記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Post-hamstring-injury residual pain may persist despite muscle-tissue healing and impairs athletes seeking early full recovery. Given their unclear cause, recent attention has focused on the role of fascial dysfunction and a method to restore fascial mobility, namely, hydrorelease (HR), involving the ultrasound (US)-guided injection of saline. We evaluated the clinical efficacy of HR for treating residual pain and ascertained the underlying pathological mechanisms. Methods: Seven patients (aged 17-49 years) with residual pain ≥8 weeks after hamstring injury were included. All exhibited localized tenderness and US findings of fascial thickening around the aponeurotic fascia (APF). HR with 6.0 mL saline-lidocaine solution (0.17% lidocaine) was performed and targeted the peri-APF loose connective tissues. Pain was evaluated using a numerical rating scale (NRS) before and after HR. Passive straight leg raise (SLR) was used to assess tightness. Results: Post-HR, the mean NRS score significantly decreased from 10 to 0.86 (p = 0.017). Four patients required a single HR session; three required two-four sessions. Post-HR, the tightness of all patients improved. Short-axis US of the posterior thigh revealed APF fascial thickening in the area of tenderness, including the posterior femoral cutaneous nerve (PFCN). No adverse events or recurrence occurred during the follow-up (mean: 6.6 months). Conclusions: HR targeting the peri-PFCN-APF effectively reduced residual pain following hamstring injury. These findings support the concept of "Perineural fascial pain"-a pathology wherein persistent pain originates not from direct nerve damage or classical myofascial pain syndrome but rather from the dysfunction of the surrounding fascia.

DOI： 10.3390/jfmk10030318

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Evaluation of medial meniscal extrusion (MME) under physiological loads is crucial because of the influence of MME on meniscal function. Reducing the MME is essential for meniscal function. Few studies have compared the extent of MME in cases of complete radial tears of the posterior segment of the medial meniscus (MM) treated using basic meniscal repair techniques: the inside-out and all-inside techniques. PURPOSE: To compare the extent of MME after the treatment of complete radial tears of the posterior segment using inside-out and all-inside meniscal repair techniques in a cadaveric model. STUDY DESIGN: Controlled laboratory study. METHODS: Six fresh-frozen human cadaveric knees were subjected to a compression load of 250 N using a 6 degrees of freedom robotic system under ultrasound evaluation. The MME was evaluated at 30° and 90° knee flexion in 4 meniscal conditions: (1) intact; (2) complete radial tear in the posterior segment of the MM; (3) inside-out repair technique; and (4) all-inside repair technique using 1 horizontal suture. Conditions 3 and 4 were performed on the same knee in a randomized order. Measurements were obtained at the center of the superficial medial collateral ligament (MCL) (central image) and 1 cm posterior to the superficial MCL (posterior image). Statistical analysis was conducted using a 2-factor repeated-measures analysis of variance with Bonferroni post-hoc correction, with significance level set at P < .05. RESULTS: The amount of MME under compression load after inside-out repair was significantly lower than that after all-inside repair (mean ± SD values for the central image: 30°, 1.93 ± 0.26 mm vs 2.45 ± 0.34 mm; 90°, 2.02 ± 0.29 mm vs 2.53 ± 0.42 mm; for the posterior image: 30°, 1.98 ± 0.30 mm vs 2.43 ± 0.35 mm; 90°, 2.45 ± 0.26 mm vs 3 ± 0.42 mm; P < .001 for all comparisons). CONCLUSION: Although the inside-out repair technique reduced the amount of MME to a greater extent than the all-inside repair technique using a single horizontal stitch for MM posterior segment tears, neither technique was able to reduce MME to the same level as that of the intact state; furthermore, the change in MME was relatively small. CLINICAL RELEVANCE: The findings indicate that the inside-out repair technique should be used to repair complete radial tears in the posterior segment of the MM.

DOI： 10.1177/23259671251356695

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記述言語：英語  

DOI： 10.1186/s12891-025-08885-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To investigate whether inducing valgus alignment and shifting the load laterally through high tibial osteotomy (HTO) alone decreases the extent of medial meniscus extrusion (MME) in the setting of medial meniscus posterior root tear (MMPRT) using ultrasound evaluation. METHODS: Eight fresh-frozen human cadaveric knee specimens were tested using a 6-degree-of-freedom robotic testing system and ultrasound. Each specimen was tested in 5 conditions: (1) intact, (2) MMPRT, (3) medial meniscus repair (MMR), (4) combined medial open-wedge HTO + MMR, and (5) HTO + MMPRT. Measurements were obtained over the medial collateral ligament (central image) and posterior to the medial collateral ligament (posterior image) with a 250-N axial load at 0°, 30°, and 90° of knee flexion. Statistical analysis was performed using a 2-factor repeated-measures analysis of variance. RESULTS: MME was significantly greater in HTO + MMPRT (0°: 2.44 ± 0.41 mm, 30°: 2.47 ± 0.37 mm, 90°: 2.41 ± 0.28 mm) than HTO + MMR in central images (mean difference +0.83 mm, P < .001). No significant difference was found between HTO + MMPRT and MMPRT in MME. MMR had significantly less MME than MMPRT (mean difference -0.58 mm, P < .001, posterior image at 0° and central image at 90°, P = .002). HTO + MMR showed significantly less MME than MMR alone at 30° and 90° of knee flexion in the central image (30°: -0.38 ± 0.05 mm, 90°: -0.45 ± 0.06 mm, P < .001) and 90° of knee flexion in the posterior image (-0.38 ± 0.08 mm, P = .004). CONCLUSIONS: HTO alone did not decrease MME in the setting of MMPRT, while MMR alone decreased MME after MMPRT. Additionally, HTO + MMR decreased MME after MMPRT compared to MMR alone, although the clinical significance was uncertain. CLINICAL RELEVANCE: The findings of this study provide clinicians with valuable insights for improving MME. HTO alone does not decrease MME in cases of MMPRT.

