Kazufumi Yamamoto

Relative contributions of porosity and mineralized matrix properties to the bulk axial ultrasonic wave velocity in human cortical bone

Velocity of ultrasound waves has proved to be a useful indicator of bone biomechanical competence. A detailed understanding of the dependence of ultrasound parameters such as velocity on bone characteristics is a key to the development of bone quantitative ultrasound (QUS). The objective of this study is to investigate the relative contributions of porosity and mineralized matrix properties to the bulk compressional wave velocity (BCV) along the long bone axis. Cross-sectional slabs from the diaphysis of four human femurs were included in the study. Seven regions of interest (ROIs) were selected in each slab. BCV was measured in through-transmission at 5 MHz. Impedance of the mineralized matrix (Z(m)) and porosity (Por) were obtained from 50 MHz scanning acoustic microscopy. Por and Z(m) had comparable effects on BCV along the bone axis (R=-0.57 and R=0.72, respectively).

Ultrasonic Wave Properties in Bone Axis Direction of Bovine Cortical Bone

Quantitative ultrasonography (QUS) is a good method for measuring elastic properties of bone in vivo. Bovine cortical bone has two typical microstructures, plexiform and Haversian. In this study, the relationship between the speed of sound (SOS) and the hydroxyapatite (HAp) crystallite orientation in the axial direction was investigated in two different aged bovine cortical bones. The dependence of attenuation on anatomical position was also investigated. Two ring-permanent hyphen shaped cortical bone samples were obtained from 36- and 24-month-old bovine femurs. SOS was measured with a conventional ultrasonic pulse system. The integrated intensity of the (0002) peak obtained by X-ray diffraction was determine to evaluate the amount of preferred orientation. Regardless of the age of the bovine femurs, a significant correlation between SOS and the preferred orientation of HAp crystallites was observed in parts of the plexiform structure, and the gradient of the relationship showed a similar tendency. Attenuation seemed to depend on bone microstructure.

Treatment of popliteal cysts via arthroscopic enlargement of unidirectional valvular slits

Abstract Objective. The aim of the present study was to investigate the efficacy of arthroscopic enlargement of unidirectional valvular slits for the treatment of popliteal cysts and to evaluate potential factors affecting the outcomes of our arthroscopic procedure. Methods. Twenty-nine patients aged 43–77 years with popliteal cysts were treated with arthroscopic cyst decompression. Surgery was performed via two posterior portals after creating a transseptal portal. Rauschning and Lindgren clinical score, magnetic resonance images, and osteoarthritic grade were evaluated pre- and postoperatively, and cartilage degeneration class was confirmed via arthroscopy. The mean follow-up period was 22.9 ± 14.6 months (range, 9–60 months). Results. Twelve cysts disappeared completely (group D), while 16 reduced and one enlarged (group R) in size by the final follow-up. Twenty-two (75.9%) of 29 popliteal cysts diminished to a volume that was less than 10% of the preoperative volume. Clinical scores improved in 93.1% of the patients, and more patients (68.8%) in group R had positive joint effusion at the final follow-up compared with group D (17.7%; p < 0.01). Conclusions. Arthroscopic cyst decompression was effective in the treatment of symptomatic popliteal cysts. Intra-articular pathologies associated with joint effusion should be corrected simultaneously.

Relationships between the anisotropy of longitudinal wave velocity and hydroxyapatite crystallite orientation in bovine cortical bone.

Quantitative ultrasound (QUS) is now widely used for evaluating bone in vivo, because obtained ultrasonic wave properties directly reflect the visco-elasticity. Bone tissue is composed of minerals like hydroxyapatite (HAp) and a collagen matrix. HAp crystallites orientation is thus one parameter of bone elasticity. In this study, we experimentally investigated the anisotropy of ultrasonic wave velocity and the HAp crystallites orientation in the axial-radial and axial-tangential planes in detail, using cylindrical specimens obtained from the cortical bone of three bovine femurs. Longitudinal bulk wave propagation was investigated by using a conventional ultrasonic pulse system. We used the one cycle of sinusoidal pulse which was emitted from wide band transmitter. The nominal frequency of the pulse was 1MHz. First, we investigated the anisotropy of longitudinal wave velocity, measuring the anisotropy of velocity in two planes using cylindrical specimens obtained from identical bone areas. The wave velocity changed due to the rotation angle, showing the maximum value in the direction a little off the bone axis. Moreover, X-ray pole figure measurements also indicated that there were small tilts in the HAp crystallites orientation from the bone axis. The tilt angles were similar to those of the highest velocity direction. There were good correlations between velocity and HAp crystallites orientation obtained in different directions. However, a comparatively low correlation was found in posterior bone areas, which shows the stronger effects of bone microstructure. In the radial-tangential plane, where the HAp crystallites hardly ever align, weak anisotropy of velocity was found which seemed to depend on the bone microstructure.

Meniscal pullout repair following meniscal ossicle resection: A case report

We present this case of a meniscal ossicle of the posterior horn of the medial meniscus that was treated by an arthroscopic ossicle resection followed by a pullout repair of the remaining meniscus. A 49-year-old businessman complained of catching and left knee pain. Radiographic and arthroscopic findings revealed a meniscal ossicle embedded in the posterior horn of the medial meniscus and posterior horn tear. After resection of the posterior horn with the ossicle, a pullout suture repair for the posterior segment of the meniscus was done to minimize the further extrusion of the meniscus. A histologic appearance supported the vestigial development of the meniscal ossicle as the etiology. This is the first report describing a repair of the meniscus after ossicle resection.

