Publications by authors named "Shuichi Matsuda"

441 Publications

A Minimally Invasive Novel Technique Using a New Device to Treat Proximal Femoral Cystic Lesions.

J Orthop Case Rep 2020 May-Jun;10(3):23-26

Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Introduction: Bone grafts are widely performed to fill bone cavities and accelerate bone ingrowth. Advances in minimally invasive surgical techniques to treat bone tumors provide the impetus for minimally invasive bone graft procedures. A special funnel with an inner plunger has been manufactured specifically for the delivery of bone graft substitutes.

Technique: Secondary bone cysts in two patients with fibrous dysplasia (a 42-year-old male and a 36-year-old female) were treated with the bone graft substitute β-tricalcium phosphateby implantation through a small fenestration in the greater trochanter using a special funnel. Bone consolidation has been observed at about 6 months after the surgery.

Conclusions: Secondary bone cysts in two patients with fibrous dysplasiaare presented as representative cases for this method. The funnel was particularly useful for proximal femoral cystic lesions, as a solitary bone cyst; it facilitated a minimally invasive surgical procedure without the need for curettage. Small fenestrations reduce the likelihood of surgery-related fractures. Long-term follow-up is necessary to confirm the method and is capable of curing secondary bone cysts in patients with fibrous dysplasia.
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http://dx.doi.org/10.13107/jocr.2020.v10.i03.1732DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051563PMC
May 2021

Comparison of four posterior approaches of the ankle: A cadaveric study.

OTA Int 2020 Sep 12;3(3):e085. Epub 2020 Aug 12.

Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Objectives: The purpose of this study is to provide a detailed comparison of 4 posterior approaches of the ankle: the posteromedial, modified posteromedial (mPM), Achilles tendon-splitting (TS), and posterolateral approaches.

Methods: Cadaveric dissections were performed to assess the influence of the medial and lateral retraction forces on the neuro-vascular bundle with suspension scales and to measure the medial and lateral exposed areas of the posterior tibia and talus. Data was acquired with the ankle in neutral position and in plantar flexion.

Results: Both the mPM and TS approaches provided excellent visualization of the posterior tibia with the ankle in plantar flexion (16.6 cm and 16.2 cm, respectively). The medial aspect of the posterior tibia, however, was significantly better exposed in the mPM approach than in the TS approach with the ankle in neutral position (8.9 cm vs 6.5 cm). The lower value for medial retraction force in the mPM approach (1.9 N in neutral position and 0.9 N in plantar flexion) indicated a lower risk of injury to the neuro-vascular bundle (the tibial nerve and the posterior tibial artery). The posterior talus, however, is best visualized through the TS approach with the ankle in neutral position (4.5 cm).

Conclusions: The current study demonstrated the usefulness of the mPM approach. When internal fixation of the fibula is unnecessary, the mPM approach is preferable, considering the potential damage to the Achilles tendon associated with the TS approach.
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http://dx.doi.org/10.1097/OI9.0000000000000085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8022904PMC
September 2020

Combining a vascular bundle and 3D printed scaffold with BMP-2 improves bone repair and angiogenesis.

Tissue Eng Part A 2021 Apr 28. Epub 2021 Apr 28.

Stanford University, Department of Orthopedic Surgery, 300 Pasteur Drive, Edwards Room 155, Stanford, California, United States, 94305-5341;

Vascularization is currently considered the biggest challenge in bone tissue engineering due to necrosis in the center of large scaffolds. We established a new expendable vascular bundle model to vascularize a 3D printed channelled scaffold with and without BMP2 for improved healing of large segmental bone defects. Bone formation and angiogenesis in an 8 mm critical sized bone defect in the rat femur were significantly promoted by inserting a bundle consisting of the superficial epigastric artery and vein into the central channel of a large porous polycaprolactone scaffold. Vessels were observed sprouting from the vascular bundle inserted in the central tunnel. While the regenerated bone volume in the group receiving the scaffold and vascular bundle was similar to that of the healthy femur, the rate of union of the group was not satisfactory (25% at 8 weeks). BMP-2 delivery was found to promote not only bone formation, but also angiogenesis in the critical sized bone defects. Both insertion of the vascular bundle alone and BMP-2 loading alone induced comparable levels of angiogenesis and when used in combination, significantly greater vascular volume was observed. These findings suggest a promising new modality of treatment in large bone defects.
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http://dx.doi.org/10.1089/ten.TEA.2021.0049DOI Listing
April 2021

Region specificity of rheumatoid foot symptoms associated with ultrasound-detected synovitis and joint destruction.

Mod Rheumatol 2021 Apr 14:1-28. Epub 2021 Apr 14.

Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Objectives: We aimed to clarify the clinical implication of ultrasound (US)-detected foot joint inflammation in tightly controlled patients with rheumatoid arthritis (RA).

Methods: We evaluated bilateral foot joints (second to fifth metatarsophalangeal joints of forefoot; tarsometatarsal, cuneonavicular and midtarsal joints of midfoot) of 430 RA patients for synovitis using Power Doppler (PD) imaging by US. We made a cross-sectional and a 3-year longitudinal analysis about the associations of US-detected synovitis with clinical, laboratory and radiographic data as well as foot-specific outcomes using a self-administered foot evaluation questionnaire (SAFE-Q).

Results: The US-detected foot synovitis was seen in 28% of patients. The US-detected synovitis was closely related to 28 joint-disease activity score (DAS28) more in the forefoot than in the midfoot, while related to joint destruction in both. Multiple regression analyses showed significant associations between midfoot PD positivity and SAFE-Q in the remission group. SAFE-Q was worsened after the 3-year interval, but PD positivity at baseline did not contribute to the changes. On the other hand, destruction of the joints with US-detected synovitis significantly progressed in 3 years than with not.

Conclusions: US-detected synovitis on foot joints were related to systemic inflammation, clinical symptoms, and future joint destruction with region specificity.
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http://dx.doi.org/10.1080/14397595.2021.1912905DOI Listing
April 2021

Intractable Fractures of the Bilateral Proximal Ulnae After 8 Years of Zoledronate Treatment for Breast Cancer Bone Metastasis.

