Publications by authors named "Takeshi Oshima"

128 Publications

Different anterolateral procedures have variable impact on knee kinematics and stability when performed in combination with anterior cruciate ligament reconstruction.

J ISAKOS 2021 03 24;6(2):74-81. Epub 2020 Nov 24.

Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia.

Objective: The optimal anterolateral procedure to control anterolateral rotational laxity of the knee is still unknown. The objective was to compare the ability of five anterolateral procedures performed in combination with anterior cruciate ligament reconstruction (ACLR) to restore native knee kinematics in the setting of a deficient anterior cruciate ligament (ACL) and anterolateral structures.

Methods: A controlled laboratory study was performed using 10 fresh-frozen cadaveric whole lower limbs with intact iliotibial band. Kinematics from 0° to 90° of flexion were recorded using a motion analysis three-dimensional (3D) optoelectronic system, allowing assessment of internal rotation (IR) and anteroposterior (AP) tibial translation at 30° and 90° of flexion. Joint centres and bony landmarks were calculated from 3D bone models obtained from CT scans. Intact knee kinematics were assessed initially, followed by sequential section of the ACL and anterolateral structures (anterolateral ligament, anterolateral capsule and Kaplan fibres). After ACLR, five anterolateral procedures were performed consecutively on the same knee: ALLR, modified Ellison, deep Lemaire, superficial Lemaire and modified MacIntosh. The last three procedures were randomised. For each procedure, the graft was fixed in neutral rotation at 30° of flexion and with a tension of 20 N.

Results: Isolated ACLR did not restore normal overall knee kinematics in a combined ACL plus anterolateral-deficient knee, leaving a residual tibial rotational laxity (p=0.034). Only the ALLR (p=0.661) and modified Ellison procedure (p=0.641) restored overall IR kinematics to the normal intact state. Superficial and deep Lemaire and modified MacIntosh tenodeses overconstrained IR, leading to shifted and different kinematics compared with the intact condition (p=0.004, p=0.001 and p=0.045, respectively). Compared with ACLR state, addition of an anterolateral procedure did not induce any additional control on AP translation at 30° and 90° of flexion (all p>0.05), except for the superficial Lemaire procedure at 90° (p=0.032).

Conclusion: In biomechanical in vitro setting, a comparison of five anterolateral procedures revealed that addition of either ALLR or modified Ellison procedure restored overall native knee kinematics in a combined ACL plus anterolateral-deficient knee. Superficial and deep Lemaire and modified MacIntosh tenodeses achieved excellent rotational control but overconstrained IR, leading to a change from intact knee kinematics.

Level Of Evidence: The level-of-evidence statement does not apply for this laboratory experiments study.
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http://dx.doi.org/10.1136/jisakos-2019-000360DOI Listing
March 2021

Lateral tenodesis procedures increase lateral compartment pressures more than anterolateral ligament reconstruction, when performed in combination with ACL reconstruction: a pilot biomechanical study.

J ISAKOS 2021 03 24;6(2):66-73. Epub 2020 Nov 24.

Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia.

Objectives: Given the common occurrence of residual laxity and re-injury post anterior cruciate ligament reconstruction (ACLR), additional anterolateral procedures are increasingly used in combination with an ACLR. Despite the perception that there is a risk of over-constraining the lateral tibiofemoral (LTF) compartment, potentially leading to osteoarthritis, assessment on their effect on intra-articular compartment pressures is still lacking. Our objective was therefore, through a pilot biomechanical study, to compare LTF contact pressures after the most commonly used anterolateral procedures.

Methods: A controlled laboratory pilot study was performed using 4 fresh-frozen cadaveric whole lower limbs. Through 0° to 90° of flexion, LTF contact pressures were measured with a Tekscan sensor, located under the lateral meniscus. Knee kinematics were obtained in 3 conditions of rotation (NR: neutral, ER: external and IR: internal rotation) to record the position of the knees for each loading condition. A Motion Analysis system with a coordinate system based on CT scans 3D bone modelling was used. After an ACLR, defined as the reference baseline, 5 anterolateral procedures were compared: anterolateral ligament reconstruction (ALLR), modified Ellison, deep Lemaire, superficial Lemaire and modified MacIntosh procedures. The last 3 procedures were randomised. For each procedure, the graft was fixed in NR at 30° of flexion and with a tension of 20 N.

Results: Compared with isolated ACLR, addition of either ALLR or modified Ellison procedure did not increased the overall LTF contact pressure (all p>0.05) through the full range of flexion for the IR condition. Conversely, deep Lemaire, superficial Lemaire and modified MacIntosh procedure (all p<0.05) did increase the overall LTF contact pressure compared with ACLR in IR. No significant difference was observed in ER and NR conditions.

Conclusion: This pilot study, comparing the main anterolateral procedures, revealed that addition of either ALLR or modified Ellison procedure did not change the overall contact pressure in the LTF compartment through 0° to 90° of knee flexion. In contrast, the deep and superficial Lemaire, and modified MacIntosh procedures significantly increased overall LTF contact pressures when the knee was internally rotated.
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http://dx.doi.org/10.1136/jisakos-2019-000368DOI Listing
March 2021

Comparison between MB11 BERAphone® and ALGO2e color for hearing screening in Japanese healthy newborns.

Int J Pediatr Otorhinolaryngol 2021 May 15;144:110673. Epub 2021 Mar 15.

Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Nihon University, Tokyo, Japan.

Background: Since 2001, newborn hearing screening has been performed in Japan.

