexed positions; these values were also significantly larger in all canal types for the conventional stem.

Interpretation: We demonstrated that the short and conventional stems can achieve the same proximal cortical contact in any femoral canal, regardless of the stem position. However, extended and flexed stem positions increase the distal contact, especially in conventional stems. Furthermore, the distal contact increases for the retroverted stem insertions.
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http://dx.doi.org/10.1016/j.clinbiomech.2021.105297DOI Listing
March 2021

Simultaneous meniscal reconstruction using semitendinosus tendon and tissue-engineering cartilage implantation for extensive cartilage defect of lateral femoral condyle after lateral meniscus resection: A case report.

J Orthop Sci 2021 Feb 19. Epub 2021 Feb 19.

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

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http://dx.doi.org/10.1016/j.jos.2020.11.019DOI Listing
February 2021

Treatment of Intra-Articular Distal Phalanx Fractures in Baseball Players by Joint Distraction and Early Mobilization Using a New Dynamic External Finger Fixator.

J Hand Surg Asian Pac Vol 2021 Mar;26(1):112-117

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

In baseball players, a high degree of functional recovery is required for the treatment of fractures in the distal interphalangeal (DIP) joint, especially on the throwing side. While dynamic external fixation is a useful treatment option to restore the joint function, existing external fixators are too large for use on DIP joints. Three cases of DIP joint intra-articular comminuted fractures in baseball players treated using the new dynamic external finger fixator which we developed are reported. The external fixator was kept attached for four weeks. The patients returned to play baseball 7-8 weeks after surgery. The total arc of the DIP joint was 90-100% of the contralateral side. Follow-up radiographs demonstrated that joint congruity had been reacquired. This technique was adaptive in the treatment of comminuted intra-articular fractures of the DIP joint and resulted in a near-normal range of joint motion and remodeling of the joint surface.
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http://dx.doi.org/10.1142/S2424835521720061DOI Listing
March 2021

Lateral wall fixation with bone pegs for advanced osteochondritis dissecans of the humeral capitellum.

JSES Int 2021 Jan 29;5(1):35-41. Epub 2020 Oct 29.

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

Background And Hypothesis: It is generally considered that fragment fixation with bone pegs (FFBP) for osteochondritis dissecans (OCD) of the humeral capitellum can be indicated for stages I and II according to the International Cartilage Repair Society (ICRS) classification of OCD and it is difficult to obtain complete bone union for advanced lesions. However, the clinical and radiologic results of FFBP with cancellous bone graft for ICRS-OCD stage III with lateral wall involvement have not been described in detail. Good bone union can be achieved with the lateral wall fragment of the capitellum by FFBP in combination with refreshing the sclerotic surface at the base of the lesion and cancellous bone grafting even in ICRS-OCD stage III lesions.

Methods: In total, 10 adolescent baseball players with a diagnosis of OCD, a median age of 13.5 years at the time of surgery, and 26.7 months of postoperative follow-up were included. Preoperative imaging showed that all patients had lesions in the late detached stage and of the lateral-widespread type based on the site of the focal lesion. The intraoperative ICRS-OCD classification was stage III. We aimed to preserve and fix the lateral wall fragment with cancellous bone grafting if the condition of the articular cartilage was good and the size and thickness of the segment could withstand fixation.

Results: Bone union of the lateral wall fragment was achieved in all cases. The elbow extension range of motion was -3.9° ± 9.7° before surgery and was eventually -0.4° ± 6.7° at the final assessment. Flexion range of motion ranged from 138.1° ± 10.5° to 142.4° ± 6.2°. The Timmerman and Andrews score significantly improved from 165.5 ± 10.9 points before surgery to 197.0 ± 6.3 points after surgery, demonstrating excellent results in all patients. All patients were able to return to competitive baseball.