J Hand Surg Am 2021 Apr 9. Epub 2021 Apr 9.

Department of Orthopaedic Surgery, School of Medicine, Kyoto University, Kyoto, Japan.

Long-term administration of bisphosphonates strongly suppresses osteoclastic bone resorption and rarely causes atypical fractures. This report presents a case of bilateral atypical ulnar fractures, following an 8-year course of zoledronate to treat breast cancer bone metastasis. Nonsurgical treatment for the left ulnar fracture failed, in spite of minimal displacement with callus formation at initial presentation. After failure of plate fixation with a pedicled vascularized bone graft, removal of osteosclerotic lesions and plate fixation with corticocancellous iliac bone graft resulted in bone healing, although the healing process took 1.5 years. Plate fixation for the contralateral fractured ulna was unsuccessful.
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http://dx.doi.org/10.1016/j.jhsa.2021.02.012DOI Listing
April 2021

Difference in Therapeutic Strategies for Joint-Preserving Surgery for Non-Traumatic Osteonecrosis of the Femoral Head between the United States and Japan: A Review of the Literature.

Orthop Surg 2021 Apr 5. Epub 2021 Apr 5.

Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

For patients with non-traumatic osteonecrosis of the femoral head (ONFH), core decompression (CD) and bone grafts (BG) are mainly performed in the West, while osteotomy is found to be predominant in Japan. It is not well recognized how the surgical procedures for joint preservation in patients with ONFH are completely different between the United States and Japan. This paper identifies the contexts and the differences in treatment strategies for ONFH between the two countries. We compared the surgical trends of the two countries over three periods, 1997-2001, 2002-2006, and 2007-2011 (the US data for the third period was 2007-2008), based on a 2014 US paper and a 2013 national publication in Japan. We compared the details of surgery for non-traumatic ONFH under the same conditions in the two reports. For the period 1997-2001, the rates of surgeries for ONFH in the US were as follows: total hip arthroplasty (THA), 86%; CD, 10%; and osteotomy, 0.4%. In Japan, THA was 61%, osteotomy 38%, and CD 0%. For the recent period, 2007-2011 (US 2007-2008), the rate of THA was 91%, CD 6%, and osteotomy 0.1%, in the US, compared to a THA rate of 73%, CD 0%, and osteotomy 26% in Japan. The results for the interim period (2002-2006) were between the old and new data. The use of joint-preserving surgery for ONFH differs greatly between the US and Japan. The first-line joint-preserving surgery was CD in the US and osteotomy in Japan. Each procedure was rarely done in the other country. From about 2000 to 2010, the percentage of THA increased in both countries. The proportion of joint-preserving surgery (CD in the US and osteotomy in Japan) declined. The decrease in joint-preserving procedures may be largely attributed to improved long-term outcomes of THA due to technological advances. There is also a reluctance for young ONFH patients to undergo joint-preserving procedures, such as osteotomy, that require long-term hospitalization.
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http://dx.doi.org/10.1111/os.12979DOI Listing
April 2021

Bone Coverage around Hydroxyapatite/Poly(-Lactide) Composite Is Determined According to Depth from Cortical Bone Surface in Rabbits.

Materials (Basel) 2021 Mar 17;14(6). Epub 2021 Mar 17.

The Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 602-8570, Japan.

Composites of unsintered hydroxyapatite (HA) and poly(-lactide) (PLLA) reinforced by compression forging are biodegradable, bioactive, and have ultrahigh strength. However, foreign body reactions to PLLA and physical irritation can occur when not covered by bone. We aimed to confirm the relationships between the depth of the implanted HA-PLLA threaded pins and the new bone formation. We inserted HA-PLLA composite threaded pins (diameter: 2.0 or 4.5 mm) into the femoral and tibial bones of 32 mature male Japanese white rabbits (weight 3.0-3.5 kg) with the pin head 1 or 0 mm below or protruding 1 or 2 mm above surrounding cortical bone. Eight euthanized rabbits were radiologically and histologically assessed at various intervals after implantation. Bone bridging was complete over pins of both diameters at ~12 weeks, when inserted 1 mm below the surface, but the coverage of the pins inserted at 0 mm varied. Bone was not formed when the pins protruded >1 mm from the bone surface. No inflammation developed around the pins by 25 weeks. However, foreign body reactions might develop if composites are fixed above the bone surface, and intraosseous fixation would be desirable using double-threaded screws or a countersink to avoid screw head protrusion.
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http://dx.doi.org/10.3390/ma14061458DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8002476PMC
March 2021

A comparison of the usefulness of nuclear beta-catenin in the diagnosis of desmoid-type fibromatosis among commonly used anti-beta-catenin antibodies.

Pathol Int 2021 Mar 31. Epub 2021 Mar 31.

Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan.

Desmoid-type fibromatosis (DF) is a locally aggressive but non-metastatic (myo)fibroblastic neoplasm. A hallmark of the tumor is nuclear positivity for beta-catenin in immunohistochemistry due mostly to CTNNB1 mutations. However, a recent study has reported that even beta-catenin 'nuclear-negative' DFs can harbor CTNNB1 mutations and that the positive ratio of nuclear beta-catenin in DF is different among antibodies. Here, we reviewed soft tissue lesions for which the possibility of DF was considered and compared the sensitivity and specificity of nuclear beta-catenin for the diagnosis of DF among commonly used anti-beta-catenin antibodies, i.e., clone beta-catenin 1, 17C2 and 14. We analyzed 26 cases of DF, 28 cases of benign fibroblastic lesions, and 27 cases of other soft tissue tumors. The sensitivity and specificity of nuclear beta-catenin for the diagnosis of DF were different among antibodies; 54% and 98% in clone beta-catenin 1, 85% and 84% in 17C2, and 96% and 62% in 14. IHC of LEF1 showed comparable results with IHC of beta-catenin, with a sensitivity of 88% and specificity of 76%. Additionally, when beta-catenin 1 was used, DFs showed characteristic dotted cytoplasmic staining, often appearing as rings. Our results might be helpful for making a correct diagnosis of DF.
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http://dx.doi.org/10.1111/pin.13096DOI Listing
March 2021

Higher exercise tolerance early after allogeneic hematopoietic stem cell transplantation is the predictive marker for higher probability of later social reintegration.

