Shintaro Asahina

The effects of tibial tunnel placement and roofplasty on reconstructed anterior cruciate ligament knees.

Seventy-five anterior cruciate ligament (ACL) reconstructions augmented with the Kennedy Ligament Augmentation Device were evaluated according to classification of tibial drill-hole position on the basis of the anatomic landmarks of the ACL by two-dimensional radiographic imaging of the fully extended knee. The effects of roofplasty to avoid graft impingement were also assessed. The tibial drill-hole position was classified in relation to the medial intercondylar tubercle on anterior-posterior (AP) view, and in relation to Blumensaats line (B-line) on lateral view. Arthroscopic evaluation of the ACL and incidence of chronic synovitis as well as Lysholm knee score, manual knee tests, knee extension and flexion angles, and knee tester measurements were performed. The results indicated that the knee joints in which the tibial drill hole was positioned laterally from the medial intercondylar tubercle or in which the tibial drill hole was positioned anteriorly to the B-line showed a tendency to develop more postoperative chronic synovitis. The knees in which the tibial drill hole was positioned anteriorly to the B-line also showed larger AP laxity. There was no difference between the non-roofplasty and roofplasty groups.

Arthoscopic meniscal repair in conjunction with anterior cruciate ligament reconstruction: Factors affecting the healing rate

Ninety-eight of 121 consecutive patients who underwent arthroscopy-assisted meniscal repair in combination with anterior cruciate ligament reconstruction were evaluated by second-look arthroscopy with an average interval of 16 months (range, 6 to 63 months). Of the 98 meniscal repairs, 73 had completely healed, 13 had incompletely healed, and 12 had not healed. Six possible factors that may have affected the healing of the repaired menisci were statistically analyzed. There were no statistically significant differences between the three groups with respect to sex, age, tear site on the medial or lateral meniscus, or residual anterior laxity as measured using the KT-1000. The factors that had a statistically significant impact on healing rate were the rim width and meniscal locking. Negative correlations with the healing rate were observed in menisci that were repaired in the central third zone and that had been locked or could be locked by probing at the time of surgery.

Computerized Tomographic Analysis of Tibial Tubercle Position in the Painful Female Patellofemoral Joint

We used computerized tomography to evaluate the po sition of the tibial tubercle and to determine if the tibial tubercle is positioned more laterally in female patients with patellofemoral pain. We also wanted to determine the relationship of the tibial tubercle to tibial external rotation and patellar tilt. Sixty female patients and 19 healthy female controls were evaluated. To evaluate the position of the tibial tubercle, the tibial tubercle rotation angle (the angle formed by the line between the pos teriormost edges of the medial and lateral femoral con dyle and the line between the central point of the in tercondylar space and the central point of the patellar tendon at the level of the tibial tubercle) was measured by superimposing the images from the level of the distal femoral condyle and the tibial tubercle. The relationship between the tibial tubercle rotation angle and patellar tilt was then assessed by dividing the patients into 3 sub groups according to the patellar tilt. The tibial tubercle rotation angle was significantly different between the patellofemoral pain patients and the controls. There were also significant differences between the patients with moderate patellar tilt (10° to 20°) and the controls, and between the patients with high patellar tilt (>20°) and the controls.

Forefoot pressures during walking in feet afflicted with hallux valgus

Forefoot pressures during walking in feet with hallux valgus were recorded using pressure-sensitive film, and the relationships between deformities and foot pressures were analyzed. There were 32 female subjects comprising 50 feet with hallux valgus, of which 20 feet underwent surgery. As in normal feet, the pressure patterns of feet with hallux valgus were varied: peak pressures were under the first metatarsal head, under the second and/or third metatarsal heads, and the first, second, and/or third metatarsal heads. Peak pressures of hallux valgus feet were larger in each type than those of the normal foot. In feet with hallux valgus showing peak pressures under the first metatarsal heads, the hallux valgus angle and the intermetatarsal angle were larger than those in feet showing peak pressures on the second and/or third metatarsal heads. After surgery, peak pressures were under the second and/or third metatarsal heads and they decreased.

