Papers - TERAMOTO Atsushi

High Tibial Osteotomy Alone Does Not Decrease Medial Meniscus Extrusion in the Setting of Medial Meniscus Posterior Root Tear: A Cadaveric Study

Kazushi Horita, Yohei Okada, Kousuke Shiwaku, Satoshi Yamakawa, Yuta Mori, Tomoaki Kamiya, Makoto Emori, Kota Watanabe, Hiromichi Fujie, Atsushi Teramoto

Arthroscopy: The Journal of Arthroscopic & Related Surgery    2025.05

DOI

The In Situ Force and Contribution of Each Ligamentous Band of the Deltoid Ligament in Ankle Joint Stability: A Cadaveric Biomechanical Study

Katsunori Takahashi, Atsushi Teramoto, Yasutaka Murahashi, Kousuke Shiwaku, Tomoaki Kamiya, Makoto Emori, Kota Watanabe, Hiromichi Fujie

Orthopaedic Journal of Sports Medicine    2025.04

DOI

Biomechanical effects of fascial hydrorelease: a cadaveric study

Kousuke Shiwaku, Hidenori Otsubo, Daisuke Suzuki, Calmero Pirri, Taiki Kodesyo, Tomoaki Kamiya, Keigo Taniguchi, Hirofumi Ohnishi, Atsushi Teramoto, Carla Stecco

BMC Musculoskeletal Disorders ( Springer Science and Business Media LLC )  26 ( 1 )  2025.03

DOI

Biomechanical Comparison of Inside-Out and All-Inside Meniscal Repair in Controlling the Peripheral Gap and Extrusion of the Lateral Meniscus With a Complete Radial Tear: A Cadaveric Study Using a Robotic Simulator.

Kousuke Shiwaku, Hidenori Otsubo, Katsunori Takahashi, Daisuke Suzuki, Satoshi Yamakawa, Tomoaki Kamiya, Tomoyuki Suzuki, Yohei Okada, Shinichiro Okimura, Kota Watanabe, Hiromichi Fujie, Atsushi Teramoto

Orthopaedic journal of sports medicine   13 ( 3 ) 23259671241308854 - 23259671241308854  2025.03  [International journal]

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BACKGROUND: Although both the classical inside-out and all-inside techniques are performed for the repair of complete radial tears, which should be the standard technique is, to the authors' knowledge, controversial considering the clinical outcomes and biomechanical studies. There are no biomechanical studies of repairs of the lateral meniscus (LM) evaluating the peripheral side gap (peripheral gap) of the radial tear site and extrusion of the LM, which seems to be important in the treatment of radial tears. PURPOSE: To compare the inside-out and all-inside meniscal repair techniques by evaluating the peripheral gap and extrusion of the LM with complete radial tear using a 6 degrees of freedom robotic system and fresh-frozen cadavers. STUDY DESIGN: Controlled laboratory study. METHODS: This study was performed using 6 fresh-frozen cadaveric knee specimens, a robotic testing system, and ultrasound evaluation. Ultrasound evaluations were performed to measure peripheral gaps and extrusions. The first ultrasound evaluation under 5 N·m of valgus load was performed on the knee at 30° and 90° of flexion. After a complete radial tear at the midsegment of the LM was created, a second ultrasound evaluation under valgus load was performed. Finally, all-inside and inside-out meniscal repairs done with 1 horizontal suture were performed on the same knee in a randomized order. Subsequently, the third and fourth ultrasound evaluations under valgus load were performed. RESULTS: The peripheral gap of the inside-out meniscal repair technique was significantly smaller than that of all-inside meniscal repairs at knee flexion angles of 30° and 90° (6.0 vs 11.5 mm and 5.6 vs 10.9 mm [both P < .0167], respectively). The extrusion of inside-out meniscal repair was significantly smaller than that of all-inside meniscal repair at a knee flexion angle of 90° (2.6 vs 3.2 mm; P < .0083). CONCLUSION: The inside-out meniscal repair technique showed less peripheral gap and extrusion of the LM in a complete radial tear than the all-inside meniscal repair. Inside-out repair may be advantageous for radial tears over all-inside repair because only inside-out repair can tighten the peripheral side of the radial tear. CLINICAL RELEVANCE: The LM with a complete radial tear should be repaired using the inside-out technique.

DOI PubMed

All-Inside Arthroscopic Anatomic Anterior Talofibular Ligament Repair for Chronic Lateral Ankle Instability and Injury at the Talar Attachment: Surgical Technique

Nanami Ueda, Yasutaka Murahashi, Katsunori Takahashi, Yuta Mori, Kota Watanabe, Makoto Emori, Atsushi Teramoto

Arthroscopy Techniques    2024.11

DOI

Intravenous Infusion of Autologous Mesenchymal Stem Cells Expanded in Auto Serum for Chronic Spinal Cord Injury Patients: A Case Series

Ryosuke Hirota, Masanori Sasaki, Satoshi Iyama, Kota Kurihara, Ryunosuke Fukushi, Hisashi Obara, Tsutomu Oshigiri, Tomonori Morita, MASAHITO NAKAZAKI, Takahiro Namioka, Ai Namioka, Rie Onodera, Yuko Kataoka-Sasaki, Shinichi Oka, Mitsuhiro Takemura, Ryo Ukai, Takahiro Yokoyama, Yuichi Sasaki, Tatsuro Yamashita, Masato Kobayashi, Yusuke Okuma, Reiko Kondo, Ryo Aichi, Satoko Ohmatsu, Noritaka Kawashima, Yoichi M. Ito, Masayoshi Kobune, Kohichi Takada, Sumio Ishiai, Toru Ogata, Atsushi Teramoto, Toshihiko Yamashita, Jeffery Kocsis, Osamu Honmou

Journal of Clinical Medicine    2024.10

DOI

Supra over the top ACL再建術の生体力学的解析 Single versus double tibial tunnels

塩泡 孝介, 鈴木 智之, 史野 根生, 大坪 英則, 山川 学志, 興村 慎一郎, 鈴木 大輔, 鍋城 尚伍, 神谷 智昭, 藤江 裕道, 寺本 篤史

日本整形外科学会雑誌 ( (公社)日本整形外科学会 )  98 ( 8 ) S1789 - S1789  2024.09

Remission of hypersensitivity by simple weight load stimuli in a complex regional pain syndrome mouse model

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

Journal of Orthopaedic Research    2024.05

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The Accuracy of Cup Placement in Total Hip Arthroplasty (THA) Using an Augmented Reality-Based Navigation System.

Junya Shimizu, Satoshi Nagoya, Ima Kosukegawa, Arata Kanaizumi, Naoya Nakahashi, Atsushi Teramoto

Cureus   16 ( 4 ) e59423  2024.04  [International journal]

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Background AR HIP Navigation System® (AR-navi; Zimmer-Biomet, Warsaw, IN) is a portable navigation system employing augmented reality via a smartphone app, which was developed in Japan. We retrospectively analyzed the accuracy of cup placement in total hip arthroplasty (THA) using AR-navi, to investigate whether obesity is associated with an absolute value error in cup placement angle. Methods We retrospectively analyzed 45 hips in 43 patients who underwent THA using AR-navi (AR-navi group) and compared them with 45 hips in 45 patients who underwent THA using alignment rods (conventional group). Results The mean absolute error of cup placement (AR-navi group vs. conventional group) was found to be 2.60° (±2.11) in radiographic inclination (RI) for the AR-navi group and 4.61° (±3.28) for the conventional group, which indicates significant difference in the AR-navi group compared to that in the conventional group (p = 0.0036). The mean absolute error of radiographic anteversion (RA) was 3.57° (±3.36) for the AR-navi group and 3.87° (±2.97) for the conventional group (p = 0.4732). The mean absolute error of RI was 2.36° (±2.24) in the obese group and 3.16° (±2.03) in the nonobese group, and the mean absolute error of RA was 4.08° (±4.51) and 3.16° (±2.05) in the obese and nonobese groups, respectively. Conclusions Cup placement accuracy for THA using AR-navi was 2.60 ± 2.11° for RI and 3.87 ± 2.97° for RA. Compared to THA using the conventional method, the RI installation error was significantly improved with AR Navi. There was no significant difference in the mean absolute error of RI and RA among the obese and nonobese groups.

DOI PubMed

Characteristics of Nonunion After Arthroscopic Ankle Arthrodesis: A Multicenter Retrospective Cohort Study

Katsunori Takahashi, Atsushi Teramoto, Satoshi Yamaguchi, Kentaro Amaha, Kenta Saiga, Koji Noguchi, Kota Watanabe

The Journal of Foot and Ankle Surgery    2024.03

DOI

ハムストリングスの局所的な力学特性 Thiel法固定献体を用いた検討

中尾 学人, 谷口 圭吾, 小出所 大樹, 山形 一真, 渡邉 耕太, 大崎 雄樹, 片寄 正樹, 寺本 篤史

日本整形外科学会雑誌 ( (公社)日本整形外科学会 )  98 ( 3 ) S1379 - S1379  2024.03

せん断波イメージングを用いた筋の粘弾性評価 静的ストレッチングの効果検証と関節可動性との関係

小出所 大樹, 谷口 圭吾, 中尾 学人, 山形 一真, 渡邉 耕太, 片寄 正樹, 寺本 篤史

日本整形外科学会雑誌 ( (公社)日本整形外科学会 )  98 ( 3 ) S1359 - S1359  2024.03

内側半月後角損傷の膝関節前方安定性への影響 未固定凍結遺体とロボットシステムを用いて

塩泡 孝介, 神谷 智昭, 鈴木 大輔, 山川 学志, 大坪 英則, 鈴木 智之, 高橋 克典, 岡田 葉平, 藤江 裕道, 寺本 篤史

日本整形外科学会雑誌 ( (公社)日本整形外科学会 )  98 ( 3 ) S1298 - S1298  2024.03

Comparison by ultrasound shear wave elastography of toe flexor muscle contraction during MTP flexion exercise and short-foot exercise

Kento Hirota, Kota Watanabe, Hiroki Miyamoto, Keisuke Negishi, Mako Watase, Atsushi Teramoto

Journal of Back and Musculoskeletal Rehabilitation ( IOS Press )    1 - 7  2024.02

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BACKGROUND: The intrinsic foot muscles play an important role in medial longitudinal arch support, as well as several extrinsic foot muscles. While various strength training methods specific to intrinsic foot muscles have been conducted, these exercises are associated with certain concerns regarding their effectiveness and difficulty. We developed a new exercise for the intrinsic muscles (MTP flexion exercise). OBJECTIVE: The aim was to compare the shear modulus of the toe flexors as the muscle contraction activity during MTP flexion and short-foot exercises using ultrasound shear wave elastography. METHODS: Eleven healthy participants were included in this study. The shear modulus of the toe flexor muscles was measured during MTP flexion and short-foot exercises using ultrasound shear wave elastography. The muscle shear modulus was statistically compared between the resting phase, and during the two exercises. RESULTS: The shear modulus during MTP flexion exercise was significantly greater than in the resting phase in the abductor hallucis, flexor hallucis brevis, flexor digitorum brevis, quadratus plantae, and flexor digitorum longus. The flexor digitorum longus showed greater shear modulus during MTP flexion exercise than during short-foot exercise. CONCLUSION: MTP flexion exercise showed equivalent or greater contraction activity in certain intrinsic and extrinsic foot muscles when compared with short-foot exercise. This exercise is considered one of the training options for strengthening the intrinsic muscles of the foot.

DOI

Platelet-rich plasma does not accelerate the healing of damaged muscle following muscle strain.

Hiroyori Fusagawa, Takashi Yamada, Tatsuya Sato, Yuki Ashida, Atsushi Teramoto, Hiroyuki Takashima, Azuma Naito, Nao Tokuda, Nao Yamauchi, Nobutoshi Ichise, Izaya Ogon, Toshihiko Yamashita, Noritsugu Tohse

Journal of orthopaedic research : official publication of the Orthopaedic Research Society    2024.01  [International journal]

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Although platelet-rich plasma (PRP) has been widely used regardless of the severity of muscle strain, there have been very few basic studies in which its effects on muscle injury were examined by using models that accurately mimic the clinical muscle strain injury process. Therefore, the aim of this study was to confirm by physiological and structural analyses whether PRP purified by a general preparation method has a muscle healing effect on muscle damage caused by eccentric contraction (ECC). Male Wistar rats were subjected to muscle injury induced by ECC in bilateral plantar flexor muscles using electrical stimulation and an automatically dorsiflexing footplate. The rats were randomly assigned to three groups by type of injection: phosphate-buffered saline (PBS), leukocyte-poor PRP (LP-PRP), or leukocyte-rich PRP (LR-PRP) injection into gastrocnemius muscles three times at weekly intervals. The platelet concentrations of the LP-PRP and LR-PRP were three to five times higher than that of whole blood. The recovery process of torque strength in the plantar flexor muscle, signal changes in MRI images, and histological evaluation 3 weeks after injury showed no obvious differences among the three groups, and every muscle recovered well from the injury without marked fibrosis. The results that neither LP-PRP nor LR-PRP was found to accelerate healing of muscle injuries suggested that conventional preparation and use of PRP for simple muscle injuries caused by muscle strain should be carefully considered, and further basic research using models that accurately mimic clinical practice should be carried out to determine the optimal use of PRP.

DOI PubMed

Minimizing the risk of injury to the popliteal artery during pullout repair of medial meniscus posterior root tears: A cadaveric study

Yuta Mori, Tomoaki Kamiya, Shinichiro Okimura, Kousuke Shiwaku, Yohei Okada, Atsushi Teramoto, Toshihiko Yamashita

Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology    2024.01

DOI

ハイドロリリースにより筋膜間の滑走抵抗は低下する 未固定凍結遺体を用いた生体力学試験

塩泡 孝介, 大坪 英則, 鈴木 大輔, 神谷 智昭, 寺本 篤史, 小出所 大樹, 谷口 圭吾, Stecco Carla

北海道整形災害外科学会雑誌 ( 北海道整形災害外科学会 )  66 ( 143rd suppl ) 51 - 51  2024

High-intensity interval training using electrical stimulation ameliorates muscle fatigue in chronic kidney disease-related cachexia by restoring mitochondrial respiratory dysfunction.

Hiroyori Fusagawa, Tatsuya Sato, Takashi Yamada, Azuma Naito, Nao Tokuda, Nao Yamauchi, Nobutoshi Ichise, Toshifumi Ogawa, Takuro Karaushi, Atsushi Teramoto, Noritsugu Tohse

Frontiers in physiology   15   1423504 - 1423504  2024  [International journal]

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BACKGROUND: Exercise, especially high-intensity interval training (HIIT), can increase mitochondrial respiratory capacity and enhance muscular endurance, but its systemic burden makes it difficult to safely and continuously prescribe for patients with chronic kidney disease (CKD)-related cachexia who are in poor general condition. In this study, we examined whether HIIT using electrical stimulation (ES), which does not require whole-body exercise, improves muscle endurance in the skeletal muscle of 5/6 nephrectomized rats, a widely used animal model for CKD-related cachexia. METHODS: Male Wistar rats (10 weeks old) were randomly assigned to a group of sham-operated (Sham) rats and a group of 5/6 nephrectomy (Nx) rats. HIIT was performed on plantar flexor muscles in vivo with supramaximal ES every other day for 4 weeks to assess muscle endurance, myosin heavy-chain isoforms, and mitochondrial respiratory function in Nx rats. A single session was also performed to identify upstream signaling pathways altered by HIIT using ES. RESULTS: In the non-trained plantar flexor muscles from Nx rats, the muscle endurance was significantly lower than that in plantar flexor muscles from Sham rats. The proportion of myosin heavy chain IIa/x, mitochondrial content, mitochondrial respiratory capacity, and formation of mitochondrial respiratory supercomplexes in the plantaris muscle were also significantly decreased in the non-trained plantar flexor muscles from Nx rats than compared to those in plantar flexor muscles from Sham rats. Treatment with HIIT using ES for Nx rats significantly improved these molecular and functional changes to the same degrees as those in Sham rats. Furthermore, a single session of HIIT with ES significantly increased the phosphorylation levels of AMP-activated protein kinase (AMPK) and p38 mitogen-activated protein kinase (MAPK), pathways that are essential for mitochondrial activation signaling by exercise, in the plantar muscles of both Nx and Sham rats. CONCLUSION: The findings suggest that HIIT using ES ameliorates muscle fatigue in Nx rats via restoration of mitochondrial respiratory dysfunction with activation of AMPK and p38 MAPK signaling. Our ES-based HIIT protocol can be performed without placing a burden on the whole body and be a promising intervention that is implemented even in conditions of reduced general performance status such as CKD-related cachexia.

DOI PubMed

Relationships between flexion strength and dexterity of the toes and physical performance.

Kota Watanabe, Yuzo Ashida, Kento Hirota, Tatsuya Taniguchi, Hiroki Miyamoto, Atsushi Teramoto

Journal of back and musculoskeletal rehabilitation    2023.12  [International journal]

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BACKGROUND: Toe function is characterised by the strength and dexterity of toe motion. However, previous studies have mostly focused on the importance of toe strength. OBJECTIVE: This study aimed to investigate the relationships between flexion strength and dexterity of the toes and physical performance. METHODS: Twenty healthy participants were included in this study. The flexion force of each toe was measured using a digital force gauge, and the toe dexterity was evaluated using the marble pick-up and rock-paper-scissors tests. These parameters were statistically analysed in relation to physical performance, including repeated side step and balance ability, which was evaluated using centre of pressure (COP) data during single-leg standing, tiptoe standing, and single-leg drop-jumping. RESULTS: A significant correlation was found between the first toe flexion force and the total trajectory length of the COP during one-leg standing and between the time required for marble pick-up and the rock-paper-scissors score and the COP during single-leg drop-jumping. CONCLUSION: The results underscore the importance of flexion strength and dexterity of the toes in human physical performance and the necessity for the evaluation and improvement of both functions.

DOI PubMed

Quantitative assessment of anterior talofibular ligament quality in chronic lateral ankle instability using magnetic resonance imaging T2* value.

Yoshihiro Akatsuka, Atsushi Teramoto, Yasutaka Murahashi, Katsunori Takahashi, Rui Imamura, Hiroyuki Takashima, Kota Watanabe, Toshihiko Yamashita

Skeletal radiology    2023.10  [International journal]

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OBJECTIVE: To determine T2* normal reference values for anterior talofibular ligament (ATFL) and to investigate the feasibility of the quantitative ATFL quality evaluation in chronic lateral ankle instability (CLAI) using T2* values. MATERIALS AND METHODS: This study enrolled 15 patients with CLAI and 30 healthy volunteers. The entire ATFL T2* values from the MRI T2* mapping were measured. The prediction equation (variables: age, height, and weight) in a multiple linear regression model was used to calculate the T2* normal reference value in the healthy group. T2* ratio was defined as the ratio of the actual T2* value of the patient's ATFL to the normal reference value for each patient. A Telos device was used to measure the talar tilt angle (TTA) from the stress radiograph. RESULTS: T2* values of ATFL in the healthy and CLAI groups were 10.82 ± 1.84 ms and 14.36 ± 4.30 ms, respectively, which are significantly higher in the CLAI group (P < 0.05). The prediction equation of the normal reference T2* value was [14.9 + 0.14 × age (years) - 4.7 × height (m) - 0.03 × weight (kg)] (R2 = 0.65, P < 0.0001). A significant positive correlation was found between the T2* ratio and TTA (r = 0.66, P = 0.007). CONCLUSION: MRI T2* values in patients with CLAI were higher than those in healthy participants, and the T2* ratio correlated with TTA, suggesting that T2* values are promising for quantitative assessment of ATFL quality preoperatively.

DOI PubMed

Ultra-Short Echo Time-MRI T2* Mapping of Articular Cartilage Layers Is Associated with Histological Early Degeneration.

Rui Imamura, Atsushi Teramoto, Yasutaka Murahashi, Yohei Okada, Shinichiro Okimura, Yoshihiro Akatsuka, Kota Watanabe, Toshihiko Yamashita

Cartilage     19476035231205685 - 19476035231205685  2023.10  [International journal]

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OBJECTIVE: Ultra-short TE (UTE) sequences on MRI are a technique that improves the visualization of tissues with short T2 relaxation time, such as deep cartilage layers. In addition, T2* relaxation time calculated from the UTE has the potential to evaluate water molecules bound to the cartilage matrix. This study was performed to determine if there is an association between UTE-T2* relaxation time by cartilage layer and histological degeneration in knee osteoarthritis (OA). DESIGN: Seven knees that had undergone total knee arthroplasty (TKA) were included in the study, and the lateral tibial cartilage, which had the least degeneration of the resected bones, was used as the sample. The T2* relaxation time of 4 patients with no abnormal findings on MRI was the reference relaxation time. Histological degeneration of TKA samples was assessed by the Mankin score and graded as the early OA group (≤3 points) and the advanced OA group (≥4 points). The association between T2* relaxation time and Mankin grade in each cartilage layer was compared. The effect of angiogenesis to the tidemark on T2* relaxation time was also compared. RESULTS: T2* relaxation time of the cartilage layer was significantly longer in early OA than that in the control group. In the deep cartilage layer, the mean T2* relaxation time for angiogenesis (-) was 15.7 ms, whereas it was significantly shorter for angiogenesis (+) at 8.2 ms. CONCLUSIONS: The UTE-T2* relaxation time was associated with histological cartilage degeneration, suggesting a potential application in monitoring early cartilage degeneration.