Objective: This study compared newborn hearing screening results between the MAICO MB11 BERAphone (MB11) and the Natus ALGO2e color (ALGO) Automated Auditory Brainstem Response (AABR) devices among healthy Japanese newborns.

Materials And Methods: From December 2014 to April 2018, 1477 healthy newborns were screened by MB11 and 267 by ALGO. Data from at-risk newborns were not included. Outcomes were 'Pass' and 'Refer' rates, specificity, false-positive rates, and assessment duration. Infants with a Refer result were examined using Interacoustics Eclipse.

Results: MB11 identified 1425 (96.5%) as Pass and 52 (3.5%) as Refer. ALGO identified 263 (98.5%) as Pass and four (1.5%) as Refer. Specificity and false-positive rates were 97.7% and 2.3% for MB11 and 98.5% and 1.5% for ALGO, respectively. Using MB11, the total mean assessment time was 320.2 ± 220.7 s, with 315.6 ± 214.2 s for Pass and 628.6 ± 288.8 s for Refer.

Conclusions: MB11 is useful for hearing screening in healthy Japanese newborns and is fast and easy to operate. MB11 showed high specificity equivalent to ALGO.
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http://dx.doi.org/10.1016/j.ijporl.2021.110673DOI Listing
May 2021

Magnetic Resonance Imaging 1 Year After Hamstring Autograft Anterior Cruciate Ligament Reconstruction Can Identify Those at Higher Risk of Graft Failure: An Analysis of 250 Cases.

Am J Sports Med 2021 04 25;49(5):1270-1278. Epub 2021 Feb 25.

Sydney Orthopaedic Research Institute, Sydney, Australia.

Background: There is currently no analysis of 1-year postoperative magnetic resonance imaging (MRI) that reproducibly evaluates the graft of a hamstring autograft anterior cruciate ligament reconstruction (ACLR) and helps to identify who is at a higher risk of graft rupture upon return to pivoting sports.

Purpose: To ascertain whether a novel MRI analysis of ACLR at 1 year postoperatively can be used to predict graft rupture, sporting level, and clinical outcome at a 1-year and minimum 2-year follow-up.

Study Design: Case-control study; Level of evidence, 3.

Methods: Graft healing and integration after hamstring autograft ACLR were evaluated using the MRI signal intensity ratio at multiple areas using oblique reconstructions both parallel and perpendicular to the graft and tunnel apertures. Clinical outcomes were assessment of side-to-side laxity and International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Lysholm, and Tegner activity level scores at 1 year. Repeat outcome measures and detection of graft rupture were evaluated at a minimum of 2 years.

Results: A total of 250 patients (42.4% female) underwent MRI analysis at 1 year, and assessment of 211 patients between 1 year and the final follow-up (range, 24-36 months) detected 9 graft ruptures (4.3%; 5 in female patients). A significant predictor for graft rupture was a high signal parallel to the proximal intra-articular graft and perpendicular to the femoral tunnel aperture ( = .032 and = .049, respectively), with each proximal graft signal intensity ratio (SIR) increase by 1 corresponding to a 40% increased risk of graft rupture. A cutoff SIR of 4 had a sensitivity and specificity of 66% and 77%, respectively, in the proximal graft and 88% and 60% in the femoral aperture. In all patients, graft signal adjacent to and within the tibial tunnel aperture, and in the mid intra-articular portion, was significantly lower than that for the femoral aperture ( < .001). A significant correlation was seen between the appearance of higher graft signal on MRI and those patients achieving top sporting levels by 1 year.

Conclusion: ACLR graft rupture after 1 year is associated with MRI appearances of high graft signal adjacent to and within the femoral tunnel aperture. Patients with aspirations of quickly returning to a high sporting level may benefit from MRI analysis of graft signal. Graft signal was highest at the femoral tunnel aperture, adding further radiographic evidence that the rate-limiting step to graft healing occurs proximally.
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http://dx.doi.org/10.1177/0363546521995512DOI Listing
April 2021

Effect of a Single Injection of Basic Fibroblast Growth Factor into the Vocal Folds: A 36-Month Clinical Study.

J Voice 2021 Feb 8. Epub 2021 Feb 8.

Department of Otorhynolaryngology, Nihon University Hospital, Tokyo, Japan.

Objective: A single injection of basic fibroblast growth factor (bFGF) into the vocal folds of patients with glottal insufficiency has been shown to be effective for a few years. However, the long-term therapeutic effect of a single injection of bFGF into the vocal folds has yet to be demonstrated. In this study, the therapeutic effect of a single injection of bFGF into the vocal folds was investigated over several years by monitoring patients for 36 months following this treatment.

Methods: Nineteen patients with glottal insufficiency received injections of bFGF diluted to 20 μg/mL in the superficial layer of the lamina propria of the bilateral vocal folds. The following parameters were evaluated at preinjection baseline and 6, 12, 18, 24, and 36 months later, and statistical comparisons were performed. The parameters evaluated were: the Grade, Rough, Breathy, Asthenic, and Strained (GRBAS) scale score; maximum phonation time; acoustic analysis; and glottal wave analysis (GWA) and kymograph edge analysis (KEA) using high-speed digital imaging (HSDI). The amplitude perturbation quotient (APQ) and period perturbation quotient (PPQ) were measured by acoustic analysis. The mean minimum glottal area during vocalization and mean minimum distance between the vocal folds were measured by GWA. The amplitudes of the bilateral vocal folds were measured by KEA.