Conclusion: The radiographic and clinical outcomes of FFBP for lateral wall fragments with cancellous bone graft were satisfactory, showing that the indications for this procedure could be extended to ICRS-OCD stage III.
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http://dx.doi.org/10.1016/j.jseint.2020.09.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846702PMC
January 2021

An older age, a longer duration between injury and surgery, and positive pivot shift test results increase the prevalence of articular cartilage injury during ACL reconstruction in all three compartments of the knee in patients with ACL injuries.

Knee Surg Sports Traumatol Arthrosc 2021 Feb 4. Epub 2021 Feb 4.

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

Purpose: To investigate factors that influence the prevalence of articular cartilage injury in patients with anterior cruciate ligament (ACL) injury.

Methods: This multicentre study included patients with ACL injury. Logistic regression analysis was conducted to identify factors that influence the prevalence of cartilage injury during ACL reconstruction.

Results: A total of 811 patients were enrolled. The factors that significantly influenced the prevalence of cartilage injury were age (odds ratio [OR], 1.04; P = 0.000), a positive pivot shift test result (OR, 1.43; P = 0.021), medial meniscal injury (OR, 2.55; P = 0.000), and delayed surgery (≥ 12 months) (OR, 2.52; P = 0.028) in the medial compartment of the knee; age (OR, 1.05; P = 0.000), subjective grades of apprehension during the pivot shift test (OR, 1.46; P = 0.010), lateral meniscal injury (OR, 1.98; P = 0.003), femoro-tibial angle (FTA) (OR, 0.92; P = 0.006), and delayed surgery (≥ 12 months) (OR, 2.63; P = 0.001) in the lateral compartment; and age (OR, 1.06; P = 0.000), body mass index (OR, 1.07; P = 0.028), a positive pivot shift test result (OR, 1.60; P = 0.018), FTA (OR, 0.90; P = 0.006), and delayed surgery (≥ 12 months) (OR, 3.17; P = 0.008) in the patellofemoral compartment.

Conclusion: An older age, a longer duration between injury and surgery, and a positive pivot shift test result were positively associated with the prevalence of cartilage injury in three compartments in patients with ACL injuries. Early ACL reconstruction is recommended to prevent cartilage injury.

Level Of Evidence: Level III.
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http://dx.doi.org/10.1007/s00167-021-06461-7DOI Listing
February 2021

Utility of intraoperative magnetic resonance imaging for giant cell tumor of bone after denosumab treatment: a pilot study.

Acta Radiol 2021 Jan 31:284185121989515. Epub 2021 Jan 31.

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

Background: Giant cell tumor of bone (GCTB) is an intermediate but locally aggressive neoplasm. Current treatment of high-risk GCTB involves administration of denosumab, which inhibits bone destruction and promotes osteosclerosis. However, denosumab monotherapy is not a curative treatment for GCTB and surgical treatment remains required. Denosumab treatment complicates surgery, and the recurrence rate of GCTB is high (20%-30%).

Purpose: To examine the utility of intraoperative magnetic resonance imaging (iMRI) for detection and reduction of residual tumor after denosumab treatment and to investigate the utility of iMRI, which is not yet widely used.

Material And Methods: We enrolled five patients who received denosumab for a median period of eight months (range 6-12 months). Surgery was performed when the degree of osteosclerosis around the articular surface was deemed appropriate. We performed iMRI using a modified operation table to identify residual tumor after initial curettage and evaluated the rate of detection of residual tumor by iMRI, intraoperative and postoperative complications, exposure time of iMRI, and operation time.

Results: Suspected residual tumor tissue was identified in all five cases and was confirmed by histopathology after additional curettage. The rate of detection of residual tumor by iMRI was 100%. Residual tumor was located in sites which were difficult to remove due to osteosclerosis. The iMRI was performed safely and without trouble. During the median follow-up period of 10 months (range 6-24 months), no adverse events or recurrences occurred.

Conclusion: Intraoperative MRI could contribute to the reduction of residual tumor tissue and it may prevent recurrence of GCTB after denosumab therapy.
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http://dx.doi.org/10.1177/0284185121989515DOI Listing
January 2021

Application of a true lateral virtual radiograph from 3D-CT to identify the femoral reference point of the medial patellofemoral ligament.