DOI PubMed

Coefficient of variation of T2-weighted MRI may predict the prognosis of malignant peripheral nerve sheath tumor

Makoto Emori, Hiroyuki Tsuchie, Hiroyuki Takashima, Atsushi Teramoto, Yasutaka Murahashi, Yoshinori Imura, Hidetatsu Outani, Sho Nakai, Satoshi Takenaka, Ryosuke Hirota, Naoya Nakahashi, Junya Shimizu, Kazuyuki Murase, Akira Takasawa, Hiroyuki Nagasawa, Shintaro Sugita, Kohichi Takada, Tadashi Hasegawa, Seiji Okada, Naohisa Miyakoshi, Toshihiko Yamashita

Skeletal Radiology ( Springer Science and Business Media LLC )   2023.09

DOI

Osteophyte Bridge Formation Correlates with Vascular Calcification and Cardiovascular Disease in Diffuse Idiopathic Skeletal Hyperostosis

Ryosuke Hirota, Atsushi Teramoto, Mitsunori Yoshimoto, Hiroyuki Takashima, Naomi Yasuda, Arihiko Tsukamoto, Noriyuki Iesato, Makoto Emori, Kousuke Iba, Nobuyoshi Kawaharada, Toshihiko Yamashita

Journal of Clinical Medicine    2023.08

DOI

Static stretching of the ankle prevents cold hypersensitivity associated with limb immobilization in model mice.

Koji Ibe, Kousuke Iba, Makoto Emori, Kenta Kiyomoto, Atsushi Teramoto, Toshihiko Yamashita

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association    2023.08  [Domestic journal]

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BACKGROUND: Limb immobilization is considered to contribute to limb pain including hyperalgesia. Approximately 50% of patients with such chronic limb pain complain that their abnormal pain worsens after exposure to cold. However, there have been few studies on the relationship between limb immobilization and cold hypersensitivity. The aim of this study was to examine whether limb immobilization induces cold hypersensitivity, and whether physical exercise such as ankle stretching prevents its induction in model mice. METHOD: We used forty-four 8-week-old male C57Bl/6J mice, consisting of 32 immobilized mice and 12 control mice. The bilateral hind limbs of the mice were immobilized by a thermoplastic cast. After limb-immobilization for 1 week, changes in mechanical, thermal and cold hypersensitivity, and the expression levels of TRPV1, TRPA1, TRPM8, IL-1β, IL-6, and TNFα in the spinal cord, dorsal root ganglia and the affected hind paw were evaluated in comparison with those in the control mice. In addition, we examined the effect of ankle stretching on the hypersensitivity and expression levels in the limb-immobilized mice. RESULTS: Mechanical, thermal and cold hypersensitivity were significantly increased in the limb-immobilized mice. In addition, ankle stretching during the immobilization period significantly prevented the increases in those hypersensitivities. There were no significant differences in the expression levels of TRPV1, TRPA1 and TRPM8 among the control, and limb-immobilized mice with and without ankle stretching. The expression levels of IL-1 and IL-6 were significantly increased in the immobilized hind limb paw. Furthermore, ankle stretching significantly prevented the increases in their expression levels. CONCLUSION: Limb-immobilization induced cold hypersensitivity as well as mechanical and thermal hypersensitivity, and ankle stretching significantly prevented the hypersensitivity induction in the model mice. It would be of great interest to clarify whether a patient with limb-immobilization experiences cold hypersensitivity and whether ankle stretching might prevent hypersensitivity induction in the future.

DOI PubMed

Skeletal muscle endurance declines with impaired mitochondrial respiration and inadequate supply of acetyl-CoA during muscle fatigue in 5/6 nephrectomized rats.

Hiroyori Fusagawa, Tatsuya Sato, Takashi Yamada, Yuki Ashida, Iori Kimura, Azuma Naito, Nao Tokuda, Nao Yamauchi, Nobutoshi Ichise, Yoshinori Terashima, Izaya Ogon, Atsushi Teramoto, Toshihiko Yamashita, Noritsugu Tohse

Journal of applied physiology (Bethesda, Md. : 1985)    2023.08  [Refereed]  [International journal]

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Chronic kidney disease (CKD)-related cachexia increases the risks of reduced physical activity and mortality. However, the physiological phenotype of skeletal muscle fatigue and changes in intramuscular metabolites during muscle fatigue in CKD-related cachexia remain unclear. In the present study, we performed detailed muscle physiological evaluation, analysis of mitochondrial function, and comprehensive analysis of metabolic changes before and after muscle fatigue in a 5/6 nephrectomized rat model of CKD. Wistar rats were randomized to a sham-operation (Sham) group that served as a control group or a 5/6 nephrectomy (Nx) group. Eight weeks after the operation, in situ torque and force measurements in plantar flexor muscles in Nx rats using electrical stimulation revealed a significant decrease in muscle endurance during subacute phase related to mitochondrial function. Muscle mass was reduced without changes in the proportions of fiber type-specific myosin heavy chain isoforms in Nx rats. Pyruvate-malate-driven state 3 respiration in isolated mitochondria were impaired in Nx rats. Protein expression levels of mitochondrial respiratory chain complexes III and V were decreased in Nx rats. Metabolome analysis revealed that the increased supply of acetyl CoA in response to fatigue was blunted in Nx rats. These findings suggest that CKD deteriorates skeletal muscle endurance in association with mitochondrial dysfunction and inadequate supply of acetyl-CoA during muscle fatigue.

DOI PubMed

第1基節骨と第1中足骨の3次元骨形態における正常足の性別による比較 相同モデルを用いた検討

山津 健太, 渡邉 耕太, 寺本 篤史

日本足の外科学会雑誌 ( (一社)日本足の外科学会 )  44 ( 1 ) 13 - 20  2023.08

Osteophyte Bridge Formation Correlates with Vascular Calcification and Cardiovascular Disease in Diffuse Idiopathic Skeletal Hyperostosis

Ryosuke Hirota, Atsushi Teramoto, Mitsunori Yoshimoto, Hiroyuki Takashima, Naomi Yasuda, Arihiko Tsukamoto, Noriyuki Iesato, Makoto Emori, Kousuke Iba, Nobuyoshi Kawaharada, Toshihiko Yamashita

Journal of Clinical Medicine    2023.08

DOI

Three-dimensional motion of the toes with simulated contraction of individual toe flexors and extensors: A cadaver study.

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

Foot (Edinburgh, Scotland)   56   102044 - 102044  2023.07  [International journal]

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BACKGROUND: The primary motion of the toes is flexion and extension. The motion results from activity of multiple muscles, and toe disorders may result from muscle dysfunction. The relationships of specific muscles related to toe function is underreported. The purpose of this study was to quantitatively evaluate three-dimensional toe motion resulting from specific muscle contraction using cadavers. METHODS: Three-dimensional joint movements of the 1st, 2nd, and 5th toe were produced by applying traction of individual muscles using six Thiel-embalmed cadaver legs. The traction increments were 3 mm, 6 mm, and 9 mm, during which the angle of the distal bone with respect to the proximal bone of each toe joint was measured using a magnetic tracking system. RESULTS: As tendon traction distance increased, the angular measure of the distal bone with respect to the proximal bone at each toe joint increased linearly and three-dimensionally. The flexor hallucis brevis significantly pronated and abducted the 1st toe compared to the extensor hallucis longus and brevis. The flexor digitorum brevis significantly supinated and adducted the 2nd toe compared to the flexor digitorum longus and quadratus plantae, while the extensor digitorum brevis demonstrated significant pronation and abduction compared to the extensor digitorum longus. CONCLUSIONS: Three intrinsic muscles produced significant toe motion in frontal and horizontal planes. Our results revealed that there was a proportional relationship between tendon excursion and joint angle, and an antagonistic relationship of muscles acting on the toes. These results can be considered regarding pathogenesis of toe disorders or deformity and regarding treatment such as exercise therapy or tendon transfer. LEVEL OF EVIDENCE: V, cadaveric study.

DOI PubMed

大腿四頭筋セッティングの収縮強度漸増課題における筋厚と筋弾性の関係

河合 誠, 小出所 大樹, 時田 諒, 山形 一真, 青木 昌弘, 寺本 篤史, 金谷 耕平, 片寄 正樹, 谷口 圭吾

日本整形外科超音波学会学術集会プログラム・抄録集 ( 日本整形外科超音波学会 )  34回   152 - 152  2023.07

Relationships of cross-sectional area of the thigh muscles before or after total knee arthroplasty with postoperative pain or patient satisfaction: A retrospective, exploratory study

Yoshihiro Akatsuka, Atsushi Teramoto, Hiroyuki Takashima, Yohei Okada, Kota Watanabe, Toshihiko Yamashita

Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology    2023.07

DOI

Quantitative magnetic resonance spectroscopy and imaging analysis of the lipid content in the psoas major and its association with intervertebral disc degeneration: a cross-sectional study

Izaya Ogon, Hiroyuki Takashima, Tomonori Morita, Mitsunori Yoshimoto, Tsuneo Takebayashi, Atsushi Teramoto

Exploration of Musculoskeletal Diseases    2023.06

DOI

Does the L4 nerve root extend during femoral nerve stretch test? A cadaveric study of four cases analyzing the extension rates of the lumbar nerve root.

Izaya Ogon, Tsuneo Takebayashi, Hironori Chiba, Hiroyuki Takashima, Tomonori Morita, Atsushi Teramoto

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association    2023.06  [Domestic journal]

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BACKGROUND: Lumbar radicular pain is a common symptom of lumbar disc herniation and spinal canal stenosis, and L4 nerve root impingement is difficult to diagnose. This study aimed to elucidate the extension rate of L4 nerve roots in Thiel-embalmed specimens using both classic and new femoral nerve stretch test (FNST), as well as straight leg raising test (SLRT). Additionally, the extension rate of the L2 and L3 nerve roots and L5 and S1 roots were determined using FNST (both classic and new) and SLRT, respectively. METHODS: Four Thiel-embalmed specimens were used. The extension rate data of the nerve root were obtained using a displacement sensor under the following conditions: knee joint flexed to 0°/45°/90°/135° with either the hip extension/flexion of 0° (classic FNST) or extension of 15° (new FNST); and hip joint flexed to 0°/30°/60°/90° with the knee flexion of 0° (SLRT). RESULTS: Case A had almost no L4 nerve root lengthening at 45° and 90° knee joint flexion; however, at 135° of knee flexion, the nerve root was lengthened. In Case B, the L4 nerve root was hardly extended by the classic FNST, but it was extended at 135° of knee flexion and 15° of hip extension. In Case C, the L4 nerve root showed little change by classic FNST and it was shortened by new FNST, whereas, it was extended by SLRT. Case D showed a shortened L4 nerve root at 135° of knee flexion in classic FNST and at 0°/45°/90°/135° of knee flexion and 15° of hip extension. Further, no root shortening was observed for L2 and L3 nerve roots according to both classic and new FNST. In contrast, the extension of L2 and L3 nerve root with the new FNST was high. In all cases, nerve roots were lengthened by the SLRT. Further, as the hip flexion angle increased, the rate of nerve elongation also increased. CONCLUSIONS: It was shown that in patients in whom L4 nerve root was extended by FNST, it was shortened by SLRT. The opposite pattern was also observed. Further, it is believed that FNST and SLRT are reliable tests for L2 and L3 radiculopathy and L5 and S1 radiculopathy, respectively, and that more tension on the femoral and sciatic nerves is better. Furthermore, we recommend that FNST should be performed with 15° hip extension and 135° knee flexion to improve the diagnostic accuracy.

DOI PubMed

How Much Experience is Required to Acquire the Skills to Independently Perform Spine Surgery? What Milestones are Needed for Successful Surgery?

Ryunosuke Fukushi, Atsushi Teramoto, Mitsunori Yoshimoto, Naohisa Miyakoshi, Daisuke Kudo, Makoto Emori, Yoichi Shimada, Toshihiko Yamashita

Advances in Medical Education and Practice    2023.06

DOI

Effects and limitations of home-based motor-control exercise for chronic low back pain: A single center prospective study

Ryosuke Hirota, Atsushi Teramoto, Takanori Murakami, Mitsunori Yoshimoto, Noriyuki Iesato, Toshihiko Yamashita

PLOS ONE    2023.04

DOI

Three-dimensional morphological variations in the calcaneus and talus in relation to the hallux valgus angle.

Shuhei Nozaki, Kota Watanabe, Masaki Katayose, Kenta Yamatsu, Atsushi Teramoto, Naomichi Ogihara

Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft   247   152053 - 152053  2023.04  [International journal]

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BACKGROUND: The present study aimed to clarify the morphological patterns of the calcaneus and talus that are associated with hallux valgus angle (HVA) by quantifying the differences in the hindfoot bone morphology between left and right sides in HV patients with clear bilateral difference of HVA. METHODS: Three-dimensional (3D) computed tomography scans of 32 feet of 16 patients with HV who had right-to-left HVA differences of more than 5 degrees (68.8 ± 8.6 years) were enrolled, and 3D surface models of the calcaneus and talus were generated. A total of 556 and 430 landmarks were placed on the calcaneal and talar surfaces, respectively, to calculate the principal components (PCs) of shape variations. The PC scores were compared between the small and large HVA sides within an individual. RESULTS: The calcaneus in patients with a larger HVA (mean, 43.2 degrees) possessed slender calcaneal tuberosity, more medially oriented posterior articular surface in the coronal plane, and narrower and more concave anterior-middle articular surfaces compared to those with a small HVA (mean, 33.7 degrees). The talus with a larger HVA exhibited more medially oriented talar head in the transverse plane and more anteriorly protruded lateral region of the talar head compared to the small HVA. CONCLUSIONS: The morphological patterns of the calcaneus in patients with a larger HVA allows the hindfoot bones to easily rotate in the everting direction, while those of the talus could induce a larger internal rotation of the first metatarsal. These morphological patterns of the calcaneus and talus could be structural factors affecting the HV.

DOI PubMed

Intravoxel Incoherent Motion Factors Affecting Collapse and Nonunion of Osteoporotic Vertebral Fracture.

Izaya Ogon, Tsuneo Takebayashi, Hiroyuki Takashima, Yasuhisa Abe, Hiroshi Oguma, Rui Imamura, Yoshihiro Akatsuka, Tomonori Morita, Atsushi Teramoto

Global spine journal     21925682231167788 - 21925682231167788  2023.03  [International journal]

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STUDY DESIGN: Longitudinal study. OBJECTIVES: Intravoxel incoherent motion (IVIM), a magnetic resonance imaging (MRI) scanning technique that applies diffusion-weighted imaging (DWI), is effective for the quantitative assessment of malignant tumors of the vertebral bone. We hypothesized that IVIM parameters of vertebral bodies are associated with the prognosis of osteoporotic vertebral fracture (OVF). We aimed to explore the relationships between IVIM parameters for vertebral collapse and non-union after OVF and calculate the cut-off values of these parameters for vertebral collapse and non-union. METHODS: A total of 150 patients with acute OVF (150 women; mean age: 79.1 ± 7.4 years) were included and treated conservatively with bracing. MRI was performed at the time of injury. IVIM parameters, such as apparent diffusion coefficient (ADC), molecular diffusion coefficient (D), and perfusion-related diffusion (D*) were recorded. The patients were classified into 3 groups: low-collapse (height loss of ≤50%), high-collapse (height loss of >50%), and non-union. We compared ADC, D, and D* among the low-collapse, high-collapse, and non-union groups and performed a receiver operating characteristic (ROC) curve analysis to determine the boundary values of the high-collapse and non-union groups. RESULTS: The low-collapse, high-collapse, and non-union groups had no significant differences in ADC and D. However, D* differed significantly among the 3 groups. ROC analysis revealed cut-off values of 19.0 × 10-3 mm2/s and 12.3 × 10-3 mm2/s for the high-collapse and non-union groups, respectively. CONCLUSIONS: D* is a significant prognostic indicator for high-collapse and non-union groups with OVF. This suggests that D* should be considered when assessing OVF.

DOI PubMed

Clinical outcomes of surgical treatment for end-stage ankle osteoarthritis in patients aged ≥ 75 years: a multicenter, retrospective study.

Kentaro Amaha, Satoshi Yamaguchi, Atsushi Teramoto, Yohei Kawasaki, Yuki Shiko, Nobuto Kitamura

Journal of orthopaedic surgery and research   18 ( 1 ) 244 - 244  2023.03  [International journal]

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BACKGROUND: This study aimed to clarify the clinical outcomes of surgical treatment for end-stage ankle osteoarthritis in patients aged ≥ 75 years and compare these outcomes with those of patients aged < 75 years. METHODS: A total of 148 patients, including 65 who underwent total ankle arthroplasty and 83 who underwent ankle arthrodesis, were retrospectively surveyed. Clinical outcomes were assessed preoperatively and at the last follow-up using the Japanese Society for Surgery of the Foot Hindfoot Scale and a self-administered foot evaluation questionnaire (SAFE-Q). Patient characteristics, including age, sex, body mass index, radiographic severity, and follow-up period, were also assessed. The patients were divided into older (≥ 75 years) and younger (< 75 years) age groups. Improvements in outcomes were then compared between age groups using univariate analysis and analysis of covariance adjusted for patient characteristics. Total ankle arthroplasty and ankle arthrodesis were analyzed separately. RESULTS: All clinical outcome scores improved postoperatively in the older age groups for both procedures. Scores for the pain and pain-related subscale of the SAFE-Q improved by 37 points (p < 0.001) in post-total ankle arthroplasty patients and by 35 points in post-ankle arthrodesis patients (p < 0.001). Furthermore, multivariate analysis showed that the improvements observed in all scores were not different between the older and younger age groups for both post-total ankle arthroplasty and post-ankle arthrodesis patients, except for the SAFE-Q physical functioning subscale score for post-ankle arthrodesis patients. The clinical outcomes improved significantly in post-total ankle arthroplasty and post-ankle arthrodesis patients aged ≥ 75 years. Moreover, these improvements were similar to those observed in patients aged < 75 years. CONCLUSIONS: Surgical treatment of end-stage ankle osteoarthritis can be a viable treatment option, even in elderly patients, and can be expected to improve similarly to younger patients.

DOI PubMed

Intravoxel Incoherent Motion Factors Affecting Collapse and Nonunion of Osteoporotic Vertebral Fracture

Izaya Ogon, Tsuneo Takebayashi, Hiroyuki Takashima, Yasuhisa Abe, Hiroshi Oguma, Rui Imamura, Yoshihiro Akatsuka, Tomonori Morita, Atsushi Teramoto

GLOBAL SPINE JOURNAL ( SAGE PUBLICATIONS LTD )   2023.03

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Study Design Longitudinal study. Objectives Intravoxel incoherent motion (IVIM), a magnetic resonance imaging (MRI) scanning technique that applies diffusion-weighted imaging (DWI), is effective for the quantitative assessment of malignant tumors of the vertebral bone. We hypothesized that IVIM parameters of vertebral bodies are associated with the prognosis of osteoporotic vertebral fracture (OVF). We aimed to explore the relationships between IVIM parameters for vertebral collapse and non-union after OVF and calculate the cut-off values of these parameters for vertebral collapse and non-union. Methods A total of 150 patients with acute OVF (150 women; mean age: 79.1 +/- 7.4 years) were included and treated conservatively with bracing. MRI was performed at the time of injury. IVIM parameters, such as apparent diffusion coefficient (ADC), molecular diffusion coefficient (D), and perfusion-related diffusion (D*) were recorded. The patients were classified into 3 groups: low-collapse (height loss of <= 50%), high-collapse (height loss of >50%), and non-union. We compared ADC, D, and D* among the low-collapse, high-collapse, and non-union groups and performed a receiver operating characteristic (ROC) curve analysis to determine the boundary values of the high-collapse and non-union groups. Results The low-collapse, high-collapse, and non-union groups had no significant differences in ADC and D. However, D* differed significantly among the 3 groups. ROC analysis revealed cut-off values of 19.0 x 10(-3) mm(2)/s and 12.3 x 10(-3) mm(2)/s for the high-collapse and non-union groups, respectively. Conclusions D* is a significant prognostic indicator for high-collapse and non-union groups with OVF. This suggests that D* should be considered when assessing OVF.

DOI

High reproducibility of a novel supported anterior drawer test for diagnosing ankle instability.

Yasutaka Murahashi, Atsushi Teramoto, Katsunori Takahashi, Yohei Okada, Shinichiro Okimura, Rui Imamura, Makoto Kawai, Kota Watanabe, Toshihiko Yamashita

BMC musculoskeletal disorders   24 ( 1 ) 148 - 148  2023.02  [International journal]

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BACKGROUND: The manual traditional anterior drawer test (ADT) is essential for deciding the treatment for chronic ankle instability, but it has been shown to have a comparatively low reproducibility and accuracy, especially in less experienced hands. To clarify the inter-examiner reproducibility, we compared the actual distance of anterior translation between junior and senior examiners in ADT. We also evaluated the diagnostic abilities of traditional ADT, and a novel modified ADT (supported ADT). METHODS: Thirty ankles were included in this study, and ankle instability was defined using stress radiography. All subjects underwent two methods of manual ADT by junior and senior examiners, and ankle instability was judged in a blinded fashion. The anterior drawer distance was calculated from the lengthening measured using a capacitance-type sensor device. RESULTS: The degree of anterior translation determined by the junior examiner was significantly lower than that determined by the senior examiner when traditional ADT was performed (3.3 vs. 4.5 mm, P = 0.016), but there was no significant difference in anterior translation between the two examiners when supported ADT was performed (4.6 vs. 4.1 mm, P = 0.168). The inter-examiner reliability of supported ADT was higher than that of traditional ADT. For the junior examiner, the diagnostic accuracy of supported ADT was higher than that of traditional ADT (sensitivity, 0.40 vs. 0.80; specificity, 0.75 vs. 0.80). CONCLUSION: Supported ADT may have the advantage of being a simple manual test of ankle instability with less error between examiners.

DOI PubMed

High-intensity interval training using electrical stimulation improves mitochondrial dysfunction and muscle endurance in rats with chronic kidney disease

Hiroyori Fusagawa, Takashi Yamada, Tatsuya Sato, Yuki Ashida, Asuma Naito, Nao Tokuda, Nao Yamauchi, Nobutoshi Ichise, Takuro Karaushi, Atsushi Teramoto, Toshihiko Yamashita, Noritsugu Tohse

Biophysical Journal ( Elsevier BV )  122 ( 3 ) 114a - 114a  2023.02

DOI

Reliability and accuracy of the critical shoulder angle measured by anteroposterior radiographs: using digitally reconstructed radiograph from 3-dimensional computed tomography images

Yuji Shibayama, Rui Imamura, Toshiaki Hirose, Akira Sugi, Emi Mizushima, Yuto Watanabe, Rira Tomii, Makoto Emori, Atsushi Teramoto, Kousuke Iba, Toshihiko Yamashita

Journal of Shoulder and Elbow Surgery    2023.02

DOI

Measurement of the median nerve strain within the carpal tunnel using a capacitance-type strain sensor: A cadaver study.