Sci Rep 2021 Mar 30;11(1):7190. Epub 2021 Mar 30.

Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan.

As the proportion of long-term survivors after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is on the rise, it is essential to consider the significance of quality of life (QOL), including reintegration with society (returning to school or work). This retrospective cohort study aims to illustrate the precise epidemiology of social reintegration later after allo-HSCT and determine its predictive indicators. We enrolled 56 patients, and 40 patients (71%) attained social reintegration at 2 years post-HSCT. Reintegration failure markedly correlated with an inferior performance status and concurrent chronic graft-versus-host disease. In non-reintegrated patients, the physical function at discharge measured by the 6-min walking distance (6MWD) was markedly decreased. On the multivariate risk analyses, sex (female; odds ratio (OR) 0.07; 95% confidence interval (CI) 0.01-0.54; p = 0.01), HCT-CI (≥ 2; OR 0.10; 95% CI 0.01-0.84; p = 0.03), and change in 6MWD (per 5% increase; OR 1.47; 95% CI 1.01-2.13; p = 0.04) were significant predictors of later social reintegration. This study suggests that a multidisciplinary strategy including rehabilitation is essential, especially in patients with poor predictive markers at an early phase, and we should consider suitable rehabilitation programs to prevent a decline in exercise tolerance and improve social reintegration and overall QOL in patients after allo-HSCT.
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http://dx.doi.org/10.1038/s41598-021-86744-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010097PMC
March 2021

Urinary sodium-to-potassium ratio associates with hypertension and current disease activity in patients with rheumatoid arthritis: a cross-sectional study.

Arthritis Res Ther 2021 03 27;23(1):96. Epub 2021 Mar 27.

Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan.

Background: Excessive salt intake is thought to exacerbate both development of hypertension and autoimmune diseases in animal models, but the clinical impact of excessive salt in rheumatoid arthritis (RA) patients is still unknown. We performed a cross-sectional study to clarify the associations between salt load index (urinary sodium-to-potassium ratio (Na/K ratio)), current disease activity, and hypertension in an RA population.

Methods: Three hundred thirty-six participants from our cohort database (KURAMA) were enrolled. We used the spot urine Na/K ratio as a simplified index of salt loading and used the 28-Joint RA Disease Activity Score (DAS28-ESR) as an indicator of current RA disease activity. Using these indicators, we evaluated statistical associations between urinary Na/K ratio, DAS28-ESR, and prevalence of hypertension.

Results: Urinary Na/K ratio was positively associated with measured systolic and diastolic blood pressure and also with prevalence of hypertension even after covariate adjustment (OR 1.34, p <  0.001). In addition, increased urinary Na/K ratio was significantly and positively correlated with DAS28-ESR in multiple regression analysis (estimate 0.12, p <  0.001), as was also the case in gender-separated and prednisolone-separated sub-analyses.

Conclusion: Urinary Na/K ratio was independently associated with current disease activity as well as with prevalence of hypertension in RA patients. Thus, dietary modifications such as salt restriction and potassium supplementation should be investigated as a potential candidate for attenuating both disease activity and hypertension in RA patients.
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http://dx.doi.org/10.1186/s13075-021-02479-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004419PMC
March 2021

Number of Levels of Spinal Fusion Associated with the Rate of Joint-Space Narrowing in the Hip.

J Bone Joint Surg Am 2021 Mar 26. Epub 2021 Mar 26.

Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Background: Fusion of a joint reportedly increases force in the adjacent joints and leads to progression of arthritis. Whether lumbar spinal fusion increases force in the hip joint and promotes wear of the joint space is unclear. The purpose of this study was to evaluate the rate of joint-space narrowing in the hip following spinal fusion and to examine the effects of the number of levels fused on the joint-narrowing rate.

Methods: We retrospectively reviewed data for patients who underwent lumbar spinal fusion from 2011 to 2018 at our institute. Patients with a previous hip surgery, Kellgren-Lawrence grade ≥II hip osteoarthritis, hip dysplasia, and rheumatoid arthritis were excluded. The rate of joint-space narrowing in the hip was measured in 205 eligible patients (410 hips) following spinal fusion, and the effects of sex, age, body mass index, indication for spinal fusion, laterality, sacral fixation, and number of levels fused on the narrowing rate were examined.

Results: The rate of joint-space narrowing for all patients was 0.114 ± 0.168 mm/year. The narrowing rate for single-level fusion was 0.062 ± 0.087 mm/year, whereas that for fusion of ≥7 levels was 0.307 ± 0.254 mm/year. In the multivariate regression analysis, only the length of fusion (standardized coefficient [SC] = 0.374, p < 0.0001) was associated with an increased narrowing rate. When the narrowing rate was normalized by height, female sex was another risk factor for increased narrowing (SC = 0.109, p = 0.023). Secondary regression modeling performed with patients who underwent spinal fusion for degenerative disc disease showed that the length of fusion (SC = 0.454, p < 0.0001) and female sex (SC = 0.138, p = 0.033) were associated with increased joint-space narrowing.

Conclusions: Longer spinal fusion was associated with the progression of hip joint narrowing following spinal fusion. Surgeons should be aware of the possible increased risk of hip degeneration following spinal fusion and should inform patients of this risk.

Level Of Evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.2106/JBJS.20.01578DOI Listing
March 2021

Physical function after lung transplantation for late-onset noninfectious pulmonary complications after allogeneic hematopoietic stem cell transplantation.

Support Care Cancer 2021 Mar 11. Epub 2021 Mar 11.

Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.

Purpose: Late-onset noninfectious pulmonary complications (LONIPCs) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) are fatal, and lung transplantation is the only curative treatment. Although lung transplantation for LONIPCs may confer good survival rates, it is unclear whether or how impaired physical functioning is restored. Thus, this study aimed to investigate the long-term course and associated changes in physical functions after lung transplantation in patients with LONIPCs after allo-HSCT.