Results: Postinjection, the GRBAS scale score decreased from 6 months after injection, and maximum phonation time was prolonged. The mean minimum glottal area during vocalization and the mean minimum distance between the vocal folds calculated by GWA of HSDI decreased significantly after 6 months. These effects persisted until 36 months postinjection. APQ and PPQ derived from acoustic analysis tended to decrease, but not significantly. There was no clear change in the amplitudes of the bilateral vocal folds calculated by KEA of HSDI before and after injection.

Conclusions: These results suggest that the effects of a single injection of bFGF into the vocal folds persist for 36 months.
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http://dx.doi.org/10.1016/j.jvoice.2021.01.015DOI Listing
February 2021

Inferior Surface Leukoplakia of Vocal Folds: Risk of Recurrence: A Preliminary Study.

Ear Nose Throat J 2021 Feb 9:145561321989437. Epub 2021 Feb 9.

Department of Otolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan.

Objectives: This study aimed to identify vocal fold leukoplakia (VFL) lesions on the inferior surface as a risk factor for recurrence.

Methods: This was a retrospective study with data collected from 2001 to 2018. The study comprised 37 patients with VFL, divided into the nonrecurrent and recurrent groups. We examined the clinicopathological characteristics and the surgical procedures performed in each patient.

Results: Among the 37 patients, 15 (40.5%) had residual (3) or recurrent (12) VFL. Of those patients with and without recurrence, 8 of 12 (66.7%) and 6 of 22 (27.3%), respectively, had inferior surface lesions of the vocal fold at the initial operation ( = .036). Recurrences were significantly higher in patients with inferior surface lesions. Other evaluated factors did not show significance for recurrence.

Conclusion: The presence of VFL lesions on the inferior surface is a significant risk factor for recurrence.
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http://dx.doi.org/10.1177/0145561321989437DOI Listing
February 2021

Adjustable suspension versus hybrid fixation in hamstring autograft anterior cruciate ligament reconstruction.

Knee 2021 Jan 2;28:1-8. Epub 2020 Dec 2.

Sydney Orthopaedic Research Institute, Sydney, Australia.

Background: There has been increased use of adjustable suspensory fixation (ASF) for anterior cruciate ligament reconstruction (ACLR). Potential benefits are the ability to use a shorter graft and to prevent graft displacement and damage. The purpose of this study was to establish the efficacy of this fixation method and assess whether it leads to less tunnel widening, and avoids known complications of screw fixation.

Methods: Thirty-eight patients who underwent ACLR with ASF on both the femoral and tibial sides met the inclusion criteria and were propensity matched demographically with 38 patients who underwent hybrid fixation with femoral suspensory and tibial screw and sheath. At one-year, KT-1000 knee laxity measurements were recorded and detailed MRI analysis looking at tunnel aperture widening, tunnel appearance, graft integration within the tunnels, and graft healing.

Results: MRI comparison between ASF and hybrid cohorts revealed no significant differences in graft signal or integration, and clinically there were no differences in knee laxity between cohorts (mean 1.5 mm ± 2.0 and 1.5 mm ± 2.3 (n.s.) in the ASF and hybrid fixation respectively). Significantly less aperture tibial tunnel widening (2.2 mm versus 4.4 mm, p < 0.0001) and tibial cysts (2 versus 9, p = 0.047) were observed in the ASF cohort, whilst mean femoral tunnel widening was comparable between both cohorts (ASF 2.8 mm, hybrid 3.2 mm; n.s.).

Conclusions: Hamstring autografts for ACLR fixed using either ASF or a hybrid fixation technique provided comparable knee stability and MRI graft signal intensity. Tibial ASF demonstrated significantly less tibial aperture widening and tunnel cyst formation when compared to screw and sheath fixation.
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http://dx.doi.org/10.1016/j.knee.2020.10.014DOI Listing
January 2021

Transitional nystagmus in a Bow Hunter's Syndrome case report.

BMC Neurol 2020 Nov 30;20(1):435. Epub 2020 Nov 30.

Saito Clinic, 5-20-11, Sakurajosui, Setagaya-ku, Tokyo, 156-0045, Japan.

Background: Bow Hunter's Syndrome (BHS) is known as one of cervical diseases which causes vertigo, but the details of its vertigo, especially nystagmus and eye movement, are still incompletely understood. This time, we reported the first case of BHS with a nystagmus chart with video record of transitional nystagmus.

Case Presentation: The patient, a 47-year-old female, complained of vertigo caused by head rotation. When she turned her head leftward, leftward nystagmus appeared, and this was followed by dullness of the right arm. After her head was returned to the central position, downbeat nystagmus appeared, which changed to rightward nystagmus. She was diagnosed with BHS by her symptoms and images. We recorded a nystagmus video and nystagmus chart of this transitional nystagmus including downbeat nystagmus. Her vertigo was cured by the modification of a prescription for her past medical history: hypertension.

Conclusion: The vertigo of BHS accompanies nystagmus. In this present case, the transitional nystagmus was observed, and it occurred toward the healthy side. Then the nystagmus direction was changed to the affected side via downbeat nystagmus. This is the first report with both a nystagmus chart with video of BHS. Nowadays, various kinds of vertigo induced by neck movement are known. BHS is a rare disease among vertigo diseases, but we should consider it as a different diagnosis of vertigo patients. A precise interview and proper examination are required to make the final diagnosis.
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http://dx.doi.org/10.1186/s12883-020-02009-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7706255PMC
November 2020

Tegner level is predictive for successful return to sport 2 years after anterior cruciate ligament reconstruction.

