Publications by authors named "Takahisa Sasho"

90 Publications

Randomized comparative study of suspension femoral fixation device in graft position maintenance in anterior cruciate ligament reconstruction: EndoButton CL vs TightRope RT.

Asia Pac J Sports Med Arthrosc Rehabil Technol 2021 Jul 1;25:42-46. Epub 2021 Jun 1.

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

Background: In double-bundle anterior cruciate ligament reconstruction (ACLR), fixed-loop and adjustable-loop cortical suspensory devices are commonly used to fix the soft graft on the femoral side. However, few studies have compared in vivo elongation of the two devices. The purpose of this study was to determine whether EndoButton CL (EB) and TightRope RT (TR), the suspensory fixation devices used in ACLR, maintained their length in vivo from the time of surgery through the postoperative period in a randomized controlled trial.

Methods: This study prospectively incorporated 30 patients undergoing initial ACLR at a single center. Participants were divided into two groups using a stratified randomization method with age and sex as assignment adjustment factors. EB or TR was used for fixation of the soft graft on the femoral side. The primary endpoint was to compare the elongation distance of the suspensory device. MRIs were taken within seven days after ACLR and 3,6,12 months postoperatively and measured by a radiologist in a blinded fashion. Secondary endpoints included the side-to-side difference in anterior translation, one leg hop test (HOP index), Lachman test, lateral pivot shift test, and Lysholm score one year postoperatively.

Results: Twenty-eight patients (EB, n = 13; TR, n = 15) were followed for one year. There was no significant difference between EB and TR groups in elongation from the immediate postoperative period to 3, 6, 12 months after surgery. However, the non-inferiority of TR to EB (non-inferiority margin: 1.5 mm) was not proved by the difference in measured elongation between the two groups (TR - EB, lower 95% CI. AM: 1.80 mm; PL: 1.86 mm) at 6 months. There was no significant difference in anterior translation, HOP index, Lachman test, lateral pivot shift test, or Lysholm score.

Conclusion: EB and TR had similar graft retaining ability in vivo for 12 months, but the non-inferiority of TR against EB was not verified statistically.
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http://dx.doi.org/10.1016/j.asmart.2021.05.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8184406PMC
July 2021

Effect of Systemic Administration of Granulocyte Colony-Stimulating Factor on a Chronic Partial-Thickness Cartilage Defect in a Rabbit Knee Joint.

Cartilage 2021 Jun 9:19476035211021905. Epub 2021 Jun 9.

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

Objective: Cartilage lesions in the knee joint can lead to joint mechanics changes and cause knee pain. Bone marrow stimulation (BMS) promotes cartilage regeneration by perforating the subchondral bone just below the injury and inducing bone marrow cells. This study aimed to investigate whether systemic administration of granulocyte colony-stimulating factor (G-CSF) with BMS improves repair of chronic partial-thickness cartilage defects (PTCDs).

Design: Eighteen 6-month-old New Zealand white rabbits were divided into 3 groups: control (C, = 6), BMS alone ( = 6), and BMS + G-CSF ( = 6). Partial cartilage defects with 5 mm diameter were created in the trochlear region of both knees; after 4 weeks, the BMS alone and BMS + G-CSF groups underwent BMS; G-CSF (50 µg/kg) or saline was administered subcutaneously for 5 days starting from 3 days before BMS. At 8 and 16 weeks after cartilage defect creation, the area of cartilage defects was macroscopically and histologically evaluated.

Results: International Cartilage Repair Society (ICRS) grades for macroscopic assessment were 0, 0.7, and 0.7 at 8 weeks and 0, 1.2, and 1.3 at 16 weeks in the C, BMS, and BMS + G-CSF groups, respectively. Wakitani scores for histological assessment were 9.8, 8.7, and 8.2 at 8 weeks and 9.5, 9, and 8.2 at 16 weeks in the C, BMS, and BMS + G-CSF groups, respectively. The BMS + G-CSF group showed significantly more repair than the C group, but there was no difference from the BMS group.

Conclusions: The effect of BMS and G-CSF on chronic PTCDs in mature rabbit knees was limited.
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http://dx.doi.org/10.1177/19476035211021905DOI Listing
June 2021

Changes in the Syndesmotic Reduction After Syndesmotic Suture-Button Fixation for Ankle Malleolar Fractures: 1-Year Longitudinal Evaluations Using Computed Tomography.

Foot Ankle Int 2021 May 21:10711007211008518. Epub 2021 May 21.

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

Background: Evaluation over time is important in assessing the reduction of the syndesmosis after suture-button fixation for ankle malleolar fractures. The purposes of this study were to evaluate time-dependent change in the syndesmotic reduction immediately after suture-button fixation for ankle malleolus fractures and 1 year after surgery using computed tomography, and to investigate the reliability of the measurement values to evaluate the reduction of syndesmosis.

Methods: We assessed 28 patients who underwent suture-button fixation for ankle fractures. Syndesmotic reduction was assessed within 2 weeks of the fracture surgery and 1 year after surgery using axial computer tomographic images. Side-to-side differences in the anterior, central, and posterior tibiofibular distances, anteroposterior fibular translation, fibular rotation, and syndesmosis area were measured.

Results: The mean anterior tibiofibular distance and anteroposterior fibular translation were 1.8 mm and 1.5 mm, respectively, after syndesmotic fixation. They decreased to 1.2 mm and 0.6 mm, respectively, at 1 year after surgery ( = .03 and = .01, respectively). The other measurement values did not change over time. The minimum detectable change in the distance of measurements was 1 mm or less.

Conclusion: The anterior tibiofibular distance and anteroposterior fibular translation had decreased 1 year after fixation in ankle malleolar fractures with syndesmotic suture button. Even if the fibula is posteriorly malreduced by the time computed tomography is performed immediately after surgery, the fibula may return to a good position 1 year after surgery.

Level Of Evidence: Level IV, case series.
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http://dx.doi.org/10.1177/10711007211008518DOI Listing
May 2021

Intra- and inter-observer reliability of implant positioning evaluation on a CT-based three-dimensional postoperative matching system for total knee arthroplasty.

BMC Musculoskelet Disord 2021 Apr 17;22(1):363. Epub 2021 Apr 17.

Department of Orthopaedic Surgery, Graduate School of Medicine, Development of Orthopaedic Surgery, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan.

Background: The evaluation of postoperative total knee arthroplasty (TKA) alignment mainly relies on measurement data obtained from plain radiographs. The aim of this retrospective observational study was to document the intra- and inter-observer reliability in assessment of TKA component positioning after surgery using a three-dimensional (3D) computed tomography (CT) image matching system.