Knee Surg Sports Traumatol Arthrosc 2021 Jan 18. Epub 2021 Jan 18.

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

Purpose: The purpose of this study is two-fold: (1) to describe the femoral reference point of the medial patellofemoral ligament (MPFL) on a virtual true lateral radiograph reconstructed from a three-dimensional computed tomography (3D-CT) image and (2) to compare this point with that of patients without patellofemoral instability and with Schöttle's point.

Methods: A total of 26 consecutive patients (29 affected knees) with recurrent patellar dislocation (RPD), who underwent MPFL reconstruction were included in this study (4 males; 22 females; mean age, 24.0 years old). Using a true lateral 3DCT image, the MPFL femoral insertion was identified and marked with a 2-mm circle, and this image was reconstructed as a virtual true lateral radiograph. Following Schöttle's method, the point of intersection was described by their anterior-posterior and proximal-distal positions. As a control population, 29 age- and gender-matched patients with anterior cruciate ligament (ACL) injuries were also analysed.

Results: The points in RPD patients were located significantly posterior (-2.5 ± 2.3 mm, p < 0.01) to the line representing an extension of the posterior cortex of the femur and distal (- 6.9 ± 2.4 mm, p < 0.01) to the posterior origin of the medial femoral condyle compared with those in the control population. The mean reference point of RPD patients was located in a 3.8-mm posterior and 4.4-mm distal position compared with Schöttle's point.

Conclusions: An anatomical and radiographic femoral reference point of the MPFL on a true lateral virtual radiograph was described with our method. In patients with RPD, this reference point was identified to be more posterior and distal to Schöttle's point. More anatomical and individualized MPFL reconstruction will be secured using our method.

Level Of Evidence: Level IV.
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http://dx.doi.org/10.1007/s00167-020-06403-9DOI Listing
January 2021

Ultrasonographic digital blood flow measurement in professional baseball pitchers - A quantitative and comparative study with non-throwers.

J Orthop Sci 2020 Dec 16. Epub 2020 Dec 16.

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

Background: Vascular disorders in throwing athletes can occur from the thoracic outlet to the fingertips. The occurrence of these disorders around the shoulder is well known, and treatment options have been established for them. However, the occurrence of vascular pathology in the digital arteries in elite baseball pitchers is unclear, and treatment options have not yet been established. We hypothesized that asymptomatic professional baseball pitchers often have existing pathological changes in their digital blood flow; therefore, we quantitatively measured the blood flow in the index finger using ultrasonography and compared the results to those of non-baseball players.

Methods: Seven asymptomatic professional baseball pitchers (pitcher group) and 11 healthy volunteers (control group) were included. The flow velocity, flow volume and vessel resistance index of the ulnar digital artery of the index finger were measured just distal to the proximal interphalangeal joint using pulsed wave Doppler in two positions: 1) with the proximal interphalangeal (PIP) joint relaxed (10-15° flexed) and 2) with the PIP joint passively extended (0-5°).

Results: The mean flow velocity and flow volume were lower in the extended position than in the relaxed position in both groups. In the dominant hand, which was the throwing hand in the pitcher group, the mean flow velocity and the flow volume in the relaxed position were significantly lower in the pitcher group than in the control group. The vessel resistance index in the relaxed position of the dominant hand was significantly higher in the pitcher group than in the control group. In the nondominant hand, there was no significant difference in any parameter between the two groups.

Conclusions: Asymptomatic professional baseball pitchers may have a pathological change in digital blood flow in the throwing hand. As treatment options for this condition have not yet been established, it is of utmost importance to carry out periodic examination and prevention before the condition progresses to the symptomatic end stage.
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http://dx.doi.org/10.1016/j.jos.2020.10.025DOI Listing
December 2020

The correlation between osteoarthritis stage and the effect of the lateral wedge insole for 3 months on medial meniscus extrusion in the knee joint.

Knee 2021 Jan 14;28:110-116. Epub 2020 Dec 14.