Knee Surg Sports Traumatol Arthrosc 2020 Oct 28. Epub 2020 Oct 28.

Sydney Orthopaedic Research Institute, 445 Victoria Ave, Chatswood, NSW, 2067, Australia.

Purpose: For a successful return to sport (RTS) after an anterior cruciate ligament reconstruction (ACLR), patients are recommended to attend a comprehensive rehabilitation program, followed by an RTS assessment, that is a combination of tests. The purpose of this study was to predict a successful return to sport using the results of the RTS assessment and self-reported questionnaires at minimum 2 years after ACLR.

Methods: A total of 123 consecutive ACLR patients undertook an intensive rehabilitation program followed by a comprehensive RTS assessment that included an established combination of balance and strength tests, the ACL-return to sport after Injury scale (ACL-RSI) questionnaire and a KT1000 laximetry test. Preinjury and expected Tegner and Lysholm were collected at baseline, at RTS and prospectively collected at minimum 2-year follow-up. The patients were asked if they returned to their previous sport and at which level. All variables were included in a regression analysis predicting a successful return to previous sport, return to the same level of sport as well as the Tegner level at 2 years.

Results: Sixty-two patients (50%) returned to their previous sport by the 2-year follow-up, without a difference in preinjury Tegner between these two groups (n.s.). Expected preoperative Tegner was the only significant predictor of a successful return to previous sport (p = 0.042; OR 1.300, 95% CI 1.010-1.672). Out of the 62 patients returning to their previous sport, 38 (61%) reported to be on the same or higher level. The only predictive variable for returning to the same level was the higher preinjury Tegner level (p = 0.048; OR 1.522). Multivariate regression analysis of Tegner level at 2 years found younger age to be the only predictive value. From the RTS assessment tests, the ACL-RSI questionnaire and the posterolateral balance test were predictive variables for Tegner at 2-year follow-up, albeit in the univariate regression analysis.

Conclusions: Preoperative Tegner and expected Tegner level collected prior to an ACL reconstruction can aid in the objective prediction of patients' return to sport after 2 years. High-level athletes are more likely to return to their previous sport and to the previous level. Younger patients achieve a higher Tegner level at 2 years.

Level Of Evidence: Level III study.
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http://dx.doi.org/10.1007/s00167-020-06335-4DOI Listing
October 2020

Severe olfactory and gustatory dysfunctions in a Japanese pediatric patient with coronavirus disease (COVID-19).

J Infect Chemother 2021 Jan 30;27(1):110-112. Epub 2020 Sep 30.

Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan. Electronic address:

Coronavirus disease (COVID-19) is often characterized by abnormal olfactory and gustatory symptoms in adults; however, detailed studies on pediatric patients with COVID-19 are extremely limited. A 13-year-old Japanese girl presented with fever and cough, and after 2 days, her olfactory and taste sensations suddenly disappeared. A real-time reverse transcriptase-polymerase chain reaction (RT-PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was performed using a nasopharyngeal swab. Because a positive result was seen, she was admitted on the 7th day of illness. On admission, the visual analogue scale (VAS) score for smell and taste was 0 of 100%. An intravenous olfaction test using prosultiamine (Alinamin test) was performed on the 15th day of illness to evaluate olfaction, and an increase in latency (33 seconds) and a decrease in duration (55 seconds) were observed. In the odor identification test using 12 different odor cards, only 7 odors were correctly identified. On the 18th day of illness, SARS-CoV-2 tested negative in the RT-PCR test; simultaneously, the VAS score for smell and taste fully improved to 100 of 100%. On the 77th day of illness, full recovery was confirmed in the Alinamin test (latency, 7 seconds; duration, 82 seconds). In this present case, an improvement in olfactory and gustatory dysfunctions was observed with negative results in RT-PCR test for SARS-CoV-2.
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http://dx.doi.org/10.1016/j.jiac.2020.09.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7526635PMC
January 2021

Prognostic factors of recovery with medication in patients with taste disorders.

PLoS One 2020 1;15(10):e0237270. Epub 2020 Oct 1.

Department of Otolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan.

Objectives: We aimed to elucidate the prognostic factors of the patients with taste disorders who were treated with popular and common medication in Japan.

Materials And Methods: A retrospective study on the medical charts of a total of 255 patients with taste disorders who were treated primarily with oral medication including a zinc agent.

Results: The factors below were significantly linked with poor prognosis: 1) male gender, 2) taste disorders that began 3 months before starting treatment and 3) a severe taste disorder grade at the initial visit.

Conclusions: We have concluded that the prognosis for the patients with taste disorders who were treated by popular and standard medication therapy in Japan recently was significantly linked to gender, the period of 3 months before starting the treatment and the severity of the disorder at the time of diagnosis. In addition, we recognized some limitations we should resolve in further research including a method of measuring "umami" and so on.

Clinical Relevance: Better awareness of these factors should be clinically useful when we manage patients with taste disorders. Earlier treatment should be started to cure the symptoms.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237270PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529239PMC
November 2020

Functional recurrent laryngeal nerve regeneration using a silicon tube containing a collagen gel in a rat model.

PLoS One 2020 27;15(8):e0237231. Epub 2020 Aug 27.

Department of Functional Morphology, Division of Cell Regeneration and Transplantation, Nihon University School of Medicine, Tokyo, Japan.