Methods: This prospective cohort study enrolled 15 patients who received lung transplantation for LONIPCs after allo-HSCT between 2012 and 2018. Dyspnea scores, performance status, physical function, and exercise tolerance were assessed before lung transplantation and up to 2 years after transplantation.

Results: Two years after lung transplantation, the dyspnea scores and performance status improved, but did not recover completely. Physical function was assessed using the knee extensor strength (KES) and 6-min walk test (6MWT); the results were poor until 3 months after transplantation but improved over 2 years. The 6MWT distance showed improvement to a nearly healthy level (562.7 m). Recovery of exercise tolerance was associated with recovery in % vital capacity (%VC; r=0.5) and KES (r=0.4) from 3 months to 2 years after lung transplantation. Furthermore, a flat thorax, which is a characteristic of patients with LONIPCs, affected the %VC at 2 years after transplantation (r=0.8).

Conclusion: Lung transplantation for LONIPCs may restore impaired physical function. A multifaceted rehabilitation program should be considered, especially to improve muscle weakness and pulmonary function.
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http://dx.doi.org/10.1007/s00520-021-06118-8DOI Listing
March 2021

Possible Association of Pedicle Screw Diameter on Pseudoarthrosis Rate After Transforaminal Lumbar Interbody Fusion.

World Neurosurg 2021 Mar 5. Epub 2021 Mar 5.

Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Background: Although pedicle screw sizes may affect the rate of bone union after lumbar fusion surgery, there is currently no supportive clinical evidence.

Methods: Eighty-five patients older than 50 years who underwent single-level L4/5 transforaminal lumbar interbody fusion with posterior pedicle screw (PS) fixation were analyzed. Patients with factors that potentially inhibit bone fusion, such as Parkinson disease, were excluded. Bone union was assessed using computed tomography and dynamic radiographs 1 year after surgery. Explanatory factors considered included sex, age, smoking, bone density, material of the cage, PS diameter (PSD), relative PS length, theoretical maximum PSD (PSD), which was defined as the maximum diameter of the screw that may be inserted without breaking cortical bone around the pedicle, and the filling index, which was defined as the difference between the cross-sectional area of maximum PS and actual PS (PSD 2 - PSD 2). Japanese Orthopaedic Association scores before and 1 year after surgery were evaluated as a clinical outcome.

Results: Nineteen levels were diagnosed as pseudoarthrosis. A multivariate logistic regression analysis identified a larger filling index (P = 0.016) and older age (P = 0.047) as risk factors for pseudoarthrosis. The Japanese Orthopaedic Association score 1 year after surgery and its recovery rate were significantly worse in patients with pseudoarthrosis than in those with fusion.

Conclusions: The selection of an appropriately sized screw is important for achieving rigid fusion after transforaminal lumbar interbody fusion. Preoperative planning using multiplanar reconstruction computed tomography is an important approach for ensuring good clinical results.
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http://dx.doi.org/10.1016/j.wneu.2021.02.117DOI Listing
March 2021

Differences in impact on adjacent compartments in medial unicompartmental knee arthroplasty versus high tibial osteotomy with identical valgus alignment.

Knee 2021 Mar 3;29:241-250. Epub 2021 Mar 3.

Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Background: It is unclear why medial unicompartmental knee arthroplasty (UKA) with postoperative valgus alignment causes adjacent compartment osteoarthritis more often than high tibial osteotomy (HTO) for moderate medial osteoarthritis of the knee with varus deformity. This study used a computer simulation to evaluate differences in knee conditions between UKA and HTO with identical valgus alignment.

Methods: Dynamic musculoskeletal computer analyses of gait were performed. The hip-knee-ankle angle in fixed-bearing UKA was changed from neutral to 7° valgus by changing the tibial insert thickness. The hip-knee-ankle angle in open-wedge HTO was also changed from neutral to 7° valgus by opening the osteotomy gap.

Results: The lateral tibiofemoral contact forces in HTO were larger than those in UKA until moderate valgus alignments. However, the impact of valgus alignment on increasing lateral forces was more pronounced in UKA, which ultimately demonstrated a larger lateral force than HTO. Valgus alignment in UKA caused progressive ligamentous tightness, including that of the anterior cruciate ligament, resulting in compression of the lateral tibiofemoral compartment. Simultaneously, patellofemoral shear forces were slightly increased and excessive external femoral rotation against the tibia occurred due to the flat medial tibial insert surface and decreased lateral compartment congruency. By contrast, only lateral femoral slide against the tibia occurred in excessively valgus-aligned HTO.

Conclusions: In contrast to extra-articular correction in HTO, which results from opening the osteotomy gap, intra-articular valgus correction in UKA with thicker tibial inserts caused progressive ligamentous tightness and kinematic abnormalities, resulting in early osteoarthritis progression into adjacent compartments.
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http://dx.doi.org/10.1016/j.knee.2021.02.017DOI Listing
March 2021

Titania-Containing Bone Cement Shows Excellent Osteoconductivity in a Synovial Fluid Environment and Bone-Bonding Strength in Osteoporosis.

Materials (Basel) 2021 Feb 27;14(5). Epub 2021 Feb 27.

Department of Orthopedic Surgery, Kyoto University, Kyoto 606-8507, Japan.