Methods: Fourteen knees from 14 patients who received primary TKA were included, and images were analyzed by blinded readers not associated with the surgeries. The examiner digitized the reference points according to defined landmarks, and the designated size component was superimposed to the 3D reconstructed CT model for measurement. In addition to the evaluation of implant position against the coronal and sagittal lower limb mechanical axes that were defined based on bony landmarks, implant position against axes connecting implant-based reference points that are easier to indicate was evaluated.

Results: The overall intra- and inter-observer reliabilities determined by the intraclass correlation coefficients (ICC) of the implant alignment measurement for both femoral and tibial components were good (ICC > 0.60), except in the direction of femoral flexion and extension, for both mechanical and implant-based axes. The difference between implant alignment measurements according to the traditional mechanical axis and the implant-based axis ranged between means of 0.08 and 1.70 and were statistically significantly different.

Conclusions: The postoperative evaluation of implant position in the coronal and sagittal planes using 3D-CT image matching is reliable and has good reproducibility except for the sagittal alignment assessment of the femoral component. The measured implant position according to the traditional mechanical axis and the implant-based axis were slightly but significantly different.
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http://dx.doi.org/10.1186/s12891-021-04228-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053298PMC
April 2021

Knowledge of and experience with transgender players among soccer team staff: a cross-sectional questionnaire design.

Phys Sportsmed 2021 Apr 5. Epub 2021 Apr 5.

Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan.

Objectives: Transgender issues have become increasingly prominent in sports. However, knowledge of and experience with supporting transgender players across soccer team staff remain unclear. The objectives of this questionnaire-based study were to 1) clarify staff knowledge of transgender-related terminology; and 2) explore soccer team staff's awareness and experience with supporting transgender players.

Methods: A questionnaire was distributed to coaches, physicians, and physical trainers affiliated with soccer teams between 2018 and 2019 to capture 1) participant characteristics (e.g., gender, age, certified license, team categories); 2) their understanding of transgender-related terms, including lesbian, gay, bisexual, and transgender (LGBT) and of the IOC Consensus Meeting on Sex Reassignment and Hyperandrogenism in 2015; 3) their awareness of transgender players; and 4) their experience supporting transgender players. Participants were categorized by age, gender, profession, qualifications, and category of involvement; their understanding and experience were investigated statistically using univariate and multivariate analysis.

Results: The 478 respondents included 30 women and 448 men with a mean age of 38 ± 10 years. Of these, 83% understood the term transgender, 75% understood the term LGBT, while only 7% were familiar with the 2015 IOC Consensus Meeting. Physicians reflected more knowledge than coaches and physical trainers (p <0.01). Altogether, 15% had identified transgender players and 1% had experience supporting them. Respondents with certified licenses who worked with women's teams were more likely to recognize transgender players (p <0.01). Four participants (1%) had witnessed transgender players receiving transgender hormone therapy.

Conclusion: Although most soccer support staff were familiar with transgender terms, many did not have sufficient knowledge of or experience with transgender athletes.
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http://dx.doi.org/10.1080/00913847.2021.1911569DOI Listing
April 2021

Anatomical factors associated with progression of hallux valgus.

Foot Ankle Surg 2021 Mar 26. Epub 2021 Mar 26.

Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan.

Background: The purpose of this study was to clarify the incidence rate and the risk factors for the progression of the hallux valgus deformity.

Methods: Patients who had weight-bearing radiographs of the foot taken twice or more, with a ≥2-year interval, were retrospectively analyzed. Progression of the deformity was defined as an increase in the hallux valgus angle of ≥5° during the follow-up. The association of hallux valgus progression with patient characteristics and radiographic measurements at baseline was determined using univariate and multivariate analyses.

Results: Totally, 268 patients (217 women and 51 men; median age, 64 years) were analyzed. An increase in the hallux valgus angle of ≥5° occurred in 44 (17%) patients in a median follow-up of 49 months. Large hallux valgus angle (odds ratio, 1.07) on the dorsoplantar radiograph at baseline were independent risk factors for the progression of the deformity.

Conclusion: Progression of the hallux valgus deformity occurred in one of six patients. Furthermore, large hallux valgus angle was the risk factor for subsequent deformity progression. Patients with large hallux valgus angle should be informed about the possible progression of the deformity.
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http://dx.doi.org/10.1016/j.fas.2021.03.019DOI Listing
March 2021

Multiple Osteochondritis Dissecans in Multiple Joints.

Case Rep Orthop 2021 28;2021:8828687. Epub 2021 Jan 28.

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

Background: Osteochondritis dissecans (OCD) rarely occurs in multiple joints. Furthermore, the existence of left-right asymmetric OCDs in different joints of the contralateral side of the body and lesions occurring with a temporal difference is rare. Here, we report a rare case with multiple OCDs sequentially detected in various joints. . The 15-year-old male patient was referred to our hospital for an OCD in the medial femoral condyle of the left knee. He had a history of an OCD in his right elbow, and his father had a history of surgically treated OCDs in both knees. One year and five months after, surgery was performed to the lesion in his left medial femoral condyle, a new OCD lesion occurred in the femoral trochlea of the same knee, which was again treated surgically. Five months after the second surgery, the patient returned with pain in the right knee, and an OCD on the right femoral trochlea was detected by an MRI scan. This lesion remained stable without any further restriction in physical activities for 17 months until detachment occurred and was again treated surgically.

Conclusion: In cases with history and a family history of multiple OCDs, in particular, with a short stature, an MRI scan should be performed for the symptomatic joint to detect and treat the lesion before progression.
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http://dx.doi.org/10.1155/2021/8828687DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7864730PMC
January 2021

Decreased physical activity in patients with ankle osteoarthritis. A case-control study comparing daily step counts.

Foot Ankle Surg 2021 Feb 1. Epub 2021 Feb 1.

Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan.

Background: The purpose of this study was to compare physical activity levels and the proportion of patients who met physical activity recommendations in patients with ankle osteoarthritis and controls.

Methods: Ankle osteoarthritis patients (n = 50) and controls (n = 50) were recruited. physical activity was measured using an accelerometer-based monitor. Physical activity parameters, including the step count/day, the proportion of patients who met physical activity recommendations of ≥7000 steps/day, and moderate to vigorous physical activity minutes/day, were compared between the patient groups.

Results: The patients with ankle osteoarthritis walked 3998 steps/day, while the controls walked 6531 steps/day (P < .001). Only 7 (14%) ankle osteoarthritis patients and 17 (34%) controls met the physical activity recommendations of ≥7000 steps/day (P =  .01). Time spent performing moderate to vigorous physical activity was 58 and 78 min/day in the ankle osteoarthritis and controls, respectively.