In this study, we examined the effect of differing gap lengths on regeneration of transected recurrent laryngeal nerves using silicon tubes containing type I collagen gel and the ability of this regeneration to result in restoration of vocal fold movements in rats. We simulated nerve gaps in Sprague-Dawley rats by transecting the left recurrent laryngeal nerves and bridged the nerve stumps using silicon tubes containing type 1 collagen gel. Three experimental groups, in which the gap lengths between the stumps were 1, 3, or 5 mm, were compared with a control group in which the nerve was transected but was not bridged. After surgery, we observed vocal fold movements over time with a laryngoscope. At week 15, we assessed the extent of nerve regeneration in the tube, histologically and electrophysiologically. We also assessed the degree of atrophy of the thyroarytenoid muscle (T/U ratio). Restoration of vocal fold movements was observed in 9 rats in the 1-mm group, in 6 rats in the 3-mm group, and in 3 rats in the 5-mm group. However, in most rats, restoration was temporary, with only one rat demonstrating continued vocal fold movements at week 15. In electromyograph, evoked potentials were observed in rats in the 1-mm and 3-mm groups. Regenerated tissue in the tube was thickest in the 1-mm group, followed by the 3-mm and 5-mm groups. The regenerated tissue showed the presence of myelinated and unmyelinated nerve fibers. In assessment of thyroarytenoid muscle atrophy, the T/U ratio was highest in the 1-mm group, followed by the 3-mm and 5-mm groups. We successfully regenerated the nerves and produced a rat model of recurrent laryngeal nerve regeneration that demonstrated temporary recovery of vocal fold movements. This rat model could be useful for assessing novel treatments developing in the future.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237231PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451556PMC
October 2020

Risk factors for noncontact anterior cruciate ligament injury in female high school basketball and handball players: A prospective 3-year cohort study.

Asia Pac J Sports Med Arthrosc Rehabil Technol 2020 Oct 8;22:34-38. Epub 2020 Aug 8.

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

Introduction: The risk factors of noncontact anterior cruciate ligament (ACL) injury remain an enigma. The purpose of this study was to prospectively evaluate the risk factors for noncontact ACL injury in female high school basketball and handball players.

Materials And Methods: We conducted a 3-year prospective cohort study between 2009 and 2014, and it included 317 female high school athletes aged 15 years. At baseline, they underwent detailed examinations for various parameters that were documented during their first year of high school. The parameters assessed were height (cm), weight (kg), general joint laxity (points), navicular drop (mm), anterior laxity of the knee using the KT-1000 Knee Ligament Arthrometer (mm), angle of femoral anteversion (º), knee extensor/flexor muscle strength (Nm/kg), and hip abductor strength (Nm/kg). All ACL injuries that occurred during these 3 years were recorded.

Results: Of 317 players, 27 were excluded because they either had a history of ACL injury or could not complete the study. Thirty ACL tears occurred. Three of the ACL injuries were contact injuries, whereas the remaining 27 were noncontact injuries. Greater body weight (95% confidence interval [CI], 1.030-1.174; P = 0.004), a high hip abductor strength (95% CI, 1.462-4.827; P = 0.001), and small femoral anteversion (95% CI, 0.746-0.982; P = 0.027) were found to be risk factors in logistic regression analysis.

Conclusion: Greater body weight, a high hip abductor strength, and small femoral anteversion were risk factors for noncontact ACL injury in female high school basketball and handball players.
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http://dx.doi.org/10.1016/j.asmart.2020.06.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7417616PMC
October 2020

The successful management for long-term intractable enteroatmospheric fistula: A case report.

Ann Med Surg (Lond) 2020 Sep 30;57:253-256. Epub 2020 Jul 30.

Department of Gastroenterological Surgery, Shizuoka General Hospital, Aoi-ku, Japan.

Introduction: Efficacy of open abdomen management with negative pressure wound therapy for enteroatmospheric fistula has been performed. But, few reports have shown its utility for enteroatmospheric fistula several years after onset.

Presentation Of Case: A 46 year-old woman underwent total colectomy due to total ulcerative colitis in her twenties. Three years before the onset of enteroatmospheric fistula, she underwent simple total hysterectomy for uterine smooth muscle tumor. Small bowel obstruction occurred early and a small bowel bypass was performed. However, she had sudden abdominal pain and was diagnosed with anastomotic leakage of small bowel bypass. Although antibiotic treatment was initiated, infection was difficult to control, and a midline abdominal incision was performed, followed by the formation of enteroatmospheric fistula. She declined early surgical intervention and started receiving home parenteral nutrition with antibiotic treatment. Although central vein management was continued, catheter infection became frequent. Hence, surgical intervention was planned 30 months after the formation of enteroatmospheric fistula. Two-stage abdominal wall reconstruction using open abdomen management with negative pressure wound therapy was planned. The definitive abdominal wall reconstruction was performed 14 days after the initial operation. Finally, she was discharged without reoperation.

Discussion: Enteroatmospheric fistula has no overlying soft tissue and no real fistula tract. Besides these complications, there were complications of the scarred abdominal wall from intestinal fluid exposure for 30 months.

Conclusion: The strategy using open abdomen management with negative pressure wound therapy for long-term enteroatmospheric fistula will have a good postoperative outcome with the same as early intervention.
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http://dx.doi.org/10.1016/j.amsu.2020.07.044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7426484PMC
September 2020

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

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

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

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

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

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

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

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

Anterior knee translation measurements after ACL reconstruction are influenced by the type of laximeter used.

Knee Surg Sports Traumatol Arthrosc 2020 Nov 2;28(11):3639-3646. Epub 2020 Apr 2.

