Kenichi Goshima

Clinical evidence of a familial predisposition to anterior cruciate ligament injury

Background Several risk factors for anterior cruciate ligament (ACL) injury have been evaluated in the literatures. It is highly probable that many of the identified risk factors for ACL injury are passed through families. However few articles describe a familial predisposition to ACL injury. Objective To investigate whether there is a familial predisposition to ACL injury. Design Retrospective study. Methods The study group comprised 350 consecutive patients who underwent ACL reconstruction between January 2005 and September 2008. All patients were surveyed by telephone or written questionnaire about their family history (FH) of ACL injury, sports in which family members participated and mechanisms of injury. We also compared age, height, weight, Tegner activity score, general joint laxity, and tibial slope between the FH group (with a FH of ACL injury) and a control group (without a FH of ACL injury). Results Complete information was obtained from 335 of the 350 patients, 38 (11.3%) of whom had a FH of ACL injury. Two families had three members with ACL injuries. Among the 40 family members with ACL injuries, 38 (95%) had a non-contact ACL injuries, and 34 (85%) injured their ACL by the same mechanism as the related patient. Comparisons of the FH and control groups identified no significant differences with regard to age, height, weight, Tegner activity score, or general joint laxity, but tibial slope was significantly larger in the FH group than in the control group. Conclusion Our results indicate a high probability that many of the identified risk factors for ACL injury are passed through families. Screening tests for a FH of ACL injury thus could identify a population at increased risk of ACL injury who would benefit most from preventative neuromuscular training programs designed to reduce the risk of ACL injury.

Geriatric tibial plateau fractures: Clinical features and surgical outcomes.

BACKGROUND Operative treatment of geriatric tibial plateau fractures is challenging and controversial. There are few studies focusing on the clinical features and operative outcomes of tibial plateau fractures in the elderly. Hence, this study aimed to investigate the clinical features and operative results of these fractures. METHODS Thirty-three displaced tibial plateau fractures in patients >65 years old (mean age: 72.1 years, range: 65-94 years) were treated operatively. We investigated the mechanisms of injury, fracture types according to the Schatzker classification, incidences of soft tissue injury, and postoperative complications. Clinical and radiographic data were analyzed in 23 patients at the last follow-up. The mean follow-up period was 4.0 years (range: 1-13 years). Twenty-one patients were treated with open reduction and internal fixation and evaluated using the Rasmussen clinical and radiologic scores. Two patients with advanced osteoarthritis were treated primarily with total knee arthroplasty and assessed using the Japanese Orthopaedic Association score for the knee osteoarthritis. RESULTS Twenty-four patients (72.7%) were injured by low-energy trauma such as a simple fall. Four patients had compartment syndrome and required fasciotomies. Rasmussen clinical and radiologic scores were satisfactory in 85.7% and 81.0% of patients, respectively. Two patients treated primarily with total knee arthroplasty showed no radiologic abnormality, and their Japanese Orthopaedic Association scores were both 70 points. CONCLUSIONS Geriatric tibial plateau fractures, although mostly due to low-energy trauma, were often accompanied with severe comminution and compartment syndrome. Postoperative results of open reduction and internal fixation for this population were relatively good. Therefore, primary total knee arthroplasty should only be considered for well-selected patients.

A pediatric case of single-level idiopathic cervical intervertebral disk calcification with symptom relapse 1 year after initial onset

Background: To date there has been only 1 reported case of the symptom relapse of pediatric idiopathic intervertebral disk calcification (PIIDC), as described by Yoon and colleagues in 1987, who reported symptom relapse in a patient with multilevel PIIDC. Thus, symptom relapse in patients with single-level PIIDC have not been reported. Methods: We report here a case of single-level PIIDC with symptom relapse 1 year after the initial onset. Results: The patient was a 7-year-old girl who developed cervical pain and fever up to 38°C without an obvious cause. Computed tomography (CT) revealed calcification in the C4/5 intervertebral disk space and in the epidural space at the C3-5 vertebral levels. The patient was diagnosed with PIIDC and treatment with oral nonsteroidal anti-inflammatory drugs was begun. Both cervical pain and fever gradually improved and resolved in approximately 1 week. CT obtained 6 months after the initial onset showed calcifications localized in the posterior area of the C4/5 intervertebral disk space and reduced epidural calcifications, which had nearly resolved. One year after the initial onset, the patient developed similar symptoms. CT revealed an enlarged calcified lesion in the epidural space. Thus, the patient was diagnosed with symptom relapse of PIIDC. Although there was enlargement of calcifications in the epidural space, there were no calcifications involving the intervertebral disk at the time of relapse. The patient was treated conservatively. Follow-up CT revealed that the lesion resolved with time. Conclusions: This report described a patient with single-level PIIDC and symptom relapse 1 year after the initial onset. In the case presented herein, calcifications of the intervertebral space had extruded into the epidural space, thus causing a symptom relapse. The patient was treated conservatively at the initial onset and at the time of relapse. The symptoms improved both times. Although patients with single-level PIIDC usually have an uneventful clinical course, it is necessary to be mindful of potential symptom relapse.

