Details of a Researcher - TERAMOTO Atsushi

Papers - TERAMOTO Atsushi

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The prevalence of posterior inferior tibiofibular ligament and inferior tibiofibular transverse ligament injuries in syndesmosis-injured ankles evaluated by oblique axial magnetic resonance imaging: a retrospective study.

Kousuke Shiwaku, Atsushi Teramoto, Kousuke Iba, Hidenori Otsubo, Tomoaki Kamiya, Hiroaki Shoji, Kota Watanabe, Toshihiko Yamashita

BMC musculoskeletal disorders 23 ( 1 ) 264 - 264 2022.03 [International journal]

BACKGROUND: Transverse ligament and posterior inferior tibiofibular ligament injuries have not been investigated till date because these are difficult to evaluate using standard magnetic resonance imaging. This study aimed to investigate the prevalence of transverse ligament and posterior inferior tibiofibular ligament injuries in syndesmosis-injured ankles using oblique axial magnetic resonance imaging. METHODS: The patients who were diagnosed with syndesmosis injury using magnetic resonance imaging (MRI) within 7 days of the trauma were included. Patients with concomitant fractures were excluded. A total of 34 patients (1 woman and 33 men) with an average age of 22 years (range, 14-64 years) were included. The anterior inferior tibiofibular, interosseous, transverse, and posterior inferior tibiofibular ligaments were classified as intact, partial tear, or complete tear using usual axial and oblique axial MRIs. RESULTS: There were 8 (23.5%) ankles with an intact, 21 (61.8%) ankles with a partially torn, and 5 (14.7%) ankles with a complete tear of transverse ligament. There were 20 (58.8%) ankles with an intact, 12 (35.3%) ankles with a partially torn, and 2 (5.9%) ankles with a complete tear of posterior inferior tibiofibular ligament. Overall, 50% of the transverse ligament injuries occurred without posterior inferior tibiofibular ligament involvement. CONCLUSIONS: The oblique axial magnetic resonance imaging scan revealed that the prevalence of transverse ligament and posterior inferior tibiofibular ligament injuries in syndesmosis-injured ankles were 76.5 and 41.2%, respectively.

Three-dimensional motion analysis of the hindfoot resulting from simulated contraction of individual lower leg muscles utilizing Thiel-embalmed cadavers.

Keisuke Negishi, Kota Watanabe, Atsushi Teramoto, Kenta Yamatsu, Mizuho Hayashi

Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons 28 ( 7 ) 1040 - 1044 2022.02 [International journal]

BACKGROUND: Joint movement within the foot is complex involving multiple muscles. We evaluated three-dimensional movement of the hindfoot through simulated traction of extrinsic tendons of the foot. METHODS: Six Thiel-embalmed cadavers were utilized and thread was sutured to each tendon of the lower leg muscles. Traction of the thread was prescribed and the change of calcaneal position used to quantify foot motion was measured for each increment using a magnetic tracking system. RESULTS: As the tendon traction length advanced, the angle of the calcaneus with respect to the tibia increased linearly. Eversion and abduction angles due to extensor digitorum longus (EDL) traction were significantly greater than that due to the peroneus longus. Plantarflexion due to Achilles tendon traction was significantly greater than that of other plantarflexors. CONCLUSIONS: Our results demonstrated three-dimensional characteristics of hindfoot motion by simulated muscle contraction and importance of EDL as an evertor. These information should be applicable for tendon transfer procedures around the ankle and physical therapy for ankle dysfunction such as chronic ankle instability.

Impact of Pain in Other Body Regions on the Foot-Specific Quality of Life in Patients with Hallux Valgus.

Yukio Mikami, Satoshi Yamaguchi, Atsushi Teramoto, Kentaro Amaha, Tetsuro Yasui, Toshinori Kurashige, Ryota Nagashima, Jun Endo, Yoshiyuki Takakura, Koji Noguchi, Aya Sadamasu, Seiji Kimura

Modern rheumatology 33 ( 2 ) 428 - 433 2022.02 [International journal]

OBJECTIVES: The purpose of this study was to clarify the prevalence of pain outside the foot, and to determine the associations of pain outside the foot with foot-specific quality of life in patients with hallux valgus. METHODS: Patients scheduled to undergo hallux valgus surgery were recruited. Patients answered whether they experienced disabling pain in 13 body regions other than the foot. Foot-specific quality of life was assessed using the Self-Administered Foot Evaluation questionnaire (SAFE-Q). Foot pain was quantified using the visual analogue scale (VAS). Patient characteristics, including age, sex, comorbidity, anxiety, and depression, were also surveyed. The association between pain elsewhere and the SAFE-Q and pain VAS scores was assessed using univariate and multivariate analyses. RESULTS: Of 102 patients, 55 (54%) experienced pain other than the foot. All SAFE-Q subscale scores were lower, and pain VAS was higher in patients with pain elsewhere than in patients without. In the multivariate analysis, an increase in the number of pain regions was independently associated with a decrease in SAFE-Q scores and an increase in pain VAS. CONCLUSION: More than half of the patients with hallux valgus experienced pain elsewhere. The presence of pain elsewhere was associated with poorer foot-specific quality of life and severer foot pain.