Conclusions: The physical activity level of ankle osteoarthritis patients was lower than that of controls. Only a limited proportion of ankle osteoarthritis patients met the physical activity recommendation.
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http://dx.doi.org/10.1016/j.fas.2021.01.011DOI Listing
February 2021

Joint effusion at 6 months is a significant predictor of joint effusion 1 year after anterior cruciate ligament reconstruction.

Knee Surg Sports Traumatol Arthrosc 2021 Jan 21. Epub 2021 Jan 21.

Musculoskeletal Pain and Disease, Center for Preventive Medical Sciences, School of Medicine, Chiba University, 1-8-1, Inohana, Chiba, 260-8677, Japan.

Purpose: This study aimed to assess the risk factors for prolonged joint effusion in patients undergoing double-bundle anterior cruciate ligament reconstruction (ACLR).

Methods: In total, 160 patients who underwent primary ACLR using autograft hamstring between 2015 and 2018 were retrospectively reviewed. Joint effusion was defined as any grade ≥ 2 (range, 0-3) according to the MRI Osteoarthritis Knee Score (MOAKS). Univariate and multivariate logistic regression analyses were performed.

Results: The median age of the patients was 25 years (range 14-68 years) at the time of the surgery; there were 89 women and 71 men. At 1 year, 46 (28.8%) patients experienced knee joint effusion, as defined by the MOAKS. Univariate analysis revealed that age, preoperative Kellgren-Lawrence (K-L) grade, and joint effusion at 6 months were significantly associated with joint effusion at 1 year. In the multivariate analysis, joint effusion at 6 months was significantly associated with joint effusion at 1 year (odds ratio, 68.0; 95% confidence interval, 22.1-209.4). No significant difference in the Lysholm scores was observed between patients with and without joint effusion at 1 year (n.s.).

Conclusions: Joint effusion at 6 months was significantly associated with joint effusion 1 year after ACLR.

Level Of Evidence: III.
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http://dx.doi.org/10.1007/s00167-021-06433-xDOI Listing
January 2021

In vivo kinematics of cruciate-retaining total knee arthroplasty after a change of polyethylene insert configuration.

Asia Pac J Sports Med Arthrosc Rehabil Technol 2021 Apr 31;24:1-8. Epub 2020 Dec 31.

Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Center for Preventive Medical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan.

Background: To investigate in vivo kinematics of total knee arthroplasty (TKA) with the introduction of a mildly constrained (MC) type of polyethylene (PE). We compared the knee kinematics with a reported pattern after surgery using the same component with a conventionally constrained (CC) type of PE.

Methods: Finite element analysis (FEA) was performed to examine different peak stress distribution of both types of PE. For in vivo study, patients who underwent cruciate-retaining TKA using a total knee system with MC-PE were included. Fluoroscopic surveillance was used to measure the weight-bearing deep knee bend (squatting) using a two-dimensional/three-dimensional (2-D/3-D) registration technique.

Results: FEA analysis revealed the edge loading of the femoral component on PE in CC but not in MC. During the study period, 42 patients underwent TKA with MC-PE. Among them, 13 agreed to participate in the present study. In vivo kinematics analysis found that starting from an average external rotation of femur being 7.1° at 0° of flexion, the rotation slightly decreased to 6.8° at 10° of flexion, then increased with increasing knee flexion until it reached 10.8° at 80° of flexion, and finally decreased to 9.8° at 100° of knee flexion. The results indicate a modest medial pivot pattern. Although the overall pattern was similar for both MC-PE and CC-PE, a slight difference was observed. MC-PE showed a slight internal rotation of 0.3° from 0 to 10° of knee flexion, whereas CC-PE showed a gradual increase of external rotation in this range.

Conclusions: Change of configuration from CC to MC did not substantially affect in vivo kinematics of knees after TKA. Considering the theoretical wider range of allowance of rotation, MC-PE is easier for knee surgeons to use.
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http://dx.doi.org/10.1016/j.asmart.2020.11.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7782324PMC
April 2021

Arthroscopic Reduction and Internal Fixation of Posterior Cruciate Ligament Avulsion Fracture Using an Adjustable-Length Loop Device.

Arthrosc Tech 2020 Dec 21;9(12):e2001-e2006. Epub 2020 Dec 21.

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

A displaced avulsion fracture at the tibial attachment of the posterior cruciate ligament is considered an indication for surgical reduction and internal fixation because nonunion and remaining posterior instability of the knee are common consequences of conservative treatment. The problems with standard open surgical techniques are that they are relatively invasive despite the limited operative field and it is impossible to explore intra-articular lesions by the posterior approach. An arthroscopic procedure has the advantage of being minimally invasive and allowing the surgeon to detect and treat associated intra-articular injuries. We present an arthroscopic reduction-internal fixation technique using an adjustable-length loop device. A trans-septal portal is created to visualize the fracture fragment directly, and the fragment is reduced and penetrated with a cannulated drill under fluoroscopic guidance. An adjustable-length loop device is relayed from the posteromedial portal and pulled out through the fragment in an anterograde fashion, placing a button on top of the fragment. By tightening the loop, downward compression can be applied to the fragment. Overall, this technique provides good reduction and bone union, and excellent clinical outcomes, including posterior knee stability, can be achieved.
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http://dx.doi.org/10.1016/j.eats.2020.08.028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768234PMC
December 2020

Indirect drainage using hindfoot endoscopy for the treatment of recurrent ganglion cysts of the hallux associated with ankle osteoarthritis: A report of two cases.

J Orthop Sci 2020 Jun 19. Epub 2020 Jun 19.

Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan.

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http://dx.doi.org/10.1016/j.jos.2020.04.019DOI Listing
June 2020

Quantitative Analysis of Patellar Tendon After Total Knee Arthroplasty Using Echo Intensity: A Nonrandomized Controlled Trial of Alpine Skiing.

J Arthroplasty 2020 10 28;35(10):2858-2864. Epub 2020 May 28.

Department of Sport and Exercise Science, Paris Lodron University of Salzburg, Salzburg, Austria.

Background: Despite the knee extensor weakness, less attention has been paid to the evaluation of patellar tendon after total knee arthroplasty (TKA). We previously observed patellar tendon hypertrophy after TKA. The purpose of this study is to reanalyze these ultrasound data to detect whether brightness mode ultrasound imaging reflects pathological changes of the patellar tendon after TKA.

Methods: Twenty-eight participants with post unilateral TKA were assigned to an intervention group or control group. The intervention group underwent a 12-week skiing program. Patellar tendon mechanical properties were obtained by combining isometric dynamometry, ultrasound imaging, and electromyography in operated knee and nonoperated knee. Luminosity ratio (LR) was measured using echo intensity in a relaxed and maximally loaded phase.