Kenichi Takashima, Atsushi Teramoto, Mitsuhiro Aoki, Hiroki Miyamoto, Egi Hidaka, Rikiya Shirato, Yasuhiro Ozasa, Akira Saito, Makoto Emori, Toshihiko Yamashita, Kousuke Iba

Clinical biomechanics (Bristol, Avon)   102   105894 - 105894  2023.01  [International journal]

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BACKGROUND: Direct and quantitative measurement of median nerve strain within the carpal tunnel has been difficult because of the technical limitations associated with conventional devices. We used capacitive sensors (C-stretch), which are thin and flexible, to measure the median nerve strain within the carpal tunnel. METHODS: We used 12 fresh frozen upper extremity specimens. The transverse carpal ligament was left in situ, and we attached the sensor to the palmar surface of the median nerve to measure the nerve strain at 60 degrees of wrist extension. The sensor measured the median nerve strain at both the carpal tunnel site and the proximal to the carpal tunnel site before and after the carpal tunnel release. The amount of nerve excursion during wrist extension was also measured with the length change of the attached suture by a digital caliper. FINDINGS: The mean median nerve strain within the carpal tunnel [8.07% (95 %CI:7.17-8.97)] was significantly higher than that proximal to the carpal tunnel [5.21% (95 %CI:4.46-5.97)] at the wrist extension. There was no significant difference of the mean nerve excursion within and proximal to the carpal tunnel. The mean nerve strain and excursion were unaffected by carpal tunnel release. INTERPRETATION: These results indicated that wrist extension position might lead to increased strain on the median nerve within the carpal tunnel compared with at the proximal to the carpal tunnel. We believe that the current study might provide new information and help us understand the pathogenesis of carpal tunnel syndrome.

DOI PubMed

アキレス腱術後感染により皮膚・腱欠損を生じた症例に運動器エコーを用いた動態評価と理学療法を行い、スポーツ復帰した一例

河合 誠, 小出所 大樹, 山田 由奈, 片寄 正樹, 渡邉 耕太, 千葉 充将, 村橋 靖崇, 寺本 篤史, 山下 敏彦, 谷口 圭吾

北海道整形災害外科学会雑誌 ( 北海道整形災害外科学会 )  65 ( 142nd suppl ) 85 - 85  2023

Reliability and validity of the Forgotten Joint Score-12 for total ankle replacement and ankle arthrodesis.

Koji Noguchi, Satoshi Yamaguchi, Atsushi Teramoto, Kentaro Amaha, Noriyuki Kanzaki, Hirofumi Tanaka, Tetsuro Yasui, Yosuke Inaba

PloS one   18 ( 6 ) e0286762  2023  [International journal]

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OBJECTIVES: This study evaluated the reliability and validity of the Forgotten Joint Score-12 (FJS-12)-a measure of patients' ability to forget their joints in daily life-in patients who underwent total ankle replacement (TAR) or ankle arthrodesis (AA). METHODS: Patients who underwent TAR or AA were recruited from seven hospitals. The patients completed the Japanese version of FJS-12 twice, at an interval of two weeks, at a minimum of one year postoperatively. Additionally, they answered the Self-Administered Foot Evaluation Questionnaire and EuroQoL 5-Dimension 5-Level as comparators. The construct validity, internal consistency, test-retest reliability, measurement error, and floor and ceiling effects were evaluated. RESULTS: A total of 115 patients (median age, 72 years), comprising 50 and 65 patients in the TAR and AA groups respectively, were evaluated. The mean FJS-12 scores were 65 and 58 for the TAR and AA groups, respectively, with no significant difference between groups (P = 0.20). Correlations between the FJS-12 and Self-Administered Foot Evaluation Questionnaire subscale scores were good to moderate. The correlation coefficient ranged from 0.39 to 0.71 and 0.55 to 0.79 in the TAR and AA groups, respectively. The correlation between the FJS-12 and EuroQoL 5-Dimension 5-Level scores was poor in both groups. The internal consistency was adequate, with Cronbach's α greater than 0.9 in both groups. The intraclass correlation coefficients of test-retest reliability was 0.77 and 0.98 in the TAR and AA groups, respectively. The 95% minimal detectable change values were 18.0 and 7.2 points in the TAR and AA groups, respectively. No floor or ceiling effect was observed in either group. CONCLUSIONS: The Japanese version of FJS-12 is a valid and reliable questionnaire for measuring joint awareness in patients with TAR or AA. The FJS-12 can be a useful tool for the postoperative assessment of patients with end-stage ankle arthritis.

DOI PubMed

アキレス腱術後感染により皮膚・腱欠損を生じた症例に運動器エコーを用いた動態評価と理学療法を行い、スポーツ復帰した一例

河合 誠, 小出所 大樹, 山田 由奈, 片寄 正樹, 渡邉 耕太, 千葉 充将, 村橋 靖崇, 寺本 篤史, 山下 敏彦, 谷口 圭吾

北海道整形災害外科学会雑誌 ( 北海道整形災害外科学会 )  65 ( 142nd suppl ) 85 - 85  2023

A Biomechanical Comparison of 2 Over-the-Top Anterior Cruciate Ligament Reconstruction Techniques: A Cadaveric Study Using a Robotic Simulator.

Kousuke Shiwaku, Tomoyuki Suzuki, Konsei Shino, Satoshi Yamakawa, Hidenori Otsubo, Shinichiro Okimura, Daisuke Suzuki, Shogo Nabeki, Atsushi Teramoto, Hirofumi Ohnishi, Hiromichi Fujie, Toshihiko Yamashita

Orthopaedic journal of sports medicine   10 ( 12 ) 23259671221139876 - 23259671221139876  2022.12  [International journal]

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BACKGROUND: For skeletally immature patients, over-the-top (OTT) anterior cruciate ligament (ACL) reconstruction (ACLR) is preferred. However, increased anterior laxity at deep knee flexion angles remains concerning. We modified the procedure to proximally shift the graft fixation site on the femur to prevent graft loosening at higher knee flexion angles and named it the supra-OTT procedure. PURPOSE: To compare anterior laxity and in situ forces of the ACL graft between conventional OTT and supra-OTT ACLR in a cadaveric model. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 11 fresh-frozen cadaveric knee specimens underwent 4 robotic testing conditions: ACL intact, ACL resected, conventional OTT, and supra-OTT. For each condition, a 100-N load was applied at 0°, 15°, 30°, 60°, and 90° of knee flexion to simulate the Lachman test or anterior drawer test. In addition, a combined load of 5-N·m internal tibial torque and 10-N·m valgus torque was applied at 15° and 30° of knee flexion as a simulated pivot-shift test. Anterior tibial translation and in situ graft forces were recorded. The only difference between conventional OTT and supra-OTT ACLR was the graft fixation site on the femur. For conventional OTT ACLR, graft fixation was performed just on the proximal and lateral ends of the posterior condyle. For supra-OTT ACLR, the fixation point was around the proximal insertion of the lateral head of the gastrocnemius and the lateral edge of the posterior cortex, approximately 2 cm proximal to the conventional OTT position. RESULTS: On the simulated anterior drawer test at 60° and 90° of knee flexion, anterior tibial translation after supra-OTT ACLR was significantly smaller than after conventional OTT ACLR (P < .01). However, no significant differences were noted at other flexion angles or on the simulated pivot-shift test between the conventional OTT and supra-OTT procedures. Some overconstraint and higher graft forces were noted with both techniques, but the supra-OTT technique caused even more overconstraint at higher flexion angles. CONCLUSION: Supra-OTT ACLR showed better biomechanical performance to control anterior laxity than conventional OTT ACLR at higher knee flexion angles. CLINICAL RELEVANCE: The supra-OTT procedure may improve anterior stability at deep knee flexion angles.

DOI PubMed

The Role of the Medial Meniscus in Anterior Knee Stability.

Kousuke Shiwaku, Tomoaki Kamiya, Daisuke Suzuki, Satoshi Yamakawa, Hidenori Otsubo, Tomoyuki Suzuki, Katsunori Takahashi, Yohei Okada, Atsushi Teramoto, Hirofumi Ohnishi, Hiromichi Fujie, Toshihiko Yamashita

Orthopaedic journal of sports medicine   10 ( 11 ) 23259671221132845 - 23259671221132845  2022.11  [International journal]

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Background: Few studies have compared the force distribution between the anterolateral, posterolateral, and medial structures of the knee. Purpose: To investigate the important structures in an intact knee contributing to force distribution in response to anterior tibial load. Study Design: Controlled laboratory study. Methods: Nine fresh-frozen cadaveric knee specimens underwent robotic testing. First, 100 N of anterior tibial load was applied to the intact knee at 0°, 15°, 30°, 60°, and 90° of knee flexion. The anterior cruciate ligament (ACL), anterolateral capsule, lateral collateral ligament, popliteal tendon, posterior root of the lateral meniscus, superficial medial collateral ligament, posterior root of the medial meniscus (MM), and posterior cruciate ligament were then completely transected in sequential order. After each transection, the authors reproduced the intact knee motion when a 100-N anterior tibial load was applied. By applying the principle of superposition, the resultant force of each structure was determined based on the 6 degrees of freedom force/torque data of each state. Results: At every measured knee flexion angle, the resultant force of the ACL was the largest of the tested structures. At knee flexion angles of 60° and 90°, the resultant force of the MM was larger than that of all other structures with the exception of the ACL. Conclusion: The MM was identified as playing an important role in response to anterior tibial load at 60° and 90° of flexion. Clinical Relevance: In clinical settings, the ACL of patients with a poorly functioning MM, such as tear of the MM posterior root, should be monitored considering the large resultant force in response to an anterior tibial load.

DOI PubMed

Degenerative Lumbar Spondylolisthesis Patients With Movement-related Low Back Pain Have Less Postoperative Satisfaction After Decompression Alone

Ryosuke Hirota, Atsushi Teramoto, Ryota Kimura, Takashi Kobayashi, Mitsunori Yoshimoto, Noriyuki Iesato, Koichiro Okuyama, Izaya Ogon, Michio Hongo, Yuji Kasukawa, Arihiko Tsukamoto, Daisuke Kudo, Makoto Emori, Kousuke Iba, Yoichi Shimada, Naohisa Miyakoshi, Toshihiko Yamashita

Spine   47 ( 19 ) 1391 - 1398  2022.10

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Study Design. Retrospective analysis of prospectively collected multicenter observational data. Objective. The aim was to examine the preoperative factors affecting postoperative satisfaction following posterior lumbar interbody fusion (PLIF) and microendoscopic muscle-preserving interlaminar decompression (ME-MILD) in patients with degenerative lumbar spondylolisthesis (DLS). Summary of Background Data. The technique involved in DLS surgery may either be decompression alone or decompression-fixation. Poor performance may occur after either of these surgical treatments. The author hypothesized that evaluating the correlation between preoperative quality of life and postoperative performance would aid in determining the optimal procedure. Materials and Methods. This study included 138 patients who underwent surgery for 1-level mild DLS. The authors performed PLIF for 79 patients and ME-MILD for 59 patients. When the satisfaction subscale of the Zurich Claudication Questionnaire exceeded 2 points, postoperative satisfaction was considered poor. The clinical characteristics were investigated. Responses to preoperative health-related quality of life questionnaires, such as the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ), short form-36 health survey (SF-36), and visual analog scale, were compared between the satisfied and unsatisfied groups. Results. In the PLIF group, no endogenous factors influenced postoperative satisfaction. The ME-MILD cohort's satisfied and unsatisfied patients differed significantly in terms of preoperative lumbar spine dysfunction (P<0.001) items of the JOABPEQ, role physical (P=0.03), and role emotional (P=0.03) items of the SF-36. A strong correlation (r=-0.609 P=0.015) was found between preoperative lumbar spine dysfunction and postoperative satisfaction. Conclusions. In the ME-MILD group, preoperative lumbar spine function was correlated with postoperative satisfaction. Decompression alone may be ineffective in cases with decreased lumbar spine function prior to surgery. The degree of low back pain on movement should be considered before selecting the surgical method.

DOI PubMed

【上肢疾患の診断と治療の進歩(新鮮外傷を除く)】総論 病態・診断 動作解析 手関節運動時における正中神経伸長率測定の新しい試み

高島 健一, 射場 浩介, 青木 光広, 寺本 篤史, 斎藤 憲, 小笹 泰宏, 白戸 力也, 日高 惠喜, 宮本 博樹, 山下 敏彦

別冊整形外科 ( (株)南江堂 )  ( 82 ) 26 - 30  2022.10

第1基節骨と第1中足骨の3次元骨形態における正常足の性別による比較 相同モデルを用いた検討

山津 健太, 渡邉 耕太, 寺本 篤史

日本足の外科学会雑誌 ( (一社)日本足の外科学会 )  43 ( Suppl. ) S165 - S165  2022.10

Patient-specific three-dimensional evaluation of interface micromotion in two different short stem designs in cementless total hip arthroplasty: a finite element analysis

Arata Kanaizumi, Daisuke Suzuki, Satoshi Nagoya, Atsushi Teramoto, Toshihiko Yamashita

Journal of Orthopaedic Surgery and Research ( Springer Science and Business Media LLC )  17 ( 1 )  2022.09

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Abstract Background Evaluation of micromotion in various activities in daily life is essential to the assessment of the initial fixation of cementless short stems in total hip arthroplasty. This study sought to evaluate three-dimensionally the micromotion of two types of cementless short stems. Methods Two types of stems were used: the Fitmore stem with a rectangular cross-section (rectangular stem) and the octagonal-oval GTS stem with fins (finned stem). Finite element analysis was used to calculate the micromotion of two activities that place a heavy load on the stem (single-leg stance and stair climbing). Three values were measured: the magnitude of micromotion (mean and 95th percentile), the location of micromotion above the 95th percentile value, and the directions of the micromotion vector. Results 1. There was no significant difference in the magnitude of the micromotion between the rectangular stem and finned stem groups for single-leg stance or stair climbing. 2. In both groups, the micromotion was greatest at the proximal and distal ends. 3. The direction of the micromotion was similar in both groups; internal rotation occurred from the distal to the middle of the stem during stair climbing. Conclusions The rectangular stem had comparable initial fixation to that of the finned stem. In both models, the micromotion was greater at the proximal and distal ends. The direction of the micromotion was not dependent on the stem shape but on the direction of the load on the artificial femoral head. These results will be important for stem selection and future stem development.

DOI

Effect of Anterior Horn Tears of the Lateral Meniscus on Knee Stability.

Kousuke Shiwaku, Tomoaki Kamiya, Hidenori Otsubo, Tomoyuki Suzuki, Shogo Nabeki, Satoshi Yamakawa, Yohei Okada, Atsushi Teramoto, Kota Watanabe, Kousuke Iba, Hiromichi Fujie, Toshihiko Yamashita

Orthopaedic journal of sports medicine   10 ( 9 ) 23259671221119173 - 23259671221119173  2022.09  [International journal]

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Background: Investigations on the biomechanical characteristics of the anterior horn of the lateral meniscus (AHLM) related to anterior cruciate ligament (ACL) tibial tunnel reaming have revealed increased contact pressure between the femur and tibia, decreased attachment area, and decreased ultimate failure strength. Purpose/Hypothesis: The purpose of this study was to investigate the influence of a complete radial tear of the AHLM on force distribution in response to applied anterior and posterior drawer forces and internal and external rotation torques. We hypothesized that the AHLM plays an important role in knee stability, primarily at lower knee flexion angles. Study Design: Controlled laboratory study. Methods: A total of 9 fresh-frozen cadaveric knee specimens and a robotic testing system were used. Anterior and posterior drawer forces up to 89 N and internal and external rotation torques up to 4 N·m were applied at 0°, 30°, 60°, and 90° of knee flexion. A complete AHLM tear was then made 10 mm from the lateral border of the tibial attachment of the ACL, and the same tests performed in the intact state were repeated. Next, the recorded intact knee motion was reproduced in the AHLM-torn knee, and the change in the resultant force after an AHLM tear was determined by calculating the difference between the 2 states. Results: In the torn AHLM, the reduction in the resultant force at 0° for external rotation torque (34.8 N) was larger than that at 60° (5.2 N; P < .01) and 90° (6.7 N; P < .01). Conclusion: The AHLM played a role in facilitating knee stability against an applied posterior drawer force of 89 N and external rotation torque of 4 N·m, especially at lower knee flexion angles. Clinical Relevance: This study provides information about the effects of AHLM injuries that may occur during single-bundle ACL reconstruction using a round tunnel.

DOI PubMed

腱板表層断裂の有無による棘上筋腱深層伸び率の比較 未固定凍結遺体を用いた検討

宮本 浩樹, 渡邉 耕太, 青木 光広, 廣田 健斗, 根岸 奎輔, 谷口 達也, 飯田 尚哉, 日高 恵喜, 高島 健一, 寺本 篤史, 山下 敏彦

日本整形外科学会雑誌 ( (公社)日本整形外科学会 )  96 ( 8 ) S1601 - S1601  2022.09

大腿四頭筋セッティング時の膝窩圧迫力と大腿四頭筋弾性の関係

小出所 大樹, 河合 誠, 時田 諒, 青木 昌弘, 寺本 篤史, 金谷 耕平, 片寄 正樹, 谷口 圭吾

日本整形外科超音波学会学術集会プログラム・抄録集 ( 日本整形外科超音波学会 )  33回   108 - 108  2022.07

Factors associated with low back pain in patients with lumbar spinal stenosis: a cross-sectional study.

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

BMC musculoskeletal disorders   23 ( 1 ) 552 - 552  2022.06  [International journal]

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BACKGROUND: Low back pain (LBP) is a major symptom of symptomatic lumbar spinal stenosis (SLSS). It is important to assess LBP in patients with SLSS to develop better treatment. This study aimed to analyse the factors associated with LBP in patients with SLSS. METHODS: This cross-sectional study included consecutive patients with SLSS aged between 51 and 79 years who had symptoms in one or both the legs, with and without LBP. The participants were classified into two groups: the high group (LBP visual analogue scale [VAS] score ≥ 30 mm) and the low group (LBP VAS score < 30 mm). We performed multiple logistic regression analysis with the high and low groups as dependent variables, and a receiver operating characteristic (ROC) analysis. RESULTS: A total of 80 patients with LSS were included (35 men and 45 women; mean age 64.5 years), with 47 and 30 patients in the high and low groups, respectively. Multivariate logistic regression analysis revealed that the sagittal vertical axis (SVA; + 10 mm; odds ratio, 1.331; 95% confidence interval, 1.051 - 1.660) and pelvic incidence-lumbar lordosis (PI-LL; + 1°; odds ratio, 1.065; 95% confidence interval, 1.019-1.168) were significantly associated with LBP. A receiver operating characteristic analysis revealed cut-off values of 47.0 mm of SVA and 30.5° of PI-LL, respectively. CONCLUSION: Our results indicated that SVA and PI-LL were significant predictors for LBP in SLSS. It is suggested that these parameters should be taken into consideration when assessing LBP in patients with SLSS.

DOI PubMed

Effects of the Ankle Flexion Angle During Anterior Talofibular Ligament Reconstruction on Ankle Kinematics, Laxity, and In Situ Forces of the Reconstructed Graft

Yuzuru Sakakibara, Atsushi Teramoto, Tetsuya Takagi, Satoshi Yamakawa, Hiroaki Shoji, Yohei Okada, Takuma Kobayashi, Tomoaki Kamiya, Mineko Fujimiya, Hiromichi Fujie, Kota Watanabe, Toshihiko Yamashita

Foot & Ankle International ( {SAGE} Publications )  43 ( 5 ) 725 - 732  2022.05  [International journal]

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BACKGROUND: This study aimed to evaluate the effects of the ankle flexion angle during anterior talofibular ligament (ATFL) reconstruction on ankle kinematics, laxity, and in situ force of a graft. METHODS: Twelve cadaveric ankles were evaluated using a 6-degrees of freedom robotic system to apply passive plantar flexion and dorsiflexion motions and multidirectional loads. A repeated measures experiment was designed using the intact ATFL, transected ATFL, and reconstructed ATFL. During ATFL reconstruction (ATFLR), the graft was fixed at a neutral position (ATFLR 0 degrees), 15 degrees of plantar flexion (ATFLR PF15 degrees), and 30 degrees of plantar flexion (ATFLR PF30 degrees) with a constant initial tension of 10 N. The 3-dimensional path and reconstructed graft tension were simultaneously recorded, and the in situ force of the ATFL and reconstructed grafts were calculated using the principle of superposition. RESULTS: The in situ forces of the reconstructed grafts in ATFLR 0 degrees and ATFLR PF 15 degrees were significantly higher than those of intact ankles. The ankle kinematics and laxity produced by ATFLR PF 30 degrees were not significantly different from those of intact ankles. The in situ force on the ATFL was 19.0 N at 30 degrees of plantar flexion. In situ forces of 41.0, 33.7, and 21.9 N were observed at 30 degrees of plantar flexion in ATFLR 0, 15, and 30 degrees, respectively. CONCLUSION: ATFL reconstruction with the peroneus longus (PL) tendon was performed with the graft at 30 degrees of plantar flexion resulted in ankle kinematics, laxity, and in situ forces similar to those of intact ankles. ATFL reconstructions performed with the graft fixed at 0 and 15 degrees of the plantar flexion resulted in higher in situ forces on the reconstructed graft. CLINICAL RELEVANCE: Fixing the ATFL tendon graft at 30 degrees of plantar flexion results in an in situ force closest to that of an intact ankle and avoids the excessive tension on the reconstructed graft.

DOI PubMed

Non-ossifying fibromas and fibrous cortical defects around the knee - an epidemiologic survey in a Japanese pediatric population.