Effect of Minimally Invasive Selective Laminectomy for Cervical Spondylotic Myelopathy on Degenerative Spondylolisthesis.

Kota Kurihara, Kousuke Iba, Atsushi Teramoto, Makoto Emori, Ryosuke Hirota, Tsutomu Oshigiri, Izaya Ogon, Noriyuki Iesato, Yoshinori Terashima, Hiroyuki Takashima, Mitsunori Yoshimoto, Tsuneo Takebayashi, Toshihiko Yamashita

Clinical spine surgery 35 ( 1 ) E242-E247 2022.02 [International journal]

STUDY DESIGN: Retrospective analysis of prospectively collected observational data. OBJECTIVE: This study aimed to evaluate the slippage, sagittal alignment, and range of motion (ROM) after selective laminectomy (SL) in patients who had cervical spondylotic myelopathy (CSM) with degenerative spondylolisthesis (DS). SUMMARY OF BACKGROUND DATA: Clinical outcomes have been reported for both decompression and fusion surgeries for DS of the lumbar spine. However, only a few reports have examined cervical spine spondylolisthesis. MATERIALS AND METHODS: This study included 178 patients who underwent SL for CSM. Those with ossification of the posterior longitudinal ligament were excluded. Slippage >2 mm was defined as spondylolisthesis, and spondylolisthesis progression was defined as an additional displacement >2 mm on a neutral radiograph. The slippage, translational motion, C2-C7 angle, local kyphosis, and ROM were examined before and ≥2 years after surgery. Radiologic parameters were evaluated according to the slip direction and the number of laminae removed. RESULTS: DS was observed in 29 patients (16.3%); 24 patients, comprising 9 and 15 in the anterolisthesis and retrolisthesis groups, respectively, were successfully followed up for more than 2 years. Preoperative and postoperative radiologic changes in slippage, translational motion, C2-C7 angle, local kyphosis, and ROM were not remarkable in either group regardless of the number of laminae removed. Revision surgery for the progression of DS and alignment deterioration was not required in any patient of either group. CONCLUSIONS: SL does not affect DS, sagittal alignment, or ROM irrespective of the slip direction and the number of laminae removed, even after >2 years after surgery. Given the preservation of the posterior elements, SL may be an effective treatment for CSM with DS. LEVEL OF EVIDENCE: Level IV.

Effect of Minimally Invasive Selective Laminectomy for Cervical Spondylotic Myelopathy on Degenerative Spondylolisthesis

Kota Kurihara, Kousuke Iba, Atsushi Teramoto, Makoto Emori, Ryosuke Hirota, Tsutomu Oshigiri, Izaya Ogon, Noriyuki Iesato, Yoshinori Terashima, Hiroyuki Takashima, Mitsunori Yoshimoto, Tsuneo Takebayashi, Toshihiko Yamashita

CLINICAL SPINE SURGERY ( LIPPINCOTT WILLIAMS & WILKINS ) 35 ( 1 ) E242 - E247 2022.02

Study Design: Retrospective analysis of prospectively collected observational data. Objective: This study aimed to evaluate the slippage, sagittal alignment, and range of motion (ROM) after selective laminectomy (SL) in patients who had cervical spondylotic myelopathy (CSM) with degenerative spondylolisthesis (DS). Summary of Background Data: Clinical outcomes have been reported for both decompression and fusion surgeries for DS of the lumbar spine. However, only a few reports have examined cervical spine spondylolisthesis. Materials and Methods: This study included 178 patients who underwent SL for CSM. Those with ossification of the posterior longitudinal ligament were excluded. Slippage >2 mm was defined as spondylolisthesis, and spondylolisthesis progression was defined as an additional displacement >2 mm on a neutral radiograph. The slippage, translational motion, C2-C7 angle, local kyphosis, and ROM were examined before and >= 2 years after surgery. Radiologic parameters were evaluated according to the slip direction and the number of laminae removed. Results: DS was observed in 29 patients (16.3%); 24 patients, comprising 9 and 15 in the anterolisthesis and retrolisthesis groups, respectively, were successfully followed up for more than 2 years. Preoperative and postoperative radiologic changes in slippage, translational motion, C2-C7 angle, local kyphosis, and ROM were not remarkable in either group regardless of the number of laminae removed. Revision surgery for the progression of DS and alignment deterioration was not required in any patient of either group. Conclusions: SL does not affect DS, sagittal alignment, or ROM irrespective of the slip direction and the number of laminae removed, even after >2 years after surgery. Given the preservation of the posterior elements, SL may be an effective treatment for CSM with DS.