Sydney Orthopaedic Research Institute, Level 1, The Gallery, 445 Victoria Ave, Chatswood, NSW, 2067, Australia.

Purpose: Laximeters were designed to diagnose an anterior cruciate ligament (ACL) deficient knee, but their use has now focused on providing an objective assessment of the anterior translation (AT) of an intact and ACL-reconstructed knee. In this study we report the introduction and direct comparison of an automated and computerized AT measurement device, GNRB, with the device previously established by the institute and as the current literature standard, the KT1000.

Methods: A prospective data collection was commenced upon introduction of the GNRB. The measurements of AT in each patient were performed by the same investigator with each device using 134 N applied to both knees, giving a side-to-side difference. The investigators were a sport scientist, a biomechanical engineer and a physiotherapist. Increased AT was defined as a difference > 3 mm.

Results: Three investigators performed the measurements in 122 patients, 9.8 (± 1.8) months after ACL reconstruction. Mean AT of the healthy knee was 5.7 mm with KT1000 and 4.4 mm with GNRB (p = 0.002). Mean AT of the ACL reconstructed knee was 7.0 mm with the KT1000 and 5.3 mm with the GNRB (p = 0.037). The KT1000 had a higher variance of results than the GNRB (p < 0.001). There were 25 patients with increased AT measured by KT1000 compared with 12 patients using the GNRB (p < 0.016), with only 5 on both devices.

Conclusions: GNRB has better consistency of results when compared to the KT1000. Both devices lack comparability for detecting increased AT, with the KT1000 recording a side-to-side difference of more than 3 mm in twice as many patients as the GNRB.

Level Of Evidence: II.
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http://dx.doi.org/10.1007/s00167-020-05950-5DOI Listing
November 2020

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

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

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

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

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

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

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

The space available for the anterior cruciate ligament in the intercondylar notch is less in patients with ACL injury.

Knee Surg Sports Traumatol Arthrosc 2020 Jul 10;28(7):2105-2115. Epub 2020 Mar 10.

Sydney Orthopaedic Research Institute, Level 1, 445 Victoria Avenue, Chatswood, Sydney, NSW, Australia.

Purpose: The aim of this study was to determine if a difference exists in the relationship between the femoral intercondylar notch volume, and the volumes of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) in ACL injured patients and healthy subjects.

Methods: Intact knees of 19 healthy subjects and bilateral knees of 18 ipsilateral ACL reconstructed patients were scanned using 3-tesla high-resolution magnetic resonance imaging. The intercondylar notch, ACL, PCL and hamstring graft were segmented using three-dimensional (3D) processing software. The native intercondylar notch, ACL, and PCL volumes were compared between both groups. The volumes of native ACL and graft were compared in ACL injured patients.

Results: The following volumes showed no significant differences between the ACL injured group and control group; intercondylar notch (9.9 ± 2.3 vs 9.6 ± 1.7 cm), ACL (2.4 ± 0.7 vs 2.4 ± 0.6 cm) and PCL (3.9 ± 1.0 vs 3.4 ± 0.8 cm), and the ratio of the ACL to the intercondylar notch (24.6 ± 5.0 vs 25.4 ± 2.9%). There was a significant difference in the ratio of PCL to the intercondylar notch (39.1 ± 4.3 vs 35.9 ± 4.9%, p = 0.023). The graft was significantly larger than native ACL volume (3.0 ± 0.7 vs 2.4 ± 0.7 cm, p = 0.012).

Conclusions: The ratio of the PCL volume in the femoral intercondylar notch was higher in the ACL injured group compared to the healthy control group, despite the ratio of ACL volume in the femoral intercondylar notch being similar in both groups. A greater awareness of the potentially limited space for the graft alongside the PCL within the femoral intercondylar notch may allow surgeons a more informed choice of graft type and size.

Level Of Evidence: IV.
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http://dx.doi.org/10.1007/s00167-020-05921-wDOI Listing
July 2020

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

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

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

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

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

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

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

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

Large osteophyte removal from the posterior femoral condyle significantly improves extension at the time of surgery in a total knee arthroplasty.

J Orthop 2020 May-Jun;19:76-83. Epub 2019 Nov 18.

Sydney Orthopaedic Research Institute, Level 1 The Gallery, 445 Victoria Avenue, Chatswood, New South Wales, 2067, Australia.

Removing osteophytes from the posterior compartment of the femur eliminates the tenting effects on the joint capsule and consequently increases the extension gap in total knee arthroplasty. However, there is no clear association with the size of osteophytes removed and the potential degree of additional extension achieved at time of surgery.

Aims: Correlate the size of posterior osteophytes removed with the degree of extension gained intraoperatively in total knee arthroplasty and develop a radiological classification system to grade these osteophytes.

Methods: Patients who underwent a TKA had pre and post operative sagittal radiographs assessed and classified according to 4 different categories of a proposed classification system. Knee extension was then assessed by a computer navigated system before incision and after implant insertion. Confounding factors were controlled and considered on the analysis. The study was done retrospectively.

Results: 147 patients were included in the study. Ninety-three (63.2%) patients had osteophytes on the posterior aspect of the femur completely removed and fifty-four patients (36.8%) did not have radiological evidence of osteophytes on the posterior aspect of the femur. There was a positive and linear correlation (Pearson correlation 0.327, p .005) between osteophyte size and degree of extension corrected at time of surgery. On Multivariate Logistic Regression Analysis, we found that small osteophytes (Grade 1) did not seem to affect the extension, while removing Grade 2 or Grade 3 osteophytes lead to a gain in extension of 2.7 and 4.5° respectively.