Rapid destruction of the humeral head caused by subchondral insufficiency fracture: a report of two cases.

Rapidly destructive arthritis (RDA) of the shoulder is a rare disease. Here, we report two cases, with different destruction patterns, which were most probably due to subchondral insufficiency fractures (SIFs). Case 1 involved a 77-year-old woman with right shoulder pain. Rapid destruction of both the humeral head and glenoid was seen within 1 month of the onset of shoulder pain. We diagnosed shoulder RDA and performed a hemiarthroplasty. Case 2 involved a 74-year-old woman with left shoulder pain. Humeral head collapse was seen within 5 months of pain onset, without glenoid destruction. Magnetic resonance imaging showed a bone marrow edema pattern with an associated subchondral low-intensity band, typical of SIF. Total shoulder arthroplasty was performed in this case. Shoulder RDA occurs as a result of SIF in elderly women; the progression of the joint destruction is more rapid in cases with SIFs of both the humeral head and the glenoid. Although shoulder RDA is rare, this disease should be included in the differential diagnosis of acute onset shoulder pain in elderly female patients with osteoporosis and persistent joint effusion.

Relationship between core strength and balance ability in high school female handball and basketball players

Background Although a lot of reports have suggested that the core strength has an important role for the prevention of sports injuries, the relationship between core strength and balance ability is poorly documented. Objective The purpose of this study is to examine the relationship between core strength and balance ability. Participants 119 healthy high school female players (age: 15–16 years, handball: 49 players, basketball: 70 players) were participated in this study. Main outcome measurements We measured endurance time of right side-bridge, left side-bridge and frontal-bridge as the core strength test (CST). To assess static balance, we used stabilometer and recorded the circumference area of the single leg standing position of 30 s. For the assessment of dynamic balance, we used star excursion balance test (SEBT). SEBT reach distances and limb lengths were examined, then the distance scores (cm) for each direction of the SEBT grid were averaged over the three trials and normalised to leg length (reach distance/leg length x 100=percentage of leg length). The normalised distances in each direction were then summed for both leg. We divided the players into three groups according to their CST score and compared them with the results of static balance and dynamic balance. Results No significant differences were found in body size among the three groups (p<0.05). The significant difference was not found with the static balance among the CST (p<0.05). In the dynamic balance, the players with good result of CST score had significantly better results of the SEBT in frontal-bridge and left side-bridge (p<0.05). There was no significant difference in right side-bridge. Conclusion This study showed that the core strength had certain relationship to the dynamic balance and may contribute to the prevention of sports injuries.

Effect of Low-Intensity Pulsed Ultrasound on Bone Healing at Osteotomy Sites After Open Wedge High Tibial Osteotomy

Objective: The purpose of this study was to evaluate the effects of low-intensity pulsed ultrasound (LIPUS) on bone healing at osteotomy sites after open wedge high tibial osteotomy (OWHTO). Materials and Methods: Twenty-six patients underwent OWHTO without bone grafting. Thirty cases treated with LIPUS (group L) after surgery were compared with 13 cases without LIPUS treatment (group C). We divided the osteotomy gap into the lateral hinge and 4 zones on anteroposterior radiography, and the progression of gap filling was evaluated at 1, 3, and 6 months post-operatively in both groups. Results: In group L, the lateral hinge formed a union at 3 months postoperatively in 11 knees (84.6%). At 6 months, gap filling in 10 knees (76.9%) reached to zone 2. In group C, while the lateral hinge formed a union at 3 months postoperatively in all cases. At 6 months, gap filling in 6 knees (46.1%) reached to zone 2. The progression of gap filling were 8.5%, 18.9%, and 32.9% (at 1, 3, and 6 months after surgery, respectively) in group L, while the progress levels at the same time points were 7.7%, 16.6%, and 24.4% in group C. There were significant differences at 6 months after surgery between the 2 groups. Discussion: LIPUS accelerated bone healing at 6 months after OWHTO. It is important that the accuracy of LIPUS methods be further studied and improved.