Results: Baseline comparisons revealed significant effects of the surgical side (P < .001) and loading phase (P = .017), but no interaction between leg and phase (P < .149). LR of the operated knee was significantly lower than LR of the nonoperated knee in relaxed (P < .001) and maximally loaded phases (P = .003). In addition, there was a significant correlation between LR of maximum phase and isometric knee extension torque (r = 0.156, P = .038). However, LR was not related to patellar tendon stiffness, Young's modulus, or strain. There was a significant time effect in knee extension torque, but no time effects on LR and tendon force.

Conclusion: Patellar tendon LR is decreased along with degenerative change after TKA. Ultrasound imaging provides a promising metric to acquire in vivo patellar tendon pathological assessment after TKA.
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http://dx.doi.org/10.1016/j.arth.2020.05.052DOI Listing
October 2020

A1 pulley stretching treats trigger finger: A1 pulley luminal region under digital flexor tendon traction.

Clin Biomech (Bristol, Avon) 2020 02 7;72:136-140. Epub 2019 Dec 7.

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

Background: A1 pulley stretching is recognized as a clinically beneficial treatment for trigger finger. It is thought to lead to an increase in the cross-sectional area of the A1 pulley luminal region, thus improving trigger finger symptoms. The purpose of the present study was thus to evaluate the resultant forces during stretching that increase the CSA of the A1 pulley luminal region using fresh-frozen cadavers.

Methods: Using seven fingers from three fresh-frozen cadavers to replicate A1 pulley stretching, we investigated the resultant forces during stretching that increase the cross-sectional area of the A1 pulley luminal region. The traction forces of the flexor digitorum profundus tendons were increased in steps to 150 N, and the cross-sectional area and height of the A1 pulley luminal region were measured using ultrasonography.

Findings: The cross-sectional area of the A1 pulley luminal region increased with step-wise increases in the flexor digitorum profundus traction. On average, the cross-sectional area and height of the A1 pulley luminal region showed increases of 31.4% and 43.6%, respectively, compared to the unloaded condition.

Interpretation: These results confirmed that A1 pulley stretching increases the cross-sectional area of the A1 pulley luminal region. A1 pulley stretching has the potential to reduce the severity of trigger finger in patients facing surgery.
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http://dx.doi.org/10.1016/j.clinbiomech.2019.11.018DOI Listing
February 2020

Influence of foot position on the measurement of first metatarsal axial rotation using the first metatarsal axial radiographs.

J Orthop Sci 2020 Jul 13;25(4):664-670. Epub 2019 Oct 13.

Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan.

Background: The purpose of this study was to clarify 1) the measurement error of the pronation angle using the first metatarsal axial radiograph with the pronation angle along the longitudinal axis of the first metatarsal as the reference standard, 2) the influence of variability in the foot position on the measurement error, and 3) the intra- and interrater reliability of pronation angle measurement using digitally reconstructed radiographs.

Methods: Digitally reconstructed radiographs of the first metatarsal were generated from the computed tomography images of 10 feet without hallux valgus (non-HV group) and 10 feet with hallux valgus (HV group). In total, 135 images were created at different degrees of supination, plantarflexion, and adduction from each foot to simulate the first metatarsal axial view. Then, the pronation angle of the first metatarsal was measured. The measurement error was determined using the mean error and 95% limits of agreement. Simple linear regression analysis was used to test the correlations of the measurement error with pronation, plantarflexion and adduction angles. The intra- and interrater reliability of measurement was assessed using the intraclass correlation coefficient and minimum detectable change values.

Results: The mean measurement errors were 0.1° for both the non-HV and HV groups. There was no significant correlation of the measurement error with pronation, plantarflexion or adduction angles for both groups. Additionally, the intraclass correlation coefficients for the intra- and interrater reliability were more than 0.9 in both the non-HV and HV groups with the minimum detectable change values ranging from 0.7° to 1.4°.

Conclusion: The measurement error of first metatarsal pronation using the axial view was clinically acceptable. The measurements were not influenced by the variability in foot position while obtaining the radiograph. The first metatarsal axial view could be used to quantify the first metatarsal coronal rotation.
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http://dx.doi.org/10.1016/j.jos.2019.09.013DOI Listing
July 2020

The shape of the first metatarsal head and its association with the presence of sesamoid-metatarsal joint osteoarthritis and the pronation angle.

J Orthop Sci 2020 Jul 17;25(4):658-663. Epub 2019 Jul 17.

Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan.

Background: The purpose of this study was to evaluate the associations of the shape of the first metatarsal head with (1) the presence of osteoarthritis in the sesamoid-metatarsal joint and (2) the pronation angle of the first metatarsal head on foot radiographs.

Methods: A total of 121 patients, with the mean age of 61 years, underwent weight-bearing dorsoplantar, lateral, and first metatarsal axial radiographs. The shape of the first metatarsal head's lateral edge was classified as either rounded, intermediate, or angular in shape in the dorsoplantar view. The presence of osteoarthritis in the sesamoid-metatarsal joint and the pronation angle of the first metatarsal head were assessed in the first metatarsal axial view. Other variables that could affect the first metatarsal shape, including the lateral first metatarsal inclination angle, were also assessed. Univariate and multivariate analyses were performed to determine the associations.

Results: The prevalence of sesamoid-metatarsal osteoarthritis was significantly higher (77%, 27%, and 29% for rounded, intermediate, and angular, respectively, P < .001), and the metatarsal pronation angle was significantly larger (14°, 8°, and 4° for rounded, intermediate, and angular, respectively, P < .001) in feet with a rounded metatarsal head. These associations were also significant in the multiple regression analysis.

Conclusion: A rounded metatarsal head was associated with a higher prevalence of osteoarthritis within the sesamoid-metatarsal joint, as well as a larger first metatarsal head pronation angle. A negative round sign can be used as a simple indicator of an effective correction to the first metatarsal pronation angle during hallux valgus surgery. However, in feet with sesamoid-metatarsal osteoarthritis, surgeons will need to be cautious as overcorrection may occur.
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http://dx.doi.org/10.1016/j.jos.2019.06.013DOI Listing
July 2020

Stage-specific meniscal features predict progression of osteoarthritis of the knee: a retrospective cohort study using data from the osteoarthritis initiative.

BMC Musculoskelet Disord 2019 Jan 22;20(1):33. Epub 2019 Jan 22.

Center for Frontier Medical Engineering, Chiba University, Chiba, Japan.

Background: In the progression of osteoarthritis (OA) of the knee, a correlation between meniscal posterior segment injuries and medial meniscal extrusion has been reported, but there have been few reports on the relationship with the meniscal shape. The purpose of this study was to clarify the features of the meniscal shape involved in the progression of knee OA.