Conclusion: Removing large osteophytes (Grade 2 and Grade 3) from the posterior femoral compartment can be used as an adjuvant strategy to ensure that intraoperative extension is optimal. However removing small osteophytes (Grade 1) should not be expected to affect extension at the time of surgery in TKA and could increase intra-operative time and morbidity.
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http://dx.doi.org/10.1016/j.jor.2019.10.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6994791PMC
November 2019

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

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

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

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

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

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

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

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

Caspase-8 Regulates Endoplasmic Reticulum Stress-Induced Necroptosis Independent of the Apoptosis Pathway in Auditory Cells.

Int J Mol Sci 2019 Nov 24;20(23). Epub 2019 Nov 24.

Department of Otolaryngology, School of Medicine, Nihon University, 30-1, Oyaguchi Kami-cho, Itabashi-ku, Tokyo 173-8610, Japan.

The aim of this study is to elucidate the detailed mechanism of endoplasmic reticulum (ER) stress-induced auditory cell death based on the function of the initiator caspases and molecular complex of necroptosis. Here, we demonstrated that ER stress initiates not only caspase-9-dependent intrinsic apoptosis along with caspase-3, but also receptor-interacting serine/threonine kinase (RIPK)1-dependent necroptosis in auditory cells. We observed the ultrastructural characteristics of both apoptosis and necroptosis in tunicamycin-treated cells under transmission electron microscopy (TEM). We demonstrated that ER stress-induced necroptosis was dependent on the induction of RIPK1, negatively regulated by caspase-8 in auditory cells. Our data suggested that ER stress-induced intrinsic apoptosis depends on the induction of caspase-9 along with caspase-3 in auditory cells. The results of this study reveal that necroptosis could exist for the alternative backup cell death route of apoptosis in auditory cells under ER stress. Interestingly, our data results in a surge in the recognition that therapies aimed at the inner ear protection effect by caspase inhibitors like zVAD-fmk might arrest apoptosis but can also have the unanticipated effect of promoting necroptosis. Thus, RIPK1-dependent necroptosis would be a new therapeutic target for the treatment of sensorineural hearing loss due to ER stress.
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http://dx.doi.org/10.3390/ijms20235896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6928907PMC
November 2019

Graft Size and Orientation Within the Femoral Notch Affect Graft Healing at 1 Year After Anterior Cruciate Ligament Reconstruction.

Am J Sports Med 2020 01 15;48(1):99-108. Epub 2019 Nov 15.

Sydney Orthopaedic Research Institute, Sydney, Australia.

Background: The combined influence of anatomic and operative factors affecting graft healing after anterior cruciate ligament (ACL) reconstruction within the femoral notch is not well understood.

Purpose: To determine the influence of graft size and orientation in relation to femoral notch anatomy, with the signal/noise quotient (SNQ) of the graft used as a measure of graft healing after primary single-bundle ACL reconstruction.

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

Methods: A total of 98 patients with a minimum 2-year follow-up after primary single-bundle ACL reconstruction with hamstring tendon autografts were included. Graft healing was evaluated at 1 year on magnetic resonance imaging (MRI) scan as the mean SNQ measured from 3 regions situated at sites at the proximal, middle, and distal graft. Patient characteristics, chondropenia severity score, tunnel sizes, tunnel locations, graft bending angle (GBA), graft sagittal angle, posterior tibial slope (PTS), graft length, graft volume, femoral notch volume, and graft-notch volume ratio (measured using postoperative 3-T high-resolution MRI) were evaluated to determine any association with 1-year graft healing. The correlation between 1-year graft healing and clinical outcome at minimum 2 years was also assessed.

Results: There was no significant difference in mean SNQ between male and female patients ( > .05). Univariate regression analysis showed that a low femoral tunnel ( = .005), lateral tibial tunnel ( = .009), large femoral tunnel ( = .011), large tibial tunnel ( < .001), steep lateral PTS ( = .010), steep medial PTS ( = .004), acute graft sagittal angle ( < .001), acute GBA ( < .001), large graft volume ( = .003), and high graft-notch volume ratio ( < .001) were all associated with higher graft SNQ values. A multivariate regression analysis showed 2 significant factors: a large graft-notch volume ratio ( = .001) and an acute GBA ( = .004). The 1-year SNQ had a weak correlation with 2-year Tegner Activity Scale score ( = 0.227; = .026) but no other clinical findings, such as International Knee Documentation Committee subjective and Lysholm scores and anterior tibial translation side-to-side difference.

Conclusion: The 1-year SNQ value had a significant positive association with graft-notch volume ratio and GBA. Both graft size and graft orientation appeared to have a significant influence on graft healing as assessed on 1-year high-resolution MRI scan.
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http://dx.doi.org/10.1177/0363546519885104DOI Listing
January 2020

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

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

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

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

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

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

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

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

Healthy knee KT1000 measurements of anterior tibial translation have significant variation.

Knee Surg Sports Traumatol Arthrosc 2020 Jul 2;28(7):2177-2183. Epub 2019 Nov 2.

Sydney Orthopaedic Research Institute, Level 1, The Gallery, 445 Victoria Ave., Chatswood, NSW, 2067, Australia.

Purpose: The most commonly used arthrometer for measuring and reporting anterior tibial translation after anterior cruciate ligament reconstruction is the KT1000. Reports on its consistency and reproducibility vary in the literature, but it remains the "gold standard". The purpose of this study was to assess agreement of KT1000 measurements in a daily clinical setting.