Intermediate-Term Results of Meniscal Repair in Anterior Cruciate Ligament-Reconstructed Knees

We investigated the incidence of and risk factors for recurrent tears of repaired menisci in anterior cruciate ligament-reconstructed knees. We observed 63 patients whose menisci had been evaluated at second-look arthroscopy as healed (N = 50) or incompletely healed (N = 13) for an average of 4 years (range, 2 to 9.5). Of the 13 patients with incompletely healed menisci, 6 (46%) required additional meniscal surgery and 2 (15%) had recurrence of meniscal symptoms such as catching or locking. Among the 50 patients with healed menisci, 5 (10%) required additional meniscal surgery and 9 (18%) had recurrence of meniscal symptoms after second-look arthroscopy. The timing of the recurrence of these symptoms was from 12 to 28 months after surgical repair. Of the 11 patients who had undergone additional surgery, 6 had sustained second injuries during sports activities and the other 5 had no identifiable cause of injury. When comparing age, tear sites, rim width, side-to-side differences with KT-1000 arthrometer testing, and the pivot shift test, there were no differences between the group requiring additional surgery, the symptomatic group, and the asymptomatic group. However, the postoperative Tegner activity score of the group requiring additional surgery was statistically significantly higher than the others.

Effects of knee flexion angle at graft fixation on the outcome of anterior cruciate ligament reconstruction

Clinical outcome in 44 patients who underwent anterior cruciate ligament (ACL) reconstruction with hamstring tendons augmented by the ligament augmentation device for chronic ACL deficiency was studied; average follow-up was 38 months (range, 24 to 52 months). In 19 patients, grafts were fixed with the knees at full extension (group 1), whereas in 25 patients, the grafts were fixed with the knees at 30 degrees of flexion (group 2). The results of subjective testing (Lysholm score), the Lachman test, the pivot-shift test, muscle strength testing, angle of extension loss, and follow-up arthroscopy were compared to assess the effects of flexion angle at fixation on stability and function. The range of motion in group 1 was significantly better than that in group 2. The stability of the knees and the arthroscopic appearance of the grafts in group 1 were, however, significantly worse than those in Group 2.

Notchplasty in anterior cruciate ligament reconstruction : An experimental animal study

The purpose of this study was to evaluate the effects of a notchplasty on the biomechanical and histological properties of the anterior cruciate ligament (ACL) and changes in patellar articular cartilage. We used an in situ freeze-thaw model for the ACL reconstruction performed with or without notchplasty in 36 Japanese white rabbits. The cross-sectional area of the regenerated ACLs without a notchplasty (6.4 +/- 0.4 mm(2)) was statistically smaller than that of the ACLs with a notchplasty (7.0 +/- 0.3 mm(2)), and the cross-sectional area of the normal ACLs (5.4 +/- 0.5 mm(2)) was statistically smaller than that of both other types. However, the mechanical strength of the ACL with the notchplasty was identical to that of the ACL without a notchplasty. Although the notchplasty areas were covered with fibrous scar tissue, caliper measurement and histological examination showed no obvious osteochondral reconstitution in the notchplasty sites of any of the specimens. Regarding the deleterious effect of notchplasty on patellar articular cartilage, the extent of the slight degenerative changes was about the same in the group with a 1-mm notchplasty and in the control group.

Lower leg fracture with Parkes-Weber syndrome complicated by disseminated intravascular coagulation.

Reports of Parkes-Weber syndrome complicated by disseminated intravascular coagulation (DIC) are rare in the orthopaedic literature. This is a case report of a 23-year-old man who had this syndrome and who sustained a lower-leg fracture complicated by the DIC. Open reduction was not attempted because the DIC worsened after manual reduction. Amputation was rejected by the patient. Three months of continuous infusion of heparin and replacement therapy with fresh frozen plasma was done. Cast immobilization without further reductions was continued. The DIC improved and union of the fractures was observed at 2 years and 3 months after injury.

The Long-term Effects of Tibial Drill Hole Position on the Outcome of Anterior Cruciate Ligament Reconstruction

Fifty-three cases of anterior cruciate ligament reconstruction were classified into two groups depending on the tibial drill hole position: in the anterior group, the center of tibial drill hole was positioned anteriorly to the dome of the intercondylar notch (Blumensaats line), and in the posterior group, it was positioned posteriorly to the Blumensaats line. Knee extension loss in the anterior group was significantly greater at 1 and 2 years postoperatively than that of the posterior group. However, there were no differences between the anterior and posterior groups 3 to 5 years postoperatively. No significant differences in anterior laxity were seen from 1 to 4 years postoperatively. After more than 5 years, anteroposterior translation of the anterior group was significantly greater than that of the posterior group. In the anterior group, extension was restricted in the early postoperative period. At latest follow-up more than 5 years postoperatively, anterior laxity in the posterior group was significantly less than that in the anterior group.

Conservative treatment of sports injuries to the lateral ligaments of the ankle

Abstract From 1987 to 1990, 54 patients with acute sports injuries to the lateral ligaments of the ankle were immobilized for 4 weeks in a below-knee plaster cast and wore a brace for the next 2 months. The average follow-up time was 28.6 months. 96% of patients returned to sports. Stress radiographs showed good stability. Even ankles which were severely unstable at the time of the injury regained stability.