DOI： 10.1016/j.arthro.2024.06.038

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Each band of the deltoid ligament cooperatively contributes to stability of the medial side of the ankle joint. Investigating the function of each band of the deltoid ligament is essential to assess abnormalities and develop treatment options. PURPOSE: To evaluate the changes in ankle kinematics when each band of the deltoid ligament is injured and to measure the in situ force of each ligamentous band in intact ankle kinematics. STUDY DESIGN: Descriptive laboratory study. METHODS: A total of 8 healthy fresh-frozen cadaveric legs were examined by applying forces through eversion and external rotation of the ankle joint using a 6 degrees of freedom robotic system. The deltoid ligament was separated into 6 discrete bands: tibionavicular ligament, tibiospring ligament, tibiocalcaneal ligament (TCL), anterior tibiotalar ligament, superficial posterior tibiotalar ligament (sPTTL), and deep posterior tibiotalar ligament; the bands were then sequentially transected. A loading test was performed in each model, and the changes in ankle motion and in situ force of each ligamentous band were measured using the robotic system. RESULTS: When an eversion force was applied to the intact ankle, the in situ force of the sPTTL was 21.6 N in dorsiflexion and that of the TCL was 19.4 N in plantarflexion, both of which were significantly greater than those of the other ligamentous bands. Additionally, the amount of eversion under eversion loading increased significantly by 3.3° with sPTTL resection in dorsiflexion and by 4.2° with TCL resection in plantarflexion. CONCLUSION: The TCL and sPTTL play important roles among the ligamentous bands of the deltoid ligament. The sPTTL played a more significant role in ankle dorsiflexion, whereas the TCL played a more significant role in ankle plantarflexion. CLINICAL RELEVANCE: The TCL and sPTTL should receive attention in the treatment of deltoid ligamentous injuries.

DOI： 10.1177/23259671251327406

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: We aimed to investigate the influence of hydrorelease (HR) on the gliding resistance force between the aponeurotic fascia and epimysial fascia of tibialis anterior and between two epimysial fasciae of tibialis posterior and flexor digitorum longus using a biomechanical testing system. METHODS: In this cadaveric comparative study, 12 paired legs amputated above the knee joint from six fresh-frozen specimens were divided into two groups. The distal insertions of the target tendons of the tibialis anterior and posterior were detached and sutured to a force gauge for tension measurement during tendon pull. These tendons were representatives of the layer between the aponeurotic and epimysial fasciae of the tibialis anterior and between the epimysial fasciae of the tibialis posterior and flexor digitorum longus. For the baseline, the position where the tension of the target tendon was approximately 15 N was determined to eliminate creep. In the HR group, the baseline test position was replicated, and force was measured. The intervention was an HR injection between the specified fascial layers. The main outcome was the gliding resistance force between the aponeurotic and epimysial fasciae and between two epimysial fasciae. RESULTS: The resistance force between the aponeurotic and epimysial fasciae in the HR group was 6.4% lower than that in the control group (P = 0.02). The resistance force between two epimysial fasciae in the HR group was 4.3% lower than that in the control group (P < 0.01). CONCLUSIONS: The gliding resistance force significantly decreased after HR in the layer between the aponeurotic and epimysial fasciae and between two epimysial fasciae in this cadaveric study.

DOI： 10.1186/s12891-025-08533-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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： 10.1177/23259671241308854

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: The clinical benefits of high tibial osteotomy (HTO) in patients with mild varus deformity with degenerative medial meniscal tear (DMMT) remain unclear. This study aimed to compare clinical outcomes among middle-aged patients with mild varus deformity who underwent arthroscopic meniscal repair and HTO for DMMT. MATERIALS AND METHODS: In this retrospective study, patients who underwent isolated arthroscopic meniscal repair via the inside-out technique and those who underwent medial opening-wedge HTO were assigned to group M and H, respectively. The inclusion criteria were: an age of 40-65 years; percentage of mechanical axis of 30-50% measured using full-length weight-bearing anteroposterior radiographs; Kellgren-Lawrence grade ≤ 2; minimum postoperative two-year follow-up; and HTO correction angle < 10°. Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and minimal clinically important difference achievement rate for the KOOS subscales preoperatively and at the final follow-up. RESULTS: Group M and H included 21 and 41 patients, respectively. The median ages were 53 and 58 years in groups M and H, respectively. In group H, 24 cases underwent meniscal repair. No significant differences in all KOOS subscales were found preoperatively. However, the median KOOS symptoms subscale in group H (89.3) was significantly better than that in group M (80.4) at the final follow-up (p = 0.04). CONCLUSION: The main finding of the study indicated that KOOS symptoms after HTO were superior to those after isolated arthroscopic meniscal repair for DMMT. HTO might be a potentially useful treatment for DMMT in middle-aged patients with mild varus deformity, even with a small correction angle. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.

DOI： 10.1007/s00402-025-05772-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The relationship between human anatomy on ultrasonography (US) and dissection is unclear.Therefore, we investigated the precise location of a solution injected into eight legs from five fresh-frozen specimens between the fascial layers of two aponeurotic fascial (APF) regions using US. METHODS: The US-guided injection target points were the fascial lata-distal, crural fascia-proximal, and crural fascia-distal. The operator searched the optimal visualization area of two close fascial layers of the two APF regions; 2.5 mL of 0.9% saline was injected through US guidance. The layers with the solution were categorized as above the APF (between the superficial fascia and APF), intra-APF, between the APF and epimysium (EPI), or intra-muscle (under the EPI). RESULTS: A small amount of solution was identified within the intra-APF region, whereas a substantial amount was observed above the APF, between the APF and EPI, and intramuscularly. Regarding the fascia lata-distal and crural fascia-distal, a substantial volume of solution was observed between the APF and EPI in all cases. For the crural fascia-proximal, the solution was observed above the APF in 25% of cases and intramuscularly in 75% of cases. CONCLUSIONS: Solution distribution may be associated with whether the muscle fibers are directly inserted into the APF and the absence of EPI in each area.