Titania bone cement (TBC) reportedly has excellent in vivo bioactivity, yet its osteoconductivity in synovial fluid environments and bone-bonding ability in osteoporosis have not previously been investigated. We aimed to compare the osteoconductivity of two types of cement in a synovial fluid environment and determine their bone-bonding ability in osteoporosis. We implanted TBC and commercial polymethylmethacrylate bone cement (PBC) into rabbit femoral condyles and exposed them to synovial fluid pressure. Rabbits were then euthanized at 6, 12, and 26 weeks, and affinity indices were measured to evaluate osteoconductivity. We generated a rabbit model of osteoporosis through bilateral ovariectomy (OVX) and an 8-week treatment with methylprednisolone sodium succinate (PSL). Pre-hardened TBC and PBC were implanted into the femoral diaphysis of the rabbits in the sham control and OVX + PSL groups. Affinity indices were significantly higher for TBC than for PBC at 12 weeks (40.9 ± 16.8% versus 24.5 ± 9.02%) and 26 weeks (40.2 ± 12.7% versus 21.2 ± 14.2%). The interfacial shear strength was significantly higher for TBC than for PBC at 6 weeks (3.69 ± 1.89 N/mm versus 1.71 ± 1.23 N/mm) in the OVX + PSL group. These results indicate that TBC is a promising bioactive bone cement for prosthesis fixation in total knee arthroplasty, especially for osteoporosis patients.
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http://dx.doi.org/10.3390/ma14051110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956823PMC
February 2021

Habitual fish intake negatively correlates with prevalence of frailty among patients with rheumatoid arthritis.

Sci Rep 2021 Mar 3;11(1):5104. Epub 2021 Mar 3.

Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Frailty is a geriatric syndrome characterized by anabolic-catabolic imbalance and multisystem dysregulation resulting in increased adverse health outcomes, and is closely related with dietary habits in the general population. Although chronic inflammatory diseases are thought to accelerate development of frailty, correlations between rheumatoid arthritis (RA), frailty and dietary habits have not been examined. We performed a cross-sectional study using our cohort database (KURAMA cohort), and classified 306 participants into three groups (robust, prefrail and frail) according to the Study of Osteoporotic Fracture (SOF) criteria. Multivariate logistic analysis revealed that the presence of frailty/prefrailty was significantly correlated with the disease activity score (DAS28-ESR) (OR 1.70 (1.30-2.22), p < 0.0001). Additional analyses of frailty and food intake showed that 5 foods (fish, meat, milk, vegetables and fruits) of 20 groups on the questionnaire were inversely associated with the prevalence of frail/prefrail categories. In multivariate analysis with the five nutrients, fish intake (> two times a week) was an independent covariate negatively correlated with frailty/prefrailty (OR 0.35 (0.19-0.63), p = 0.00060). In conclusion, habitual fish intake may play a key role in nutritional intervention to prevent progression of frailty and RA.
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http://dx.doi.org/10.1038/s41598-021-84479-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7930016PMC
March 2021

Self-quarantine programme and pre-operative SARS-CoV-2 PCR screening for orthopaedic elective surgery: experience from Japan.

Int Orthop 2021 05 2;45(5):1147-1153. Epub 2021 Mar 2.

Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo-ku, Kyoto, 606-8507, Japan.

Purpose: This study aimed to evaluate the acceptability of 14 days of self-quarantine and the positivity rate of pre-operative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) screening for patients undergoing elective orthopaedic surgery.

Methods: The self-quarantine programme and pre-operative SARS-CoV-2 PCR screening were initiated for patients who were scheduled for admission later than 7 May 2020 for elective orthopaedic surgery on admission. On the day of admission, the patients declared compliance with self-quarantine regulations. The admission was refused in cases of non-compliance. After admission, the patients underwent SARS-CoV-2 PCR screening. If PCR results were negative, isolation was terminated. If PCR results were positive, the surgery was postponed. If the patients had symptoms suspicious of coronavirus disease (COVID-19) after surgery, the PCR test was repeated.

Results: Overall, 308 patients (age: 63.2 ± 18.8 years, 197 female and 111 male) were scheduled for elective orthopaedic surgery. Two patients did not agree with the requirements of self-quarantine, and two other procedures were cancelled. No non-compliance was reported; thus, the completion rate of the self-quarantine programme was 304/308 (98.7%). Finally, 304 patients underwent PCR testing, and there were no positive PCR results. After cancellations of four operations due to reasons other than COVID-19, 300 surgical procedures were performed. No patients developed COVID-19 during hospitalisation.

Conclusions: Although this system is based on trusting the good behaviour of patients, accompanied by PCR screening, we believe that the results showed the efficacy of the system in safely performing orthopaedic surgery during the COVID-19 pandemic.
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http://dx.doi.org/10.1007/s00264-021-04997-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924815PMC
May 2021

Chronic Expanding Hematomas That Occurred 20 Years or More After Primary Total Hip Arthroplasty: A Report of 2 Cases.

JBJS Case Connect 2021 03 2;11(1). Epub 2021 Mar 2.

Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Case: We report 2 patients who developed chronic expanding hematomas (CEHs) more than 20 years after ceramic-on-polyethylene total hip arthroplasty (THA). One CEH occurred after a minor fall, and the other appeared with no obvious injury. Neither of the 2 was on anticoagulation. Each caused extensive osteolysis.

Conclusion: The only 2 previously reported post-THA cases of CEH involved metal-on-metal THAs and occurred several years after the index THA. Our patients show that CEH also can occur after ceramic-on-polyethylene THA, even after an uneventful clinical course of more than 20 years. Complete removal of both hematoma stopped osteolytic progression, with no recurrence to date.
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http://dx.doi.org/10.2106/JBJS.CC.20.00619DOI Listing
March 2021

Corticosteroid-associated osteonecrosis of the femoral head after orthotopic liver transplantation and the outcomes of subsequent total hip arthroplasty.

J Orthop Sci 2021 Feb 26. Epub 2021 Feb 26.

Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto, 606-8507, Japan.

Background: Corticosteroids are essential for immunosuppression after orthotopic liver transplantation (OLT), but also have many side effects. Osteonecrosis of the femoral head (ONFH) is one of the most serious complications requiring prostheses. However, few studies have investigated ONFH after OLT. The purpose of this study is to survey the incidence of corticosteroid-induced ONFH after OLT and the outcomes of total hip arthroplasty (THA).