Health Sciences Major, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.

Background: Medial meniscus extrusion (MME) leads to symptomatic knee osteoarthritis (OA) due to increased mechanical stress. MME increases with weight-bearing, and the difference in MME between non-weight-bearing and weight-bearing status (ΔMME) is a factor that causes greater MME. The lateral wedge insole (LWI) is an ideal approach for decreasing the amount of ΔMME associated with the reduction of medial loading stress in the early stage of knee OA. However, the effect of the LWI for 3 months on the ΔMME and its response to OA stage have not been elucidated.

Objective: To investigate the effects of the LWI for 3 months on MME and the ΔMME in each stage of OA.

Methods: Participants were divided into three groups: no intervention with the LWI (control group; n = 9) and intervention with the LWI in early OA (early OA group: Kellgren-Lawrence (K/L) stage = 2, n = 17) and late OA (late OA group: K/L stage > 2, n = 13). MME was evaluated using ultrasound, and the ΔMME was obtained as the difference in MME from non-weight-bearing and weight-bearing conditions. These measurements were performed at two time points: the initial office visit as a baseline and post-3 months.

Results: The weight-bearing MME and ΔMME values post-3 months were significantly decreased compared with those at baseline in the early OA group but not in the control or late OA groups.

Conclusions: The use of the LWI for 3 months decreased weight-bearing MME and ΔMME values, and its effectiveness was more pronounced in the early stage of knee OA.
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http://dx.doi.org/10.1016/j.knee.2020.11.016DOI Listing
January 2021

Altered Resting-State Connectivity with Pain-Related Expectation Regions in Female Patients with Severe Knee Osteoarthritis.

J Pain Res 2020 2;13:3227-3234. Epub 2020 Dec 2.

Sports Medical Center, Hiroshima University Hospital, Hiroshima, Japan.

Purpose: Expectation affects pain experience in humans. Numerous studies have reported that pre-stimulus activity in the anterior insular cortex (aIC), together with prefrontal and limbic regions, integrated pain intensity and expectations. However, it is unclear whether the resting-state functional connectivity (rs-FC) between the aIC and other brain regions affects chronic pain. The purpose of this study was to examine the rs-FC between the aIC and the whole brain regions in female patients with severe knee osteoarthritis (OA).

Patients And Methods: Nineteen female patients with chronic severe knee OA and 15 matched controls underwent resting-state functional magnetic resonance imaging. We compared the rs-FC from the aIC seed region between the two groups. A disease-specific measurement of knee OA was performed.

Results: The aIC showed stronger rs-FC with the right orbitofrontal cortex (OFC), subcallosal area, and bilateral frontal pole compared with controls. The strength of rs-FC between the left aIC and the right OFC was positively correlated with the knee OA pain score ( = 0.49, = 0.03). The strength of rs-FC between the right aIC and right OFC was positively correlated with the knee OA total score ( = 0.48, = 0.036) and pain score ( = 0.46, = 0.049). The OFC, subcallosal area, and frontal pole, together with the aIC, were activated during anticipation of pain stimulus. These areas have been reported as representative pain-related expectation regions.

Conclusion: This was the first study to show the stronger rs-FCs between the aIC and other pain-related expectation regions in female patients with severe knee OA. Female sex and preoperative pain intensity are risk factors of persistent postoperative pain after total knee arthroplasty. It is suggested that the functional relationship between pain-related expectation regions affects the formation of severe knee OA and persistent postoperative pain following total knee arthroplasty.
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http://dx.doi.org/10.2147/JPR.S268529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719440PMC
December 2020

Arthroscopic Rotator Cuff Repair With Muscle Advancement and Artificial Biodegradable Sheet Reinforcement for Massive Rotator Cuff Tears.

Orthop J Sports Med 2020 Oct 30;8(10):2325967120960166. Epub 2020 Oct 30.