Anisotropy of Longitudinal Wave Velocity and Hydroxyapatite Orientation in Bovine Cortical Bone

The anisotropy of longitudinal wave velocity and the hydroxyapatite (HAp) crystallite orientation in bovine cortical bone were experimentally investigated in detail. A ring-shaped cortical bone sample was obtained from the midshaft of a 32-month-old bovine femur. Four cylindrical specimens (diameter 11 mm) were taken from the ring-shaped cortical bone specimen along the radial direction. Velocity was measured by a conventional ultrasonic pulse system, by rotating the specimen in the axial-tangential plane. The direction of the fastest wave velocity observed was inclined 5–10° from the axial direction. The HAp crystallite orientation in the specimen was also investigated by X-ray diffraction pole-figure analysis. We observed a strong intensive peak of (0002), indicating HAp crystallite c-axis alignment along the bone axis. However, the pole-figure also revealed a small tilt in the HAp crystallite orientation from the axial direction. Comparing the velocity and X-ray diffraction peak at each angle of the axial-tangential plane, a significant correlation between the velocity and the HAp orientation was observed.

Medial extrusion of the posterior segment of medial meniscus is a sensitive sign for posterior horn tears

BACKGROUND To evaluate medial extrusion of the posterior segment of the medial meniscus in posterior horn tears. METHODS This study enrolled 72 patients without medial meniscal tears (group N), 72 patients with medial meniscal tears without posterior horn tears (group PH-), 44 patients with posterior horn tears of the medial meniscus (group PH+). All meniscal tears were confirmed by arthroscopy. Medial extrusion of the middle segment and the posterior segment was measured on coronal MRIs. RESULTS Extrusions of both middle and posterior segments in groups PH- and PH+ (middle segment; 2.94±1.51 mm for group PH- and 3.75±1.69 mm for group PH+, posterior segment; 1.85±1.82 mm for group PH- and 4.59±2.74 mm for group PH+) were significantly larger than those in group N (middle segment; 2.04±1.20, posterior segment; 1.21±1.86). Both indicators of extrusion in group PH+ were larger than those in group PH-. In the early OA category, neither middle nor posterior segment in group PH- extruded more than in group N. However, only the posterior segment in group PH+ extruded significantly more than in group N. Multiple lineal regression analyses revealed that posterior segment extrusion was strongly correlated with the posterior horn tears (p<0.001) among groups PH- and PH+. CONCLUSION The newly presented indicator for extrusion of the posterior segment of the medial meniscus is associated with posterior horn tears in comparison with the extrusion of the middle segment, especially in the early stages of osteoarthritis. LEVEL OF EVIDENCE Level II--Diagnostic Study.

Snapping Knee Caused by Medial Meniscal Cyst

Snapping phenomenon around the medial aspect of the knee is rare. We present this case of snapping knee caused by the sartorius muscle over a large medial meniscal cyst in a 66-year-old female. Magnetic resonance images demonstrated a large medial meniscal cyst with a horizontal tear of the medial meniscus. Arthroscopic cyst decompression with limited meniscectomy resulted in the disappearance of snapping, and no recurrence of the cyst was observed during a 2-year follow-up period.

Propagation of ultrasonic longitudinal wave in the cancellous bone covered by the subchondral bone of bovine femur

In order to understand the mechanism of two longitudinal wave propagation phenomena in the cancellous bone, we have tried to investigate the wave separation in the bone specimen by changing the main frequency of the longitudinal pulse wave. Here, we have used the specimens obtained from the end of bovine femur, which are covered by cartilage and subchondral bone. The pore size changed gradually in the specimens. We have then found the effect of the structure on the wave separation. The FDTD simulation with the CT image of the specimens showed similar behavior of wave propagation.

Changes of bone mineral density and serum pentosidine during a 27-month follow-up of monthly minodronate in osteoporotic patients

ABSTRACT Purpose: Monthly regimen of minodronate for osteoporosis more than two years has not been reported yet. The aim of this study is to elucidate the effect of monthly minodronate (M-MIN) on bone mineral density (BMD) and serum pentosidine (Pen) during 27 months. Materials and methods: The study consisted of 52 newly treated patients (73.3 ± 8.8 years) (new group) and 47 patients (75.9 ± 9.5 years) who were switched from either alendronate or risedronate (switch group). Monthly minodronate (50 mg/every 4 weeks) was administered for 27 months. Lumbar, femoral neck, and total hip BMDs and serum pentosidine were monitored at baseline and after 9, 18, and 27 months of treatment. Results: In the new condition, lumbar, neck, and total hip BMDs increased significantly by 9.07%, 3.15%, and 3.06%, respectively. Only the lumbar BMD significantly increased in the switch condition. Serum Pen increased in both groups in a time-dependent manner. In the group switch, multivariate logistic regression analysis revealed that the initial change in serum intact procollagen type I N-terminal propeptide (P1NP) at 9 months was an independent predictor of changes in neck and total hip BMDs at 27 months (OR = 1.039, 95% CI 1.003–1.077, p = 0.032 for neck and OR = 1.055, 95% CI 1.009–1.104, p = 0.020 for total hip). Conclusions: Monthly minodronate treatment increased BMDs in newly treated patients over 27 months. Serum Pen increased with M-MIN therapy, possibly indicating prolonged bone turnover. The initial 9-month changes in serum P1NP predicted the 27-month changes in hip BMDs when M-MIN replaced alendronate or risedronate.