DOI： 10.7759/cureus.78867

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The purpose of this study was to assess the differences in lower limb global alignment and anatomical parameters of coronal whole-leg radiographs, which were generally used in preoperative planning for high tibial osteotomy (HTO), according to different weight-bearing standing positions. METHODS: Between April 2021 and December 2022, 176 patients (60 males and 116 females) were investigated. Full-weight-bearing coronal whole-leg radiographs were obtained with the patella centred on the femoral condyle. Patients were divided by Kellgren-Lawrence grade (KL-0, KL-I, KL-II and KL-III) and assessed in two standing positions: legs closed and legs spread. Patients with flexion contractures or those unable to stand with full weight bearing were excluded. The mechanical distal femoral angle, medial proximal tibial angle (MPTA), femorotibial angle, joint line convergence angle, percentage weight-bearing line (%WBL) and hip-knee-ankle angle (HKAA) were measured. The Student's t test was used to compare the two standing positions. A p value < 0.05 indicated a statistically significant difference. RESULTS: The MPTAs of legs closed standing and legs spread standing were 84.9 ± 2.6° and 85.1 ± 2.4° in KL-0, 84.7 ± 2.0° and 84.9 ± 2.1° in KL-I and 85.0 ± 2.43° and 85.4 ± 2.4° in KL-II, respectively. There were statistically significant differences in the MPTA between the two standing positions in KL-0, KL-I and KL-II. In contrast, the %WBL and HKAA did not change regardless of the standing position. In the KL-III group, no statistical significance was observed for any of the anatomical parameters. CONCLUSION: Several anatomical parameters were changed between the legs closed standing and the legs spread standing positions. It was suggested that the standing position should be taken into consideration in the planning for HTO. LEVEL OF EVIDENCE: Level IV, Case series with no comparison group.

DOI： 10.1002/jeo2.12085

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: This study evaluated the correlation between postoperative knee joint line obliquity after medial open-wedge high tibial osteotomy and patient-reported outcome measures excluding excessively overcorrected knees. This study further identified preoperative radiological factors related to the increased postoperative knee joint line obliquity. MATERIALS AND METHODS: We retrospectively evaluated patients who underwent medial open-wedge high tibial osteotomy between March 2013 and March 2021. Postoperative excessively overcorrected knees with hip-knee-ankle angle > 7° were excluded. We investigated radiological parameters and patient-reported outcome measures preoperatively and at the last follow-up. The following radiologic parameters were measured: hip-knee-ankle angle, weight-bearing line ratio, mechanical medial proximal tibial angle, mechanical lateral distal femoral angle, lateral distal tibial angle, joint line convergent angle, knee joint line obliquity, ankle joint line obliquity, hip abduction angle, tibial posterior slope, Carton-Deschamps index, and patella tilting angle. Clinical outcomes were evaluated using Japanese knee outcome measures. This assessment criterion is based on the Western Ontario McMaster Universities Arthritis Index and MOS Short Form 36. Multiple regression analysis was performed to evaluate the association between postoperative knee joint line obliquity and patient-reported outcome measures or preoperative radiological factors (P < .05). RESULTS: A total of 52 knees were included. The mean age at the time of the surgery was 61.6 ± 9.0 years and the mean follow-up period was 30.6 ± 10.1 months. Increased postoperative knee joint line obliquity was associated with lower Japanese knee outcome measures. The preoperative hip-knee-ankle angle was significantly associated with postoperative knee joint line obliquity. CONCLUSIONS: Increased knee joint line obliquity after medial open-wedge high tibial osteotomy is associated with inferior clinical outcomes. Care should be given to the center of the rotational angulation in around-knee osteotomy to avoid postoperative increased knee joint line obliquity. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.

DOI： 10.1007/s00402-024-05203-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The purpose of this study was to investigate the positional effect of guide pins used in the transtibial pullout repair of medial meniscus posterior root tears on the popliteal artery. METHODS: We used eight cadaveric knees. Two 2.4-mm guide pins were inserted into the posterior root of the medial meniscus at 50° to the articular surface from the medial edge of the tibial tuberosity (anteromedial group) and the anterior edge of the medial collateral ligament (posteromedial group) using an aiming guide placed at the posterior root attachment of the medial meniscus from the anteromedial portal. The posterior capsule was dissected, and the popliteal artery was identified. The positional effect of the guide pins on the popliteal artery was photographed arthroscopically at 0°, 30°, 60°, and 90° knee flexion angles. The popliteal artery diameter and the minimum distance between the popliteal artery center and the guide pin tip were measured. RESULTS: At 90° knee flexion, most of the guide pins in the anteromedial (6 knees; 75 %) and posteromedial groups (7 knees; 87.5 %) collided with the femoral intercondylar wall. The rate of collision was significantly higher at the 90° knee flexion position than that at other angles (p = 0.02). The average shortest distance between the popliteal artery center and the guide pin tip at 0° knee flexion in the posteromedial group (5.4 mm ± 3.4 mm) was significantly greater than that at other knee flexion angles, although the mean distance in the posteromedial group was so negligible that the guide pin could penetrate the popliteal artery. CONCLUSIONS: Knee flexion at 90° causes less damage to the popliteal artery during the transtibial pullout repair of medial meniscus posterior root tears.

DOI： 10.1016/j.asmart.2023.11.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: No study thus far has compared tunnel enlargement between double-bundle and triple-bundle anterior cruciate ligament reconstruction. We compared tibial tunnel enlargement and rate of tibial tunnel coalition between these two reconstructions, hypothesizing that tibial tunnel enlargement in triple-bundle reconstruction is less than that in double-bundle reconstruction, and that the tunnel coalition rate is equal between the two procedures. METHODS: This prospective randomized clinical trial included 25 patients who underwent computed tomography 2 weeks and 1 year postoperatively. Eleven patients underwent double-bundle anterior cruciate ligament reconstruction and 14 underwent triple-bundle anterior cruciate ligament reconstruction. Tunnel positions and tunnel coalition at the tibial tunnel aperture were assessed using three-dimensional computed tomography. Tunnel enlargement rate was calculated by measuring the sagittal and axial widths of the tibial bone tunnel 10 mm from the tibial tunnel aperture. These parameters were then compared between the groups. RESULTS: The changes in tunnel positions and tunnel coalitions between groups were not significantly different. On both sagittal and axial views, the tunnel enlargement rates of the medial and lateral sections of the anteromedial bundle in the triple-bundle group were significantly smaller than those in the double-bundle group (sagittal view, p = 0.02 and < 0.01, respectively; axial view, p = 0.02 and ≤ 0.05, respectively). The groups did not differ significantly in terms of posterolateral tunnel enlargement. CONCLUSION: Tunnel widening in the medial and lateral sections of the anteromedial bundle-associated tibial tunnel in triple-bundle anterior cruciate ligament reconstruction was smaller than that of double-bundle reconstruction. The tunnel coalition rates between the two reconstructions were not significantly different.