Evaluation of the Activities of the Intrinsic and Extrinsic Muscles of the Foot During Toe Flexion With or Without Interphalangeal Joint Flexion Using Ultrasound Shear Wave Elastography

Kento Hirota, Kota Watanabe, Keisuke Negishi, Hiroki Miyamoto, Tatsuya Taniguchi, Atsushi Teramoto

The Foot ( Elsevier BV ) 101945 - 101945 2022 [Refereed]

Symptomatic ossicle lesion at the anterior tip of the medial malleolus in soccer players.

Atsushi Teramoto, Kousuke Iba, Kota Watanabe, Tomoaki Kamiya, Yohei Okada, Toshihiko Yamashita

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 26 ( 6 ) 1069 - 1073 2021.11 [Domestic journal]

BACKGROUND: Unfused accessory ossification centers in the medial ankle are sometimes misdiagnosed and should be distinguished from other bone lesions such as fracture, stress fracture, os subtibiale, or pseudoarthrosis of the medial malleolus. The purpose of this study was to report our experience in treating soccer players with bony elements in the subtibial region. METHODS: We surgically treated seven soccer players who experienced medial ankle pain with bony fragments at the tip of the medial malleolus. Their ages were between 13 and 27 years. The mean duration from symptom onset to hospital visit was 4.7 years (range: 2 months to 14 years). The bony lesion located at the anterior tip of the medial malleolus in all patients and we diagnosed the lesion as an unfused accessory ossification center. RESULTS: Three types of surgical treatments were performed in patients according to age, ossicle size, status of the epiphyseal plate, and degenerative changes around the lesion. Bony fusion was achieved in patients who underwent open reduction and fusion with bone graft. Patients who underwent focal drilling or removal of the bony fragment experienced improvement in symptoms, and all patients were allowed to resume their sports or full preinjury activities. CONCLUSION: We believe that surgery is the first-line treatment for the patients with unfused accessory ossification centers with their prolonged symptom and favorable outcomes can be expected. Bony fusion should be attempted in the patients with the large ossicle especially in their growth period.

Relationship Between Plantar Callosity and Foot Deformity in Hallux Valgus Using Weightbearing Computed Tomography

Yasutaka Murahashi, Kousuke Iba, Atsushi Teramoto, Katsunori Takahashi, Yohei Okada, Tomoaki Kamiya, Hiroyuki Takashima, Kota Watanabe, Hirofumi Ohnishi, Toshihiko Yamashita

JOURNAL OF FOOT & ANKLE SURGERY ( ELSEVIER SCIENCE INC ) 60 ( 6 ) 1207 - 1211 2021.11

Plantar callosities under lesser metatarsals are often accompanied by the hallux valgus, and the cause of callosity is thought to be associated with the foot deformity, such as the metatarsal length discrepancy, the abnormal metatarsal head height, cavus, flat foot, and rheumatoid conditions. However, it is unclear which variable is most involved in the cause of callosity in hallux valgus deformity. To clarify the factors associated with the callosity with hallux valgus deformity, we conducted multiple image assessments based on weightbearing radiography and computed tomography. A retrospective review was performed based on the collection of clinical records from all patients with hallux valgus treated from 2010 to 2019 in our institution. We measured the hallux valgus angle, intermetatarsal angles, calcaneal pitch angles, talo-first metatarsal angles, metatarsal length, metatarsal head height, first metatarsal pronation angles, and sesamoid position with weightbearing radiography and computed tomography. We analyzed the relation between callosity formation and imaging assessments using univariate and multivariate logistic regression models. Fifty feet were retrospectively evaluated, and multiple logistic analyses by the stepwise method revealed that the first metatarsal-lateral-sesamoid distance was the only radiographical variable associated with callosity formation among all the tested variables (p < .001). As the grade of the callosity became more severe, the lateral shift of the lateral sesamoid increased. The position of the sesamoid bone appears to have a critical role in the assessment and choice of treatment protocols and further research needs to be conducted on the relationship with the position of sesamoid bone to elucidate the mechanism of callus formation. (c) 2021 by the American College of Foot and Ankle Surgeons. All rights reserved.