Methods: Data were obtained from the Osteoarthritis Initiative (OAI) database. We defined two sets of subjects. One set included 455 knees of subjects whose OA grade on the Kellgren Lawrence (KL) scale progressed in 24 months from baseline and the other set consisted of 455 knees with no progression. The OA progressed subjects were divided to three groups: the "OA change group", KL0 and KL1 knees that progressed to KL2 and KL3; the "mild change group", KL2 knees that progressed to KL3; and the "severe change group", KL2 and KL3 knees that progressed to KL4. The no progression set was divided into three groups whose OA grade remained unchanged. We used magnetic resonance imaging data and manually measured seven items (longitudinal diameter [LD], anterior wedge thickness, anterior wedge width, posterior wedge width, posterior wedge thickness, anterior wedge angle, posterior wedge angle) from the sagittal slice and the extrusion from the coronal slice. These measurements were compared between knees with and without OA progression.

Results: In the "OA change group" and "mild change group", the anterior and posterior wedge widths and the extrusion were significantly larger, but the anterior and the posterior wedge angles were significantly smaller. In the "severe change group," the LD and the extrusion were significantly larger. In each group, there was no uniform tendency for the correlation coefficient of the parameters evaluated.

Conclusions: Our findings suggested (1) a larger meniscal LD at the baseline predicted progression of knee OA after 24 months and (2) a larger meniscal width and smaller meniscal angle predicted progression of knee OA after 24 months.
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http://dx.doi.org/10.1186/s12891-019-2413-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343308PMC
January 2019

Development and validation of a culturally relevant Japanese KOOS.

J Orthop Sci 2019 May 24;24(3):514-520. Epub 2018 Dec 24.

Department of Orthopaedic Surgery, Aichi Medical University, Nagakute, Japan.

Introduction: The Knee Injury and Osteoarthritis Outcomes Survey (KOOS) has been translated into 50 languages worldwide. These translations have adhered to guidelines for cross cultural adaptation of health surveys. However, after release of the Japanese KOOS (JKOOS) we discovered the JKOOS was not fully culturally relevant to Japanese patients. Therefore, we undertook the development and validation of the JKOOS+.

Methods: We completed this project in 2 phases across 9 hospitals. In Phase 1, 187 surgically naïve patients with knee pain were asked about activities limited by their knee pain. An expert panel reconciled these activities against existing KOOS items to identify novel items. In Phase 2, 241 surgically naïve patients with knee pain were administered the Japanese Oxford Knee Survey, JKOOS, and these novel items. An iterative Rasch analysis was used to test item fit of these novel items within the KOOS Activities of Daily Living (ADL) domain and a potential new domain. Unidimensionality was assessed using principle component analysis. Internal consistency (Cronbach's alpha) and external validity (Spearman's Correlations) were assessed for Japanese ADL (J-ADL) and the novel domain.

Results: Phase 1 identified 4 activities relevant to Japanese knee patients: sitting seiza, using a Japanese toilet, climbing hills, and getting on/off a bus/train. In Phase 2, climbing hills and bus/train were well fit in JADL. Seiza and using a Japanese toilet were not well fit in J-ADL, yet both require deep knee flexion so a knee flexion (KF) domain was constructed by considering all KOOS items that require knee flexion using an iterative Rasch model. An 8 item KF domain emerged. Both J-ADL and KF were deemed to be unidimensional with high internal consistency (Cronbach's alpha >0.92) and external validity (Spearman Correlations 0.723-0.929).

Conclusions: We have successfully developed and validated JKOOS+, a more culturally relevant knee survey for Japanese patients.
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http://dx.doi.org/10.1016/j.jos.2018.11.014DOI Listing
May 2019

Efficacy of foot orthoses as nonoperative treatment for hallux valgus: A 2-year follow-up study.

J Orthop Sci 2019 May 1;24(3):526-531. Epub 2018 Dec 1.

Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan.

Background: The purpose of this study was to clarify the 2-year clinical and radiological outcomes of nonoperative treatment using foot orthosis for hallux valgus patients.

Methods: Patients who underwent nonoperative treatment using foot orthosis were surveyed prospectively. Foot orthoses were made by one certified orthotist using the standardized method. Pain and quality of life were evaluated using subjective and objective assessment measures at 3, 6, 12, 18, and 24 months. Furthermore, radiological outcomes, patient satisfaction, and adherence to treatment were surveyed.

Results: A total of 53 patients (50 women and 3 men; median age, 63 years) were included for analysis. The pain visual analogue scale score significantly decreased over time, with the lowest score observed at 12 months. The treatment effect was maintained over 24 months (median score, 52, 21, and 27 points at baseline, 12 months, and 24 months, respectively; P < .001). The Japanese Society for Surgery of the Foot hallux scale, American Academy of Orthopaedic Surgeons Foot and Ankle Scale, and 36-Item Short-Form Health Survey bodily pain subscale also improved, although the treatment effects were maximal at 6 months and decreased thereafter. At 24 months, 43 (81%) patients continued to use the orthosis, with the median visual analogue scale score for patient satisfaction of 76 points. The hallux valgus angle and intermetatarsal angle did not change during the 24-month period.

Conclusion: Nonoperative treatment using foot orthoses decreased pain in patients with hallux valgus. The effect of treatment was maintained up to 2 years with a relatively high degree of patient satisfaction. However, treating physicians should inform patients to set realistic expectations and be aware that a limited degree of pain reduction is expected.
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http://dx.doi.org/10.1016/j.jos.2018.11.003DOI Listing
May 2019

Superior graft maturation after anatomical double-bundle anterior cruciate ligament reconstruction using the transtibial drilling technique compared to the transportal technique.

Knee Surg Sports Traumatol Arthrosc 2019 Aug 29;27(8):2468-2477. Epub 2018 Oct 29.

Department of Radiology, Toho University Sakura Medical Center (Chiba), Chiba, Japan.

Purpose: To evaluate and compare the femoral tunnel aperture position, graft bending angle and the magnetic resonance imaging (MRI) graft signal intensity after anatomical double-bundle anterior cruciate ligament (ACL) reconstruction between transtibial and transportal drilling techniques of the femoral tunnel.

Methods: Eighty-seven patients who underwent anatomic double-bundle ACL reconstruction with hamstring tendon autograft between January 2012 and December 2014 were included in this retrospective study. Forty-one patients underwent reconstruction using a transportal technique (TP group) and 46 patients underwent reconstruction using a transtibial technique (TT group). The anteromedial (AM) femoral aperture position and the graft bending angle were assessed using transparent three-dimensional CT 2 weeks postoperatively. MRI assessment was performed with proton density-weighted images in an oblique coronal plane 6 and 12 months postoperatively. Signal/noise quotient was calculated for two specific graft sites (femoral tunnel site and mid-substance site). Femoral aperture position, the graft bending angle and signal/noise quotient were compared between the TP and TT groups.