DOI： 10.1016/j.jos.2022.08.010

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Bi-cruciate retaining total knee arthroplasty with an asymmetrical design may improve knee function and clinical outcomes. This study aimed to compare the kinematics, anteroposterior laxity, and in situ forces of the anterior and posterior cruciate ligaments of knees subjected to this treatment with those of healthy knees. METHODS: Seven fresh-frozen cadaveric knees were tested using a robotic/universal force-moment sensor system. The kinematics during passive flexion-extension motion and anteroposterior laxity for native knee, treated knee, and treated knee with cruciate ligament transection states were investigated. The motions of the intact and treated knees during each test were repeated after anterior/posterior cruciate ligament transection to calculate the in situ force in the ligaments. FINDINGS: The screw-home movement of normal knees disappeared after treatment. The in situ force of the anterior cruciate ligament in treated knees was higher than that in intact knees at ˃15° during flexion and at 60° and 90° against an anterior force. The in situ force of the posterior cruciate ligament in treated knees was higher at 0°, 15°, and 30° during flexion and at all flexion angles against a posterior force. INTERPRETATION: The screw-home movement of normal knees decreased, and the in situ force of the anterior and posterior cruciate ligaments increased after treatment.

DOI： 10.1016/j.clinbiomech.2023.106038

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Lower extremity sports injuries frequently occur during an individual's growth period. The object of the current study was to analyse the risk factors for lower extremity sports injuries for youth athletes. The secondary objective was to clarify the factors related to new injuries after a lower extremity injury. METHODS: We extracted information on youth athletes (aged 10-15 years) with sports-related disorders. Background data and injury situations were collected via a specific application. During the follow-up period, new injuries were also recorded. The athletes were divided into two groups according to injury location (lower extremity or other). We performed a multiple logistic regression analysis to clarify the association between injury location and background data. RESULTS: 1575 complaints of lower extremity disorders and 328 complaints in other body parts were registered. According to the multiple regression analysis, practice time per week was significantly shorter for the lower extremity group than the other locations group (OR 0.98; 95% CI 0.963 to 0.999). Athletes whose future goal was at the recreational level had a significantly low incidence of new injuries after experiencing lower extremity disorders. CONCLUSION: The practice environments and psychological factors should receive more attention to prevent lower extremity injuries.

DOI： 10.1136/bmjsem-2022-001493

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Subtalar arthrodesis in addition to ankle arthrodesis (AA) should have effect on foot motion and functional capabilities pertaining to activities of daily living (ADL); however, it is not well characterized. We compared the foot range of motion and ADL-related functional capabilities between patients who had undergone AA and tibiotalocalcaneal arthrodesis (TTC). Twenty-one AA patients and 10 TTC patients were enrolled. Foot sagittal motion arc was measured by radiographs. Patient satisfaction, ADL, footwear restriction, and rating scale scores were compared between the 2 groups. The mean sagittal motion arc in the AA group (23.5 ± 6.2°) was significantly greater than that in the TTC group (15.3 ± 3.5°). Patient satisfaction and overall ADL status was comparable in the 2 groups. Difficulties in climbing stairs, wearing rubber boots, and sitting in cross-legged position were more frequently reported in the TTC group. Our findings may be valuable for both surgeons and patients in predicting post-treatment ADL status and avoiding over expectations.

DOI： 10.1053/j.jfas.2022.12.007

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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： 10.1177/23259671221132845

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Studies on ankle syndesmosis have focused on anterior inferior tibiofibular ligament (AITFL) and interosseous membrane injuries; however, the characteristics of posterior inferior tibiofibular ligament (PITFL) ruptures remain unclear. PURPOSE/HYPOTHESIS: This study evaluated the biomechanical characteristics of syndesmotic instability caused by PITFL injury and compared various treatment methods. We hypothesized that PITFL injury would lead to syndesmotic internal rotational instability and that the stability would be restored with suture tape (ST) PITFL augmentation. STUDY DESIGN: Controlled laboratory study. METHODS: Ten uninjured fresh-frozen cadaveric leg specimens were tested via forces applied to the external and internal rotation of the ankle joint. The fibular rotational angle (FRA) related to the tibia, anterior tibiofibular diastasis (aTFD), and posterior tibiofibular diastasis (pTFD) were measured using a magnetic tracking system. Six models were created: (1) intact, (2) AITFL injury; (3) AITFL + PITFL injury; (4) suture button (SB) fixation; (5) SB + anterior ST (aST) fixation; and (6) SB + aST + posterior ST fixation. The FRA, aTFD, and pTFD were statistically compared between the intact ankle and each injury or fixation model. RESULTS: In the intact state, the changes in FRA and aTFD were 1.09° and 0.33 mm when external rotation force was applied and were 0.57° and 0.41 mm when internal rotation force was applied. In the AITFL injury model, the changes in FRA and aTFD were 2.38° and 1.51 mm when external rotation force was applied, which were significantly greater versus intact (P = .032 and .008, respectively). In the AITFL + PITFL injury model, the changes in FRA and pTFD were 2.12° and 1.02 mm when internal rotation force was applied, which were significantly greater versus intact (P = .007 and .003, respectively). In the SB fixation model, the change in FRA was 2.98° when external rotation force was applied, which was significantly higher compared with intact (P < .001). There were no significant differences between the SB + aST fixation model and the intact state on any measurement. CONCLUSION: PITFL injury significantly increased syndesmotic instability when internal rotation force was applied. SB + aST fixation was effective in restoring syndesmotic stability. CLINICAL RELEVANCE: These results suggest that SB + aST fixation is sufficient for treating severe syndesmotic injury with PITFL rupture.