Surgical Procedures Based on the Arthrographic Findings of the Fifth MTP Joint With Proximal Phalanx Duplication in Postaxial Polydactyly of the Foot

Takafumi Kurokawa, Kousuke Iba, Megumi Hanaka, Atsushi Teramoto, Makoto Emori, Hikaru Hayakawa, Akira Saito, Kenichi Takashima, Toshihiko Yamashita

Journal of Foot and Ankle Surgery ( Academic Press Inc. ) 60 ( 5 ) 983 - 989 2021.09

Radiographic findings in several atypical cases of postaxial polydactyly of the foot do not provide sufficient information to assess the cartilaginous structures or duplicated digit connections at the MTP joint. The purpose of this study was to demonstrate the surgical procedures using arthrography for the cartilaginous structures of the MTP joint in postaxial polydactyly of the foot. We performed arthrography in 7 feet of 7 patients with postaxial polydactyly of the foot in which duplication of the proximal phalanx was observed at the fifth MTP joint on the basis of radiographic evaluation. The average age at surgery was 13.5 months and average duration of postsurgical follow-up was 36 months. Individual surgical procedures were confirmed or modified during the operation by reference to the arthrographic findings. Radiographic and arthrographic findings were assessed in relation to the findings from direct observation of the cartilaginous structures at surgery. Postoperative malalignment, functional disturbance and pain in the reconstructed toe were evaluated. The arthrographic findings provided different forms of cartilaginous structures that could be categorized in 4 types, and reflected the cartilaginous connection visualized at surgery that could not be detected on radiographs in each case. No cases revealed any deformities, functional disturbance, or pain in the reconstructed toe after surgery. The parents’ evaluation in each case was “very satisfied” or “satisfied.” The arthrographic findings provided additional information regarding variations in the cartilaginous structures of the fifth MTP joint and for determining individual surgical procedure for postaxial polydactyly of the foot.

Clinical features of bone and soft tissue tumors of the foot and ankle: Results from a retrospective single-center case-series.

Yasutaka Murahashi, Kousuke Iba, Atsushi Teramoto, Makoto Emori, Yohei Okada, Tomoaki Kamiya, Kota Watanabe, Toshihiko Yamashita

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 26 ( 5 ) 885 - 890 2021.09 [Domestic journal]

BACKGROUND: The malignant potential of the musculoskeletal tumors of the foot and ankle has often been underestimated because of their rarity. The current study reviewed the clinical features of the tumors of the foot and ankle, and evaluated the tumor size via imaging-based analysis to distinguish between benign and malignant lesions. METHODS: A retrospective review was performed using the clinical records of all patients with histologically confirmed musculoskeletal tumors of the foot and ankle, treated between 1998 and 2020 at our institution. We examined the distribution of tumors, rate of unplanned excision for primary surgery, and subsequent outcomes. In addition, the tumor size was examined via magnetic resonance imaging, and the cut-off value was determined via receiver operating characteristic (ROC) curve. RESULTS: A total of 103 bone and soft tissue tumors of the foot and ankle were included, of which 78 were soft tissue tumors and 25 were bone tumors. Of the 14 cases of malignant bone and soft tissue tumors, 6 (42.9%) received unplanned excision in the primary surgery, followed by amputation in 3 cases. Tumor size of malignant soft tissue tumors was significantly larger than that of benign soft tissue tumors (47.6 mm vs. 31.0 mm, respectively, P < .001). However, the difference between benign and malignant bone tumors was not statistically significant with the numbers available. ROC curve determined that the optimum diagnostic cutoff value for soft tissue tumor size was 40 mm, with a high area under the ROC curve 0.816 (95% CI: 0.711-0.921, sensitivity 91.7%, specificity 70.5%) CONCLUSIONS: We highlighted that bone and soft tissue tumors of the foot and ankle were often misdiagnosed and initially inadequately treated. We suggest that a cutoff value of 40 mm may be a useful index for prediction of malignancy in soft tissue tumors of the foot and ankle. LEVEL OF EVIDENCE: Ⅲ.

Quantitative Evaluation of Ankle Instability Using a Capacitance-Type Strain Sensor

Atsushi Teramoto, Kousuke Iba, Yasutaka Murahashi, Hiroaki Shoji, Kento Hirota, Makoto Kawai, Yuma Ikeda, Rui Imamura, Tomoaki Kamiya, Kota Watanabe, Toshihiko Yamashita

Foot & Ankle International ( {SAGE} Publications ) 42 ( 8 ) 1074 - 1080 2021.08 [International journal]