Makoto Emori, Hiroyuki Tsuchie, Atsushi Teramoto, Junya Shimizu, Emi Mizushima, Yasutaka Murahashi, Hiroyuki Nagasawa, Naohisa Miyakoshi, Toshihiko Yamashita

BMC musculoskeletal disorders   23 ( 1 ) 378 - 378  2022.04  [International journal]

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BACKGROUND: The aim of the present study was to evaluate the prevalence of non-ossifying fibroma (NOF) and fibrous cortical defect (FCD) in a Japanese pediatric population and the association between the lesion size and pain. METHODS: This retrospective study, conducted across 10 Japanese institutions, included patients aged 5-15 years who had undergone standard antero-posterior and lateral view radiography of the knee. Using these radiographs, we diagnosed the lesion as a NOF or FCD. Patient demographics, including age, sex, the size and location of the NOF, and chief complaint were recorded. The lesion size was determined using radiographs. Student's t-test was used to compare the associations between the lesion size and spontaneous pain. RESULTS: A total of 6222 subjects (3567 boys and 2455 girls) were included in this study. The number of NOF and FCD cases was 143 and 437, respectively, and the prevalence of NOF and FCD was 2.3% and 7.0%, respectively. The average size of NOF and FCD was 22.1 mm (range: 4-102 mm) and 13.2 mm (range: 5-21 mm), respectively. Three patients (2.1%) had pathological fractures due to NOF. Of the 140 NOFs and 437 FCDs, we obtained complaints from the medical records of 126 and 393 patients, respectively. The number of patients with spontaneous pain or other problems with NOF was 68 (54%) and 58 (46%), respectively, that of patients with FCD was 195 (50%) and 198 (50%) patients, respectively. The lesion size was not associated with spontaneous pain in either lesion (p = 0.67 and p = 0.27, respectively). CONCLUSION: The prevalence of NOF and FCD around the knee was lower than that reported in previous studies. The prevalence of NOF increased and that of FCD decreased with advancing age. In both lesions, the lesion size may not be associated with pain.

DOI PubMed

Risk Factors for Postoperative Loss of Correction in Thoracolumbar Injuries Caused by High-Energy Trauma Treated via Percutaneous Posterior Stabilization without Bone Fusion

Ryosuke Hirota, Atsushi Teramoto, Hideto Irifune, Mitsunori Yoshimoto, Nobuyuki Takahashi, Mitsumasa Chiba, Noriyuki Iesato, Kousuke Iba, Makoto Emori, Toshihiko Yamashita

Medicina ( {MDPI} {AG} )  58 ( 5 ) 583 - 583  2022.04  [International journal]

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Background and Objectives: Percutaneous pedicle screws were first introduced in 2001, soon becoming the cornerstone of minimally invasive spinal stabilization. Use of the procedure allowed adequate reduction and stabilization of spinal injuries, even in severely injured patients. This decreased bleeding and shortened surgical time, thereby optimizing outcomes; however, postoperative correction loss and kyphosis still occurred in some cases. Thus, we investigated cases of percutaneous posterior fixation for thoracolumbar injury and examined the factors affecting the loss of correction. Materials and Methods: Sixty-seven patients who had undergone percutaneous posterior fixation for thoracolumbar injury (AO classifications A3, A4, B, and C) between 2009 and 2016 were included. Patients with a local kyphosis angle difference ≥10° on computed tomography at the postoperative follow-up (over 12 months after surgery) or those requiring additional surgery for interbody fusion were included in the correction loss group (n = 23); the no-loss group (n = 44) served as the control. The degree of injury (injury level, AO classification, load-sharing score, local kyphosis angle, cuneiform deformity angle, and cranial and caudal disc injury) and surgical content (number of fixed intervertebral vertebrae, type of screw used, presence/absence of screw insertion into the injured vertebrae, and presence/absence of vertebral formation) were evaluated as factors of correctional loss and compared between the two groups. Results: Comparison between each group revealed that differences in the wedge-shaped deformation angle, load-sharing score, degree of cranial disc damage, AO classification at the time of injury, and use of polyaxial screws were statistically significant. Logistic regression analysis showed that the differences in wedge-shaped deformation angle, AO classification, and cranial disc injury were statistically significant; no other factors with statistically significant differences were found. Conclusion: Correction loss was seen in cases with damage to the cranial intervertebral disc as well as the vertebral body.

DOI PubMed

Surgically treated reactive arthritis of the ankle after COVID-19 infection: A case report

Kohei Shimoyama, Atsushi Teramoto, Yasutaka Murahashi, Katsunori Takahashi, Kota Watanabe, Kousuke Iba, Toshihiko Yamashita

Journal of Infection and Chemotherapy ( Elsevier {BV} )  28 ( 4 ) 587 - 590  2022.04  [International journal]

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A 37-year-old man developed right ankle pain and swelling six days after being diagnosed with coronavirus disease (COVID-19). Despite conservative treatment, his ankle symptoms persisted. Magnetic resonance imaging and computed tomography showed synovial hypertrophy and bone erosion in the ankle. Following arthroscopic synovectomy, performed 69 days after the COVID-19 diagnosis, the pain improved significantly. The clinical course was consistent with that of reactive arthritis following severe acute respiratory syndrome coronavirus 2 infection. The pathological findings resembled rheumatoid nodules. The bone erosion may have originated from the inflammatory pathway, which resembles the mechanism of rheumatoid arthritis.

DOI PubMed

Syndesmotic instability can be assessed by measuring the distance between the tibia and the fibula using an ultrasound without stress: a cadaver study.

Hiroaki Shoji, Atsushi Teramoto, Yasutaka Murahashi, Kota Watanabe, Toshihiko Yamashita

BMC musculoskeletal disorders   23 ( 1 ) 261 - 261  2022.03  [International journal]

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BACKGROUND: Ultrasound examinations for syndesmosis injury might be useful for the quantitative evaluation of syndesmotic instability. The purpose of this study was to evaluate the efficacy of ultrasound assessment by measuring the tibiofibular distance of syndesmosis injuries in various ligament-injured models and stress load conditions. METHODS: Five normal ankles from Thiel-embalmed cadavers were used. Ultrasound assessment was performed by placing a probe in parallel with the ligament running just above the anterior inferior tibiofibular ligament (AITFL). The distance between the anterior border of the tibia and the fibula was measured in the intact condition. Next, Bassett's ligament was cut arthroscopically to reduce damage to soft tissues as much as possible and measurement was performed in the same way. After that, the AITFL, interosseous membrane (IOM), deltoid ligament, and posterior inferior tibiofibular ligament (PITFL) were macroscopically cut and measured in that order. Ankle positions were without stress (natural plantar flexion without applying stress to the ankle joint), dorsiflexion stress, inversion stress, and external rotation stress. All stress to the ankle joint was carried out manually to the maximum extent. RESULTS: As with the without-stress condition, significant increases in tibiofibular distances after AITFL dissection were seen compared with the intact state under all stress conditions (intact: 4.9 ± 1.0 mm without stress, 5.6 ± 1.2 mm with dorsiflexion, 5.9 ± 1.0 mm with inversion, and 6.7 ± 1.3 mm with external rotation; AITFL dissection: 6.7 ± 1.5 mm without stress, 7.3 ± 1.2 mm with dorsiflexion, 7.5 ± 1.4 mm with inversion, and 8.7 ± 1.6 mm with external rotation). AITFL dissection with external rotation stress significantly increased the tibiofibular distance compared to without stress. CONCLUSION: Changes in tibiofibular distance with the severity of syndesmosis injury were measured by ultrasound using cadavers. No significant change was seen with Bassett's ligament injury, but tibiofibular distance increased significantly with injuries of equal to or greater severity than AITFL injury. Results were similar not only for external rotation stress, but also for dorsiflexion stress and inversion stress, and even in unloaded states, significant tibiofibular widening was confirmed with injuries of equal to or greater severity than AITFL injury.

DOI PubMed

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]

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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.

DOI PubMed

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]

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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.

DOI PubMed

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]

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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.

DOI PubMed

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]

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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.

DOI PubMed

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

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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.

DOI

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]

DOI

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]

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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.

DOI PubMed

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

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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.

DOI

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

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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.

DOI PubMed

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]

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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.

DOI PubMed

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]

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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.

DOI PubMed

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

DOI

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]

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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.

DOI PubMed

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

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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.

DOI

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]

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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.

DOI PubMed

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]

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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.

DOI PubMed

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]

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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.

DOI PubMed

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]

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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.

DOI PubMed

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]

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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.

DOI PubMed

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]

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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.

DOI PubMed

四肢発生異型脂肪腫様腫瘍に対する術後再発因子の検討

銭谷 俊毅, 江森 誠人, 射場 浩介, 清水 淳也, 村橋 靖崇, 寺本 篤史, 山下 敏彦, 土江 博幸, 永澤 博幸, 宮腰 尚久, 島田 洋一, 水島 衣美

北海道整形災害外科学会雑誌 ( 北海道整形災害外科学会 )  63 ( 139th suppl ) 73 - 73  2021

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

The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons   60 ( 6 ) 1207 - 1211  2021  [International journal]

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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.

DOI PubMed

Prevalence of multiple-level spondylolysis and the bone union rates among growth-stage children with lower back pain

Noriyuki Iesato, Kousuke Iba, Mitsunori Yoshimoto, Hidenori Otsubo, Tomoaki Kamiya, Tsuyoshi Miyakawa, Yuko Narita, Makoto Emori, Atsushi Teramoto, Toshihiko Yamashita

Spine Surgery and Related Research ( Japanese Society for Spine Surgery and Related Research )  5 ( 4 ) 292 - 297  2021

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Introduction: Lumbar spondylolysis is usually single level, and only a few multiple-level cases have been reported. We investigated the frequency of multiple-level spondylolysis and the bone union rates among growth-stage children with lower back pain (LBP). Methods: The subjects were growth-stage children examined for LBP between April 2013 and December 2018. All patients with LBP persisting for at least 2 weeks and severe enough to make playing sports difficult underwent lumbar plain radiogram, computed tomography, and magnetic resonance imaging. The cases diagnosed as multiple-level spondylolysis and classified as early or progressive stage received conservative treatment to achieve bone union. Results: A total of 782 growth-stage children were examined for LBP. Of them, 243 children (31.1%) were diagnosed with lumbar spondylolysis. Of these 243 children, 23 (9.5%) children had multiple-level spondylolysis. Of the children diagnosed with multiple-level spondylolysis, most children (87.0%) had pars defects in the early or progressive stage in which bone union could be expected. Most children (78.3%) had pars defects in the terminal stage and combined with these defects, had pars defects in the early or progressive stage at a different spinal level. Twenty children diagnosed with multiple-level spondylolysis who also had pars defects in the early or progressive stage received conservative treatment for bone union, which was achieved in 31 of 39 sites (79.5%). The bone union rate by stage was 92.9% (26 of 28 sites) in the early stage and 45.5% (5 of 11 sites) in the progressive stage. Conclusions: In cases of multiple-level spondylolysis, bone union is likely to be achieved with conservative treatment when the pars defects are in the early or progressive stage. Therefore, the first choice of treatment should be conservative treatment to achieve bone union, the same for single-level spondylolysis.

DOI

Long-term outcomes after phalangeal distraction lengthening in patients with constriction band syndrome

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

Journal of Plastic Surgery and Hand Surgery ( Taylor and Francis Ltd. )  55 ( 5 ) 268 - 272  2021

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We investigated the long-term post-operative outcomes, more than 10 years after surgery, of distraction lengthening of phalanges in patients with congenital constriction band syndrome. Five shortened digits of two patients with congenital constriction band syndrome underwent distraction lengthening of the proximal phalanges using external fixator for the reconstruction of grasp and pinch at age of 53 and 41 months. The post-operative followed-up was 126 and 124 months. Subjective evaluation of hand function was performed using the tape measure method and Functional Dexterity Test pre-operatively and at 1 year after surgery. The parameters for proximal phalangeal distraction and the changes in the length ratio of the phalanges were evaluated. Grasp and pinch function was markedly improved after phalangeal lengthening. Regarding the radiographic findings, the length of distraction was 9.7 mm, % increase of lengthening: 52%, duration of distraction: 28 days, duration of fixation: 83 days, and healing index: 90 days. At the latest follow-up, the relative length of the proximal phalanx did not change significantly (−6%) during the 10 years after distraction lengthening. Patients with constriction band syndrome obtained favorable hand function and preserved those functions for more than 10 years after distraction lengthening of short phalanges using an external fixator.

DOI

Strain measurement of the deep layer of the supraspinatus tendon using fresh frozen cadaver: The influence of shoulder elevation.

Hiroki Miyamoto, Kota Watanabe, Atsushi Teramoto, Naoya Iida, Tatsuya Taniguchi, Kento Hirota, Keisuke Negishi, Mineko Fujimiya

Clinical biomechanics (Bristol, Avon)   80   105160 - 105160  2020.12  [International journal]

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BACKGROUND: The shoulder is a uniquely complex large joint. Effective and safe physical therapy efforts towards rehabilitating injured and repaired shoulders requires a thorough understanding of shoulder mechanics from both generalized and very specific perspectives. Numerous biomechanical studies have been published on the shoulder. None of the studies, to our knowledge, considered the strain of the deep layers of the supraspinatus tendon for scapular plane elevation. METHODS: Ten unilateral fresh-frozen human cadaveric specimens were used for the study. Scapular plane angles ranging from -10 to 30 degrees were evaluated for tensile loads, ranging from 0 to 120 Newtons, exerted on the supraspinatus tendon. Strain measurements that specifically targeted the deep layer of the supraspinatus tendon during tensile loading were recorded. FINDINGS: Strains recorded in the supraspinatus deep layer while increasing tendon force of the supraspinatus were significant for isometric gleno-humeral elevation of 30° and 20°. The response of strain to tendon force was less pronounced for 10° or less of gleno-humeral elevation. INTERPRETATION: When performing isometric shoulder exercise regimens, rotator cuff forces and both surface and deep tendon strain, relative to scapular positioning, are relevant and should be considered.

DOI PubMed

Flexor hallucis longus tendinous slips and the relationship to toe flexor strength.

Kento Hirota, Kota Watanabe, Atsushi Teramoto, Yuki Saito, Masaki Katayose

Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons ( Elsevier {BV} )  27 ( 8 ) 851 - 854  2020.11  [International journal]

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BACKGROUND: In the general population, the flexor hallucis longus (FHL) often has tendinous slips to lesser toes and the number of FHL slips varies between individuals. The purpose of this study was to investigate the relationship between the number of FHL tendinous slips in an individual foot and its toe flexor strength. METHODS: Forty healthy men were included in the study. The FHL branch test was used to assess each subject for the number of FHL tendinous slips. Toe flexor strength in each toe was measured using a force gauge. A two-way ANOVA was used to compare toe flexor strength between groups classified according to the number of FHL slips. RESULTS: The group of subjects with FHL branching to the second toe was the most common (20/40). The toe flexor strength ratio of the third toe was significantly lower in feet lacking FHL branching to the third toe than in those feet which did have branching to the third toe (P = 0.005). CONCLUSIONS: Toe flexor strength was affected by FHL tendinous slips. Considering the number of the FHL tendinous slips an individual foot has may be useful in clinical practice for rehabilitation or training of toe flexor muscles.

DOI PubMed

Sex- and age-related variations in the three-dimensional orientations and curvatures of the articular surfaces of the human talus

Shuhei Nozaki, Kota Watanabe, Atsushi Teramoto, Tomoaki Kamiya, Masaki Katayose, Naomichi Ogihara

Anatomical Science International ( Springer Science and Business Media LLC )  96 ( 2 ) 258 - 264  2020.11  [Domestic journal]

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The high prevalence of foot pathologies in women and the elderly could be associated with gender and age difference in the morphology of the foot, particularly the morphology of the keystone of the foot, the talus. The present study investigated the orientation and curvature of the three articular surfaces of the talus in relation to sex and age based on computer tomography (CT), to identify possible morphological factors of the higher prevalence of foot disorders in women and elderly. Fifty-six participants were included in this study. The orientations of the talocrural, subtalar, and talonavicular joints were quantified three-dimensionally by calculating normal and principal axes of the articular surfaces defined by planar approximation. The curvature radii of the articular surfaces were quantified by cylindrical and spherical approximations. The talonavicular surface was significantly more twisted in the frontal plane and less adducted in the transverse plane in females than in males. With aging, the subtalar articular surface was significantly facing more posteriorly. Moreover, it was found that the curvature radii of the trochlea and navicular articular surfaces significantly increased with aging, indicating a flattening of these surfaces. The identified changes in the talar morphology with aging could potentially lead to a higher prevalence of foot disorders in the elderly.

DOI PubMed

Tibial Plafond Attachment of the Posterior-Inferior Tibiofibular Ligament: A Cadaveric Study

Shutaro Fujimoto, Atsushi Teramoto, Ken Anzai, Yasutaka Murahashi, Yohei Okada, Tomoaki Kamiya, Kota Watanabe, Mineko Fujimiya, Toshihiko Yamashita

Foot & Ankle Orthopaedics   5 ( 4 ) 2473011420945689 - 2473011420945689  2020.10  [International journal]

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BACKGROUND: Some recent studies have reported the role of the posterior malleolus as an attachment of the posterior-inferior tibiofibular ligament (PITFL) and suggested that even a small fragment should be fixed. However, there are few anatomic studies of the tibial plafond attachment of the PITFL. METHODS: Seven Thiel-embalmed ankles were obtained. The margin of the distal tibial joint surface and the attachments of the superficial fiber of the PITFL (sPITFL) and the deep fiber (dPITFL) were identified. In the frontal view, the percentages of the attachments of the sPITFL and dPITFL of the mediolateral dimension of the posterior tibial plafond were measured. In the lateral view, the line that started from the proximal margin of the attachment of the sPITFL and parallel to the tibial axis was drawn, and the distance between that line and the posterior edge of the joint surface was measured (AP distance of the sPITFL). Then, the percentage of the AP distance of the sPITFL of the joint surface in the anteroposterior dimension of the tibial plafond was measured. RESULTS: In the frontal view, the mediolateral distance of the attachment of the sPITFL was 5.0 mm, and that of the dPITFL was 19.5 mm. The percentage of the attachment of the sPITFL on the tibial plafond was 20.6%, and that of the dPITFL was 78.2%. In the lateral view, the average AP distance of the sPITFL was 0.5 mm, and the percentage in the anteroposterior dimension of the tibial plafond was 1.7%. CONCLUSION: The PITFL was attached to less than 10% of the anteroposterior dimension of the tibial plafond in most ankles. Conversely, the PITFL attached widely in the mediolateral dimension. CLINICAL RELEVANCE: This study suggests that the size of the posterior malleolar fragment in the mediolateral dimension could help estimate how much of the PITFL attaches to the fragment which may have implications for ankle stability.

DOI PubMed

Effective stretching positions for the posterior shoulder capsule as determined by shear wave elastography.

Naoya Iida, Keigo Taniguchi, Kota Watanabe, Hiroki Miyamoto, Tatsuya Taniguchi, Atsushi Teramoto, Masaki Katayose

Journal of shoulder and elbow surgery ( Elsevier {BV} )  30 ( 5 ) 1186 - 1195  2020.09  [International journal]

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BACKGROUND: Stretching is often used to prevent and treat posterior shoulder capsule tightness; however, the most effective stretching positions are not clearly defined. The purpose of this study was to identify the stretching positions that specifically applied the greatest passive tension on the posterior shoulder capsule by evaluating the elastic characteristics of posterior capsules and muscles in various stretching positions using ultrasound shear wave elastography (SWE). METHODS: We evaluated 9 fresh-frozen shoulders (mean age 86.6 ± 7.7 years) without osteoarthritis or rotator cuff tears. All posterior shoulder tissues were preserved intact. Shear moduli of the middle and inferior posterior shoulder capsules and the posterior shoulder muscles were evaluated using SWE. We obtained shear modulus measurements in 9 stretching positions using a combination of glenohumeral elevation planes and angles (frontal, sagittal, scapular; -30°, 0°, 30°, 60°, respectively). A 4-Nm torque for shoulder internal rotation or horizontal adduction was applied in each position. We also measured shear moduli in the resting position (0° elevation with neutral shoulder internal/external rotation). We compared the shear moduli of all stretching and resting positions using 1-way repeated measures analysis of variance (P < .05). In addition, we compared the shear modulus in 2 positions (ie, resting and each stretching) among tissues (ie, capsules and muscles) with repeated measures using 2-way analysis of variance (P < .05). RESULTS: Shear modulus values for the middle posterior capsules in "internal rotation at 30° in scapular plane elevation" (28.7 ± 14.3 kPa, P = .01) and in "horizontal adduction at 60° of elevation" (31.1 ± 13.1 kPa, P < .001) were significantly higher than that of the resting position (11.0 ± 7.3 kPa). The shear modulus value for the inferior posterior capsule in "internal rotation at 30° of flexion" was significantly higher than that of the resting position (39.0 ± 17.3 vs. 15.4 ± 13.9 kPa, respectively; P = .004). Additionally, the shear modulus values for the posterior capsules in "internal rotation at 30° in scapular plane elevation and flexion" were significantly higher than that of the posterior shoulder muscles. CONCLUSION: Effective middle posterior shoulder capsule stretching positions were shoulder "internal rotation at 30° of scapular plane elevation" and "horizontal adduction at 60° of elevation." Shoulder "internal rotation at 30° of flexion" was the most effective position for the inferior posterior shoulder capsule. Stretching in these positions could relieve posterior shoulder capsule tightness and contribute to the prevention and treatment of throwing injuries of the shoulder.

DOI PubMed

Is the Lipid Content of the Psoas Major Correlated with Chronic Low Back Pain and Spinopelvic Alignment? A Magnetic Resonance Spectroscopic Study.