DOI： 10.1177/23259671221122811

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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： 10.1177/23259671221119173

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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： 10.1177/10711007211069327

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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： 10.1186/s12891-022-05220-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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： 10.1016/j.jos.2020.09.008

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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： 10.1016/j.jos.2020.08.016

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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： 10.1177/1071100721996714

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To investigate the graft diameters and mechanical properties of hamstring tendons sutured using different materials and techniques. METHODS: This study used 30 fresh, frozen human cadaveric semitendinosus tendons; the free ends of 10 specimens each were sutured by 2 No. 3 braided polyester sutures with the Krackow technique (BP group), SutureTape with the Krackow technique (ST group), or SutureTape Loop with the locking SpeedWhip technique (SL group). First, the changes in graft diameter from before suturing to after suturing were investigated. Each graft was pre-tensioned to 100 N for 3 cycles and then cyclically loaded to 200 N for 200 cycles. Elongation after cyclic loading and displacement in the 200th cycle were calculated. Finally, each specimen was loaded to failure. The ultimate failure load and stiffness were analyzed. These mechanical properties were statistically analyzed using 1-way analysis of variance. The level of statistical significance was set at P < .05. RESULTS: In the BP group, the changes in graft diameter were significantly larger than those in the ST and SL groups (P = .001). The elongation values after 200 cycles in the BP and ST groups were 3.1 ± 2.0 mm and 5.9 ± 3.4 mm, respectively. In the SL group, elongation (7.7 ± 3.6 mm) was significantly larger compared with that in the BP group (P = .037). In contrast, displacement in the 200th cycle was significantly smaller in the ST and SL groups compared with the BP group (P = .017). No statistically significant difference was evident for the ultimate failure loads among the 3 groups (P = .543). CONCLUSIONS: The results of this study suggest that SutureTape may be an appropriate option for preparing the hamstring graft in anatomic anterior cruciate ligament (ACL) reconstruction. CLINICAL RELEVANCE: This biomechanical study shows the effectiveness of SutureTape in ACL graft preparation. Clinically, SutureTape may be of benefit in single- or double-bundle ACL reconstruction.

DOI： 10.1016/j.asmr.2021.02.008

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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： 10.1055/s-0039-1700977

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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： 10.1016/j.eats.2021.02.026

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: The shape of the talus determines the positional and kinematic features of the subtalar, talonavicular, and talocrural joints during walking. Thus, detailed knowledge of the pattern of sexual dimorphism of the human talus may be useful for revealing the pathogenetic mechanism of foot and knee disorders, which are more prevalent in females. The aim of this study was to characterize and visualize the three-dimensional shape variations of the talus in relation to sex and age using geometric morphometrics. MATERIALS AND METHODS: Computed tomography images of 56 feet without talar injuries or disorders were used in this study. Thirty-seven anatomical landmarks were identified on a bone model of the talus to calculate principal components (PCs) of shape variations among specimens. PC scores were compared between sexes, and their correlations with age were also investigated. RESULTS: The female talus had a longer neck and narrower head width than the male talus. The superior trochlea was tilted more laterally in the frontal plane in females. Furthermore, the female talar head was more twisted and was more elongated in the dorsoplantar direction. CONCLUSIONS: Morphological features of the talus in females could alter the subtalar and talonavicular joint kinematics during walking and could be a structural factor in the pathogenetic mechanism underlying foot and knee disorders. This study contributes to the comprehensive understanding of shape variations in the human talus.

DOI： 10.1002/ca.23588

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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： 10.1007/s12565-020-00585-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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： 10.1053/j.jfas.2021.05.007

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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： 10.22603/ssrr.2020-0165

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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： 10.1177/2473011420945689

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The shape of the calcaneus determines the mechanical interaction of the foot with the ground during the heel-strike in human walking. Detailed knowledge of the pattern of sexual dimorphism of the human calcaneus could help to clarify the pathogenetic mechanism of foot and knee disorders, which are more prevalent in females. Therefore, the aim of this study was to characterize and visualize the three-dimensional shape variations of the calcaneus in relation to sex and age using geometric morphometrics. Computed tomography images of 56 feet without subtalar injuries or disorders were used in this study. Thirty-seven anatomical landmarks were identified on the bone model of the calcaneus to calculate principal components (PCs) of shape variations among specimens. The PC scores were compared between males and females, and their correlations with age were also analyzed. The female calcaneus was longer in length and shorter in height than that of males. The medial process of the calcaneal tuberosity in females was more inferiorly projected and the tuberosity was shifted more laterally. Also, the calcaneus was wider and the sustentaculum tali thickened with aging. Female structural features of the calcaneus alter the kinematics of the foot during walking and could be a structural factor in foot and knee disorders. This study contributes to a comprehensive understanding of shape variations in the human calcaneus. Clin. Anat., 33:751-758, 2020. © 2019 Wiley Periodicals, Inc.

DOI： 10.1002/ca.23501

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The prevalence of foot pathologies, such as flatfoot deformity and hallux valgus, is higher in women and increases with age. It has been reported that these types of foot disorders may also be linked to excessive mobility of the subtalar joint to the eversion direction during weight bearing. Given that the mobility of the joint is determined by its articular morphology, sex- and age-related variations in the subtalar articular surface morphology are possible. The purpose of this study was to investigate the orientation and the curvature radii of the talar articular facets of the calcaneus in relation to age and sex using three-dimensional computer tomography. METHODS: Fifty-six feet without subtalar injuries or disorders were included in this study. The orientations of the talar articular surfaces of the calcaneus were quantified in the sagittal and coronal planes. The curvature radii of the articular surfaces of the calcaneus were also assessed based on the approximations of the sphere surfaces. RESULTS: The talar articular surface was oriented more anteriorly and medially in the females than in the males. The curvature radius of the calcaneal posterior facet in the females exhibited a positive correlation with age, indicative of increased articular surface flattening. CONCLUSIONS: The morphological features of the female calcaneus could induce excessive eversion and could lead to a higher prevalence of foot disorders, including flatfoot and hallux valgus, in elderly females. This study contributes to an understanding of the sexual dimorphism of the articular surfaces of the calcaneus and provides insight into the mechanisms that underline various foot disorders.