BACKGROUND: Manual evaluation is an important method for assessing ankle instability, but it is not quantitative. Capacitance-type sensors can be used to measure the distance on the basis of the capacitance value. We applied the sensor to the noninvasive device for measuring ankle instability and showed its utility. METHODS: First, 5 ankles embalmed by Thiel's method were used in an experiment using a cadaver. The capacitance-type sensor was fixed alongside the anterior talofibular ligament (ATFL) of a specially made brace, and the anterior drawer test was performed. The test had been performed for the intact ankle, with the ATFL transected and with both the ATFL and calcaneofibular ligament (CFL) transected. The anterior drawer distance was calculated by the sensor. Intra- and interinvestigator reliability were also analyzed.Next, as a clinical study, a brace with a sensor was fitted to 22 ankles of 20 patients with a history of ankle sprain. An anterior drawer test at a load of 150 N was conducted using a Telos stress device. The anterior drawer distances measured by the sensor and based on radiographic images were then compared. RESULTS: The mean anterior drawer distances were 3.7 ± 1.0 mm for the intact cadavers, 6.1 ± 1.6 mm with the ATFL transected (P < .001), and 7.9 ± 1.8 mm with the ATFL and CFL transected (P < .001). The intrainvestigator intraclass correlation coefficients (ICCs) were 0.862 to 0.939, and the interinvestigator ICC was 0.815. In the experiments on patients, the mean anterior drawer distance measured by the sensor was 2.9 ± 0.9 mm, and it was 2.7 ± 0.9 mm for the radiographic images. The correlation coefficient between the sensor and the radiographic images was 0.843. CONCLUSION: We quantitatively evaluated anterior drawer laxity using a capacitance-type sensor and found it had high reproducibility and strongly correlated with stress radiography measurements in patients with ankle instability. Capacitance-type sensors can be used for the safe, simple, and accurate evaluation of ankle instability.

Hamstring Graft Prepared With Suture Tape Is Effective in Anterior Cruciate Ligament Reconstruction: A Biomechanical Analysis

Tomoaki Kamiya, Hidenori Otsubo, Tomoyuki Suzuki, Kousuke Shiwaku, Chihiro Kitamura, Atsushi Teramoto, Toshihiko Yamashita

Arthroscopy, Sports Medicine, and Rehabilitation ( Elsevier {BV} ) 3 ( 4 ) e1003 - e1009 2021.08

Magnetic Resonance Spectroscopic Analysis of Multifidus Muscle Lipid Contents and Association with Nociceptive Pain in Chronic Low Back Pain.

Izaya Ogon, Kouske Iba, Hiroyuki Takashima, Mitsunori Yoshimoto, Tomonori Morita, Tsutomu Oshigiri, Yoshinori Terashima, Makoto Emori, Atsushi Teramoto, Tsuneo Takebayashi, Toshihiko Yamashita

Asian spine journal 15 ( 4 ) 441 - 446 2021.08 [International journal]

STUDY DESIGN: Cross-sectional study. PURPOSE: This study aimed to analyze the differences in the lipid contents in chronic low back pain (CLBP) patients with nociceptive pain (NocP) and neuropathic pain (NeP) using magnetic resonance spectroscopy (MRS) of the multifidus muscle (Mm). OVERVIEW OF LITERATURE: Early identification of the pain characteristics with CLBP is important because specific treatment approaches are required, depending on NocP and NeP. METHODS: The participants were 50 patients with CLBP (23 men and 27 women; mean age, 63.1±17.8 years; range, 41-79 years). We compared the Visual Analog Scale (VAS) scores, intramyocellular lipids (IMCLs) and extramyocellular lipids (EMCLs) of the Mm in NocP and NeP groups, as evaluated with the Japanese NeP screening questionnaire. RESULTS: The patients were categorized into the NocP (n=32) and NeP (n=18) groups. The mean VAS score of the NocP group was 59.3±3.1 mm and that of the NeP group was 73.6±4.6 mm. The mean VAS score was significantly higher in the NeP group as compared to that in the NocP group (p<0.01). As per the analysis of covariance for the VAS score, the mean IMCL levels of the Mm in the NocP and NeP groups were 722.3 mmol/L (95% confidence interval [CI], 611.4-833.1) and 484.8 mmol/L (95% CI, 381.1-588.5), respectively. The mean IMCL level was significantly higher in the NocP group than in the NeP group (p<0.05). The mean EMCL levels of the Mm for the NocP and NeP groups were 6,022.9 mmol/L (95% CI, 4,510.6-7,535.2) and 5,558.1 mmol/L (95% CI, 4,298.3-6,817.9), respectively; however, the difference was not significant (p=0.72). CONCLUSIONS: The results indicated an association between the IMCL level of the Mm and NocP. Our results suggest that MRS of the Mm might be beneficial for the assessment of CLBP as well as appropriate targeted analgesic therapies.