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

Asian spine journal   14 ( 4 ) 430 - 437  2020.08  [Refereed]  [International journal]

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STUDY DESIGN: Cross-sectional observational study. PURPOSE: This study aimed to analyze any potential associations of extramyocellular lipid (EMCL) and intramyocellular lipid (IMCL) contents with (1) the intensity of low back pain (LBP); (2) age, cross-sectional area (CSA), and fatty infiltration (FI) of the psoas major; and (3) spinopelvic parameters. OVERVIEW OF LITERATURE: The psoas major has clinically relevant function; however, the association of this muscle with chronic LBP is controversial. Magnetic resonance spectroscopy enables a detailed analysis of the composition of muscular fat tissues such as its EMCL and IMCL contents. METHODS: The study population comprised 40 patients (19 males, 21 females; mean age, 61.7±2.4 years). Possible correlations of LBP Visual Analog Scale (VAS) scores, age, CSA, FI, and spinopelvic parameters with EMCL and IMCL contents of the psoas major were assessed. RESULTS: No association was identified between the EMCL and IMCL contents and LBP VAS scores (r=0.05, p=0.79 and r=0.06, p=0.75, respectively). The EMCL content correlated with age (r=0.47, p<0.01), body mass index (BMI) (r=0.44, p<0.01), CSA (r=-0.59, p< 0.01), and FI (r=0.49, p<0.01). EMCL content showed a significant negative correlation with sacral slope (SS) (r=-0.43, p<0.05) and positive correlation with pelvic tilt (PT) (r=0.56, p<0.01). CONCLUSIONS: EMCL content correlated with age, BMI, CSA, and FI of the psoas major, while IMCL content had no correlation. This study found correlations between SS and PT and EMCL content of the psoas major, but no correlations were found between spinopelvic parameters and IMCL content of the psoas major.

DOI PubMed

【キャダバー・サージカル・トレーニングの現状と展望】骨盤・下肢領域における橋渡し研究を生むサージカルトレーニングの役割

名越 智, 鈴木 大輔, 寺本 篤史, 岡田 葉平, 佐々木 幹人, 渡邉 耕太, 小助川 維摩, 舘田 健児, 金泉 新, 山下 敏彦

関節外科 ( (株)メジカルビュー社 )  39 ( 8 ) 861 - 866  2020.08

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＜文献概要＞サージカルトレーニング(cadaver surgical training;CST)は,若手医師への適切な手術手技の教育,シニア医師による実践に則した手術方法の改良や医療機器の開発と同時に,臨床解剖を通じて手術中の問題点や疑問点を解き明かす研究手法として有用であり,基礎と臨床の橋渡し研究として萠芽的な生体工学的研究に結びつく大きな役割を果たす。

超音波診断装置による足部腱滑走距離計測 異なる足関節肢位の影響

谷口 達也, 渡邉 耕太, 宮本 浩樹, 廣田 健斗, 寺本 篤史

日本足の外科学会雑誌 ( (一社)日本足の外科学会 )  41 ( 1 ) 118 - 121  2020.08

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超音波診断装置で足・足趾運動に伴う腱滑走距離を計測し、その信頼性と腱滑走距離への関節肢位の影響を検討した。対象は成人男性10名10足で、対象腱は後脛骨筋腱、腓骨筋腱、長母趾屈筋腱、長趾屈筋腱とした。運動条件は他動運動とし、後脛骨筋腱の計測は内がえし20°から外がえし20°、腓骨筋腱では外がえし20°から内がえし20°を行い、それぞれ足関節底屈40°、中間位、足関節背屈10°の3肢位で計測した。長母趾屈筋腱と長趾屈筋腱は運動条件(1)(足関節中間位で足趾中間位から足趾最大伸展)と運動条件(2)(足関節底屈40°、足趾中間位から足関節背屈10°、足趾最大伸展)で計測した。検者間、検者内信頼性(ICC)はおおむね0.7以上と高かった。後脛骨筋腱、腓骨筋腱では足関節底屈位で腱滑走距離が有意に大きく、長母趾屈筋腱、長趾屈筋腱では運動条件(1)の腱滑走距離は運動条件(2)の6割程度だった。本法によって、関節運動に伴う足部の腱滑走距離とそれに対する関節運動や肢位の影響を定量化し得た。(著者抄録)

大腿骨髄内ロッドを使用せずに行ったPS型人工膝関節全置換術後の中期臨床成績

鍋城 尚伍, 寺本 篤史, 岡田 葉平, 神谷 智昭, 山下 敏彦, 渡邉 耕太

東日本整形災害外科学会雑誌 ( 東日本整形災害外科学会 )  32 ( 3 ) 382 - 382  2020.08

後足部内視鏡手術が有効であった色素性絨毛結節性滑膜炎の1例

銭谷 俊毅, 寺本 篤史, 神谷 智昭, 渡邉 耕太, 山下 敏彦

日本足の外科学会雑誌 ( (一社)日本足の外科学会 )  41 ( 1 ) 279 - 281  2020.08

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色素性絨毛結節性滑膜炎(PVNS)の発生部位は膝関節が多く、足部・足関節の発生は比較的まれである。治療法は切除が基本であり、鏡視下手術は低侵襲で有効であるが、open synovectomyと比べると取り残しによる再発の可能性があるとされている。今回、著者らは長母趾屈筋腱鞘から後足部に発生したPVNSに対して後足部内視鏡手術を施行し腫瘍の摘出を行った。症例は45歳女性。1年前より右後足部の腫脹と熱感が出現し近医を受診した。MRIで軟部腫瘍を指摘され、手術目的に当科を紹介受診した。初診時、足関節後方に腫脹を認め、荷重時に疼痛も認めた。可動域制限は認めず、筋力低下や採血での炎症反応の上昇も認めなかった。FHL testは陰性であった。MRIでは距腿関節後方からFHL腱鞘内にかけてT1、T2強調像で低信号の腫瘤像を認めた。van Dijkの方法に準じた後足部内視鏡下に腫瘤切除を施行した。病理診断の結果はPVNSであった。現在、術後半年を経過しているが疼痛は改善しており、再発の徴候も認められていない。(著者抄録)

Lumbar disc degeneration assessment using T2* relaxation time with ultra-short TE.

Hiroyuki Takashima, Mitsunori Yoshimoto, Izaya Ogon, Yoshinori Terashima, Rui Imamura, Yoshihiro Akatsuka, Noriyuki Iesato, Tsutomu Oshigiri, Tomonori Morita, Tsuneo Takebayashi, Makoto Emori, Atsushi Teramoto, Toshihiko Yamashita

Magnetic resonance imaging   73   11 - 14  2020.07  [Refereed]  [International journal]

DOI PubMed

High bone turnover state under osteoporotic changes induces pain-like behaviors in mild osteoarthritis model mice.

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

Journal of bone and mineral metabolism   38 ( 6 ) 806 - 818  2020.07  [Refereed]  [Domestic journal]

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INTRODUCTION: Our previous studies demonstrated that a high bone turnover state under osteoporotic changes decreased the threshold of skeletal pain. Recent studies reported that the incidence of joint pain due to osteoarthritis (OA) in postmenopausal women was higher than that in males even with the same radiographic OA grade. The aim of this study was to evaluate whether a high bone turnover state affects the induction of pain-like behaviors in mild OA model mice. MATERIALS AND METHODS: We established mild OA model mice with accompanying osteoporotic changes by monosodium iodoacetate injection after ovariectomy. We assessed pain-like behaviors by von Frey test and paw-flick test; histological changes in OA joints; the expression of Runx2, Osterix, Osteocalcin, and Rankl; bone micro-architecture by μCT and measured serum tartrate-resistant acid-phosphatase 5b levels in the model mice. RESULTS: Pain-like behaviors in mice with OA and osteoporotic changes were significantly increased in comparison with those in OA mice without osteoporotic changes. The severity of histological OA changes did not differ significantly between the OA mice with and without osteoporotic changes. Bisphosphonate significantly improved pain-like behaviors accompanied with improvement in the high bone turnover state in the OA mice with osteoporosis, while it had no significant effect on pain-like behaviors in the OA mice without osteoporosis. In addition, the improvement was maintained for more than 4 weeks even after the discontinuation of bisphosphonate treatment. CONCLUSION: These results indicated that a high bone turnover state under osteoporotic changes could affect the induction of pain-like behaviors in mild OA model mice.

DOI PubMed

Tibiofibular Space Widening Assessment With a Ball-Tipped Probe in a Syndesmosis Injury Model.

Atsushi Teramoto, Hiroaki Shoji, Ken Anzai, Tomoaki Kamiya, Kota Watanabe, Toshihiko Yamashita

The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons    2020.07  [Refereed]  [International journal]

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Assessment of syndesmotic instability is not precise with existing evaluation methods. This study was conducted to investigate the use of a ball-tipped probe under arthroscopy for quantitative assessment of tibiofibular space widening in a syndesmosis injury model. The test specimens were 5 uninjured ankles from Thiel-fixed cadavers of 2 male subjects and 3 female subjects of mean age of 82.4 years at death. The ball-tipped probe consisted of a metal probe having a ball at each end with diameters ranging from of 1.5 mm to 5.0 mm, in increments of 0.5 mm. The tibiofibular joint was observed arthroscopically as the largest-diameter ball probe as possible was inserted into its anterior third, middle, or posterior third portion with the ankle in natural plantarflexion or under external rotational stress. These measurements were performed for the uninjured ankle and then performed following Bassett's ligament sectioning, anterior inferior tibiofibular ligament sectioning, interosseous membrane distal 15 cm sectioning, or deltoid ligament, and posterior inferior tibiofibular ligament sectioning, with the sections added in this sequence and each followed by a similar assessment. The results of quantitative assessment of tibiofibular space widening with the ball-tipped probe in the syndesmosis injury model under arthroscopy were that the maximum possible diameter of ball probe that could be inserted was 1.5 to 2.0 mm in the uninjured state, 3.0 to 3.5 mm in the sectioned anterior inferior tibiofibular ligament model, and 5.0 mm in the severe-state model. The ball probe can serve as an effective tool for quantitative assessment of the intraoperative instability in cases of syndesmosis injury.

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Hypersensitivity to cold stimulation associated with regional osteoporotic changes in tail-suspended mice.

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

Journal of bone and mineral metabolism   38 ( 4 ) 469 - 480  2020.07  [Refereed]  [Domestic journal]

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INTRODUCTION: Cold intolerance is defined as abnormal pain resulting from exposure to cold stimulation after trauma. However, the pathophysiology remains unclear. We recently demonstrated that regional osteoporotic changes accompanied by high bone turnover were involved in causing pain-like behaviors in the unloaded hind limbs of tail-suspended mice. Bisphosphonate prevented pain-like behaviors and high bone turnover conditions in tail-suspended mice. The aims of this study were to examine the relationship between regional osteoporotic changes and the induction of hypersensitivity to cold stimulation. MATERIALS AND METHODS: The hind limbs of tail-suspended mice were unloaded for 2 weeks. The von Frey test and paw-flick test assessed pain-like behaviors and cold plate test evaluated cold escape behaviors. Furthermore, we examined whether cold hypersensitivity associated with regional osteoporotic changes could be improved by bisphosphonate, TRPV1 and TRPA1 antagonists. RESULTS: Hypersensitivity to cold stimulation was induced more noticeably in the tail-suspended mice, and this effect was related to the increased expression of bone metabolism markers. In addition, the cold hypersensitivity was improved by the resumption of weight bearing and prevented by bisphosphonate or a TRPV1 antagonist, and was accompanied with a decrease in the expression of bone metabolism markers. TRPA1 antagonist significantly improved the cold escape behavior, but had no significant effects on the expression of those markers. CONCLUSION: We demonstrated that the regional osteoporotic changes accompanying a high bone turnover state could be involved in the induction of hypersensitivity to cold stimulation in the tail-suspended mice.

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Biomechanical Analysis of Midfoot Instability After Bifurcate Ligament Injury and Ankle Brace Application: A Cadaveric Study

Takuma Kobayashi, Kota Watanabe, Atsushi Teramoto, Daisuke Suzuki, Mineko Fujimiya, Toshihiko Yamashita

JOURNAL OF FOOT & ANKLE SURGERY ( ELSEVIER SCIENCE INC )  59 ( 4 ) 711 - 715  2020.07  [Refereed]

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This cadaveric study investigated the biomechanical characteristics and stabilizing contribution of the bifurcate ligament using a multidirectional loading method and assessed the stabilizing effect of a brace after injury of the ligament. Eight freshly frozen cadaveric feet were tested for forefoot torque in inversion, eversion, adduction, and plantar flexion. Each band of the bifurcate ligament was transected sequentially, and the contribution of each por-tion of the ligament, as well as the stabilizing effects of the ankle brace, were examined. Stability decreased sub-stantially after calcaneocuboid ligament transection for inversion and adduction loading. Bracing restored some stability, except for the adduction loading direction, for which it had only limited effect. The data indicate that inversion and adduction loading are strongly related to bifurcate ligament injury. The stabilizing effect of the ankle brace may have limited effectiveness for loads under adduction. (c) 2019 by the American College of Foot and Ankle Surgeons. All rights reserved.

DOI

Varus kinematics at knee flexion affect clinical outcomes of unicompartmental knee arthroplasty: Intraoperative navigation-based kinematics evaluation.

Kousuke Shiwaku, Atsushi Teramoto, Satoshi Nuka, Takashi Matsumura, Kota Watanabe, Toshihiko Yamashita

Asia-Pacific journal of sports medicine, arthroscopy, rehabilitation and technology   20   6 - 11  2020.04  [Refereed]  [International journal]

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Background: The aim of the study was to investigate the effects of navigation-based varus or axial rotational alignment through knee flexion on patient reported outcomes or the maximum flexion angle of unicompartmental knee arthroplasty (UKA). Methods: Data were retrospectively collected from 46 knees that underwent UKA for medial unicompartmental knee osteoarthritis. An image-free knee navigation system was used in all cases, and intraoperative varus and axial rotational alignment at every knee flexion angle were recorded before and after implantation. All patients completed the Knee injury and Osteoarthritis Outcome Score (KOOS) at final follow-up. By varus or valgus at 0° knee flexion, the knees were subdivided into two groups (varus at 0° group, varus above the median value; neutral at 0° group, varus equal to or below the median value). By varus or valgus at 90° knee flexion, patients were similarly subdivided into two groups (varus at 90° group; neutral at 90° group). The maximum knee flexion angle was measured 3 months after surgery. Results: There were no differences in the KOOS between the neutral at 0° group and the varus at 0° group. However, the KOOS activity score (79 ± 17 vs 69 ± 16, p = 0.02) and the KOOS total score (72 ± 17 vs 65 ± 15, p = 0.03) of the neutral at 90° group were better than those of the varus at 90° group. The alignment and the maximum knee flexion angle 3 months after surgery were not correlated. Conclusion: Varus at 0° knee flexion and axial rotational alignment did not affect the clinical outcomes of UKA. Patient reported outcomes was better for the neutral knees with less varus at 90° knee flexion than for varus knees.

DOI PubMed

Relevance between Schmorl's Node and Lumbar Intervertebral Disc Degeneration Quantified with Magnetic Resonance Imaging T2 Mapping in Chronic Low Back Pain.

Izaya Ogon, Hiroyuki Takashima, Tomonori Morita, Tsutomu Oshigiri, Yoshinori Terashima, Mitsunori Yoshimoto, Ryunosuke Fukushi, Shutaro Fujimoto, Makoto Emori, Atsushi Teramoto, Tsuneo Takebayashi, Toshihiko Yamashita

Asian spine journal   14 ( 5 ) 621 - 628  2020.03  [Refereed]  [International journal]

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Study Design: Cross-sectional study. Purpose: The purpose of this study was to elucidate the relevance among Schmorl's node (SN), chronic low back pain (CLBP), and intervertebral disc degeneration (IVDD) with the use of magnetic resonance imaging T2 mapping. Overview of Literature: SN may be combined with CLBP and/or IVDD; however, their relationship has not been determined to date. Methods: A total of 105 subjects were included (48 men and 57 women; mean age, 63.2±2.7 years; range, 22-84 years). We analyzed five functional spinal unit levels (L1-S1) and evaluated the T2 values of the anterior annulus fibrosus (AF), nucleus pulposus, and posterior AF. We compared the low back pain (LBP) Visual Analog Scale (VAS) scores and the T2 values in each decade with or without SN. Results: There were no remarkable differences in SN prevalence rate regarding age decade or gender. SNs were more prevalent in the upper 2 levels (70.3%). LBP VAS scores with and without SN were 64.7±4.3 mm and 61.9±2.8 mm, respectively, with no significant differences between the groups (p =0.62). The T2 values of anterior AF with SN were significantly lower than those without SN in patients in their 50s, 60s, 70s, and 80s (p <0.01). Conclusions: SN presence is not itself a risk factor for CLBP; however, it indicates IVDD of the anterior AF in subjects with SN who are ≥50 years old.

DOI PubMed

Denosumab prevents periprosthetic bone mineral density loss in the tibial metaphysis in total knee arthroplasty.

Yasutaka Murahashi, Atsushi Teramoto, Shunsuke Jimbo, Yohei Okada, Tomoaki Kamiya, Rui Imamura, Hiroyuki Takashima, Kota Watanabe, Satoshi Nagoya, Toshihiko Yamashita

The Knee   27 ( 2 ) 580 - 586  2020.03  [Refereed]  [International journal]

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BACKGROUND: Periprosthetic bone quality is one of the most important factors preventing early prosthesis migration and long-term failure. Although denosumab, which binds to the receptor activator of nuclear factor kappa-B ligand (RANKL), has been linked with periprosthetic bone mineral density (BMD), the effectiveness of denosumab against bone loss remains unclear. We hypothesized that denosumab treatment after total knee arthroplasty (TKA) could prevent periprosthetic bone resorption. METHODS: In this prospective cohort study, 28 patients with primary knee osteoarthritis were divided into two groups: denosumab (denosumab and vitamin D) and control (vitamin D only) groups. All patients underwent TKA with the same implant model and received medication after surgery. We used dual-energy X-ray absorptiometry to measure periprosthetic BMD after TKA. RESULTS: In the control group, the BMD of the proximal medial tibia decreased drastically at 12 months after TKA (-19.7%). Denosumab treatment significantly preserved this BMD loss (0.7%). The linear regression analysis revealed that denosumab intervention had the highest significantly positive relationship with BMD. CONCLUSIONS: Our results indicate that denosumab treatment significantly reduces periprosthetic BMD loss, even at the early stages after TKA. This therapeutic strategy may facilitate early stable fixation of the prosthesis which, in turn, may help to prevent early implant migration and reduce the need for revision surgery.

DOI PubMed

Effect of Initial Graft Tension During Anterior Talofibular Ligament Reconstruction on Ankle Kinematics, Laxity, and In Situ Forces of the Reconstructed Graft.

Yuzuru Sakakibara, Atsushi Teramoto, Tetsuya Takagi, Satoshi Yamakawa, Hiroaki Shoji, Yohei Okada, Takuma Kobayashi, Tomoaki Kamiya, Mineko Fujimiya, Hiromichi Fujie, Kota Watanabe, Toshihiko Yamashita

The American journal of sports medicine   48 ( 4 ) 916 - 922  2020.03  [Refereed]  [International journal]

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BACKGROUND: Although a variety of surgical procedures for anterior talofibular ligament (ATFL) reconstruction have been reported, the effect of initial graft tension during ATFL reconstruction remains unclear. PURPOSE/HYPOTHESIS: This study investigated the effects of initial graft tension on ATFL reconstruction. We hypothesized that a high degree of initial graft tension would cause abnormal kinematics and laxity. STUDY DESIGN: Controlled laboratory study. METHODS: Twelve cadaveric ankles were tested with a robotic system with 6 degrees of freedom to apply passive plantarflexion and dorsiflexion motions and a multidirectional load. A repeated measures experiment was designed with the intact ATFL, transected ATFL, and reconstructed ATFL at initial tension conditions of 10, 30, 50, and 70 N. The 3-dimensional path and reconstructed graft tension were simultaneously recorded, and the in situ forces of the ATFL and reconstructed graft were calculated with the principle of superposition. RESULTS: Initial tension of 10 N was sufficient to imitate normal ankle kinematics and laxity, which were not significantly different when compared with those of the intact ankles. The in situ force on the reconstructed graft tended to increase as the initial tension increased. In situ force on the reconstructed graft >30 N was significantly greater than that of intact ankles. The in situ force on the ATFL was 19 N at 30° of plantarflexion. In situ forces of 21.9, 30.4, 38.2, and 46.8 N were observed at initial tensions of 10, 30, 50, and 70 N, respectively, at 30° of plantarflexion. CONCLUSION: Approximate ankle kinematic patterns and sufficient laxity, even with an initial tension of 10 N, could be obtained immediately after ATFL reconstruction. Moreover, excessive initial graft tension during ATFL reconstruction caused excessive in situ force on the reconstructed graft. CLINICAL RELEVANCE: This study revealed the effects of initial graft tension during ATFL reconstruction. These data suggest that excessive tension during ATFL reconstruction should be avoided to ensure restoration of normal ankle motion.

DOI PubMed

Screw Internal Fixation and Ilizarov External Fixation: A Comparison of Outcomes in Ankle Arthrodesis

Atsushi Teramoto, Koji Nozaka, Tomoaki Kamiya, Takeshi Kashiwagura, Hiroaki Shoji, Kota Watanabe, Yoichi Shimada, Toshihiko Yamashita

JOURNAL OF FOOT & ANKLE SURGERY ( ELSEVIER SCIENCE INC )  59 ( 2 ) 343 - 346  2020.03  [Refereed]

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The purpose of this study was to compare the mid-term clinical outcomes between screw internal fixation and Ilizarov external fixation in patients who underwent ankle arthrodesis and to elucidate the differences between the 2 fixation methods. This study investigated 43 ankles in 41 patients who underwent ankle arthrodesis at 1 of the 2 study institutions. There were 15 men and 26 women, and their mean age was 66.2 (range 49 to 87) years. The primary disease included osteoarthritis (OA) (79%), rheumatoid arthritis (RA) (16.3%), and Charcot joint (4.7%). Patients were divided into 2 groups depending on the surgical approach: the screw group (S) and the Ilizarov group (I). The following items were evaluated and compared between the 2 groups: patient characteristics, Tanaka-Takakura classification based on preoperative plain X-ray images, duration of surgery, blood loss, surgical complications, time to start weightbearing, and the Japanese Society of Surgery of the Foot (JSSF) standard rating system for the ankle-hind-foot. Duration of surgery was significantly shorter in the S group (162.3 versus 194.9 min), and the amount of blood loss was also significantly lower in the S group (29.2 versus 97.5 ml). Preoperative JSSF scale was significantly lower in the I group (44.8 versus 33), but postoperative JSSF scale was not significantly different between the 2 groups (82.1 versus 77.9). The S group had satisfactory clinical outcomes with a shorter duration of surgery and smaller amount of blood loss than the I group. However, severe patients in the I group achieved similar treatment outcomes. (C) 2019 by the American College of Foot and Ankle Surgeons. All rights reserved.