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

Background: Because high failure rates have frequently been reported after arthroscopic rotator cuff repair (ARCR) of massive rotator cuff tears (mRCTs), we introduced the technique of ARCR with supraspinatus and infraspinatus muscle advancement (MA). However, for cases where the original footprint cannot be completely covered, additional surgery using an approved artificial biomaterial is performed.

Purpose: To investigate the postoperative clinical outcomes and failure rate after MA-ARCR, with and without our reinforcement technique.

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

Methods: A total of 74 patients (mean ± SD age, 68.7 ± 7.7 years) diagnosed with mRCT with a minimum postoperative follow-up of 2 years were included in the current study. Of these patients, 47 underwent MA-ARCR with polyglycolic acid (PGA) sheet reinforcement (study group), and 27 patients underwent MA-ARCR alone (control group). PGA reinforcement was performed when full coverage of the footprint could not be achieved by MA alone, but where the latter was possible, reinforcement was not required. Thus, the study group had significantly worse muscle quality than the control group ( < .05). The pre- and postoperative range of motion (ROM), isometric muscle strength, acromiohumeral interval, and clinical outcomes were evaluated and compared between these 2 groups. Cuff integrity during the last follow-up period was assessed with magnetic resonance imaging, and the failure rate was calculated. In addition, the postoperative foreign body reaction was investigated in the study group.

Results: In both groups, significant postoperative improvements were seen in acromiohumeral interval, clinical scores, ROM in anterior flexion, and isometric muscle strength in abduction, external rotation, and internal rotation ( < .001 for all). The failure rate of the study group was 12.8% (6 patients) and that of the control group was 25.9% (7 patients). No significant differences were noted between the 2 groups on any of the data findings, even regarding the failure rate. Foreign body reactions in the early period were found in 3 patients, although these spontaneously disappeared within 3 months.

Conclusion: Patients who underwent PGA patch reinforcement for MA-ARCR when the footprint could not be completely covered had clinical results similar to isolated MA-ARCR when the footprint could be covered. Both procedures resulted in significant improvement in symptoms and function compared with preoperatively.
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http://dx.doi.org/10.1177/2325967120960166DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607773PMC
October 2020

Arthroscopic triple arthrodesis for the patient with rheumatoid arthritis; a case report.

Mod Rheumatol Case Rep 2021 01 19;5(1):29-35. Epub 2020 Nov 19.

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

We treated a 60 - year - old man with pes planovalgus due to rheumatoid arthritis. He had been suffering from left foot pain with swelling. Despite drug therapy, his foot pain and deformity had got worsen. Taking into consideration his skin and bone quality, arthroscopic triple arthrodesis was performed. To access the subtalar joint, 2 portals were applied at the sinus tarsi, and decortication was performed. For calcaneocuboid joint, 1.5 cm portal was applied along with joint line at calcaneocuboid joint. Calcaneocuboid joint was fully decorticated, then, 1.5 cm portal was applied at the joint line of talonavicular joint in parallel. Synovectomy and decortication under arthroscopy were performed. Once each joint was sufficiently prepared, it was fixed using screws a percutaneous stab incision with an autologous bone graft from the iliac crest to the calcaneocuboid and talonavicular joint. At 12 weeks postoperatively, bone union was confirmed. The Japan Society for Surgery of the Foot (JSSF) RA foot and ankle scale had improved from the postoperative value of 38 points to a postoperative score of 86 points at one year. Plain radiographs showed that good alignment of the patient's hindfoot was maintained. We found that arthroscopic approach was able to achieve satisfactory outcome and minimise soft tissue trauma in a compromised patient.
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http://dx.doi.org/10.1080/24725625.2020.1847430DOI Listing
January 2021

Quantitative Assessment of Bone Marrow Edema in Adolescent Athletes with Lumbar Spondylolysis Using Contrast Ratio on Magnetic Resonance Imaging.

Asian Spine J 2020 Nov 16. Epub 2020 Nov 16.

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

Study Design: Prospective cohort study.

Purpose: To quantitatively evaluate bone marrow edema (BME) in the pedicle on magnetic resonance imaging (MRI) for adolescent athlete patients with spondylolysis.