Magnetic Resonance Spectroscopic Analysis of Multifidus Muscle Lipid Contents and Association with Nociceptive Pain in Chronic Low Back Pain

Izaya Ogon, Kouske Iba, Hiroyuki Takashima, Mitsunori Yoshimoto, Tomonori Morita, Tsutomu Oshigiri, Yoshinori Terashima, Makoto Emori, Atsushi Teramoto, Tsuneo Takebayashi, Toshihiko Yamashita

ASIAN SPINE JOURNAL ( KOREAN SOC SPINE SURGERY ) 15 ( 4 ) 441 - 446 2021.08

Study Design: Cross-sectional study.Purpose: This study aimed to analyze the differences in the lipid contents in chronic low back pain (CLBP) patients with nociceptive pain (NocP) and neuropathic pain (NeP) using magnetic resonance spectroscopy (MRS) of the multifidus muscle (Mm).Overview of Literature: Early identification of the pain characteristics with CLBP is important because specific treatment approaches are required, depending on NocP and NeP. Methods: The participants were 50 patients with CLBP (23 men and 27 women; mean age, 63.1 +/- 17.8 years; range, 41-79 years). We compared the Visual Analog Scale (VAS) scores, intramyocellular lipids (IMCLs) and extramyocellular lipids (EMCLs) of the Mm in NocP and NeP groups, as evaluated with the Japanese NeP screening questionnaire.Results: The patients were categorized into the NocP (n=32) and NeP (n=18) groups. The mean VAS score of the NocP group was 59.3 +/- 3.1 mm and that of the NeP group was 73.6 +/- 4.6 mm. The mean VAS score was significantly higher in the NeP group as compared to that in the NocP group (p<0.01). As per the analysis of covariance for the VAS score, the mean IMCL levels of the Mm in the NocP and NeP groups were 722.3 mmol/L (95% confidence interval [CI], 611.4-833.1) and 484.8 mmol/L (95% CI, 381.1-588.5), respectively. The mean IMCL level was significantly higher in the NocP group than in the NeP group (p<0.05). The mean EMCL levels of the Mm for the NocP and NeP groups were 6,022.9 mmol/L (95% CI, 4,510.6-7,535.2) and 5,558.1 mmol/L (95% CI, 4,298.3-6,817.9), respectively; however, the difference was not significant (p=0.72).Conclusions: The results indicated an association between the IMCL level of the Mm and NocP. Our results suggest that MRS of the Mm might be beneficial for the assessment of CLBP as well as appropriate targeted analgesic therapies.

Nano-Arthroscopic Ultrasound-Guided Excision of Unresolved Osgood−Schlatter Disease

Tomoaki Kamiya, Atsushi Teramoto, Yuta Mori, Chihiro Kitamura, Kota Watanabe, Toshihiko Yamashita

Arthroscopy Techniques ( Elsevier {BV} ) 10 ( 6 ) e1581 - e1587 2021.06 [International journal]

The nano-arthroscopic ultrasound-guided ossicle excision technique is used in the management of an unresolved Osgood-Schlatter disease. The NanoScope is inserted slightly lateral to the proximal patella tendon and moved on between the ossicle and anterior surface of the proximal tibia under ultrasonographic guidance. The 5-mm skin incision is made as a working portal on the medial side of the proximal patella tendon. The proximal border of the ossicle is clearly identified after bursectomy. Then, the ossicles are removed piece by piece using a 2-mm arthroscopic punch. During the resection, the remaining ossicle is continuously confirmed by ultrasound. Finally, the complete excision of the ossicle is shown by the nano-arthroscopic view and ultrasound. The patient is allowed to have a full weight-bearing and an unrestricted range of motion on the day of surgery. Patients are permitted to resume their sports activities without any restriction after 6 weeks. This technique is recommended to athletes who suffer from painful unresolved Osgood-Schlatter disease because of the benefits of it being a minimally invasive surgery with an early postoperative recovery.

Association between lumbar segmental mobility and intervertebral disc degeneration quantified by magnetic resonance imaging T2 mapping.

Izaya Ogon, Kousuke Iba, Hiroyuki Takashima, Yoshinori Terashima, Mitsunori Yoshimoto, Makoto Emori, Atsushi Teramoto, Tsuneo Takebayashi, Toshihiko Yamashita

North American Spine Society journal 5 100044 - 100044 2021.03 [International journal]