DOI： 10.1016/j.aanat.2020.151468

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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： 10.1177/0363546520902725

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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： 10.1016/j.knee.2019.12.010

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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.

DOI： 10.1053/j.jfas.2020.03.024

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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-hindfoot. 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.

DOI： 10.1053/j.jfas.2019.09.012

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

CASE: Nontraumatic chronic subcutaneous rupture of the extensor digitorum longus (EDL) tendon is rare. A 66-year-old man, recreational runner, suddenly injured his EDL tendon while walking. We surgically reconstructed the ruptured EDL tendon with a free palmaris longus tendon graft. During the surgery, an osteophyte was found to have penetrated the ankle joint capsule and was considered the cause of the tendon rupture. Active toe extension was restored, and the patient completed a 10-km race at 2 months postoperatively. CONCLUSION: EDL tendon reconstruction using a free palmaris longus tendon graft is an effective surgical option for athletes.

DOI： 10.2106/JBJS.CC.19.00058

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Insoles are often applied as preventive therapy of flatfoot deformity, but the therapeutic effects on obese individuals are still controversial. We aimed to investigate the effect of insole use on time-dependent changes in the foot arch during a repeated-loading simulation designed to represent 20,000 contiguous steps in individuals with a BMI value in the range of 30-40 kg/m2. METHODS: Eighteen cadaveric feet were randomly divided into the following three groups: normal, obese, and insole. Ten thousand cyclic loadings of 500 N (normal group) or 1000 N (obese and insole groups) were applied to the feet. We measured time-dependent change in arch height and calculated the bony arch index (BAI), arch flexibility, and energy absorption. RESULTS: The normal group maintained more than 0.21 BAI, which is the diagnostic criterion for a normal arch, throughout the 10,000 cycles; however, BAI was less than 0.21 at 1000 cycles in the obese group (mean, 0.203; 95% confidence interval [CI] 0.196-0.209) and at 6000 cycles in the insole group (mean, 0.200; 95% CI, 0.191-0.209). Although there was a significant time-dependent decrease in flexibility and energy absorption in both the obese and insole groups (P < 0.001), the difference between 1 and 10,000 cycles were significantly smaller in the insole group than in the obese group (P = 0.024). CONCLUSIONS: Use of insoles for obese individuals may help to slow time-dependent foot structural changes. However, the effect was not enough to maintain the foot structure against repeated hyper loadings.

DOI： 10.1186/s12891-019-2819-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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： 10.1177/0363546518820527

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The coupled behavior of talocrural joint motion is primarily determined by the morphological features of the talar trochlea and tibiofibular mortise. Features of the radius of curvature of the talocrural joint, however, remain unclear. The objectives of this study were to evaluate the radius of curvature at the mid, medial, and lateral regions of both the talar trochlea and the tibial plafond, and to estimate subject-specific kinematics of the talocrural joint. METHODS: Computed tomography images of 44 subjects with healthy talocrural joints were assessed by creating three-dimensional bone models. The radii of curvature of the anterior and posterior regions at the mid, medial, and lateral regions of both the talar trochlea and the tibial plafond were calculated. Hypothetical dorsiflexion and plantarflexion axes of the talocrural joint were estimated from the shape of the talar trochlea. Orientations and distances of these axes were calculated. RESULTS: At both the talar trochlea and the tibial plafond, the anteromedial and posteromedial radii exhibited the largest coefficients of variation. The anterior-to-posterior radius ratio (APRR) of the medial talar trochlea significantly correlated with the mid APRR, anterior medial-to-lateral radius ratio (MLRR), and posterior MLRR of the trochlea (r = 0.45, 0.52, - 0.60, respectively, and all P < 0.01). CONCLUSIONS: The asymmetric shape of the medial talar trochlea seems to determine a fixed or changing axis of rotation at the talocrural joint. This subject-specific rotational axis of the talocrural joint should be considered in the management of patients with ankle injuries.

DOI： 10.1007/s00276-018-2098-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Hypermobile lateral meniscus (HLM) is one of the causes of knee pain and a locking sensation. It is thought that disruption of the popliteomeniscle fascicles lead to hypermobility of the lateral meniscus in adults. In cases of HLM, the posterior portion of the lateral meniscus shows forward abnormal translation with knee flexion and backward translation with knee extension. We refer to this phenomenon as paradoxical motion. The purpose of this study was to report an arthroscopic HLM stabilization and evaluate the midterm clinical outcomes. METHODS: Twenty consecutive HLM patients (21 knees) who underwent arthroscopic surgery were included. The mean age at the time of surgery was 37.7 (19-63) years. Mean duration from surgery to final follow-up was 37 (24-68) months. Meniscus movement according to the knee flexion and extension was observed by diagnostic arthroscopy. We performed arthroscopic inside-out vertical stacked suturing of disrupted popliteomeniscle fascicles. The number of suturing and details of meniscal movement were assessed. The Tegner activity level score and Lysholm knee scores were determined preoperatively and at 2 years postoperatively. Clinical outcomes included locking sensation, recurrences and complications reported at the final follow-up. RESULTS: Paradoxical motion of the lateral meniscus was observed in all patients. We performed an average of 5.0 (2-8) vertical stacked sutures of the disrupted popliteomeniscal fascicles. Physiological motion of the lateral meniscus was observed after meniscus repairs. The mean Tegner activity level scales before and after surgery were 4.6 (2-8) and 4.7 (2-8), respectively. The mean Lysholm knee scores significantly improved from 72.0 (48-85) preoperatively to 97.8 (78-100) at 2 years postoperatively. There were no complications or recurrences of locking symptoms at the final follow-up. CONCLUSIONS: Use of arthroscopic inside-out vertical sutures for disrupted popliteomeniscle fascicles improved the clinical outcomes for HLM patients without complications.