YOUNG FEMALE ATHLETES HAVE CHANGED CONSIDERABLY IN THE TWO YEARS AFTER BASELINE EVALUATION IN A PROSPECTIVE STUDY

Background A 3-year prospective cohort study has been initiated in Japanese young female handball and basketball players to identify risk factors for non-contact ACL injuries. Although we examined the baseline data of the players at their first year of high school, it raises concern about the use of the individual baseline data as the characteristics of the players (might be identified as a risk factor) in cases where the players get injured during their senior year of high school. Objectives To compare the players data examined at the first year and the senior year of high school. Design Case-control study. Participants 21 of 84 high school female players (handball: 4 players, basketball: 17 players) who participated in our prospective cohort study. Methods Body compositions, static balance (locus length per unit area examined by stabilometer), dynamic balance (star excursion balance test; SEBT), isokinetic hamstrings/quadriceps strength, isometric hipabduction strength, hamstrings flexibility, knee laxity (KT1000), navicular drop, generalized joint laxity (Beighton index), and psychological-competitive ability (DIPCA-3) were examined. Results Significantly better result of isokinetic hamstrings/quadriceps strength, isometric hip abduction strength, and hamstrings flexibility were found at the senior. Significantly lower result of navicular drop was found at the senior. No significant differences were found between the groups in body compositions, static and dynamic balance, and DIPCA-3. Generalized joint laxity in the senior was significantly higher level of the index than that at the first. Conclusions During two years after baseline evaluation, the players increased their hip and knee strength without matching increases of static and dynamic balance ability. Considering that even generalized joint laxity which assumed to be consistent had changed, careful interpretation is needed to use the baseline data as a risk factor in a prospective cohort study.

Psychological profiling of young female handball and basketball players – a pilot study

Background The influence of psychological factors on injuries in female handball and basketball is poorly documented. Objective The aim of this study was to examine the influence of psychological factors on injuries in female handball and basketball players, especially for non-contact anterior cruciate ligament (ACL) injuries. Design Case control study. Setting and Participants A three-year prospective cohort study has been initiated in Japanese young female handball and basketball players to identify risk factors for non-contact ACL injuries. At baseline, 99 of 104 young female players (handball: 30 players, basketball: 69 players, age;15–16 years) were asked to complete a detailed questionnaire covering player history, previous injuries, KOOS, personality and psychological-competitive ability using the Y-G personality questionnaire and questionnaire for diagnostic inventory of psychological-competitive ability score (DIPCA-3). Results There were no correlation between KOOS and DIPCA-3, and no significant differences were found between handball players and basketball players. There were no significant differences between previously injured and non-injured players in the score of KOOS and DIPCA-3. The players evaluated as D (director) type by the Y-G personality questionnaire scored significantly better result in DIPCA-3 than the A (average), B (burst), E (engineer) type (p=0.0128, p=0.001, p<0.001, respectively). Conclusion Since perceived mastery climate has been reported as a significant predictor for new injuries, the players who has high psychological-competitive ability evaluated as D type may be the injury-prone athletes. Prospective follow-up is necessary to elucidate whether high psychological-competitive ability is a risk factor for ACL injury or new injury.

Video analysis of anterior cruciate ligament injuries in sumo wrestling

Background Sumo is one of the traditional Japanese contact sports. Many sumo wrestlers suffer knee joint injuries, especially anterior cruciate ligament (ACL) injuries. ACL injuries can lead to serious consequences for injured sumo wrestlers. Therefore, Understanding the mechanisms of these injuries is crucial to prevent ACL injuries. Objective To describe the mechanisms of ACL injuries in sumo wrestling. Design Descriptive video analysis. Methods Eight videotapes of ACL injuries from seven professional sumo wrestlers and one high school student were collected. Four medical doctors and two physical therapists systematically analyzed these videos to describe the injury mechanisms and playing situations. We estimated knee flexion, internal/external rotation, and valgus/varus position at the time when the ACL ruptured. Results Two main mechanisms of ACL injuries in sumo wrestling were identified. Five knees had been injured while the wrestlers tried to make a stand at the edge of the ring, and three knees had been injured when the wrestlers tried to stay on their feet before they were thrown by their opponents. All of the mechanisms for ACL injuries were non-contact injuries; they were not caused by direct external impacts. The injuries occurred when the foot was planted and firmly fixed at the edge of the ring or the floor. In all cases, the foot was externally rotated. The knee was in flexion (the mean angle was 57.2°) and valgus, combined with internal rotation of the tibia relative to the femur. Conclusion Many of the sumo wrestlers suffered ACL injuries when they tried to make a stand at the edge of the ring. The mechanism of ACL injuries in sumo wrestling appeared to be non-contact injuries.