Results: There was no significant difference in the aperture position between the two groups. The graft bending angle of the AM tunnel in the axial plane was significantly greater in the TP group (p < 0.001). On the other hand, the TP group had a significantly more acute angle in the coronal plane (p < 0.001). There was no significant difference at either site in the signal/noise quotient of the graft between the two groups at 6 months. However, the TT group had a lower signal/noise quotient at 12 months at both sites (femoral aperture: p = 0.04, mid-substance: p = 0.004).

Conclusion: There was a significant difference in signal/noise quotient between the two drilling techniques 12 months postoperatively. There was no significant difference in femoral tunnel aperture position between the two groups. However, graft bending angle at the femoral tunnel aperture was significantly different between the two groups, indicating the possibility that graft bending angle is a factor that influences graft maturation. This indicates that the TT technique has an advantage over the TP technique in terms of graft maturation.
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http://dx.doi.org/10.1007/s00167-018-5240-8DOI Listing
August 2019

Single vs. repeated matrix metalloproteinase-13 knockdown with intra-articular short interfering RNA administration in a murine osteoarthritis model.

Connect Tissue Res 2019 07 26;60(4):335-343. Epub 2018 Oct 26.

a Department of Orthopaedic Surgery , Graduate School of Medical and Sciences, Chiba University , Chiba , Japan.

Our aims were 1) to estimate the duration of short interfering RNA (siRNA) effect on matrix metalloproteinase-13 () levels by a single intra-articular injection using a mouse knee osteoarthritis (OA) model and 2) to test whether repeated injections results in any additional suppressive effect on cartilage degradation compared to a single injection. OA was induced in 9 weeks old male C57BL/6 mice by destabilization of medial meniscus (DMM). Chemically modified siRNA targeted for was injected into the knee joint at 1 week post-DMM surgery. Control group of knees received that for non-targeted genes. Synovial tissue was collected to measure expression levels by quantitative polymerase chain reaction (qPCR) at 2, 3, and 6 weeks after surgery in each group. To test the effect of multiple injections, we created four experiment groups according to the number of injections. Histological assessment of articular cartilage was performed at 8 weeks post-DMM surgery. In the siRNA-treated group, expression levels of mRNA were decreased by 40% compared to the control group at 2 weeks after surgery ( = 0.04), before returning to baseline at 3 weeks after surgery. A significant improvement in the histological score was observed in all siRNA-treated groups compared to the control group ( < 0.05). However, no significant differences were seen between the single and multiple injection group. Our results suggested that the duration of siRNA effect in the knee joint lasts for at least 1 week, and that no further benefit is achieved by multiple injections.
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http://dx.doi.org/10.1080/03008207.2018.1539082DOI Listing
July 2019

Age-dependent differences in response to partial-thickness cartilage defects in a rat model as a measure to evaluate the efficacy of interventions for cartilage repair.

Cell Tissue Res 2019 Feb 26;375(2):425-435. Epub 2018 Sep 26.

Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.

The objectives of this study are (1) to examine age-dependent longitudinal differences in histological responses after creation of partial-thickness articular cartilage defects (PTCDs) in rats and to use this model (2) to objectively evaluate the effectiveness of interventions for cartilage repair. Linear PTCDs were created at a depth of 100 μm in the weight-bearing region of the medial femoral condyle in rats of different ages (3 weeks, 6 weeks, 10 weeks and 14 weeks). One day, one week, two weeks, four weeks and twelve weeks after PTCD generation, spontaneous healing was evaluated histologically and immunohistochemically. Effects of interventions comprising mesenchymal stem cells (MSCs) or platelet-rich plasma (PRP) or both on 14-week-old PTCD rats were evaluated and compared with natural courses in rats of other ages. Younger rats exhibited better cartilage repair. Cartilage in 3-week-old and 6-week-old rats exhibited nearly normal restoration after 4-12 weeks. Cartilage in 14-week-old rats deteriorated over time and early signs of cartilage degeneration were observed. With injection of MCSs alone or MSCs + PRP, 14-week-old PTCD rats showed almost the same reparative cartilage as 6-week-old rats. With injection of PRP, 14-week-old PTCD rats showed almost the same reparative cartilage as 10-week-old rats. This model will be of great use to objectively compare the effects of interventions for small cartilage lesions and may help to advance the development of disease-modifying osteoarthritis drugs.
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http://dx.doi.org/10.1007/s00441-018-2914-yDOI Listing
February 2019

Nonradiographic Measurement of Hallux Valgus Angle Using Self-photography.

J Orthop Sports Phys Ther 2019 Feb 12;49(2):80-86. Epub 2018 Sep 12.

Background: Radiographs of the feet are the reference standard for measuring the hallux valgus angle. However, the availability and use of radiographs are constrained due to cost and radiation exposure. Less invasive, nonradiographic assessments have been proposed, although measurement using self-photography has not been reported.

Objectives: To determine (1) reliability of photographic hallux valgus angle (pHVA) measurement using the same photographs of the feet, (2) reliability of repeated self-photography trials, and (3) measurement error when the radiographic hallux valgus angle (rHVA) is estimated using the pHVA.

Methods: In this reliability study, participants took photographs of their own feet using a digital camera. The intrarater and interrater reliability of pHVA measurements were then assessed using the intraclass correlation coefficient (ICC) and 95% minimum detectable change (MDC). The participants took photographs twice, and the reliability of repeated self-photography trials was examined. Participants also received radiographs of their feet, from which the rHVA was measured. The measurement error was assessed using the mean difference and 95% limits of agreement.

Results: The intrarater and interrater ICC of pHVA measurement was 0.99, with MDCs less than 2°. The ICC of pHVA measurement for repeated self-photography was 0.96, and the MDC was 6.9°. The pHVA was systematically lower than the rHVA, by 5.3°.

Conclusion: Measurement of the pHVA using self-photography was reproducible, although pHVA measurement underestimated the rHVA. The pHVA can be a useful nonradiographic method to quantify hallux valgus deformity. J Orthop Sports Phys Ther 2019;49(2):80-86. Epub 12 Sep 2018. doi: 10.2519/jospt.2019.8280.
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http://dx.doi.org/10.2519/jospt.2019.8280DOI Listing
February 2019

Comparison of meniscal extrusion and osteophyte formation at the intercondylar notch as a predictive biomarker for incidence of knee osteoarthritis-Data from the Osteoarthritis Initiative.

J Orthop Sci 2019 Jan 28;24(1):121-127. Epub 2018 Aug 28.

Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan; Center for Preventive Medical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan. Electronic address:

Background: Medial meniscal extrusion (ME) is a biomarker to predict later development of knee osteoarthritis (KOA). On the other hand, we have reported osteophyte formation at the posterior condylar notch of the femur served as a biomarker for the same purpose. The purpose of this study is to compare capacity of the two biomarkers in predicting KOA development.

Methods: Two cohort of knees were established utilizing publicly available data from the Osteoarthritis Initiative (OAI). No OA group (NOA) consisted of knees that were grade 0 or 1 on Kellgren and Lawrence grade (K/L) both at baseline and 48 months later, and pre-radiographic-OA group (PROA) consisted of knees that were grade 0 or 1 at baseline but grade ≥2 48 months later. Baseline MR images were evaluated in terms of ME and osteophyte formation at the posterior condylar notch. ME was evaluated both by meniscus subluxation index (MSI) indicating the ratio of the extruded width of the medial meniscus to the width of medial meniscal body and by the medial radial displacement (MRD) indicating actual extruded width. The size of the osteophyte was assessed using a semi-quantitative whole-organ magnetic resonance imaging score (WORMS). The predictive accuracy of KOA was assessed by the area under the receiver operating characteristic curve (AUC) and optimal cutoff was determined for each parameter.

Results: The AUC for MSI was 0.654 (0.561-0.748: 95% CI) and the cutoff value was determined as 17%. That for MRD was 0.677 (0.584-0.770) and the cutoff value was 2.2 mm. The AUC for the WORMS score at the posterior condylar notch was 0.667 (0.579-0.756) and the cutoff value was 2.

Conclusions: Similar predicting capacity of KOA development was found both in ME and osteophyte formation at the posterior condylar notch. Using these simple parameter, mas-screening for KOA development would be possible.
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http://dx.doi.org/10.1016/j.jos.2018.08.003DOI Listing
January 2019

A comparative study of flat surface design and medial pivot design in posterior cruciate-retaining total knee arthroplasty: a matched pair cohort study of two years.

BMC Musculoskelet Disord 2018 Jul 18;19(1):234. Epub 2018 Jul 18.

Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.

Background: Component design is one of the contributory factors affecting the postoperative flexion angle. The purpose of this study was to compare short-term outcomes of flat surface and medial pivot designs in posterior cruciate-retaining (CR) total knee arthroplasty (TKA).

Methods: A retrospective, case-control, and observational cohort study consisted of matched-pairs of the flat surface design (Hi-Tech Knee II) and the medial pivot design (FINE Knee) in CR-TKA with a two-year follow-up period.

Results: Hi-Tech Knee II and FINE knee groups each included 7 males and 38 females. Surgical time was significantly shorter in the FINE Knee group than in the Hi-Tech Knee II group (104.8 min versus 154.9 min, p = 0.001). Estimated total blood loss was significantly lower in the FINE Knee group than in the Hi-Tech Knee II group (654 ml versus 1158 ml, p = 0.001). The postoperative flexion angle was significantly better in the FINE Knee group than in the Hi-Tech Knee II group (119.3 degrees versus 112.5 degrees), and was positively correlated with the preoperative flexion angle. Postoperative Knee Society scores were significantly better in the FINE Knee group than in the Hi-Tech Knee II group (93.0 points versus 85.0 points, p = 0.001), especially for postoperative pain relief (46.0 points versus 39.0 points out of 50, p = 0.001). Complications were not observed in either group over a two-year follow-up period.

Conclusion: The short-term outcome of the medial pivot design used in CR-TKA was more favorable than the flat surface design, especially for surgical time, estimated total blood loss, postoperative flexion angle, and knee pain.
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http://dx.doi.org/10.1186/s12891-018-2138-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052709PMC
July 2018

Avulsion fracture of the distal fibula is associated with recurrent sprain after ankle sprain in children.

Knee Surg Sports Traumatol Arthrosc 2019 Sep 10;27(9):2774-2780. Epub 2018 Jul 10.

Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan.

Purpose: The purpose of this study was to clarify radiographic and clinical outcomes, as well as their association, of ankle sprain in children.

Methods: Patients who sustained a first-time ankle sprain were prospectively surveyed. Patients underwent radiography of the ankle in the mortise, lateral, anterior talofibular ligament (ATFL), and calcaneofibular ligament views at the first clinic visit to assess avulsion fractures of the distal fibula. Patients with avulsion fractures underwent radiography after 8 weeks to assess bone union. The treatment method was not standardized and was determined by the patient, their parents, and the treating physician. Recurrent sprain and quality of life were evaluated by using the Self-Administered Foot Evaluation Questionnaire and reviewing the medical records of patients. The association between avulsion fracture and recurrent sprain was assessed using univariate and multivariate analyses.

Results: A total of 143 patients with a median age of 9 (range 6-12) years were analyzed. Avulsion fractures were present in 89 (62%) patients. The sensitivity of the ATFL view for the diagnosis of avulsion fractures was 0.94, whereas that for the anteroposterior and lateral views was significantly lower at 0.46 (P < 0.001). Only 17% of fractures united at 8 weeks. Of 114 (follow-up rate, 80%) patients who were followed up for a median period of 24 months, recurrent sprain occurred in 41 (36%) patients. The incidence rate was significantly higher in patients with avulsion fractures than in patients without the fractures (44 vs. 23%, P = 0.027). In multivariate logistic regression analysis, avulsion fracture was independently associated with recurrent sprain (P = 0.027).

Conclusion: More than one-third of patients experienced recurrent sprain. The presence of avulsion fracture was associated with an increased risk of recurrent sprain. Patients with avulsion fracture and their parents should be informed about the risk of recurrent sprain and subsequent ankle instability, and careful follow-up is needed for these patients.

Level Of Evidence: III.
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http://dx.doi.org/10.1007/s00167-018-5055-7DOI Listing
September 2019

Timing of Intra-Articular Injection of Synovial Mesenchymal Stem Cells Affects Cartilage Restoration in a Partial Thickness Cartilage Defect Model in Rats.

Cartilage 2020 01 10;11(1):122-129. Epub 2018 Jul 10.

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

Objective: We investigated the effect of administration of intra-articular mesenchymal stem cells (MSCs) on cartilage repair at different timings, and the distribution of MSCs in the knee.

Design: A partial thickness cartilage defect (PTCD) was created on the medial femoral condyle in 14-week-old Sprague-Dawley rats. Intra-articular injection of 1 × 10 MSCs was performed at 3 time points, namely at the time of surgery (0w group), at 1 week after surgery (1w group), and at 2 weeks after surgery (2w group). For the control, 50 μL phosphate-buffered saline was injected at the time of surgery. The femoral condyles were collected at 6 weeks after creation of PTCD and assessed histologically. To investigate the distribution of MSCs, fluorescent-labeled MSCs were injected into the knee joint.