DOI： 10.1016/j.jos.2018.06.003

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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： 10.1177/1071100717696252

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Rupture of the patellar tendon is an uncommon injury that requires acute surgical repair to restore the function of the knee. Multiple techniques for repair have been described in the literature. Complications with these repair techniques include rerupture and extensor lag caused by gap formation at the site of repair. Thus, many surgeons have suggested augmenting the standard repair. Several methods of augmentation have been described each with disadvantages. The purpose of this article was to present our case series of six patients with acute patella tendon ruptures treated by a novel procedure using strong sutures. In this method, eight strands of four-strong sutures run within the tendon. At the patellar site, a combination of suture button and figure eight pattern techniques is used, avoiding stress concentration. The optimal tension is applied to each suture, so as the patella might be positioned at the original placement. Then all sutures are secured onto the tibia. Postoperatively with a mean follow-up of 32.7 months (range: 25-48 months), all patients had a stable knee with mean flexion of 143.3 degrees (range: 140-150 degrees) and without any extension lag. With an improvement in the International Knee Documentation Committee score to 86.8 (range: 80-92), the excellent outcome was noted in all patients. The average postoperative Lysholm score was 98.8 (range: 97-100) and the average Kujala score was 95.2 (range: 92-97). All patients recovered to near-normal strength and stability of the patellar tendon as well as restoration of function after the operation. This augmentation technique offers a distinct advantage over previous augmentation methods and materials, and may be especially useful in managing patellar tendon rupture caused by rheumatoid arthritis or other systemic conditions. For these reasons, we recommend this procedure for acute patellar tendon ruptures.

DOI： 10.1055/s-0036-1586725

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The anterior cruciate ligament (ACL) can be morphologically separated into not only two, but three bundles: the anteromedial-medial bundle (AM-MB), the anteromedial-lateral bundle (AM-LB), and the posterolateral bundle (PLB). Our hypothesis was that the three bundles differ in their microstructures. The purpose of this study was to clarify the microstructural differences among the three bundles. The normal ACLs of six fresh frozen cadavers were harvested. After the AM-MB, AM-LB, and PLB were identified, their fibril structures were analyzed using a transmission electron microscope. The fibril orientation, distribution pattern, and the mass average diameter of the fibrils (MAD) were compared among the AM-MBs, AM-LBs, and PLBs. The AM-MB and AM-LB fibrils were arranged mostly in the longitudinal direction, while the PLB fibrils were not aligned in a uniform direction. The fibril diameter distribution pattern of AM-MBs showed a bi-modal pattern due to the existence of small-diameter (30-40 nm) and large-diameter fibrils (70-80 nm), while that of the AM-LBs and PLBs had a unimodal pattern with one prominent high peak at a diameter of 50-60 nm. The mean MAD of the AM-MBs (83.2 - 11.2 nm) was significantly larger than that of the PLBs (66.8 - 7.7 nm), while it showed no significant difference compared to that of the AM-LBs (77.6 - 12.3 nm). The three ACL bundles have different ultrastructures. The AM-MB predominantly includes thick, uni-directionally oriented fibrils like tendons, while the PLB consists of thinner, multi-directionally oriented fibrils. The AM-LB shows an intermediate structure between the AM-MB and the PLB.

DOI： 10.1002/ca.22586

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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： 10.2106/JBJS.CC.O.00002

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Vascular complications of distal femoral fractures are rare but can have disastrous consequences if not recognised and treated promptly. We present the case of a 55-year-old woman who developed a pseudoaneurysm of the superficial femoral artery after osteosynthesis to repair a supracondylar femoral fracture. Eight weeks after surgery, swelling of the right thigh persisted and was accompanied by severe pain. Enhanced computed tomography revealed a pseudoaneurysm in the medial aspect of the affected thigh. Open surgical repair was performed by direct arterial suture. Although the true aetiology of the development of the pseudoaneurysm is unknown, a bony fragment from the reduction manoeuvre may have damaged the adventitia of the superficial femoral artery. In cases of continuous thigh swelling after osteosynthesis to repair a supracondylar femoral fracture, a diagnosis of pseudoaneurysm should be considered and treatment should be initiated immediately.

DOI： 10.1308/003588414X13946184900165

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: There are numerous reports and evidences to suggest that exercise therapy is effective for knee osteoarthritis (knee OA). However, there is a lack of sufficient research concerning the factors influencing its application and effectiveness. The purposes of this study were to evaluate effects of the mode of treatment delivery on the improvement of symptoms in knee OA, and to analyze potential risk factors affecting improvement after exercise therapies. METHODS: The 209 women applicants diagnosed with knee OA were randomly allocated into either a group performing group exercise in a class or a group performing home exercise. The 90 min exercise program was performed under the guidance of physiotherapists as a group exercise therapy. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) of the subjects of both groups before and after intervention was compared to examine the effect of exercise therapy. In addition, body mass index, knee range of motion (ROM), the femorotibial angle from radiographs, OA severity from Kellgren-Lawrence grade, and meniscus abnormality and subchondral bone marrow lesions from MRI findings were statistically analyzed as factors that may affect exercise therapy. RESULTS: A significantly greater improvement in WOMAC was observed in the subjects of group exercise (81 subjects) as compared with the subjects of home exercise (122 subjects). There was a significantly high proportion of subjects with knee flexion contracture among the subjects participating in group exercise that showed only minor symptom improvement (p < 0.05). In addition, exercise therapy proved to be highly effective for subjects with limited quadriceps muscle strength (p < 0.05). CONCLUSIONS: When prescribing exercise therapy for knee OA, evaluation of a subject's ROM and muscle strength is important in deciding whether to commence exercise therapy and what type of exercise therapy to apply; it is also important in predicting the effect of exercise therapy.