BACKGROUND: The relation between segmental mobility and degree of lumbar degenerative change is still unknown. This cross-sectional study aimed to elucidate the association between intervertebral disc degeneration (IVDD) and segmental mobility in chronic low back pain using magnetic resonance imaging (MRI) T2 mapping. METHODS: Subjects comprised 60 patients (29 men, 31 women; mean age, 61.8 ± 1.9 years; range, 41-79 years). T2 values of the anterior annulus fibrosus (AF), the nucleus pulposus (NP) and the posterior AF were evaluated with MRI T2 mapping. Facet joint degeneration was divided into 4 grades using MRI. We analyzed the correlation between segmental mobility and T2 values of anterior AF, NP and posterior AF using multiple linear regression analysis adjusted for age and facet joint degeneration. RESULTS: The standardized partial regression coefficient of the anterior AF, NP and posterior AF T2 values were 0.125 (p=0.72), 0.499 (p<0.01) and -0.026 (p=0.11), respectively, for the L1-2 level; 0.102 (p=0.27), 0.395 (p<0.01) and -0.094 (p=0.20), respectively, for the L2-3 level; 0.108 (p=0.38), 0.415 (p<0.01) and -0.050 (p=0.51), respectively, for the L3-4 level; 0.124 (p=0.09), 0.396 (p<0.01) and 0.025 (p=0.73), respectively, for the L4-5 level; and 0.011 (p=0.89), 0.443 (p<0.01) and 0.030 (p=0.72), respectively, for the L5-S level. There was a significantly positive correlation between segmental mobility and the T2 values of NP at L1-L2, L2-L3, L3-L4, L4-L5, and L5-S1. No significant correlations arose between segmental mobility and the T2 values of the anterior AF and the posterior AF at L1-L2, L2-L3, L3-L4, L4-L5, and L5-S1. CONCLUSION: Characterization of the relationship between NP degeneration and lumbar segmental mobility may enhance our ability to evaluate the changes seen in kinematics of functional spinal unit.

Associations between visceral fat chronic low back pain and central sensitization in patients with lumbar spinal stenosis.

Izaya Ogon, Atsushi Teramoto, Hiroyuki Takashima, Yoshinori Terashima, Mitsunori Yoshimoto, Makoto Emori, Kousuke Iba, Tsuneo Takebayashi, Toshihiko Yamashita

Journal of back and musculoskeletal rehabilitation 35 ( 5 ) 1035 - 1041 2021.02 [International journal]

BACKGROUND: Pain sensitization may be one of the mechanisms contributing to chronic low back pain (CLBP). OBJECTIVE: To evaluate the association between visceral fat, CLBP, and central sensitization (CS); describe the relationship between low back pain (LBP) intensity and CS; and identify possible correlation between visceral fat and LBP intensity. METHODS: Patients with CLBP were divided using their CS inventory (CSI) scores into low- (CSI < 40) and high-CSI (CSI ⩾ 40) subgroups. We compared computed tomography (CT) measurements and scores for association with pain according to the visual analogue scale (VAS) between the two groups. RESULTS: The low-CSI and the high-CSI groups had 47 patients (67.1%; 21 men, 26 women) and 23 patients (32.9%; 11 men and 12 women), respectively. The high-CSI group had a significantly higher mean VAS score (p< 0.01) and estimated mean visceral fat area (p< 0.05) than the low-CSI group. There was a moderate positive correlation between VAS score and visceral fat (standardised partial regression coefficient: 0.659, p< 0.01) in the high-CSI group according to multiple linear regression analysis adjusted for age and sex. CONCLUSIONS: Visceral fat is associated with CLBP, regardless of sex or age, and may be a potential therapeutic target for CLBP with CS.

Time Course of Quality of Life Improvement Between Resection Arthroplasty and Metatarsophalangeal Joint-Preserving Forefoot Arthroplasty for Rheumatoid Arthritis

Kota Shimomura, Tetsuro Yasui, Atsushi Teramoto, Yasuhiro Ozasa, Toshihiko Yamashita, Mitsuyasu Iwasawa

Foot & Ankle International ( {SAGE} Publications ) 42 ( 2 ) 107110072096209 - 107110072096209 2021.02 [International journal]

BACKGROUND: Resection arthroplasty has long been a major treatment option for forefoot deformity caused by rheumatoid arthritis (RA). However, metatarsophalangeal (MTP) joint-preserving surgery is now surpassing classic resection arthroplasty. This study was performed to compare the postoperative results of these 2 operative methods. METHODS: Fifty-one toes of 40 patients with RA who underwent resection arthroplasty (resection group) or MTP joint-preserving arthroplasty (preservation group) from 2014 to 2017 for forefoot deformity were followed up for >1 year and were retrospectively analyzed. In the preservation group, open reduction of joint dislocation was performed if needed, and the deformity was corrected by metatarsal shortening osteotomy. The mean follow-up period was 21 months. The Japanese Society for Surgery of the Foot (JSSF) scales (objective outcome measures), the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) (subjective outcome measure), and radiographic indices were compared between the groups. The resection group and preservation group comprised 15 toes of 11 patients and 36 toes of 29 patients, respectively. RESULTS: There were no significant differences in the preoperative radiographic indices, JSSF scales, or SAFE-Q results between the 2 groups. The preservation group showed better JSSF scores at the last follow-up (median hallux scale, 89 vs 74; median lesser scale, 87 vs 79). In the preservation group, the SAFE-Q scores gradually improved with time until 12 months postoperatively. In the resection group, the scores decreased 3 months postoperatively and then improved and reached a plateau 6 months postoperatively. At 12 months postoperatively, there was no significant difference in the SAFE-Q scores between the 2 groups. CONCLUSIONS: MTP joint-preserving arthroplasty resulted in superior objective scores to resection arthroplasty in patients with RA forefoot deformity. Although the subjective scores did not differ between the groups at the last follow-up, the time course of postoperative quality of life improvement was different between the 2 surgeries. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Delayed tendon healing after injury in tetranectin-deficient mice.