Methods: Between January 2001 and December 2010, a series of 926 patients underwent OLT at our Hospital. A retrospective analysis was performed on a total of 738 patients who survived at least 2 years after OLT. The incidence of symptomatic ONFH, the interval from OLT to the initial diagnosis of ONFH, and the cumulative dose of corticosteroids were analyzed. The side effects related to OLT, such as other osteonecrosis lesions, osteoporotic fractures, and infection, were monitored. For patients who underwent THA, radiological findings and Japanese Orthopaedic Association (JOA) scores were evaluated.

Results: ONFH occurred in 10 patients (13 hips) (6 men [7 hips], 4 women [6 hips]), with an incidence of 1.36%. The average age at OLT was 51.4 years (range, 31-61 years). The average interval from OLT to ONFH was 86.7 months (range, 22-155 months). The average cumulative dose of corticosteroids was 7274 mg (range, 1342-29,514 mg). Twenty patients suffered from side effects related to OLT. Seven patients (8 hips) underwent THA. No adverse events including infection arose during the perioperative process. One hip dislocated, and one femoral stem displayed a radiolucent line. The average JOA score improved from 45.4 (range, 25-76) preoperatively to 86.9 (range, 73-99) at final follow-up. No patients required revision surgery.

Conclusions: The incidence of symptomatic ONFH after OLT was 1.36%. Once the graft function becomes stable, THA can be a safe and effective treatment option for patients with ONFH after OLT.
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http://dx.doi.org/10.1016/j.jos.2020.12.014DOI Listing
February 2021

Coexistence of low back pain and lumbar kyphosis is associated with increased functional disability in knee osteoarthritis: the Nagahama Study.

Arthritis Care Res (Hoboken) 2021 Feb 19. Epub 2021 Feb 19.

Kyoto University, Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto, Japan.

Objective: To examine the association of low back pain (LBP) and lumbar kyphosis with functional disabilities and knee symptoms in patients with knee osteoarthritis (OA).

Methods: We analyzed 586 participants (80.1% female; age, 68.8 ± 5.2 years) from the Nagahama Study who were aged ≥60 years and had radiographically confirmed knee OA. The Knee Scoring System (KSS) was used to assess functional disabilities and knee symptoms. LBP was defined as the presence of any persistent back pain for more than 3 months. Lumbar kyphosis was determined by skin-surface methods using a computer-aided electronic device called the Spinal Mouse. Multiple linear regression analysis was used for assessing the association of LBP and lumbar kyphosis with the KSS scores. Subgroup analyses based on sex were also performed.

Results: LBP and lumbar kyphosis were independently associated with a lower KSS function score after adjustment for covariates (mean difference [95%CI, confidence interval] = -4.96 [-7.56 to -2.36] points for LBP alone, -4.47 [-8.51 to -0.43] points for lumbar kyphosis alone, and -13.86 [-18.86 to -8.86] points for the coexistence of LBP and lumbar kyphosis, respectively). The coexistence of LBP and lumbar kyphosis in women was associated with a lower KSS symptom score (mean difference [95%CI] = -4.49 [-6.42 to -2.55] points).

Conclusion: These findings suggest that both LBP and lumbar kyphosis are useful clinical signals indicating functional disability and knee symptoms in patients with knee OA.
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http://dx.doi.org/10.1002/acr.24580DOI Listing
February 2021

Percutaneous autologous impaction bone graft for advanced femoral head osteonecrosis: a retrospective observational study of unsatisfactory short-term outcomes.

J Orthop Surg Res 2021 Feb 17;16(1):141. Epub 2021 Feb 17.

Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto, 606-8507, Japan.

Background: Half of osteonecrosis of the femoral head (ONFH) patients suffer femoral head collapse at initial diagnosis, and more than half are bilaterally affected. This study developed a percutaneous autologous impaction bone graft (IBG) technique as a modification of core decompression (CD). We also summarized the short-term results and treatment efficacy of percutaneous autologous IBG in advanced ONFH.

Methods: Twenty patients (12 males, 8 females) with nontraumatic, postcollapse ONFH except one case underwent CD (10-mm core diameter) and reverse IBG. Radiological changes of the ONFH stage and type were analyzed. Survival analysis using Kaplan-Meier estimates was performed with conversion to total hip arthroplasty (THA) as the endpoint. In addition, the Harris hip score (HHS) and University of California, Los Angeles (UCLA) activity rating scale were evaluated.

Results: Percutaneous autologous IBG was performed successfully, with an average operation time of < 1 h and small blood loss, and 7 patients (35%) needed conversion to THA at an average of 17 months postoperatively. We observed radiological progressive change in 60% of the patients during a mean observation period of 3 years. The mean clinical scores, except data recorded, after THA significantly improved (before vs. after 3 years: UCLA activity score, 3.7 vs. 5.2 [P = 0.014]; HHS, 57.6 vs. 76.5 points [P = 0.005]). In addition, 6 patients showed radiological progression but no clinical deterioration.

Conclusions: Percutaneous autologous IBG was technically simple and minimally invasive, but short-term results were unsatisfactory for advanced ONFH. Indications for this procedure should be carefully examined to improve it in order to enable bone formation.
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http://dx.doi.org/10.1186/s13018-021-02288-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7888152PMC
February 2021

Arthroscopic evaluation after osteochondral autogenous transfer with osteotomy of medial malleolus for osteochondral lesion of the talar dome.

Foot Ankle Surg 2021 Feb 4. Epub 2021 Feb 4.

Department of Orthopedic Surgery, Kyoto Katsura Hospital, Japan.

Background: The purpose of this study was to investigate the second-look arthroscopic evaluation after osteochondral autogenous transfer (OAT) for osteochondral lesion of the talar dome (OLT) with the criteria of the International Cartilage Repair Society (ICRS).

Methods: Ten patients (twelve ankles) with OLT underwent OAT with osteotomy of the medial malleolus. Clinical outcomes were evaluated using the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale. The condition of the transplanted cartilage was evaluated at the time of second-look arthroscopy using the ICRS Cartilage Repair Assessment.

Results: The AOFAS ankle-hindfoot scale was significantly improved from 65.1 ± 1.9 points before surgery to 98.1 ± 2.8 points at the time of second-look arthroscopy (p < 0.01). The ICRS Cartilage Repair Assessment was 11.4 points on average (9-12 points).

