Shinji Imade

Leg Anterior Compartment Syndrome Following Ankle Arthroscopy After Maisonneuve Fracture

We report a case of leg anterior compartment syndrome following ankle arthroscopy after Maisonneuve fracture. A 21-year-old football player sprained his left ankle. Plain radiography of his left ankle showed a lateral dislocation of the talus without obvious fractures. Plain radiography of his left lower extremity showed a spiral fracture of the proximal fibula approximately one third distal to the fibular head. According to these findings, we diagnosed this fracture as a Maisonneuve fracture and treated it by ankle arthroscopy and drilling of the talar osteochondral injury followed by arthroscopic ankle visualization during syndesmosis screw fixation. Six hours after surgery, the patient complained of pain in the lower extremity. We diagnosed acute compartment syndrome and performed emergent fasciotomy. One year after surgery, he was able to fully participate in athletic activities. We consider ankle arthroscopy to be available for the treatment of ankle fracture with the suspected complication of an intra-articular disorder such as a Maisonneuve fracture. However, with this type of ankle fracture, there is a higher potential risk of acute compartment syndrome developing than with other types of ankle fractures. Therefore we suggest that surgeons guard against this complication.

A comparison of patient-reported outcomes and arthroscopic findings between drilling and autologous osteochondral grafting for the treatment of articular cartilage defects combined with anterior cruciate ligament injury.

BACKGROUND To compare the patient-reported outcomes and arthroscopic findings between drilling and autologous osteochondral grafting (AOG) for the treatment of articular cartilage defects combined with anterior cruciate ligament (ACL) injuries. METHODS The subjects were 40 patients who had articular cartilage defects in the weight-bearing part of the medial and lateral femur condyle combined with ACL injuries that were treated by drilling (20 patients) or AOG (20 patients) at the same time as ACL reconstruction was performed. In the drilling group patients, lesions were penetrated with multiple 1.2-mm Kirschner wires, and in the AOG group patients, grafts were made to cartilage defects from one to three osteochondral pegs harvested from the less-weight-bearing periphery of the articular surface of the femoral condyle. The patient-reported outcomes were assessed using the International Knee Documentation Committee (IKDC) subjective knee examination score. Second-look arthroscopy was performed to evaluate the repaired cartilage macroscopically. RESULTS The median follow-up duration was 25 (range, 12-42) months. The IKDC scores were significantly improved from 64.4 to 95.4 points in the drilling group and from 52.3 to 94.3 points in the AOG group, with no difference between the two groups, although there was a difference in the repaired cartilage findings of arthroscopy. CONCLUSION In this study, no differences in IKDC scores were found in patients with a concomitant ACL rupture and an osteochondral lesion treated by drilling or AOG at a minimum follow-up of 1year, regardless of the differences at arthroscopic grading of the ICRS classification. LEVEL OF EVIDENCE Case-control study (LEVEL III).

Effect of implant surface roughness on bone fixation: the differences between bone and metal pegs

BackgroundPegs made from cortical bone are used to fix osteochondral fractures and osteochondral dissecans. This technique has many advantages, but it requires long-term immobilization. This study examined the effect of surface roughness on fixation with bone and metal pegs.MethodsPegs with either rough or smooth surfaces were made of cortical bone from Japanese black cattle or from stainless steel (SUS316L). The mean roughness of the rough surface was 15.0 µm, whereas that of the smooth surface was less than 0.6 µm. Pegs were inserted into holes made in the distal femurs of 34 rabbits. At the time of surgery and 14 days later, mechanical tests and micro-computed tomography were performed.ResultsAt the time of surgery, although the push-out forces were less than 0.3 N, the rough surface had a higher value than the smooth surface (P = 0.0002). No difference was observed according to the material (P = 0.54). Fourteen days after surgery, no significant difference was detected in the push-out forces between bone pegs with rough and smooth surfaces (489.0 ± 149.6 vs 478.3 ± 134.4 N (mean ± SD), respectively), but a marked difference was seen with the metal pegs (235.7 ± 115.7 vs 2.2 ± 1.6 N). The bone pegs with rough surfaces made contact with the recipient bone at the high points on the abraded surfaces. After the mechanical tests, the fusion was broken within the new bone for bone pegs with rough or smooth surfaces, but no breakage occurred at the junction of bone peg and new bone.ConclusionThe surface roughness of bone pegs has little effect on bone-to-bone fusion 2 weeks postoperatively, unlike the effect with metal pegs.