DOI

股関節屈曲・伸展運動時における長内転筋の筋スティフネスに及ぼす股関節角度の影響

加藤 拓也, 谷口 圭吾, 神谷 智昭, 寺本 篤史, 渡邉 耕太, 片寄 正樹, 山下 敏彦

日本整形外科学会雑誌 ( (公社)日本整形外科学会 )  94 ( 3 ) S995 - S995  2020.03

Radiographic Evaluation of Medial Opening-Wedge High Tibial Osteotomy Using a New Internal Fixator with a Wedge-Shaped Spacer Block.

Shinichiro Okimura, Atsushi Teramoto, Kota Watanabe, Satoshi Nuka, Tomoaki Kamiya, Toshihiko Yamashita

The journal of knee surgery    2020.01  [Refereed]  [International journal]

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We developed a new internal fixator: a rigid T: -shaped plate with locking screws and wedge-shaped spacer block for high tibial osteotomy. The purpose of the present study was to evaluate the radiographic outcome of opening-wedge high tibial osteotomy (OWHTO) using this new internal fixator. Sixty OWHTOs were performed in patients with medial compartment osteoarthritis and varus deformity (28 males and 23 females). Patients' mean age was 60.4 years. Preoperative and postoperative radiographs were obtained. The paired t-test was used to evaluate the differences over time with respect to radiographic variables. Union of the osteotomy gap was obtained in all patients, and no implant breakage was found. On anterior-posterior radiographs, a significant difference was observed (p < 0.01) between the preoperative and postoperative mean values of femorotibial angles (179.6 ± 3.2 vs. 170.6 ± 2.5 degrees), weight-bearing line ratios (23.8 ± 13.5 vs. 60.5 ± 11.5%), anatomical medial proximal tibial angles (84.8 ± 2.5 vs. 91.0 ± 2.6 degrees), and joint line coverage angles (3.6 ± 2.0 vs. 2.4 ± 1.7 degrees). On lateral radiographs, posterior tibial slopes were 11.5 ± 3.9 degrees preoperatively and 12.2 ± 4.0 degrees postoperatively (p < 0.01), and Insall-Salvati ratios were 1.04 ± 0.12 preoperatively and 1.06 ± 0.13 postoperatively (p = 0.24). Performing OWHTO using a new internal fixator with a wedge-shaped spacer achieves adequate correction of lower limb alignment without implant-related complications. This is a Level IV, case series study.

DOI PubMed

Do We Have Adequate Flexion-extension Radiographs for Evaluating Instability in Patients With Lumbar Spondylolisthesis?

Tomonori Morita, Mitsunori Yoshimoto, Yoshinori Terashima, Katsumasa Tanimoto, Noriyuki Iesato, Izaya Ogon, Tsutomu Oshigiri, Atsushi Teramoto, Makoto Emori, Hiroyuki Takashima, Ryosuke Hirota, Shutaro Fujimoto, Toshihiko Yamashita

Spine   45 ( 1 ) 48 - 54  2020.01  [Refereed]  [International journal]

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STUDY DESIGN: A retrospective cohort study of consecutive patients. OBJECTIVE: To investigate whether adequate flexion-extension was acquired in standard functional radiographs in lumbar spondylolisthesis. SUMMARY OF BACKGROUND DATA: In lumbar spondylolisthesis, flexion-extension radiographs taken in the standing position are most commonly used to evaluate spinal instability. However, these functional radiographs occasionally depend on the patient's effort and cooperation, they can provide different results. METHODS: This study included 92 consecutive patients diagnosed with L4-5 degenerative lumbar spondylolisthesis. We analyzed the flexion-extension radiographs taken with the patient being led by the hand (LH) and those taken without LH (NLH). Sagittal translation (ST), segmental angulation (SA), posterior opening (PO), and lumbar lordosis (LL) were measured on functional radiographs taken in both tests. Then, ST, SA, PO, detection rate of instability, and LL observed in LH were compared with those observed in NLH. Furthermore, the correlation of the difference was evaluated between ST, lumbar angulation, and LL. RESULTS: A relative value of ST was 9.5% ± 4.3% in LH and 5.6% ± 3.3% in NLH, which differed significantly (P < 0.001). SA and PO were also significantly greater in LH than in NLH. The detection rate of instability was 71.7% in LH and 30.4% in NLH (P < 0.001). LL measurement on flexion showed 17.6° ± 13.5° in LH and 28.2° ± 12.2° in NLH, which differed significantly (P < 0.001). However, no significant difference was found in LL on extension between LH and NLH. There was a moderate correlation between the difference of ST, SA, PO, and LL on flexion. CONCLUSION: Flexion with physical assistance was useful for the detection of abnormal lumbar mobility. Taking radiation exposure into consideration, physical assistance such as using a table in front of a patient could lead the similar evaluation of the segmental instability. LEVEL OF EVIDENCE: 2.

DOI PubMed

3D MRI evaluation of morphological characteristics of lateral ankle ligaments in injured patients and uninjured controls.

Atsushi Teramoto, Yoshihiro Akatsuka, Hiroyuki Takashima, Hiroaki Shoji, Yuzuru Sakakibara, Kota Watanabe, Toshihiko Yamashita

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association   25 ( 1 ) 183 - 187  2020.01  [Refereed]  [Domestic journal]

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BACKGROUND: With ultrasonography or 2D magnetic resonance imaging (MRI) of the lateral ankle ligament, it is particularly difficult to show the entire calcaneofibular ligament (CFL). The purpose of this study was to evaluate the morphological characteristics of the lateral ankle ligaments in injured patients and uninjured controls using 3D MRI. METHODS: A total of 64 ankles of 59 healthy volunteers and lateral ligament injury patients (mean age of 32.4 years) were examined. The 64 ankles included a healthy group of 11 ankles, an acute injury group of 12 ankles that underwent MRI a month after injury, and a chronic injury group of 41 ankles that underwent MRI more than 3 months after injury. Using a 3.0-T MRI system, imaging was done with fast imaging employing steady-state acquisition cycled phases. Oblique sagittal images that most clearly depicted the entire anterior talofibular ligament (ATFL) and CFL were prepared manually and evaluated using a workstation. RESULTS: In the healthy group, both the ATFL and CFL were clearly and entirely visualized. The mean width in the central portion was 4.0 ± 1.0 mm in the ATFL and 4.8 ± 0.6 mm in the CFL. 3D MRI in the acute injury group showed findings of diffuse swelling with hyperintensity in the ATFL of all patients. The CFL in 7 of 12 ankles showed findings of diffuse swelling with hyperintensity. In the chronic injury group, morphological abnormalities of the ATFL were seen in 19 of 41 ankles. The ligament signal disappeared in 2 ankles, thinned in 4 ankles, and showed swelling in 13 ankles. Morphological abnormalities of the CFL were seen in 17 of 41 ankles. The ligament signal disappeared in 1 ankle, thinned in 2 ankles, and showed swelling in 14 ankles. CONCLUSION: 3D MRI may be a useful modality to visualize both the ATFL and the CFL.

DOI PubMed

Glossopharyngeal and Hypoglossal Nerve Paralysis Secondary to Prevertebral Phlegmon.

Ryunosuke Fukushi, Izaya Ogon, Yoshinori Terashima, Hiroyuki Takashima, Tsutomu Oshigiri, Noriyuki Iesato, Mitsunori Yoshimoto, Makoto Emori, Atsushi Teramoto, Toshihiko Yamashita

Case reports in orthopedics   2020   3795035 - 3795035  2020  [Refereed]  [International journal]

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A 50-year-old man presented to the clinic with severe neck pain, fever, and difficulty breathing and was subsequently admitted to the local orthopedics department with possible retropharyngeal abscess and pyogenic spondylitis. Antibiotic therapy was initiated; however, due to poor oxygenation, he was referred and transferred to our department and admitted. Magnetic resonance imaging showed signal changes at the left C1/2 lateral atlantoaxial joint, posterior pharynx, longus colli muscle, carotid space, and medial deep cervical region, predominantly on the left side. In addition, despite lymph node enlargement from the posterior pharynx to the deep cervical region, there was no abscess formation. There were no signs of a space-occupying lesion or signal changes in the jugular foramen. One day postadmission, the patient's temperature had risen to 39.1°C and his SpO2 had fallen. His neck pain had also worsened, and emergency surgery was decided. Preoperatively, we suspected retropharyngeal abscess and pyogenic spondylitis. On day 13 postadmission, the patient exhibited dysphagia, deviated tongue protrusion, and the curtain sign. Glossopharyngeal and hypoglossal nerve paralysis were diagnosed. The patient's swallowing functions recovered and he was discharged on day 36. We experienced a case of glossopharyngeal and hypoglossal nerve paralysis secondary to pyogenic cervical facet joint arthritis.

DOI PubMed

Nontraumatic Chronic Subcutaneous Extensor Digitorum Longus Tendon Rupture in a Recreational Runner

Kodai Hamaoka, Kota Watanabe, Tomoaki Kamiya, Atsushi Teramoto, Toshihiko Yamashita

JBJS Case Connector    2020

DOI

A Case of Acute Intervertebral Disc Herniation into Both the Upper and Lower Vertebral Body.

Mitsunori Yoshimoto, Makoto Emori, Atsushi Teramoto, Toshihiko Yamashita

Spine surgery and related research   3 ( 2 ) 193 - 195  2019.04  [Refereed]  [Domestic journal]

DOI PubMed

Kinematics and Laxity of the Ankle Joint in Anatomic and Nonanatomic Anterior Talofibular Ligament Repair: A Biomechanical Cadaveric Study.

Hiroaki Shoji, Atsushi Teramoto, Yuzuru Sakakibara, Tomoaki Kamiya, Kota Watanabe, Hiromichi Fujie, Toshihiko Yamashita

The American journal of sports medicine   47 ( 3 ) 667 - 673  2019.03  [Refereed]  [International journal]

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BACKGROUND: Although it is crucial to accurately identify the anterior talofibular ligament (ATFL) attachment site, it may not be feasible to fully observe the ATFL attachment site during arthroscopic surgery. As a result, the repair position might often be an unintentionally nonanatomic ATFL attachment site. HYPOTHESIS: Anatomic ATFL repair restores kinematics and laxity to the ankle joint, while nonanatomic ATFL repair does not. STUDY DESIGN: Controlled laboratory study. METHODS: Seven normal fresh-frozen human cadaveric ankles were used. The ankles were tested with a 6 degrees of freedom robotic system. The following ankle states were evaluated: intact, ATFL injured, ATFL anatomic repair, and ATFL nonanatomic repair. The ATFL nonanatomic repair position was set 8 mm proximal from the center of the ATFL attachment site of the fibula. For each state, a passive plantarflexion (PF)-dorsiflexion (DF) kinematics test and a multidirectional loading test (anterior forces, inversion moment, and internal rotation moment) were performed. RESULTS: The kinematics and laxity of the anatomic repair were not significantly different from those of the intact state. In nonanatomic repair, the inversion-eversion angle showed significant inversion (3.0°-3.4°) from 5° to 15° of DF, and the internal rotation-external rotation angle showed significant internal rotation (2.0°) at neutral PF-DF versus the intact state. In addition, internal rotation laxity was significantly increased (5.5°-5.8°) relative to the intact state in the nonanatomic repair at 30° and 15° of PF. There were no significant differences in anterior-posterior translation between the repairs. CONCLUSION: Although the anatomic ATFL repair state did not show significant differences in kinematics and laxity relative to the intact state, the nonanatomic ATFL repair state demonstrated significant inversion and internal rotation kinematics and internal rotation laxity when compared with the intact state. CLINICAL RELEVANCE: Nonanatomic repair alters kinematics and laxity from the intact condition.

DOI PubMed

Modified distal tibial oblique osteotomy for osteoarthritis of the ankle: Operative procedure and preliminary results.

Kota Watanabe, Atsushi Teramoto, Takuma Kobayashi, Yuzuru Sakakibara, Hiroaki Shoji, Shinichiro Okimura, Satoshi Nuka, Toshihiko Yamashita

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association   24 ( 2 ) 306 - 311  2019.03  [Refereed]  [Domestic journal]

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BACKGROUND: Low tibial osteotomy is an effective joint-preserving surgery for ankle arthritis. However, poor postoperative wound healing, infection, and delayed or non-union of bones remain significant concerns. We describe a modified distal tibial oblique osteotomy procedure and report preliminary results for varus ankle arthritis. METHODS: The osteotomy path consisted of an oblique doglegged line from the lateral end of the distal tibia to a proximal point about one-third from the lateral edge and continuing along an arc defined by virtual coronal-plane rotation of the doglegged line to the medial edge. After osteotomy, the distal tibial fragment was rotated distally in the coronal plane for realignment while maintaining contact with the proximal tibia and the distal tibial fragment. The resulting wedge-shaped gap was filled with artificial bone blocks and tibial bone projecting medially from rotation. A locking plate was then applied for stabilization. We evaluated 7 ankles from 6 osteoarthritis patients both clinically and radiographically following this procedure. RESULTS: Bone union was achieved within 3 months for all patients. The Japanese Society for Surgery of the Foot ankle-hindfoot scale improved from a mean of 38.4 points preoperatively to 85.7 points at the latest follow-up. No wound healing problems, infections, or nerve disturbances were observed. Multiple radiographic parameters were also improved following the operation. CONCLUSIONS: This procedure maintains close bone contact for better postoperative union, obviates the need for iliac bone harvesting, and reduces tension on medial soft tissue. We believe these modifications are potential advantages for achieving stable results in patients with ankle osteoarthritis.

DOI PubMed

Morphological evaluation of the calcaneofibular ligament in different ankle positions using a three-dimensional MRI sequence.

Yoshihiro Akatsuka, Atsushi Teramoto, Hiroyuki Takashima, Kota Watanabe, Toshihiko Yamashita

Surgical and radiologic anatomy : SRA   41 ( 3 ) 307 - 311  2019.03  [Refereed]  [International journal]

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PURPOSE: Evaluating images of the lateral ligament of the ankle is not easy, and evaluation of the calcaneofibular ligament (CFL) in particular is difficult. We prospectively conducted morphological measurements of the CFL in different ankle positions and obtain basic data for use in functional assessment of the CFL, diagnosis of CFL injury, and determination of treatment effects. METHODS: The subjects were ten healthy volunteers (ten ankles) with a mean age of 27.8 years and no history of ankle disease. Imaging was done using a 3-T magnetic resonance imaging (MRI) machine and fast imaging employing steady-state acquisition cycled phases (FIESTA-C), a three-dimensional (3D) sequence, with the ankle in a neutral position, maximum dorsiflexion, and maximum plantar flexion. 3D images of the CFL, peroneal muscle tendons, fibula, and calcaneus were prepared at a workstation, and morphological measurements of the CFL were made. RESULTS: In all positions, the CFL showed a gently curving course with the peroneal muscle tendons as a fulcrum. The tortuosity angle was significantly smaller in plantar flexion (30.0° ± 7.4°) than in the neutral position (41.7° ± 8.3°). CONCLUSIONS: 3D MRI sequences showed that, in all positions, the CFL curved due to the influence of the peroneal muscle tendons. With maximum plantar flexion, the CFL tortuosity angle was small, which was thought to have been due to the tension in the CFL.

DOI PubMed

Antinociceptive effects of hyaluronic acid on monoiodoacetate-induced ankle osteoarthritis in rats.

Shunsuke Jimbo, Yoshinori Terashima, Atsushi Teramoto, Tsuneo Takebayashi, Izaya Ogon, Kota Watanabe, Tatsuya Sato, Nobutoshi Ichise, Noritsugu Tohse, Toshihiko Yamashita

Journal of pain research   12   191 - 200  2019  [Refereed]  [International journal]

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Purpose: Ankle osteoarthritis (OA) causes significant pain and debilitation; yet, its underlying mechanisms remain unclear. Clinically, hyaluronic acid (HA) is widely used to treat OA. The present study aimed to investigate the roles of HA in pain-related behavior, joint function, swelling, and pathological changes in cartilage in a rat model of monoiodoacetate (MIA)-induced ankle OA. Materials and methods: Male Sprague Dawley rats were assigned to three experimental groups as follows: 1) MIA rats injected with 1 mg MIA in the right tibiotarsal joint for two consecutive days; 2) sham rats injected with saline instead of MIA; and 3) MIA-HA rats injected with HA in the tibiotarsal joint at 7, 14, and 21 days after MIA injection. Joint swelling, range of motion (ROM), and pain-related behavior were evaluated 1 day before and on the 7th, 14th, 21st, and 28th day after MIA or saline injection. Pathological changes in the ankle joint were assessed 28 days after MIA or saline injection. Results: No significant difference in the degree of ankle swelling or ROM reduction was observed between MIA rats and MIA-HA rats. However, compared with those in MIA rats, mechanical and thermal hypersensitivity was significantly reduced and stride length significantly improved in MIA-HA rats. Histologic analysis revealed that cartilage degeneration was significantly suppressed in MIA-HA rats compared with that in MIA rats, reflecting the chondroprotective effects of HA. Conclusion: HA improved pain-related behavior and stride length and suppressed MIA-induced cartilage degeneration. HA may thus inhibit OA progression and suppress peripheral and/or central sensitization.

DOI PubMed

A Case of Ankylosing Spinal Hyperostosis with Massive Hemothorax Due to Thoracic Vertebral Fracture Caused by Minor Trauma.

Ryosuke Hirota, Hideto Irifune, Nobuyuki Takahashi, Makoto Emori, Atsushi Teramoto, Mitsunori Yoshimoto, Masahiro Miyajima, Atsushi Watanabe, Toshihiko Yamashita

Spine surgery and related research   3 ( 3 ) 274 - 276  2019  [Refereed]  [Domestic journal]

DOI PubMed

Phosphorylated Platelet-Derived Growth Factor Receptor-Positive Cells With Anti-apoptotic Properties Accumulate in the Synovium of Patients With Rheumatoid Arthritis.

Takashi Matsumura, Yuki Saito, Tomoyuki Suzuki, Atsushi Teramoto, Yasuhiro Ozasa, Toshihiko Yamashita, Mineko Fujimiya, Takako Saito-Chikenji

Frontiers in immunology ( Frontiers Media {SA} )  10 ( FEB ) 241 - 241  2019  [Refereed]  [International journal]

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Rheumatoid arthritis (RA) is an autoimmune disease caused by inflammation of the synovium and characterized by chronic polyarthritis that destroys bone and cartilage. Fibroblast-like synoviocytes (FLSs) in the synovium of patients with RA can promote cartilage and bone destruction by producing proteins such as matrix metalloproteinases and receptor activator of NF-κB ligand, thereby representing an important therapeutic target for RA. FLSs have several phenotypes depending on which cell surface proteins and adhesion factors are expressed. Identifying the cellular functions associated with different phenotypes and methods of controlling them are considered essential for developing therapeutic strategies for RA. In this study, synovial tissue was collected from patients with RA and control subjects who required surgery due to ligament injury or fracture. Immunohistological analysis was used to investigate the rates of positivity for phosphorylated platelet-derived growth factor receptor-αβ (pPDGFRαβ) and cadherin-11 (CDH11) expression, and apoptosis-related markers were assessed for each cell phenotype. Next, FLSs were isolated in vitro and stimulated with tumor necrosis factor-α (TNF-α) in addition to a combination of PDGF and transforming growth factor (2GF) to investigate pPDGFRαβ and CDH11 expression and the effects of the inhibition of TNF and cyclin-dependent kinase (CDK) 4/6 on FLSs. Immunohistological analysis showed a large percentage of pPDGFRαβ+CDH11- cells in the sub-lining layer (SL) of patients with RA. These cells exhibited increased B-cell lymphoma-2 expression, reduced TNF receptor-1 expression, resistance to cell death, and abnormal proliferation, suggesting a tendency to accumulate in the synovium. Further, in vitro 2GF stimulation of FLSs lowered, whereas 2GF + TNF stimulation increased the pPDGFRαβ/CDH11 ratio. Hypothesizing that FLSs stimulated with 2GF + TNF would accumulate in vivo in RA, we determined the therapeutic effects of TNF and CDK4/6 inhibitors. The TNF inhibitor lowered the pPDGFRαβ/CDH11 ratio, whereas the CDK4/6 inhibitor suppressed cell proliferation. However, a synergistic effect was not observed by combining both the drugs. We observed an increase in pPDGFRαβ+CDH11- cells in the SL of the RA synovium and accumulation of these cells in the synovium. We found that the TNF inhibitor suppressed FLS activity and the CDK4/6 inhibitor reduced cell proliferation.

DOI PubMed

Mid-term Clinical Results of Microendoscopic Decompression for Lumbar Foraminal Stenosis.

Mitsunori Yoshimoto, Noriyuki Iesato, Yoshinori Terashima, Katsumasa Tanimoto, Tsutomu Oshigiri, Makoto Emori, Atsushi Teramoto, Toshihiko Yamashita

Spine surgery and related research   3 ( 3 ) 229 - 235  2019  [Refereed]  [Domestic journal]

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Introduction: There have been several reports on surgical techniques involving microendoscopy or percutaneous endoscopy for treating lumbar foraminal stenosis (LFS). However, no studies have assessed the mid-term clinical results of endoscopic techniques in spite of their relatively long history. In this study, we report 20 consecutive cases of LFS treated by our microendoscopic technique focusing on clinical results with a follow-up of at least two years. Methods: Twenty consecutive cases of LFS treated with microendoscopic decompression were followed up at 1, 2, 6, and 12 months postoperatively and annually thereafter. The patients were 14 males and 6 females, and the mean age at the time of surgery was 64.7 years. The Japanese Orthopaedic Association (JOA) score was used as the clinical outcome index. Results: Of the 20 patients, 16 were monitored successfully for more than 2 years. The follow-up rate was 80.0%, and the mean follow-up period was 66.3 months. The JOA score improved from 13.8 points before surgery to 24.6 points at final follow-up. Revision fusion surgeries were performed in two cases for LFS recurrence. Conclusions: The microendoscopic technique effectively treats LFS.