Conclusions: The OAT for OLT is considered to be a useful treatment even if invasion by medial malleolus osteotomy is added.

Level Of Evidence: Level IV, Case series.
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http://dx.doi.org/10.1016/j.fas.2021.01.005DOI Listing
February 2021

Thoracoabdominal flap reconstruction after resection of superficial soft-tissue sarcomas in the chest wall.

J Surg Case Rep 2021 Jan 29;2021(1):rjaa571. Epub 2021 Jan 29.

Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

The thoracoabdominal flap is a rotation flap, and is well known for reconstruction of defects following resections for breast cancer, but the flap is not well known for reconstructing defects following resections of soft-tissue sarcomas involving the chest wall. Here we present two patients with superficial chest wall sarcomas consisting of a dermatofibrosarcoma protuberans in a 42-year-old man and a recurrent myxofibrosarcoma in a 76-year-old man. The tumors were resected with the surrounding tissue. The defect was reconstructed with a thoracoabdominal flap elevated from the ipsilateral thorax (medially-based flap). Neither case developed necrosis of the flap or reduced shoulder range of motion. The chest wall presents few options for a donor vessel. The thoracoabdominal flap has an axial blood supply and does not require a microsurgical procedure. A thoracoabdominal flap is a suitable reconstruction option for a defect after the resection of a superficial soft-tissue sarcoma in the chest wall.
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http://dx.doi.org/10.1093/jscr/rjaa571DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850005PMC
January 2021

Genome-wide association study in patients with pulmonary complex disease.

Eur Respir J 2021 Feb 4. Epub 2021 Feb 4.

Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan.

Rationale: Nontuberculous mycobacteria (NTM) are environmental mycobacteria that can cause a chronic progressive lung disease. Although epidemiological data indicate potential genetic predisposition, its nature remains unclear.

Objectives: We aimed to identify host susceptibility loci for complex (MAC), the most common NTM pathogen.

Methods: This genome-wide association study (GWAS) was conducted in Japanese patients with pulmonary MAC and healthy controls, followed by genotyping of candidate single-nucleotide polymorphisms (SNPs) in another Japanese cohort. For verification by Korean and European ancestry, we performed SNP genotyping.

Results: The GWAS discovery set included 475 pulmonary MAC cases and 417 controls. Both GWAS and replication analysis of 591 pulmonary MAC cases and 718 controls revealed the strongest association with chromosome 16p21, particularly with rs109592 (p=1.64E-13, odds ratio=0.54), which is in an intronic region of the calcineurin like EF-hand protein 2 (). Expression quantitative trait loci analysis demonstrated an association with lung CHP2 expression. CHP2 was expressed in the lung tissue in pulmonary MAC disease. This SNP was associated with the nodular bronchiectasis subtype. This SNP was also significantly associated with the disease in patients of Korean (p=2.18E-12, odds ratio=0.54) and European (p=5.12E-03, odds ratio=0.63) ancestry.

Conclusions: We identified rs109592 in the locus as a susceptibility marker for pulmonary MAC disease.
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http://dx.doi.org/10.1183/13993003.02269-2019DOI Listing
February 2021

Indirect decompression via oblique lateral interbody fusion for severe degenerative lumbar spinal stenosis: a comparative study with direct decompression transforaminal/posterior lumbar interbody fusion.

Spine J 2021 Feb 2. Epub 2021 Feb 2.

Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine.

Background Context: Previous studies have shown that oblique lateral interbody fusion (OLIF) can improve neurological symptoms via "indirect decompression." However, data are lacking in terms of its benefits when compared with conventional transforaminal lumbar interbody fusion (TLIF) and/or posterior lumbar interbody fusion (PLIF) approach, especially in patients with severe central canal stenosis.

Purpose: To investigate the clinical outcome of OLIF without posterior decompression versus conventional TLIF and/or PLIF in severe lumbar stenosis diagnosed on preoperative magnetic resonance imaging.

Study Design: Retrospective comparative study.

Patient Sample: Fifty-one patients who underwent OLIF and 41 patients who underwent conventional TLIF and/or PLIF.

Outcome Measures: Clinical outcome score by Japanese Orthopedic Association (JOA) score and radiographic outcomes (disc height and fusion rate on computed tomography scan).

Materials/methods: We retrospectively reviewed 51 patients who underwent OLIF with supplemental percutaneous pedicle screws (55 levels; OLIF group) and 41 patients who underwent conventional TLIF and/or PLIF (47 levels; TPLIF group). The cross-sectional area of the thecal sac was measured preoperatively in OLIF and TPLIF groups, but postoperatively only in the OLIF group. All patients were diagnosed with severe stenosis based on Schizas classification (Grade C or D) on magnetic resonance imaging. We compared radiographic and clinical outcome scores (JOA score) between the 2 groups at 1 year of follow-up. The radiographic evaluation included the fusion status and disc height on computed tomography scan. Surgical data and perioperative complications were also investigated.

Results: The baseline demographic data of the 2 groups were equivalent in preoperative diagnosis, JOA score, and disc height and/or angle. The cross-sectional area significantly increased postoperatively, which confirmed indirect decompressive effect in the OLIF group. The JOA score improved in both groups at the 1-year follow up (76.6% vs. 73.5% improvement rate in the OLIF and TPLIF groups, respectively). The fusion rate at the 1-year follow-up was higher in the OLIF group than in the TPLIF group (87.2% vs. 57.4%). The disc height restoration was also better in the OLIF group. The operative data demonstrated less estimated blood loss and operative time in the OLIF group.

Conclusions: OLIF and conventional TLIF and/or PLIF demonstrated comparable short-term clinical outcomes in the treatment of severe degenerative lumbar stenosis. However, the surgical and radiographic outcomes were better in the OLIF group. Surgeons should choose an appropriate approach on a case by case basis, recognizing the perioperative complications specific to each fusion procedure.
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http://dx.doi.org/10.1016/j.spinee.2021.01.025DOI Listing
February 2021

Extracellular-to-intracellular water ratios are associated with functional disability levels in patients with knee osteoarthritis: results from the Nagahama Study.