Clinical Outcomes of Revision Meniscal Repair A Case Series

Background: Meniscal preservation results in better clinical outcomes than meniscectomy; however, no studies have evaluated the results of revision meniscal repair. Hypothesis: Revision meniscal repair can achieve good clinical outcomes. Study Design: Case series; Level of evidence, 4. Methods: The study participants were 16 patients with symptomatic meniscal retears of a total of 96 patients who underwent primary arthroscopic meniscal repair. Fifteen of these 16 patients underwent revision meniscal repair. The mean age at revision was 27 years, and the mean duration between the primary operation and revision was 27 months. Eight patients had degenerative changes of the meniscus at revision. Clinical outcomes were assessed using the Lysholm score and the Tegner sports activity score, and image assessment was performed using magnetic resonance imaging. Results: Five patients had re-retears of a resutured meniscus, and the mean duration between revision and the re-retear was 25 months (range, 8-68 months). The mean follow-up of patients without re-retears was 41 months (range, 24-74 months), and the mean Lysholm score in those without re-retears significantly improved from 81.4 points (range, 73-89 points) at pre-revision to 97.4 points (range, 90-100 points) at the final survey (P = .0001). Degenerative changes of the meniscus at the revision site were observed in all 5 patients with re-retears but in only 3 of the 10 patients without re-retears. Conclusion: Revision meniscal repair should be considered in the setting of a retorn meniscus without degenerative changes.

Effectiveness and biocompatibility of a novel biological adhesive application for repair of meniscal tear on the avascular zone

Abstract We have investigated the effectiveness and safety of a newly developed biological adhesive for repair of meniscal tear. The adhesive was composed of disuccinimidyl tartrate (DST) as a crosslinker and human serum albumin (HSA) as a hardener. To determine adequate concentration, bonding strength was measured using a tensiometer 5 min after applying the adhesive on the avascular zone tear of porcine meniscus; it was compared with the strengths of commercially available cyanoacrylate-based and fibrin-based adhesives. In vivo examination was performed using Japanese white rabbits, creating longitudinal tears on the avascular zone of meniscus and applying DST–HSA adhesive. Three months after operation the rabbits were sacrificed and tension test and histological evaluation were performed. Bonding strength was measured in three porcine meniscus groups: (i) only suturing, (ii) suturing after applying the adhesive on surface and (iii) suturing using an adhesive-soaked suture. The optimum concentrations were 0.1 mmol of DST and 42 w/v% of HAS. Bonding strength was greatest with cyanoacrylate-based adhesive, followed by DST–HSA adhesive, and fibrin-based adhesive. No inflammation was observed in the synovium or surrounding tissues 3 months after using the DST–HSA adhesive. Bonding strength was greatest with DST–HSA adhesive-soaked suturing group (77 ± 6 N), followed by suturing only group (61 ± 5 N) and surface adhesive application group (60 ± 8 N). The newly developed DST-HSA adhesive is considered safe and may be effective in enforcement of bonding of avascular zone tear of the meniscus.

Intratendinous ganglion in the extensor digitorum brevis tendon

Ganglia are common benign lesions that usually arise adjacent to joints and tendons and are frequently observed around the hand and wrist. However, an intratendinous ganglion is a rare condition, with only 20 cases reported in the English-language literature. The most common location is the hand, and most lesions were localized within approximately 3 cm, whereas massive lesions that were widely extended in the tendon were rare. We report a case of an intratendinous ganglion in the extensor digitorum brevis tendon of the fourth toe, measuring 7 cm in the longitudinal direction, that was treated by en bloc resection of the tendon.

Modification of Side-locking Loop Suture Technique Using an Antislip Knot for Repair of Achilles Tendon Rupture

The 2-strand side-locking loop suture technique provides high tensile strength and stiffness immediately after surgery, and good clinical results have been reported in the treatment of Achilles tendon rupture. However, it is assumed that major differences exist among surgeons with regard to the optimal tension of the side-locking loop suture. We report a detailed technique to ensure application of a standard tension with the use of the side-locking loop suture in the clinical setting.