DOI PubMed

関節リウマチの滑膜リン酸化PDGFR陽性細胞に対するEtanerceptおよびPalbociclibの効果 in vitroにおける検討

松村 崇史, 小笹 泰宏, 寺本 篤史, 山下 敏彦, 齋藤 悠城, 千見寺 貴子, 藤宮 峯子, 鈴木 智之

北海道整形災害外科学会雑誌 ( 北海道整形災害外科学会 )  61 ( 136th suppl ) 28 - 28  2019

TNF阻害薬とCDK4/6阻害薬の併用が関節リウマチの滑膜リン酸化PDGFR陽性細胞に与える影響 in vitroにおける検討

松村 崇史, 小笹 泰宏, 鈴木 智之, 寺本 篤史, 山下 敏彦, 千見寺 貴子, 齋藤 悠城, 藤宮 峯子

北海道整形災害外科学会雑誌 ( 北海道整形災害外科学会 )  61 ( 137th suppl ) 13 - 13  2019

Suture-button fixation and anterior inferior tibiofibular ligament augmentation with suture-tape for syndesmosis injury: A biomechanical cadaveric study.

Hiroaki Shoji, Atsushi Teramoto, Daisuke Suzuki, Yohei Okada, Yuzuru Sakakibara, Takashi Matsumura, Tomoyuki Suzuki, Kota Watanabe, Toshihiko Yamashita

Clinical biomechanics (Bristol, Avon)   60   121 - 126  2018.12  [Refereed]  [International journal]

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BACKGROUND: Suture-button (SB) fixation has been widely performed for syndesmosis injuries, but it has been reported unstable in some biomechanical studies. The purpose of this study was to evaluate the stability of the syndesmosis using SB fixation with anterior inferior tibiofibular ligament augmentation using suture-tape (ST). METHODS: Eight normal fresh-frozen cadaveric legs were used. After initial tests of intact and injured models, SB fixation, SB fixation with ST augmentation, ST augmentation alone, and screw fixation were performed sequentially for each specimen. Loading tests stimulating dorsiflexion, inversion, and external rotation of the ankle joint were performed for each model. The tibiofibular diastasis (TFD) and the fibular rotational angle related to the tibia (FRA) were measured using a magnetic tracking system. FINDINGS: In the injured model, both TFD and FRA increased significantly compared with the intact model in all directions (P < .05). In the SB fixation model, TFD and FRA generally showed significant increases (P < .05, except for TFD in external rotation). In the SB fixation with ST augmentation model and ST augmentation alone, TFD and FRA were not significantly different compared with the intact model (P > .05). In the screw fixation model, FRA with inversion force at the ankle was significantly decreased compared with the intact model (P = .027). INTERPRETATION: SB fixation alone did not provide stability of the syndesmosis, and screw fixation became too rigid compared with the intact model. Using ST augmentation achieved dynamic stability similar to the intact model for syndesmotic injuries.

DOI PubMed

Early surgical management of traumatic dislocation of the tibialis posterior tendon: a case report and review of the literature.

Yuzuru Sakakibara, Hideji Kura, Atsushi Teramoto, Toshihiko Yamashita

Journal of medical case reports   12 ( 1 ) 348 - 348  2018.11  [Refereed]  [International journal]

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BACKGROUND: Traumatic dislocation of the tibialis posterior tendon at the ankle is a rare injury. Some of these cases are misdiagnosed as ankle sprains and are not treated properly. In addition, because the conservative treatment is not as effective as the surgical treatment, it is essential that patients be diagnosed early so that proper surgical treatment can be performed. We report the early surgical management of traumatic dislocation of the tibialis posterior tendon. CASE PRESENTATION: A 44-year-old Japanese man, who was a karate coach, was injured while acting as an umpire in a karate competition. On the same day of his injury, he came to our hospital. He complained of swelling and pain in the medial malleolus. Anterior dislocation of the tibialis posterior tendon was detected upon palpation. Magnetic resonance imaging showed the presence of anterior dislocation of the tibialis posterior tendon with retinaculum injury. Four days after the injury, we performed the Das De procedure as the surgical treatment. Three months after the surgery, the patient was able to participate in karate again. CONCLUSIONS: Dislocation of the tibialis posterior tendon is likely to be misdiagnosed, thus delaying the start of proper treatment. It is essential to diagnose the patient accurately by carefully assessing the physical symptoms manifested. Moreover, magnetic resonance imaging can also be used for better diagnosis, thereby leading to an early and proper surgical treatment.

DOI PubMed

Investigation of factors related to the occurrence of osteochondral lesions of the talus by 3D bone morphology of the ankle

Teramoto, A., Shoji, H., Sakakibara, Y., Kamiya, T., Yamashita, T., Kura, H., Watanabe, K.

Bone and Joint Journal   100B ( 11 ) 1487 - 1490  2018.11  [Refereed]

DOI

Effect of Initial Graft Tension During Calcaneofibular Ligament Reconstruction on Ankle Kinematics and Laxity.

Yuzuru Sakakibara, Atsushi Teramoto, Tetsuya Takagi, Satoshi Yamakawa, Yohei Okada, Hiroaki Shoji, Takuma Kobayashi, Mineko Fujimiya, Hiromichi Fujie, Kota Watanabe, Toshihiko Yamashita

The American journal of sports medicine   46 ( 12 ) 2935 - 2941  2018.10  [Refereed]  [International journal]

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BACKGROUND: Although a variety of surgical procedures for lateral ankle ligament reconstruction have frequently been reported, little is known about the effects of initial graft tension. Purpose/Hypothesis: The purpose was to investigate the effects of initial graft tension in calcaneofibular ligament (CFL) reconstruction. It was hypothesized that a high degree of initial graft tension would cause abnormal kinematics, laxity, and excessive graft tension. STUDY DESIGN: Controlled laboratory study. METHODS: Twelve cadaveric ankles were tested with a 6 degrees of freedom robotic system to apply passive plantarflexion-dorsiflexion motion and multidirectional loads. A repeated-measures experiment was designed with the CFL intact, CFL transected, and CFL reconstructed with 4 initial tension conditions (10, 30, 50, and 70 N). The 3-dimensional path and reconstructed graft tension were simultaneously recorded. RESULTS: The calcaneus in CFL reconstruction with an initial tension of 70 N had the most eversion relative to the intact condition (mean eversion translations of 1.2, 3.0, 5.0, and 6.2 mm were observed at initial tensions of 10, 30, 50, and 70 N, respectively). The calcaneus also moved more posteriorly with external rotation as the initial tension increased. The reconstructed graft tension tended to increase as the initial tension increased. CONCLUSION: Ankle kinematic patterns and laxity after CFL reconstruction tended to become more abnormal as the initial graft tension increased at the time of surgery. Moreover, excessive initial graft tension caused excessive tension on the reconstructed graft. CLINICAL RELEVANCE: This study indicated the importance of initial graft tension during CFL reconstruction. Overtensioning during CFL reconstruction should be avoided to imitate a normal ankle.

DOI PubMed

ACL Function in Bicruciate-Retaining Total Knee Arthroplasty.

Yohei Okada, Atsushi Teramoto, Tetsuya Takagi, Satoshi Yamakawa, Yuzuru Sakakibara, Hiroaki Shoji, Kota Watanabe, Mineko Fujimiya, Hiromichi Fujie, Toshihiko Yamashita

The Journal of bone and joint surgery. American volume   100 ( 17 ) e114  2018.09  [Refereed]  [International journal]

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BACKGROUND: Bicruciate-retaining total knee arthroplasty (BCR-TKA) is attracting attention because of the functional and satisfaction outcomes associated with keeping the anterior cruciate ligament (ACL) intact. However, knowledge of the functional importance of the ACL after BCR-TKA is limited. We performed a biomechanical investigation of ACL function following BCR-TKA compared with that in the intact knee. METHODS: We investigated 8 fresh-frozen human cadaveric knees using a 6-degrees-of-freedom robotic system that allowed natural joint motion. Three knee states-intact knee, BCR-TKA, and BCR-TKA with ACL transection (BCR-TKA + ACLT)-were evaluated. For each knee state, the kinematics during passive flexion-extension motion (from 0° to 120°) and anteroposterior laxity at 0°, 15°, 30°, 60°, and 90° of flexion in response to a 100-N load were investigated. The recorded knee motions of the intact and BCR-TKA knees during each test were repeated after ACLT to calculate the ACL in situ force. RESULTS: The femur in the BCR-TKA group translated posteriorly and rotated externally during passive knee flexion and was in an anterior position compared with the femur in the intact-knee state. After ACLT, the femur translated posteriorly, compared with the BCR-TKA group, at 0° and 10° (p < 0.05). The anteroposterior laxities of the BCR-TKA and intact knees were comparable at all flexion angles and increased 2-fold or more after ACLT (p < 0.01). The ACL in situ force in the BCR-TKA knees was 2-fold to 6-fold higher than that in the intact knees at 0°, 15°, 90°, and 120° during a passive path (p < 0.05) and equivalent to that in the intact knees under anterior loading. CONCLUSIONS: The preserved ACL in the BCR-TKA knees was functional, like the ACL in the intact knees, under anterior tibial loading and contributed to good anteroposterior stability. However, the kinematics and ACL in situ force differed between the intact and BCR-TKA knees during passive flexion-extension movements. CLINICAL RELEVANCE: Surgeons may not be able to prevent overtensioning of the ACL during a standardized BCR-TKA procedure, which could potentially limit range of motion.

DOI PubMed

Radiographic assessment and clinical outcomes after total knee arthroplasty using an accelerometer-based portable navigation device.

Hiroaki Shoji, Atsushi Teramoto, Tomoyuki Suzuki, Yohei Okada, Kota Watanabe, Toshihiko Yamashita

Arthroplasty today ( Elsevier Inc )  4 ( 3 ) 319 - 322  2018.09  [Refereed]  [International journal]

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It has been reported that an accelerometer-based portable navigation device can achieve accurate bone cuts, but there have been few studies of clinical outcomes after total knee arthroplasty (TKA) using such a device. The aim of this study was to evaluate lower limb alignment and clinical outcomes after TKA using an accelerometer-based portable navigation device. Thirty-five patients (40 knees) underwent primary TKAs using an accelerometer-based portable navigation device. Postoperative radiographic assessments included the hip-knee-ankle angle, femoral component angle (FCA), and tibial component angle (TCA) in the coronal plane and the sagittal FCA and sagittal TCA in the sagittal plane. Clinical outcomes were evaluated by the Japanese Orthopedic Association score for osteoarthritic knees, Japanese Knee Osteoarthritis Measure, and the New Knee Society Score. The frequency of outliers (>3 degrees) was 10% for the hip-knee-ankle angle, 8% for FCA, 0% for TCA, 19% for sagittal FCA, and 9% for sagittal TCA. The Japanese Orthopedic Association score and Japanese Knee Osteoarthritis Measure were significantly improved postoperatively. The postoperative New Knee Society Score was 67.2% for symptoms, 50.3% for satisfaction, 58.6% for expectation, and 44.1% for function. TKA using an accelerometer-based portable navigation device achieved good results for both lower limb alignment and clinical outcomes.

DOI PubMed

The distal margin of the lateral malleolus visible under ankle arthroscopy (articular tip) from the anteromedial portal, is separate from the ATFL attachment site of the fibula: A cadaver study.

Atsushi Teramoto, Hiroaki Shoji, Yuzuru Sakakibara, Tomoyuki Suzuki, Kota Watanabe, Toshihiko Yamashita

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association ( Elsevier )  23 ( 3 ) 565 - 569  2018.05  [Refereed]  [Domestic journal]

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PURPOSE: The purpose of this study was to evaluate the relationship between the lateral malleolus view under ankle arthroscopy and the anterior talofibular ligament (ATFL) attachment site. METHODS: Seven normal ankles from Thiel-embalmed cadavers were investigated. Ankle arthroscopy was performed using a 2.7 mm-diameter, 30-degree, oblique-viewing endoscope. An antero-medial portal (AM), a medial midline portal (MML), and an antero-central portal (AC) were created in order, and the ankle arthroscope was inserted. The lateral malleolus was visualized as distally as possible, and the site that appeared to be the distal margin was marked with a 1.5 mm-diameter K-wire. Visualization with arthroscopy was carried out from all portals to mark the distal margin, and the ankle was subsequently exposed to directly measure the distance from the center of the ATFL attachment site at the fibula to each marking. RESULTS: The distances from the ATFL attachment site to the markings made under arthroscopy from the AM, MML, and AC portals were 10.4 ± 2.6 mm, 7.4 ± 1.9 mm, and 7.3 ± 1.9 mm, respectively. Compared to markings made from the MML or AC portal, the marking made from the AM portal was significantly further away from the ATFL attachment site. CONCLUSIONS: A typical ankle arthroscopy portal may not allow complete visualization of the tip of the lateral malleolus, indicating that it may not be feasible to thoroughly observe the ATFL attachment site. It is necessary to perform arthroscopic surgeries with the understanding that the distal margin of the lateral malleolus that appears under ankle arthroscopy is 7-10 mm proximal to the ATFL attachment site.

DOI PubMed

Suture-Button Fixation and Mini-Open Anterior Inferior Tibiofibular Ligament Augmentation Using Suture Tape for Tibiofibular Syndesmosis Injuries

Atsushi Teramoto, Hiroaki Shoji, Yuzuru Sakakibara, Tomoyuki Suzuki, Kota Watanabe, Toshihiko Yamashita

JOURNAL OF FOOT & ANKLE SURGERY ( ELSEVIER SCIENCE INC )  57 ( 1 ) 159 - 161  2018.01  [Refereed]

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Tibiofibular fixation using suture-button implants is an optional method for the surgical treatment of syndesmosis injuries. Although good clinical outcomes have been reported, inadequate stability between the tibia and fibula has also been documented. Thus, suture-button fixation is not considered the reference standard. For surgical treatment of lateral ligament injuries of the ankle, good treatment outcomes have also been reported with ligament augmentation using nonabsorbable suture tape. Ligament augmentation tape with suture-button fixation could also be promising for improved treatment outcomes in syndesmosis injuries. We describe suture-button fixation together with mini-open anterior inferior tibiofibular ligament augmentation using suture tape for treatment of syndesmosis injuries. (C) 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.

DOI PubMed

前距腓靱帯再建術における足関節肢位が足関節キネマティクスと制動性、再建靱帯張力に与える影響

榊原 醸, 寺本 篤史, 高木 鉄也, 山川 学志, 岡田 葉平, 小路 弘晃, 小林 拓馬, 神谷 智昭, 藤宮 峯子, 渡邉 耕太, 藤江 裕道, 山下 敏彦

北海道整形災害外科学会雑誌 ( 北海道整形災害外科学会 )  60 ( 135th suppl ) 25 - 25  2018

前距腓靱帯再建術における初期固定張力が足関節キネマティクスと制動性に及ぼす影響

榊原 醸, 寺本 篤史, 高木 鉄也, 山川 学志, 岡田 葉平, 小路 弘晃, 小林 拓馬, 渡邉 耕太, 藤江 裕道, 山下 敏彦

北海道整形災害外科学会雑誌 ( 北海道整形災害外科学会 )  60 ( 134th suppl ) 38 - 38  2018

足関節固定術におけるスクリュー内固定とイリザロフ創外固定の治療成績比較

寺本 篤史, 野坂 光司, 神谷 智昭, 柏倉 剛, 小路 弘晃, 渡邉 耕太, 島田 洋一, 山下 敏彦

北海道整形災害外科学会雑誌 ( 北海道整形災害外科学会 )  60 ( 135th suppl ) 62 - 62  2018

両十字靱帯温存型TKAにおいてインサート厚がACL及びPCLの張力に与える影響

岡田 葉平, 寺本 篤史, 高木 鉄矢, 山川 学志, 榊原 醸, 小路 弘晃, 渡邉 耕太, 藤宮 峯子, 藤江 裕道, 山下 敏彦

北海道整形災害外科学会雑誌 ( 北海道整形災害外科学会 )  60 ( 134th suppl ) 56 - 56  2018

関節リウマチの滑膜にはアポトーシス抵抗性を示すリン酸化PDGFR陽性細胞が蓄積する

松村 崇史, 千見寺 貴子, 齋藤 悠城, 小笹 泰宏, 鈴木 智之, 寺本 篤史, 山下 敏彦, 藤宮 峰子

北海道整形災害外科学会雑誌 ( 北海道整形災害外科学会 )  60 ( 135th suppl ) 57 - 57  2018

超音波診断装置による足部腱滑走距離の評価 Thiel法固定標本を用いた妥当性検証

谷口 達也, 渡邉 耕太, 寺本 篤史

北海道整形災害外科学会雑誌 ( 北海道整形災害外科学会 )  60 ( 135th suppl ) 60 - 60  2018

Preoperative corrections are required for planning of patient-specific instrumentation in total knee arthroplasty.

Yohei Okada, Atsushi Teramoto, Tomoyuki Suzuki, Yuichiro Kii, Kota Watanabe, Toshihiko Yamashita

The Knee ( Elsevier B.V. )  24 ( 6 ) 1492 - 1497  2017.12  [Refereed]  [International journal]

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BACKGROUND: Patient-specific instrumentation (PSI) is attracting attention as a mechanical method of ensuring the accuracy of osteotomy during total knee arthroplasty (TKA). Few studies have focused on preoperative plans; thus, it is unclear how often initial plans have to be corrected preoperatively and intraoperatively. We investigated the frequency of corrections, the accuracy of intraoperative osteotomy, and postoperative alignment. METHODS: We analyzed 45 knees of 40 patients who underwent TKA using magnetic resonance imaging (MRI)-based PSI. We evaluated the frequency of corrections to preoperative plans and intraoperative corrections for each part. We also evaluated osteotomy error, defined as the difference between the planned and actual thickness of resected bone. Hip-knee-ankle angle (HKA), femoral component angle (FCA), and tibial component angle (TCA) on plain X-rays were evaluated for postoperative alignment. RESULTS: Corrections were made to the initial plans in 91.1% of cases with a mean of 3.3 corrections per knee. Intraoperative corrections were made in 57.8% of cases, with a mean of 0.6 corrections per knee. Mean absolute osteotomy error was around one millimeter, and values were within two millimeters over 80% of cases on most parts except the proximal lateral tibia. In terms of postoperative alignment, HKA was 178.5±1.7°, FCA was 89.0±1.6°, and TCA was 89.4±1.9°. Proportions of outliers were 11.1%, 15.6%, and 20.0%, respectively. CONCLUSIONS: Most of the cases required preoperative corrections for planning of PSI. PSI may be useful for ensuring the accuracy of osteotomy and postoperative alignment.

DOI PubMed

Tibiotalocalcaneal Arthrodesis Using a Soft Tissue-Preserved Fibular Graft for Treatment of Large Bone Defects in the Ankle.

Kota Watanabe, Atsushi Teramoto, Takuma Kobayashi, Izaya Ogon, Yuzuru Sakakibara, Tomoaki Kamiya, Tomoyuki Suzuki, Toshihiko Yamashita

Foot & ankle international ( SAGE PUBLICATIONS INC )  38 ( 6 ) 671 - 676  2017.06  [Refereed]  [International journal]

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BACKGROUND: Pathogenesis of ankle disorders with a large bone defect is varied and treatment for those problems is challenging for orthopaedic surgeons. The aims of this study were to present an operative technique of arthrodesis for the reconstruction of the ankle and hindfoot with a large bone defect using a soft tissue-preserved fibular strut graft and to report outcomes of consecutively treated patients. METHODS: Twelve feet from 11 patients, including feet with aseptic necrosis of the talus and total ankle implant loosening, were treated. Bone defects were filled using iliac bone and/or resected fibula and tibiotalocalcaneal arthrodesis was performed using a retrograde intramedullary nail. A modified transfibular approach was used to expose the affected joint while preserving the lateral to posterior skin and soft tissues on the fibula. The periods of bony fusion and outcomes were radiographically and clinically evaluated. The mean follow-up period was 33.4 months. RESULTS: Bony fusion was achieved within 3 months in all cases. Coronal and sagittal alignments were acceptable, and the mean American Orthopaedic Foot & Ankle Score improved from 53.8 to 75.5 at the final follow-up. All patients graded their results of treatment as "satisfied." CONCLUSION: This procedure did not require special techniques and it should be applicable to complicated cases with large bone defects. High fusion rates that we believe are due to preserving blood supply to the fibular graft can be expected with preservation of the hindfoot height. LEVEL OF EVIDENCE: Level IV, case series.

DOI PubMed

Soleal vein dilatation assessed by ultrasonography is an independent predictor for deep vein thrombosis after major orthopedic surgery.

Kiyoshi Abe, Satoshi Yuda, Kenji Yasui, Ayumi Okubo, Chihiro Kobayashi, Atsuko Muranaka, Hirofumi Ohnishi, Akiyoshi Hashimoto, Atsushi Teramoto, Satoshi Nagoya, Kazufumi Tsuchihashi, Toshihiko Yamashita, Satoshi Takahashi, Tetsuji Miura

Journal of cardiology ( ELSEVIER SCIENCE BV )  69 ( 5 ) 756 - 762  2017.05  [Refereed]  [International journal]

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BACKGROUND: Deep vein thrombosis (DVT) develops after major orthopedic surgery despite the current use of prophylaxis. DVT frequently develops in the soleal vein (SV) and might develop easily at the site of SV dilatation because of blood flow stasis. However, whether preoperative SV dilatation detected by ultrasonography predicts DVT after major orthopedic surgery remains unknown. OBJECTIVE: We examined whether SV dilatation detected by preoperative ultrasonography predicts DVT after major orthopedic surgery. METHODS: Ultrasonography was performed preoperatively and postoperatively in 243 patients with orthopedic diseases (mean age of 67±13 years, 77% women) who underwent total hip arthroplasty (THA, n=180) or total knee arthroplasty (TKA, n=63). Presence of DVT was diagnosed by ultrasonography and SV diameter ≥10mm was defined as SV dilatation. Patients with preoperative DVT were excluded. RESULTS: Sixty-nine patients (28%) developed postoperative DVT. SV dilatation was found in 24 patients (10%), and 16 (67%) of those patients had postoperative DVT. Multivariate logistic regression analysis showed that female gender [odds ratio (OR): 4.09, p=0.004], TKA (OR: 2.52, p=0.011), and SV dilatation (OR: 6.67, p<0.001), but not presence of comorbidities, medications, or plasma d-dimer value, independently predict postoperative DVT. Subgroup analyses according to the operation site showed that female gender (OR: 3.27, p=0.043) and SV dilatation (OR: 3.72, p=0.022) were independent predictors of postoperative DVT in the THA group. SV dilatation (OR: 12.0, p=0.027) was an independent predictor of postoperative DVT also in the TKA group. CONCLUSIONS: In addition to gender and TKA, SV dilatation detected by ultrasonography is an independent predictor of DVT after major orthopedic surgery. Determination of SV diameter by ultrasonography before major orthopedic surgery is useful for assessing the risk of postoperative DVT.