Results: In the control group, the cartilage lesion was distinguishable from surrounding cartilage. In the 0w group, hypocellularity and a slight decrease in safranin O stainability were observed around the injured area, but cartilage was restored to a nearly normal condition. In contrast, in the 1w and 2w groups, the cartilage surface was irregular and safranin O stainability in the injured and surrounding areas was poor. Histological score in the 0w group was significantly better than in the control, 1w, and 2w groups. At 1 day postinjection, fluorescent-labeled MSCs were mostly distributed in synovium. However, no migration into the PTCD was observed.

Conclusions: Early intra-articular injection of MSCs was effective in enhancing cartilage healing in a rat PTCD model. Injected MSCs were distributed in synovium, not in cartilage surrounding the PTCD.
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http://dx.doi.org/10.1177/1947603518786542DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6921951PMC
January 2020

Evaluating different closed loop graft preparation technique for tibial suspensory fixation in ACL reconstruction using TightRope™.

Asia Pac J Sports Med Arthrosc Rehabil Technol 2018 Apr 7;12:5-11. Epub 2018 Mar 7.

Department of Orthopaedic Surgery, Graduated School of Medicine, Chiba University, 1-8-1, Inohana, Cyuou, Chiba, 260-8677, Japan.

In most anterior cruciate ligament (ACL) reconstructions, grafts are fixed to the femoral side first followed by the tibial side. Various techniques have been reported to achieve optimal tension on the grafts, but once the grafts are fixed it is difficult to adjust graft tension further. To enable post fixation tension control we have invented a new graft configuration using an adjustable loop-device (TightRope, Arthrex, FL, USA) on the tibial side. In this paper, biomechanical properties of this configuration using soft tissue were examined in terms of graft diameter and various suture techniques (referred to as base suture) to make a closed circle to support TightRope. Two experiments were conducted under different conditions. In each experiment, cyclic load, followed by a pull-to-failure load, was applied to the grafts and elongation and failure mode were recorded. (1) To evaluate the effects of diameter, 5.0 or 6.0 mm grafts were prepared by a single locking loop stitch as the base suture (SLL5, SLL6). (2) To evaluate different base sutures, 5.0 mm tendons were used, and grafts were prepared using five kinds of base sutures (SLL, ZLL: zigzag locking loop, DZLL: double zigzag locking loop, DK: double Krackow, DK w/o TR: double Krackow without TightRopeTM). In the first experiment, tearing was observed in 2 of 6 cases in the SLL5 test group, whereas no tearing was observed with SLL6. In the second experiment, no tearing was observed with DZLL or DK. Elongation was smaller in these two groups compared to the other groups. Mechanical strength decreases with a smaller graft diameter. Biomechanical properties differed with different base sutures and, among them, the double-zigzag-suture stitch and double Krackow provided less elongation and higher ultimate load in this graft configuration.
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http://dx.doi.org/10.1016/j.asmart.2018.01.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023109PMC
April 2018

Histological analysis and biomechanical evaluation of fatty infiltration after rotator cuff tear and suprascapular nerve injury in a rat model.

J Orthop Sci 2018 Sep 5;23(5):834-841. Epub 2018 Jun 5.

Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.

Background: Rotator cuff tears are the most common shoulder injury, and little is known about the underlying etiology of fatty infiltration after rotator cuff tear. Previous studies speculated that rotator cuff tears lead to neural injury due to tethering of the suprascapular nerve at the notch. This study aimed to evaluate fatty infiltration after suprascapular nerve injury and rotator cuff tears.

Methods: Ninety adult male Sprague-Dawley rats were used and were divided into four groups: sham, tendon transection only, suprascapular nerve ligation, and tendon transection plus suprascapular nerve ligation. The suprascapular nerve injury models were created by tying the suprascapular nerve. At 2, 4, and 8 weeks postoperatively, histological analysis and biomechanical testing were performed to evaluate fatty infiltration and elastic change in the supraspinatus muscles.

Results: The amount of fatty infiltration in the supraspinatus muscle was significantly higher in both the suprascapular nerve ligation and tendon transection plus suprascapular nerve ligation groups than in the tendon transection only group at 2, 4, and 8 weeks. The ultimate failure load and tensile strength were significantly different among the tendon transection only, suprascapular nerve ligation, and tendon transection plus suprascapular nerve ligation groups at 8 weeks postoperatively. Furthermore, the mean Young's modulus of the muscle was significantly greater in the tendon transection plus suprascapular nerve ligation group than in both the tendon transection only and suprascapular nerve ligation groups at 8 weeks postoperatively.

Conclusions: In this study, based on the results of histological and biomechanical examinations in our rat models, the etiology of fatty infiltration after massive rotator cuff tear might be different from the suprascapular nerve injury.
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http://dx.doi.org/10.1016/j.jos.2018.04.004DOI Listing
September 2018

Comparative Analysis of Gene Expression between Cartilage and Menisci in Early-Phase Osteoarthritis of the Knee-An Animal Model Study.

J Knee Surg 2018 Aug 15;31(7):664-669. Epub 2017 Sep 15.

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

Cartilage degeneration is believed to be the primary event in the development of osteoarthritis (OA). On the other hand, meniscal degeneration is observed with high prevalence, and some researchers have pointed out that pathological changes in menisci precede that of cartilage. The purpose of the present study is to investigate comprehensive gene expression pattern of cartilage and menisci in the initial phase of surgically induced OA and to compare them. Secondary OA was surgically induced in 10-week-old male Wistar rats by anterior cruciate ligament transection (ACLT). Articular cartilage and menisci were separately dissected from six ACLT- and six sham-operated rats. Each specimen was analyzed by microarray, histological, and immunohistochemical analysis 3 weeks after surgery. Of the 36,685 transcripts detectable by microarray, the number of upregulated transcripts in ACLT menisci was >2.5-fold compared with that in ACLT menisci in any given threshold. Cluster analysis using the Database for Annotation Visualization and Integrated Discovery (DAVID) showed genes related to OA, such as response to stimulus, angiogenesis, and apoptosis, which were predominantly found in menisci in ACLT rats. Representative proteases including Adamts2, 4, Mmp2, 12, 13, 14, 16, extracellular matrix genes including versican (Vcan), lumican (Lum), syndecan1 (Sdc1), and Prostaglandin endoperoxide synthase2 (Ptgs2) were up-regulated in menisci, but were not up-regulated in cartilage. Our results indicated that the molecular changes that occurred in menisci preceded those occurred in cartilage in the very early phase of surgically induced OA models.
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http://dx.doi.org/10.1055/s-0037-1606549DOI Listing
August 2018