Mid-Term Outcome of Talocalcaneal Coalition Treated with Interposition of a Pedicle Fatty Flap After Resection

Background: We have previously reported a new technique to treat symptomatic talocalcaneal coalition. The purpose of the present study was to evaluate the mid-term outcome of the interposition of a pedicle fatty flap after the resection of a talocalcaneal coalition. Methods: Six feet of 5 patients with persistently symptomatic talocalcaneal coalition were treated with this method. We investigated the clinical outcome using the visual analog scale (VAS) for hindfoot pain including around coalition and the American Orthopaedic Foot and Ankle Society (AOFAS) score pre- and postoperatively, and investigated whether or not recurrence was present using computed tomography (CT) at the final followup. Results: The VAS score was significantly improved from 5.5 ± 1.0 (mean ± SD) to 9.7 ± 0.5 points (p = 0.0006). The AOFAS hindfoot score was also improved significantly (from 73.3 ± 26.7 points to 96.7 ± 7.1 points). No recurrence was detected by CT at the final followup. Conclusion: The interposition of a pedicle fatty flap after resection has been a durable procedure for treating a symptomatic talocalcaneal coalition. Level of Evidence: IV; Retrospective Case Series

Acute Achilles Tendon Rupture Treated by Double Side-Locking Loop Suture Technique With Early Rehabilitation

Background: Although early accelerated rehabilitation is recommended for the treatment of acute Achilles tendon rupture, most traditional rehabilitation techniques require some type of brace. Methods: We retrospectively analyzed 44 feet of 44 patients (25 male and 19 female) with a mean age of 31.8 years who had an acute Achilles tendon rupture related to athletic activity. Patients had been treated by a double side-locking loop suture (SLLS) technique using double antislip knots between stumps and had undergone early accelerated rehabilitation, including active and passive range of motion exercises on the day following the operation and full weight-bearing at 4 weeks. No brace was applied postoperatively. The evaluation criteria included the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale (AOFAS) score; active plantar flexion and dorsiflexion angles; and the intervals between surgery and the time when patients could walk normally without any support, perform double-leg heel raises, and perform 20 continuous single-leg heel raises of the operated foot. Results: Despite postoperative early accelerated rehabilitation, the AOFAS score and active dorsiflexion angles improved over time (6, 12, and 24 weeks and 2 years). A mean of 4.3 ± 0.6 weeks was required for patients to be able to walk normally without any support. The mean period to perform double-leg heel raises and 20 continuous single-leg heel raises of the injured foot was 8.0 ± 1.3 weeks and 10.9 ± 2.1 weeks, respectively. All patients, except one who was engaged in classical ballet, could return to their preinjury level of athletic activities, and the interval between operation and return to athletic activities was 17.1 ± 3.7 weeks. Conclusion: The double SLLS technique with double antislip knots between stumps adjusted the tension of the sutured Achilles tendon at the ideal ankle position and provided good clinical outcomes following accelerated rehabilitation after surgery without the use of a brace. Level of Evidence: Level IV, retrospective case series.

Avulsion fracture of the calcaneal tuberosity treated using a side-locking loop suture (SLLS) technique through bone tunnels

Fractures of the calcaneal tuberosity are relatively uncommon. In 2008, Beavis et al. proposed a classification system for describing this type of fracture [1]. Fractures of Types I and III are difficult to fix rigidly because they have small fragments. Various operative techniques using screws, Kirschner wires (K-wires), Steinmann pins, suture anchors, or tension band wiring have been described [1e6]. However, these techniques are unable to resist the force of the Achilles tendon or require a bulky construct, which may lead to soft tissue complications. On the other hand, Banerjee et al. describe a technique using a suture passed through bone tunnels in the calcaneal tuberosity [7], but the strength of fragment fixation has not yet been clarified. The side-locking loop suture (SLLS) technique using a braided polyethylene and polyester suture provides high tensile strength and stiffness [8,9], and it ensures sufficient strength to perform a safe and early rehabilitation [10e12]. We applied this technique to rigidly fix a Type I calcaneal tuberosity fracture. Here, we report our case of avulsion fracture of the calcaneal tuberosity treated using the SLLS technique.