DOI： 10.1007/s00776-013-0443-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The most common cause of acquired flatfoot deformity is tibialis posterior tendon dysfunction. The present study compared the change in medial longitudinal arch height during cyclic axial loading with and without activated tibialis posterior tendon force. METHODS: Fourteen normal, fresh frozen cadaveric legs were used. A total of 10,000 cyclic axial loadings of 500 N were applied to the longitudinal axis of the tibia. The 32-N tibialis posterior tendon forces were applied to the specimens of the active group (n=7). Specimens of another group (non-active group, n=7) were investigated without the tibialis posterior tendon force. The bony arch index was calculated from the displacement of the navicular height. FINDINGS: The mean initial bony arch indexes with maximal weightbearing were 0.239 (SD 0.009) in active group and 0.239 (SD 0.014) in non-active group. After 7000 cycles, the bony arch indexes with maximal weightbearing were significantly greater in the active group (mean 0.214, SD 0.013) than in the non-active group (mean 0.199, SD 0.013). The mean bony arch indexes with maximal weightbearing after 10,000 cycles were 0.212 (SD 0.011) in the active group and 0.196 (SD 0.015) in the non-active group. INTERPRETATION: The passive supportive structures were inadequate, and the tibialis posterior muscle was essential to maintain the medial longitudinal arch of the foot in the dynamic weightbearing condition. The findings underscore that physical therapy and arch supportive equipments are important to prevent flatfoot deformity in the condition of weakness or dysfunction of the tibialis posterior muscle.

DOI： 10.1016/j.clinbiomech.2012.06.006

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Normal anterior cruciate ligament (ACL) can be divided into three fiber bundles-i.e., anteromedial (AM), intermediate (IM), and posterolateral (PL) bundles. However, their arrangement and attachment areas had remained unclear. The purpose of this study was to clarify the arrangement of these three ACL fiber bundles and their attachment sites, and to provide information on the tunnel placement in anatomical triple bundle ACL reconstruction. METHODS: Seven non-embalmed human frozen knees were used. ACL fibers were bluntly divided into three bundles. A different-colored thread was wound around each fiber bundle in a spiral. Macroscopical investigation was performed to clarify the arrangement of three ACL bundles. Each fiber bundle was carefully detached from the femur and tibia, and then the distribution of attachment sites of each fiber bundle was observed. RESULTS: In knee extension, all bundles consisting of AM, IM and PL bundles ran parallel to each other in the lateral view from the medial side. The AM bundle overlapped with the IM bundle, whereas the PL bundle ran parallel to them on the distal aspects. As the knee flexion increased, the bundles became twisted around each other. On the tibial side, the attachment areas of three fiber bundles formed a triangular shape showing arrangements of AM, IM and PL bundles on the anteromedial, anterolateral and posterior aspects, respectively. On the femoral side, the PL bundle was attached on the distal-posterior areas; the IM bundle was attached distal-anterior to the AM bundle. They were arranged in a triangular shape on the tibia side as well. CONCLUSION: This study clarified the arrangement of three fiber bundles of ACL and detailed geographical locations of their attachment sites. The detailed anatomic description of the natural ACL attachment might suggest to surgeons where to make tunnels during anatomical double/triple bundle ACL reconstruction.

DOI： 10.1007/s00167-011-1576-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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： 10.1177/0363546511413455

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The locking screws target the radial styloid, theoretically provide greater stability against radial styloid fragment. However, it is unknown whether the radial styloid locking screws increased the stability of the volar plating system fixation along the entire distal radius or not. In this study, we evaluated the stability of the volar plating system fixation with or without the radial styloid screws using a biomechanical study in a cadaver fracture model. METHODS: Six matched pairs of fresh-frozen human cadaver wrists complete from the proximal forearm to the metacarpal bones were prepared to simulate standardized 3-part intra-articular and severe comminuted fractures. Specimens were fixed using the volar plating system with or without 2 radial styloid screws. Each specimen was loaded at a constant rate of 20 mm/min to failure. Load data was recorded and, ultimate strength and change in gap between distal and proximal fragments were measured. Data for ultimate strength and screw failure after failure loading were compared between the 2 groups. RESULTS: The average ultimate strength at failure of the volar plate fixation with radial styloid screws (913.5 ± 157.1 N) was significantly higher than that without them (682.2 ± 118.6 N). After failure loading, the average change in gap between the ulnar and proximal fragment was greater than that between the radial and proximal fragment. The number of bent or broken screws in ulnar fragment was higher than that in radial fragment. The number of specimens with bent or broken screws in cases with radial styloid screws was fewer than that in the fixation without radial styloid screws group. CONCLUSION: The ulnar fragment is more intensively stressed than the radial fragment under axial loading of distal radius at full wrist extension. The radial styloid screws were effective in stable volar plate fixation of distal radial fractures.

DOI： 10.1186/1749-799X-5-90

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The roles of each ligament supporting the subtalar joint have not been clarified despite several biomechanical studies. The effects of ankle braces on subtalar instability have not been shown. HYPOTHESIS: The ankle brace has a partial effect on restricting excessive motion of the subtalar joint. STUDY DESIGN: Controlled laboratory study. METHODS: Ten normal fresh-frozen cadaveric specimens were used. The angular motions of the talus were measured via a magnetic tracking system. The specimens were tested while inversion and eversion forces, as well as internal and external rotation torques, were applied. The calcaneofibular ligament, cervical ligament, and interosseous talocalcaneal ligament were sectioned sequentially, and the roles of each ligament, as well as the stabilizing effects of the ankle brace, were examined. RESULTS: Complete sectioning of the ligaments increased the angle between the talus and calcaneus in the frontal plane to 51.7 degrees + or - 11.8 degrees compared with 35.7 degrees + or - 6.0 degrees in the intact state when inversion force was applied. There was a statistically significant difference in the angles between complete sectioning of the ligaments and after application of the brace (34.1 degrees + or - 7.3 degrees ) when inversion force was applied. On the other hand, significant differences in subtalar rotation were not found between complete sectioning of the ligaments and application of the brace when internal and external rotational torques were applied. CONCLUSION: The ankle brace limited inversion of the subtalar joint, but it did not restrict motion after application of internal or external rotational torques. CLINICAL RELEVANCE: In cases of severe ankle sprains involving the calcaneofibular ligament, cervical ligament, and interosseous talocalcaneal ligament injuries, application of an ankle brace might be less effective in limiting internal-external rotational instabilities than in cases of inversion instabilities in the subtalar joint. An improvement in the design of the brace is needed to restore better rotational stability in the subtalar joint.

DOI： 10.1177/0363546509339578

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