Megumi Hanaka, Kousuke Iba, Hikaru Hayakawa, Kenta Kiyomoto, Koji Ibe, Atsushi Teramoto, Makoto Emori, Toshihiko Yamashita

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 2021.01 [Domestic journal]

BACKGROUND: Tetranectin, a plasminogen-binding protein, is present in human serum and has a role in tissue remodeling. The wound healing process is established and follows a similar cascade in tendon tissue as in other tissues. In this study, we investigated whether tetranectin has a role in regulating tissue formation of injured tendon. METHODS: Using the patella tendon injury model in the tetranectin-null mice, healing processes of the injured tendon were evaluated by histological and immunohistochemical analyses, and measurement of the expression of tetranectin, type 1 collagen (Col 1), tenomodulin, scleraxis, TGFβ, IL-1β, IL-6 and TNF-α. RESULTS: At the inflammatory phase within 7 days after the injury, involvement of inflammatory cells and the expressions of IL-1β, IL-6 and TNF-α were significantly decreased in tetranectin-null mice. Tetranectin expression increased at 1 day and peaked at 3 days, and finally disappeared at 7 days after the injury in wild-type mice. The tendon healing period and maturity were significantly delayed in the tetranectin-null mice. Expression levels of type 1 collagen and tenomodulin in tetranectin-null mice were significantly lower than those in the wild-type mice until 70 days after injury. With regard to the long-term processes, the healing and maturation of the injured tendon in tetranectin-null mice were eventually completed. CONCLUSION: We believe that tetranectin might have a potential role in enhancing tissue formation of healing tendon at the inflammatory phase after injuries. The characteristics of tetranectin as a purified protein from human serum could be interested in an attractive candidate as a potential agent to enhance tendon healing after injury.

Soft tissue injury in the limbs increased regional bone turnover.

Hikaru Hayakawa, Megumi Hanaka, Kousuke Iba, Kenta Kiyomoto, Makoto Emori, Atsushi Teramoto, Toshihiko Yamashita

Injury 2021.01 [International journal]

BACKGROUND: Pathological conditions after skeletal tissue injury such as trauma and surgical intervention are often accompanied with regional osteoporotic changes, which are recognized to be mainly caused by limb immobility after injury. However, the mechanisms for the progression of regional osteoporotic changes related to the injury remains unknown. Previous studies reported that the pathophysiological conditions related to tissue injury include the acidic micro-environment formation and increased ATP levels. In addition, we previously demonstrated that those changes in the micro-environment induced a high bone turnover state through the activation of TRPV1, ASICs and P2X expressed in bone cells. We, therefore, hypothesized that tissue injury could enhance a high bone turnover state due to those pathophysiological changes in soft tissue in the injured limb. The aim of this study was to examine whether soft tissue injury associated with cutaneous incisions in a limb affects regional bone turnover. METHODS: Eight-week-old male C57BL/6 J mice underwent soft tissue injury associated with cutaneous incisions in the right femoral skin. During the 14 days after the incision, changes in the expression of osteoblast and osteoclast differentiation regulators and ATP were evaluated in comparison with those in uninjured mice. The pain-like behaviors and the expression of those differentiation regulators with and without treatment with bisphosphonate and Cox2 inhibitor were assessed in the injured limb. RESULTS: Consistent with the wound healing process, the expression levels of Osterix, osteocalcin and RANKL in the femur of the incised limb were significantly increased up to 7 days, and then decreased to the same level as those in the control limbs by 14 days after the incisions. The levels of TRAP 5b and ATP were initially significantly increased, and then decreased to the same level as before injury by day 14. Bisphosphonate significantly improved the pain-like behaviors in the injured limb associated with the inhibition of osteoblast and osteoclast differentiation regulators. CONCLUSION: We believe that the pathophysiological changes in soft tissue resulting from cutaneous incisions could be related to the induction of osteoblast and osteoclast differentiation regulators.

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