Overview Of Literature: Spondylolysis, a stress fracture of the pars interarticularis, is a common occurrence in adolescent athletes with low back pain. T2-weighed fat-saturated MRI is reportedly useful for the detection of BME in the pedicle in the early stage of spondylolysis; however, to our knowledge, the quantitative assessment of BME in spondylolysis has not been reported.

Methods: Adolescent athletes with spondylolysis, including those with symptoms of low back pain, were enrolled. The sporting activity of the patients was restricted, and a hard brace was attached to the spine. The BME range of interest was taken on T2-weighed fat-saturated MRI, and the signal intensity (SI) of the BME (SIedema) was measured. The contrast ratio (CR) between the SI of the BME and SI of the spinal cord (SIcord) was calculated per the following formulae: CRedema=(SIedema-SIcord)/(SIedema+SIcord). The CR of the normal pedicle was measured as a control per the following formulae: CRcontrol=(SIcontrol-SIcord)/(SIcontrol+SIcord).

Results: The study enrolled 32 men and one woman; the mean patient age was 15.2 years (range, 12-18 years). The average CR of the edema and normal pedicle at the first visit was 0.506 (range, 0.097-0.804) and 0.137 (range, -0.741 to 0.572), respectively. The CR of the edema was significantly higher as compared to that of the normal pedicle (p<0.01). MRI that was performed 1 month after the first visit showed that the CR of the edema had decreased to 0.204 (range, -0.152 to 0.517). The CR of the edema 1 month thereafter was significantly lower than that at the first visit (p<0.01).

Conclusions: Quantitative assessment of BME using CR on MRI is useful in the evaluation of the healing process of spondylolysis.
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http://dx.doi.org/10.31616/asj.2020.0173DOI Listing
November 2020

Long-term Natural Course of the Osteochondral Lesion of the Talus in a Child: A Case Report.

J Foot Ankle Surg 2021 Mar-Apr;60(2):396-398. Epub 2020 Sep 20.

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

Recent reports have described midterm natural courses of osteochondral lesion of the talus (OLT) and lack of progression of ankle osteoarthritis (OA) in adult patients. The relationship between the OLT managed with nonoperative treatment and development of OA in children remains unknown. We report the long-term course of medial OLT in a 12-year-old female who was treated nonoperatively for 10 years. Radiographically, no osteoarthritic changes were observed at the first examination. She initially returned to her basketball club after nonoperative treatment. Although daily activities were not restricted, limitation of recreational activities began to appear at 4 years of follow-up. Subsequently, plain radiographs revealed bone absorption around the osteochondral fragment and osteophyte formation at the medial gutter, then ankle OA was advanced at the final follow-up.
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http://dx.doi.org/10.1053/j.jfas.2020.09.008DOI Listing
September 2020

Development of an Oncolytic Recombinant Vesicular Stomatitis Virus Encoding a Tumor-suppressor MicroRNA.

Anticancer Res 2020 Nov;40(11):6319-6325

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

Background: Attempts have been made to enhance systemic therapy for osteosarcoma. In our previous study, the systemic administration of a vesicular stomatitis virus (VSV) improved the survival rates of mice with osteosarcoma but did not improve the long-term survival of the animals.

Materials And Methods: In the present study, we developed a novel oncolytic VSV by incorporating tumor-suppressor microRNA143 (rVSV-miR143) to compare the antitumor effects of various doses (10×10, 5×10, and 1×10 multiplicity of infection) of rVSV-miR143 with those of VSV in vitro.

Results: The cytotoxicity and migration-inhibitory effects of rVSV-miR143 on the osteosarcoma cells were significantly higher than those of VSV alone at a dose of 5×10 multiplicity of infection, indicating that rVSV-miRNA143 enhances the antitumor effect at certain doses.

Conclusion: VSV incorporating tumor-suppressor miRNA143 demonstrated a synergistic antitumor effect on osteosarcoma cells in vitro.
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http://dx.doi.org/10.21873/anticanres.14652DOI Listing
November 2020