Methods: A retrospective analysis of anterior knee translation in the healthy knee of 770 patients over a 17-year time period was performed. In this cohort, a total of 24 investigators performed 1890 measurement sets at 89 Newtons (N), 134N and at maximum manual force (MMax) level. To assess the inter- and intra-observer agreement, the intraclass-correlation coefficient (ICC) was calculated. The "investigator effect" was a difference between two examiners in the same patient and the "device effect'' a difference within one examiner in the same patient. Minimally important difference (MID) was calculated as 0.5 of the standard deviation.

Results: Thirteen investigators were female, performing 1099 measurements and 11 were male, performing 791 measurements. ICC ranged between 0.558 and 0.644. At the MMax level, male investigators had a higher mm reading than female investigators (p < 0.001). Increased experience did not correlate with a higher ICC. MID ranged between 0.85 and 1.65 mm.

Conclusion: This study investigated the KT1000 arthrometer in a clinical setting with a large number of investigators. This device delivers moderate agreement of results. Both the device and investigator effect are present. The MMax level has shown the lowest agreement and a dependency on the investigator gender.

Level Of Evidence: Level III diagnostic study.
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http://dx.doi.org/10.1007/s00167-019-05768-wDOI Listing
July 2020

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

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

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

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

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

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

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

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

Efficacy of a silicone plug for patulous eustachian tube: A prospective, multicenter case series.

Laryngoscope 2020 05 10;130(5):1304-1309. Epub 2019 Aug 10.

Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.

Objectives/hypothesis: To report the efficacy and safety of transtympanic plugging of the eustachian tube (ET) using a silicone plug (Kobayashi plug) for chronic patulous ET (PET).

Study Design: Prospective and multicenter trial conducted in which 30 PET patients were resistant to at least 6 months of conservative treatment.

Methods: The efficacy and safety of 28 and 27 patients, respectively, were analyzed. All patients fulfilled inclusion and exclusion criteria. The primary end point used the patulous eustachian tube handicap inventory-10 (PHI-10), and the secondary end point used ET function tests such as sonotubometry, tubo-tympano-aerodynamic-graphy, and respiratory movement of the tympanic membrane and auscultation of voice sounds transmitted from the nose through the ET to the external auditory canal at 3months after surgery.

Results: PHI-10 scores were 34.4 ± 4.2, 6.4 ± 9, and 5.7 ± 8.6 at screening, and 3 and 6 months after surgery. Twenty-three cases (82.1%, 95% confidence interval: 63.1%-93.9%) were judged as successes. There were five cases (17.2%) of middle ear effusion, four cases (13.8%) of tympanic membrane perforation, and one case of tinnitus due to surgery to remove the plug. No severe or life-threatening complications were found.

Conclusions: This study revealed the efficacy and safety of silicone plug insertion for severe PET patients.

Level Of Evidence: 2 Laryngoscope, 130:1304-1309, 2020.
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http://dx.doi.org/10.1002/lary.28229DOI Listing
May 2020

Effectiveness of Adhering Adipose-Derived Stem Cells to Defective Cartilage in Promoting Cartilage Regeneration in a Rabbit Model.

Arthroscopy 2019 09 12;35(9):2619-2626. Epub 2019 Jul 12.

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

Purpose: To evaluate the therapeutic effect of using a local adherent technique to transplant adipose-derived stem cells (ADSCs) for cartilage regeneration in a rabbit model for patients with traumatic damage or osteochondritis dissecans.

Methods: Cartilage defects were created in the trochlear groove of 60 adult white rabbit knees. The rabbits were either left untreated (control group), treated with intra-articularly injected ADSCs (injected group), or treated by adhering ADSCs (adherent group). The 3 groups were compared at 4, 12, and 24 weeks postoperatively using the International Cartilage Repair Society macroscopic scoring system and a modified Wakitani histologic grading system to quantitatively evaluate the regenerated cartilage. The degree of defect repair, integration to the border zone, macroscopic appearance, cell morphology, matrix staining, surface regularity, cartilage thickness, and integration of the donor with the host were evaluated.

Results: The mean International Cartilage Repair Society scores in the control, injected, and adherent groups were 6.4 ± 2.9, 7.6 ± 0.8, and 7.6 ± 1.4, respectively, at 4 weeks; 6.2 ± 2.4, 8.2 ± 1.5, and 9.6 ± 1.0, respectively, at 8 weeks; and 7.6 ± 1.0, 8.4 ± 1.4, and 10.2 ± 1.7, respectively, at 24 weeks. Although the scores were higher in the adherent group, no significant difference was noted. The mean modified Wakitani scores in the control, injected, and adherent groups were 3.8 ± 2.0, 5.1 ± 1.8, and 7.8 ± 1.3, respectively, at 4 weeks (P = .041); 5.1 ± 1.0, 5.4 ± 2.7, and 9.6 ± 1.4, respectively, at 12 weeks (P = .016); and 5.4 ± 1.0, 5.9 ± 1.5, and 9.8 ± 1.8, respectively, at 24 weeks (P = .007).

Conclusions: The histologic modified Wakitani scores showed that adhering ADSCs to osteochondral cartilage defects was more effective than intra-articular injection for promoting cartilage regeneration.

Clinical Relevance: Local adhesion of ADSCs can promote cartilage regeneration and may be a treatment option for cartilage repair.
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http://dx.doi.org/10.1016/j.arthro.2019.03.018DOI Listing
September 2019

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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