DOI PubMed

Three-dimensional analysis of tarsal bone response to axial loading in patients with hallux valgus and normal feet.

Kota Watanabe, Yasutoshi Ikeda, Daisuke Suzuki, Atsushi Teramoto, Takuma Kobayashi, Tomoyuki Suzuki, Toshihiko Yamashita

Clinical biomechanics (Bristol, Avon) ( ELSEVIER SCI LTD )  42   65 - 69  2017.02  [Refereed]  [International journal]

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BACKGROUND: Patients with hallux valgus present a variety of symptoms that may be related to the type of deformity. Weightbearing affects the deformities, and the evaluation of the load response of tarsal bones has been mainly performed using two-dimensional plane radiography. The purpose of this study was to investigate and compare structural changes in the medial foot arch between patients with hallux valgus and normal controls using a computer image analysis technique and weightbearing computed tomography data. METHODS: Eleven patients with hallux valgus and eleven normal controls were included. Computed tomograms were obtained with and without simulated weightbearing using a compression device. Computed tomography data were transferred into a personal computer, and a three-dimensional bone model was created using image analysis software. The load responses of each tarsal bone in the medial foot arch were measured three-dimensionally and statistically compared between the two groups. FINDINGS: Displacement of each tarsal bone under two weightbearing conditions was visually observed by creating three-dimensional bone models. At the first metatarsophalangeal joint, the proximal phalanges of the hallux valgus group showed significantly different displacements in multiple directions. Moreover, opposite responses to axial loading were also observed in both translation and rotation between the two groups. INTERPRETATION: Weightbearing caused deterioration of the hallux valgus deformity three-dimensionally at the first metatarsophalangeal joint. Information from the computer image analysis was useful for understanding details of the pathology of foot disorders related to the deformities or instability and may contribute to the development of effective conservative and surgical treatments.

DOI PubMed

A Novel Rat Model of Ankle Osteoarthritis Induced by the Application of Monoiodoacetate

Jimbo S, Terashima Y, Takebayashi T, Teramoto A, Ogon I, Watanabe K, Sato T, Ichise N, Tohse N, Yamashita T

J Arthritis   6   260  2017  [Refereed]

The in situ force in the calcaneofibular ligament and the contribution of this ligament to ankle joint stability.

Takuma Kobayashi, Satoshi Yamakawa, Kota Watanabe, Kei Kimura, Daisuke Suzuki, Hidenori Otsubo, Atsushi Teramoto, Mineko Fujimiya, Hiromichi Fujie, Toshihiko Yamashita

Clinical biomechanics (Bristol, Avon) ( ELSEVIER SCI LTD )  40   8 - 13  2016.12  [Refereed]  [International journal]

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BACKGROUND: Numerous biomechanical studies of the lateral ankle ligaments have been reported; however, the isolated function of the calcaneofibular ligament has not been clarified. We hypothesize that the calcaneofibular ligament would stabilize the ankle joint complex under multidirectional loading, and that the in situ force in the calcaneofibular ligament would change in each flexed position. METHODS: Using seven fresh frozen cadaveric lower extremities, the motions and forces of the intact ankle under multidirectional loading were recorded using a 6-degree-of-freedom robotic system. On repeating these intact ankle joint complex motions after the calcaneofibular ligament transection, the in situ force in the calcaneofibular ligament and the contribution of the calcaneofibular ligament to ankle joint complex stability were calculated. Finally, the motions of the calcaneofibular ligament-transected ankle joint complex were recorded. FINDINGS: Under an inversion load, significant increases of inversion angle were observed in all the flexed positions following calcaneofibular ligament transection, and the calcaneofibular ligament accounted for 50%-70% of ankle joint complex stability during inversion. The in situ forces in the calcaneofibular ligament under an anterior force, inversion moment, and external rotation moment were larger in the dorsiflexed position than in the plantarflexed position. INTERPRETATION: The calcaneofibular ligament plays a role in stabilizing the ankle joint complex to multidirectional loads and the role differs with load directions. The in situ force of the calcaneofibular ligament is larger at the dorsiflexed position. This ligament provides the primary restraint to the inversion ankle stability.

DOI PubMed

Cuboid-navicular tarsal coalition in an adolescent female athlete

Tomoaki Kamiya, Kota Watanabe, Atsushi Teramoto, Toshihiko Yamashita

JBJS Case Connector ( Lippincott Williams and Wilkins )  5 ( 4 ) e93  2015.10  [Refereed]

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Case: A fourteen-year-old female shot-putter developed midfoot pain with activity that initially responded to nonoperative care. However, the symptoms subsequently returned and became persistent. Advanced imaging demonstrated a fibrous cuboid-navicular tarsal coalition. Surgical resection of the tarsal coalition was performed when the patient was seventeen years old, and she returned to sports activities postoperatively with no pain. Conclusion: Although fibrous cuboid-navicular tarsal coalition is a very rare condition, it should be considered as one cause of persistent midfoot pain in an adolescent athlete. Surgical resection of the tarsal coalition can lead to a resolution of symptoms.

DOI PubMed

Biomechanical stability of open-wedge high tibial osteotomy: comparison of two locking plates

Watanabe K, Kamiya T, Suzuki D, Otsubo H, Teramoto A, Suzuki T, Yamashita T

Open Journal of Orthopedics   4   257 - 262  2014.10  [Refereed]

Subtalar joint stress imaging with tomosynthesis.

Atsushi Teramoto, Kota Watanabe, Hiroyuki Takashima, Toshihiko Yamashita

Foot & ankle specialist ( SAGE Publications Ltd )  7 ( 3 ) 182 - 4  2014.06  [Refereed]  [International journal]

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UNLABELLED: The purpose of this study was to perform stress imaging of hindfoot inversion and eversion using tomosynthesis and to assess the subtalar joint range of motion (ROM) of healthy subjects. The subjects were 15 healthy volunteers with a mean age of 29.1 years. Coronal tomosynthesis stress imaging of the subtalar joint was performed in a total of 30 left and right ankles. A Telos stress device was used for the stress load, and the load was 150 N for both inversion and eversion. Tomographic images in which the posterior talocalcaneal joint could be confirmed on the neutral position images were used in measurements. The angle of the intersection formed by a line through the lateral articular facet of the posterior talocalcaneal joint and a line through the surface of the trochlea of the talus was measured. The mean change in the angle of the calcaneus with respect to the talus was 10.3 ± 4.8° with inversion stress and 5.0 ± 3.8° with eversion stress from the neutral position. The result was a clearer depiction of the subtalar joint, and inversion and eversion ROM of the subtalar joint was shown to be about 15° in healthy subjects. LEVELS OF EVIDENCE: Diagnostic, Level IV.

DOI PubMed

Recurrent knee arthritis diagnosed as juvenile idiopathic arthritis with a 10-year asymptomatic period after arthroscopic synovectomy: a case report.

Atsushi Teramoto, Kota Watanabe, Yuichiro Kii, Miki Kudo, Hidenori Otsubo, Takuro Wada, Toshihiko Yamashita

Journal of medical case reports   7   166 - 166  2013.06  [Refereed]  [International journal]

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INTRODUCTION: Juvenile idiopathic arthritis is a chronic inflammatory disease associated with arthritis of unknown etiology that begins before the age of 16 and persists for longer than 6 weeks. The frequency of recurrence after arthroscopic synovectomy in patients with oligoarthritis juvenile idiopathic arthritis was reported to be lower than that in patients with polyarthritis. However, recurrence in cases of oligoarthritis after arthroscopic knee synovectomy was shown to be 67% in one recent study and, furthermore, a shorter period free from recurrence was also reported after synovectomy. Here we report a child who suffered recurrent knee arthritis with a 10-year asymptomatic period after arthroscopic synovectomy. CASE PRESENTATION: A 12-year-old Japanese girl presented with normal birth and developmental history. At the age of 2 years she experienced joint swelling in both knees. Her symptoms continued and arthroscopic synovectomy was eventually performed. During the operation, rice bodies and thickening of the synovial membrane were observed; however, no definitive diagnosis was made. After a 10-year asymptomatic period, knee joint swelling recurred on one side without any cause. Arthroscopic synovectomy was beneficial in reducing the symptoms and in diagnosis. CONCLUSIONS: Children who suffer prolonged joint swelling have a risk of juvenile idiopathic arthritis. Even if the symptoms heal and no definite diagnosis is made at the first treatment, informed consent is needed to make the patients understand the future risk of recurrent arthritis after even lengthy asymptomatic periods.

DOI PubMed

Epidemiological Study and Clinical Characteristics of Poliomyelitis Survivors in Japan

Atsushi Teramoto, Kazutoshi Yokogushi, Megumi Toki, Takanori Murakami, Toshihiko Yamashita

JOURNAL OF PHYSICAL THERAPY SCIENCE ( SOC PHYSICAL THERAPY SCIENCE )  25 ( 4 ) 375 - 378  2013.04  [Refereed]

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[Purpose] The aim of this study was to examine factors related to the development and frequency of post-polio syndrome (PPS) based on the results of a survey of polio survivors. [Subjects and Methods] Characteristics of 265 polio survivors were evaluated on the basis of the results of a self-administered survey comprising 48 items. The frequency of PPS and factors that influence its development were evaluated. [Results] PPS was found to affect 25.7% of the polio survivors who responded to our survey. In addition to musculoskeletal symptoms, polio survivors were found to exhibit general physical and psychiatric symptoms such as sensitivity to cold, respiratory symptoms, dysphagia, sleep disorders, and depression tendencies. In addition, the polio survivors with PPS were restricted in daily living activities such as work and social participation. [Conclusion] Weight gain after adulthood and overuse of muscles were identified as risk factors for the development of PPS. Support systems such as health consultations and direct health screenings are needed to deal with the physical and social consequences of PPS.

DOI

Comparison of different fixation methods of the suture-button implant for tibiofibular syndesmosis injuries.

Atsushi Teramoto, Daisuke Suzuki, Tomoaki Kamiya, Takako Chikenji, Kota Watanabe, Toshihiko Yamashita

The American journal of sports medicine ( SAGE PUBLICATIONS INC )  39 ( 10 ) 2226 - 32  2011.10  [Refereed]  [International journal]

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BACKGROUND: Suture-button fixation for tibiofibular syndesmosis injuries is a relatively new surgical technique thought to provide semirigid dynamic stabilization. However, adequate information is still not available and there are controversies as to whether it provides enough fixation for syndesmosis injuries. HYPOTHESIS: Optimally directed suture-button fixation brings physiologic dynamic stabilization of the ankle syndesmosis. STUDY DESIGN: Controlled laboratory study. METHODS: Stabilization of the ankle syndesmosis fixed by a suture-button construct was examined using 6 normal fresh-frozen cadaver legs. After initial tests of intact and injured models, suture-button fixation and screw surgical techniques were performed sequentially for each specimen, with single suture-button fixation, double suture-button fixation, anatomic suture-button fixation, and metal screw. Anterior and medial traction forces, as well as external rotation force, were applied to the tibia; the diastasis of the syndesmosis and the rotational angle of the fibula related to the tibia were measured using a magnetic tracking system. RESULTS: Each traction and rotation force significantly increased the diastasis and fibular rotational angles in the created injury models. With single fixation, the diastases increased significantly compared with the intact model with an anterior traction force (P < .001), a medial traction force (P = .005), and an external rotation force (P = .015). The fibular rotational angles increased significantly with a medial traction force (P = .005) and an external rotation force (P < .001). With double fixation, the diastases increased significantly with a medial traction force (P = .004) and an external rotation force (P = .012). The fibular rotational angles increased significantly with a medial traction force (P = .035) and an external rotation force (P = .002). With anatomic fixation, there were no significant differences compared with the intact model. With the metal screw, the diastases decreased significantly with an external rotation force (P = .037). CONCLUSION: Neither single nor double fixation for syndesmosis injuries provided multidirectionally stabilizing syndesmosis. Anatomic fixation directed from the posterior cortex of the fibula to the anterolateral edge of the tibia allowed dynamic stabilization of intact cadaver specimens. The metal screw provided very rigid fixation. CLINICAL RELEVANCE: Optimal direction of the suture button can provide adequate stabilization of the ankle and could benefit athletes with syndesmosis injuries.

DOI PubMed

Does distal tibiofibular joint mobilization decrease limitation of ankle dorsiflexion?

Misaki Fujii, Daisuke Suzuki, Eiichi Uchiyama, Takayuki Muraki, Atsushi Teramoto, Mitsuhiro Aoki, Shigenori Miyamoto

Manual therapy ( CHURCHILL LIVINGSTONE )  15 ( 1 ) 117 - 21  2010.02  [Refereed]  [International journal]

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Limitation of ankle motion is in many cases treated by joint mobilization (JM), a kind of manual physical therapy technique. Until now, the JM approach has mainly focused on the talocrural joint, with less attention to the distal tibiofibular joint. We applied cyclic loading to the lateral malleolus as in JM in order to clarify the relationship between the dorsiflexion angle and the excursion of the lateral malleolus. Seven normal, fresh-frozen cadaver legs were used. To each specimen, cyclic loading with a 30N force was applied 1000 times to the lateral malleolus at a speed of 15N/s. The displacement of the lateral malleolus was measured with a magnetic tracking system. The maximum dorsiflexion angle was measured before and after cyclic loading. After the first 100 and 1000 times of cyclic loading, the tibia was displaced 0.44+/-0.30mm and 0.75+/-0.36mm, respectively, and the fibula was displaced 0.44+/-0.28mm and 0.92+/-0.39mm, respectively. The average dorsiflexion angle increased from 14.36+/-7.51 degrees to 16.74+/-7.21 degrees after cyclic loading (P<0.05). Movement of the distal tibiofibular joint led to a significant increase in the range of ankle dorsiflexion. These results suggest that tibiofibular JM would be effective for limitation of ankle dorsiflexion.

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Glenoid morphology in reverse shoulder arthroplasty: Classification and surgical implications

Mark A. Frankle, Atsushi Teramoto, Zong-Ping Luo, Jonathan C. Levy, Derek Pupello

JOURNAL OF SHOULDER AND ELBOW SURGERY ( MOSBY-ELSEVIER )  18 ( 6 ) 874 - 885  2009.11  [Refereed]

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Background: A great challenge in reverse shoulder arthroplasty is the wide variation in glenoid morphology that adds uncertainties in glenoid component placement. The purpose of this study was to classify glenoid morphology and examining its effect on possible glenoid component fixation.Materials and methods: The morphology of 216 glenoids was classified into normal and abnormal with subgroups defined by erosion sites. Six anatomic and 2 surgical parameters were compared among the classified groups. Plain radiographs or 2-dimensional (21)) computed tomography (CT) scans showed 62.5% of glenoids were normal and 37.5% were abnormal, with further subclassification of abnormal in posterior (17.6%), superior (9.3%), global (6.5%), and anterior (4.2%) erosions using 3D CT models.Results: The standard centerline became significantly shorter in abnormal (19.6 +/- 9.1 mm) than in normal (28.6 +/- 4.1 mm, P < .0001) glenoids. Alternatively, the spine centerline provided longer bony distance in abnormal glenoids (34.9 +/- 17.0 mm). Abnormal glenoid morphology also reduced peripheral screw placement area by 42% and limited it to the anterior and inferior quadrants.Discussion: Glenoid morphology of the rotator cuff deficient shoulder can be reliably classified using this classification system consisting of normal and abnormal, which included 4 subgroups of posterior, superior, global, and anterior erosions.Conclusions: Abnormal glenoid morphology was shown to have a significant effect on anatomical and surgical factors which can necessitate adjustments in surgical technique for reverse shoulder arthroplasty.Level of evidence: Basic Science Study (C) 2009 Journal of Shoulder and Elbow Surgery Board of Trustees.

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Temporary tendon strengthening by preconditioning.

Atsushi Teramoto, Zong-Ping Luo

Clinical biomechanics (Bristol, Avon) ( ELSEVIER SCI LTD )  23 ( 5 ) 619 - 22  2008.06  [Refereed]  [International journal]

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BACKGROUND: Tendon is frequently injured structure in sports activities. Stretching before activities has been recommended to prevent athletes from injuries. Clinical studies reported that stretching had effects to reduce passive muscle stiffness and leads to an increased range of motion. Recent biomechanical studies suggested that stretching might also temporary affect tensile property of tendon. However, the detailed information regarding optimizing this preconditioning has not been defined. The purpose of this study is to investigate time-dependent effect of preconditioning on the mechanical strength of tendon, and to determine an optimal duration of preconditioning for tendon strengthening. METHODS: Forty eight Achilles tendons from euthanized Sprague-Dawley rats were used. The specimens were randomly divided into six groups. The specimens in control group were tested to failure without preconditioning. In preconditioning groups, 30, 100, 300, 600, and 1000 s stretching at 2% strain were performed. The specimens were subsequently loaded to failure. FINDINGS: Preconditioning from 30s to 600 s significantly increased the ultimate failure load and strength. Ultimate failure load was significantly different between control and each of 30, 100, 300, and 600 s stretching groups (P=0.033, 0.031, 0.004, and 0.029, respectively). There was no significant difference between control and 1000 s stretching group. Ultimate strength was significantly different between control and each of 30, 100, 300, and 600 s stretching groups (P=0.007, 0.008, <0.001, and 0.006, respectively), but not between control and 1000 s stretching group. INTERPRETATION: The time-dependent effect of preconditioning on the mechanical strength of tendon may be due to progressive collagen fibre recruitment and subsequent fatigues at the micro-level.

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Three-dimensional analysis of ankle instability after tibiofibular syndesmosis injuries: a biomechanical experimental study.

Atsushi Teramoto, Hideji Kura, Eiichi Uchiyama, Daisuke Suzuki, Toshihiko Yamashita

The American journal of sports medicine ( SAGE PUBLICATIONS INC )  36 ( 2 ) 348 - 52  2008.02  [Refereed]  [International journal]

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BACKGROUND: Rupture of the distal tibiofibular syndesmosis commonly occurs with extreme external rotation. Most studies of syndesmosis injuries have concentrated only on external rotation instability of the ankle joint and have not examined other defects. HYPOTHESIS: Syndesmosis injuries cause multidirectional ankle instability. STUDY DESIGN: Controlled laboratory study. METHODS: Ankle instability caused by distal tibiofibular syndesmosis injuries was examined using 7 normal fresh-frozen cadaveric legs. The anterior tibiofibular ligament, interosseous membrane, and posterior tibiofibular ligament, which compose the distal tibiofibular syndesmosis, were sequentially cut. Anterior, posterior, medial, and lateral traction forces, as well as internal and external rotation torque, were applied to the tibia; the diastasis between the tibia and fibula and the angular motion among the tibia, fibula, and talus were measured using a magnetic tracking system. RESULTS: A medial traction force with a cut anterior tibiofibular ligament significantly increased the diastasis from 1.1 to 2.0 mm (P = .001) and talar tilt angles from 9.6 degrees to 15.2 degrees (P < .001). External rotation torque significantly increased the diastasis from 0.5 to 1.8 mm (P = .009) with a complete cut; external rotation torque also significantly increased rotational angles from 7.1 degrees to 9.4 degrees (P = .05) with an anterior tibiofibular ligament cut. CONCLUSION: Syndesmosis injuries caused ankle instability with medial traction force and external rotation torque to the tibia. CLINICAL RELEVANCE: Both physicians and athletes should be aware of inversion instability of the ankle joint caused by tibiofibular syndesmosis injuries.

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Effect of cyclic preconditioning on the failure load, strength, and stiffness of multiple rat tendons and ligaments

Atsushi Teramoto, Wei-Ren Su, Zong-Ping Luo

Journal of Musculoskeletal Research   11 ( 2 ) 89 - 95  2008  [Refereed]

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Purpose: Ligaments and tendons are frequently injured structures in sports activities. It has been well known that stretching before activities largely warms up muscles and prevents athletes from getting injuries. Recent studies have suggested that the tendon might also benefit from such preconditioning stretching however, it is unclear whether the same benefit exists for all ligament and tendon structures. We hypothesized that the effect of preconditioning on mechanical strength is dependent on the type of ligament or tendon. Methods: Twenty-six anterior cruciate ligaments (ACLs), 22 medial collateral ligaments (MCLs), 20 patellar tendons (PTs), and 18 Achilles tendons (ATs) from euthanized mature Sprague-Dawley rats were used. The specimens in the control group were tested for load to failure without preconditioning. In the preconditioning group, 150 sinusoid cyclic stretchings were performed the specimens were then consecutively loaded to ultimate failure. Results: Preconditioning significantly increased the mechanical strengths of the MCL, PT, and AT (p = 0.04, p = 0.006, and p = 0.002, respectively) however, it did not affect that of the ACL. There were no significant differences among the mechanical strengths of MCL, PT, and AT in the preconditioning group. Conclusion: Preconditioning significantly enhanced all ligament and tendon structures, except for the ACL. The results suggest that optimal preconditioning exists, but depends on the specific ligament or tendon. Different preconditioning strategies may be needed for different ligament and tendon structures in order to gain maximal protection from injuries. © 2008 World Scientific Publishing Company.

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