Clin Rheumatol 2021 Jan 23. Epub 2021 Jan 23.

Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.

Introduction/objectives: To test the hypothesis that greater extracellular-to-intracellular water (ECW/ICW) ratios in lower-limb muscles are associated with worsened functional abilities in patients with knee osteoarthritis (OA).

Methods: We analyzed data from 787 participants (82.2% female; mean age, 69.6 ± 5.3 years) from the Nagahama Prospective Cohort who were ≥60 years old and had radiographically confirmed bilateral knee OA. The Knee Scoring System (KSS) was used to assess functional abilities. Lower-limb ECW/ICW ratios and skeletal mass index values were determined with multi-frequency bioelectrical impedance analysis (BIA). Multiple linear regression analysis was used to test for associations between ECW/ICW ratios and functional abilities. Subgroup analyses based on OA severities and symptomaticity were also conducted.

Results: Increased ECW/ICW ratios were associated with a 4.38-point decrease in the KSS function scores (95% confidence interval [CI], 3.15-5.62 points) after adjusting for covariates. This association varied according to the degree of knee symptoms, especially in individuals with radiologically mild OA. ECW/ICW ratios in individuals with asymptomatic mild OA were associated with a 2.14-point decrease in the KSS function score (95% CI, 0.32-3.96 points), whereas those in individuals with severe symptomatic mild OA were associated with a 6.16-point decrease (95% CI, 2.13-10.19 points).

Conclusions: Our findings indicate that higher ECW/ICW ratios are associated with greater functional disability in patients with knee OA. Therefore, ECW/ICW ratio measurements with multi-frequency BIA can serve as valuable indicators for functional disability in patients with knee OA. Key Points • Higher extracellular-to-intracellular water (ECW/ICW) ratios are associated with greater functional disability levels in patients with knee osteoarthritis (OA). • ECW/ICW ratios are useful clinical signs as a biomarker for poor functional abilities in patients with knee OA.
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http://dx.doi.org/10.1007/s10067-021-05591-0DOI Listing
January 2021

A histoanatomical study of the fiber bundle forming the 'Comma Sign,' a critical marker of the torn edge of the subscapularis tendon.

Arch Orthop Trauma Surg 2021 Jan 17. Epub 2021 Jan 17.

Department of Orthopaedic Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto City, Kyoto, 606-8507, Japan.

Introduction: The "Comma sign" is a well-known indicator of the subscapularis torn edge of the shoulder. We undertook a histoanatomical study of the fiber bundle forming Comma sign (FBCS) to determine why FBCS is maintained even in cuff tear cases.

Materials And Methods: Part 1: five tissue blocks including the supraspinatus tendon (SSP), rotator interval (RI), and subscapularis tendon (SSC) out of 5 cuff-intact cadavers were histologically observed in serial sections. Part 2: another tissue blocks of 6 cuff-intact cadavers were serially sectioned along the estimated FBCS direction based on the Part 1 findings. Additionally, 5 tissue blocks of cuff-torn cadavers including the three components, SSP, FBCS, and SSC, were serially sectioned along the apparent FBCS. In one slice clearly demonstrating FBCS fibers out of each section series, the components were measured of the sound speed and visualized through a scanning acoustic microscope (SAM).

Results: At the lateral portion, RI tissue with the joint capsule became thick and tightly surrounded SSP. Similarly, thicker RI tissue adhered to SSC from the superior and bursal side. More laterally, the borders of SSP/FBCS and FBCS/SSC were unclear with intermingled fibers. At the lateral most portion, RI tissue formed a fiber bundle, FBCS, extending from SSP to the bursal side of SSC. The sound speeds of SSP and SSC were significantly faster than FBCS in both cuff-intact and cuff-torn slices. In SAM images of cuff-torn specimens the FBCS borders were all unclear.

Conclusions: As FBCS extends from the capsule beneath SSP and to the bursal surface of SSC, the FBCS connection to SSP and SSC is hardly lost, even though SSP or SSC detaches from the greater or lesser tubercle, respectively. Additionally, as degeneration make the elasticity difference gradual, the stress concentration at the borders may be diminished, leading to less breakage of FBCS.
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http://dx.doi.org/10.1007/s00402-021-03775-6DOI Listing
January 2021

Anatomical evaluation of the femoral attachment of the posterior oblique ligament.

Arch Orthop Trauma Surg 2021 Jan 8. Epub 2021 Jan 8.

Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.

Introduction: Tibiofemoral joint instability reduces patient satisfaction after total knee arthroplasty (TKA). However, surgeons sometimes encounter excessive medial joint laxity without medial over-release on the tibial side. It was hypothesized that over-resection of the posteromedial femoral condyle can injure the medial stabilizers, especially the posterior oblique ligament (POL) at its femoral attachments.

Materials And Methods: Thirteen fixed cadaveric knees were exposed, and 3 anatomical points were identified: the posterior edge and midpoint of the POL femoral attachment, and the posterior edge of the superficial medial collateral ligament (sMCL) femoral attachment. The distance from the surface of the posteromedial femoral condyle to each point was measured. Correlations between each point and the anterior-posterior or medial-lateral dimensions of the distal femur were also calculated.

Results: The average distances to the posterior edge and midpoint of the POL femoral attachment and the posterior edge of the sMCL femoral attachment were 13.7 mm (9.0-18.4), 17.9 mm (11.5-22.6), and 22.7 mm (14.7-29.4), respectively. There were moderate correlations between the distance to each point and the anterior-posterior or medial-lateral dimensions of the distal femur.

Conclusions: The minimal distance from the surface of the posteromedial condyle to the POL posterior edge was 9.0 mm. Over-resection of the posteromedial femoral condyle, even with a general TKA femoral component, might injure the POL at its femoral attachments, especially in patients with small distal femurs, while the sMCL is rarely damaged.

Level Of Evidence: Level IV.
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http://dx.doi.org/10.1007/s00402-020-03728-5DOI Listing
January 2021