Tomonobu Hagio

Arthroscopic Bone Marrow Stimulation Techniques for Osteochondral Lesions of the Talus: Prognostic Factors for Small Lesions

Background: The defect size of an osteochondral lesion of the talus is one of the most important prognostic factors for deciding clinical outcomes. However, the prognostic factors for small osteochondral lesions of the talus are unknown. Purpose: To investigate the significant prognostic factors for small osteochondral lesions of the talus using arthroscopic bone marrow stimulation techniques. Study Design: Case series; Level of evidence, 4. Methods: Fifty ankles in 50 patients treated with arthroscopic bone marrow stimulation techniques for an osteochondral lesion of the talus (<150 mm2) were evaluated for prognostic factors. The patients were 22 men and 28 women (mean age, 35.0 years). Outcomes were measured using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, Berndt and Harty scale, and Saxena criteria. Results: The mean lesion size was 62 mm2 (range, 7-119 mm2). The mean AOFAS score improved from 74 (range, 18-90) preoperatively to 90 (range, 67-100) postoperatively. The Saxena criteria results were excellent, good, fair, and poor in 36 (72%), 8 (16%), 5 (10%), and 1 (2%) patients, respectively. The Berndt and Harty scale results were good in 34 (68%), fair in 6 (12%), and poor in 10 (20%) patients. Linear regression analyses showed prognostic significance for lesion depth and outcome. Medial lesions had a significantly higher incidence of poor outcomes than lateral lesions (P < .05). Among the medial lesions, lesions uncovered with the medial malleolus had inferior outcomes compared with covered lesions (P < .0001). There was no association between clinical outcome and lesion size or body mass index. In older patients (≥40 years), there was a significant trend toward inferior clinical outcomes (P < .05). Conclusion: Arthroscopic bone marrow stimulation techniques provided satisfactory clinical outcomes. However, older patients, deep lesions, and medial lesions uncovered with the medial malleolus were associated with inferior clinical outcomes.

Prevalence and characteristics of cam-type femoroacetabular deformity in 100 hips with symptomatic acetabular dysplasia: a case control study

BackgroundCam-type femoroacetabular deformity in acetabular dysplasia (AD) has not been well clarified. The primary purpose of this study was to determine the prevalence and characteristics of femoroacetabular deformity in symptomatic AD patients.MethodsWe retrospectively reviewed the cases of 86 women (92 hips) and eight men (eight hips) with symptomatic AD. The mean patient age was 37.9 (range, 14-60) years. All participants underwent lateral cross-table and lateral whole-spine radiographic examinations to measure the alpha angle and pelvic tilt. Pelvic computed tomography scans were used to measure femoral anteversion. The patients were classified into two groups: AD only group, containing hips with an alpha angle less than 55°; and AD with cam-type femoroacetabular deformity (AD + cam-type deformity) group, containing hips with an alpha angle greater than or equal to 55°.ResultsOf the patients with AD, 40 hips displayed additional radiographic evidence of cam-type morphology, while 60 hips had exclusive AD morphology. The patients in the AD + cam-type deformity group had significantly increased forward pelvic tilt in the standing position (p =0.023) and decreased femoral anteversion (p =0.047) compared with the AD only group.ConclusionsOur data revealed that 40% of patients with AD also had radiographic evidence of cam-type femoroacetabular deformity. Greater forward pelvic tilt in the standing position and decreased femoral anteversion seemed to be associated with the cam-type deformity in these patients. These results indicate the morphological features that are most likely to induce secondary symptoms to developmental hip dysplasia. It is suggested that the symptoms in the AD + cam-type deformity group could arise through femoroacetabular impingement (FAI) after periacetabular osteotomy, because a predisposition was present preoperatively.

Usefulness of Ultrasonography for Detection of Pseudotumors After Metal-On-Metal Total Hip Arthroplasty

We retrospectively analyzed 83 metal-on-metal total hip arthroplasties in 74 patients. Ultrasonography and magnetic resonance imaging (MRI) of each hip were performed to detect abnormal patterns and pseudotumors. We examined the reliability of ultrasonography for detecting pseudotumors in comparison with MRI. We also compared the acetabular component inclination between patients with and without pseudotumors. The mean positive and negative predictive values for pseudotumor detection by ultrasonography were 65% and 91%, respectively. The mean positive and negative likelihood ratios were 5.78 and 0.32, respectively. There was no clear association between pseudotumor presence and acetabular component inclination. We concluded that ultrasonography is a suitable technique to screen for the presence of pseudotumors. We also need to distinguish between bearing-related and taper junction corrosion-related complications.

The Effect of Screw Position and Number on the Time to Union of Arthroscopic Ankle Arthrodesis

PURPOSE This study aimed to investigate the factors that influence the time to union after arthroscopic ankle arthrodesis. METHODS From June 2005 to October 2010, 46 patients (50 ankles) underwent arthroscopic ankle arthrodesis with 6.0-mm cannulated cancellous screws. There were 22 men and 24 women (mean age, 63 years). Medical records and radiographs were retrospectively reviewed. Screw configurations used were as follows: 3 transmedial and translateral malleolar screws (ML3) in 12 ankles (24%), 2 transmedial and translateral malleolar screws (ML2) in 4 ankles (8%), 3 transmedial malleolar screws (M3) in 23 ankles (46%), and 2 transmedial malleolar screws (M2) in 11 ankles (22%). RESULTS Radiographic fusion was achieved in 46 (92%) of the 50 ankles. The mean time to fusion was 11.0 ± 4.5 weeks for ML3, 13.1 ± 3.3 weeks for ML2, 9.7 ± 2.7 weeks for M3, and 12.5 ± 3.5 weeks for M2 (P < .05). The mean American Orthopaedic Foot & Ankle Society scores were 81.3 ± 2.2 for ML3, 83.5 ± 4.4 for ML2, 88.3 ± 1.5 for M3, and 85.3 ± 2.2 for M2. The mean time until radiographic fusion was 10.2 ± 3.4 weeks for correction angles of less than 10° and 13.2 ± 3.4 weeks for angles of 10° or greater (P < .01). In obese patients a significant difference in ankle fusion time was observed (12.6 ± 3.5 weeks for patients with body mass index ≥25 v 9.4 ± 2.9 weeks for patients with body mass index <25, P < .01). CONCLUSIONS Overall, this study showed that arthroscopic ankle arthrodesis achieves a high rate of union, with fastest union achieved with 3 parallel screws placed medially from the distal tibia into the talus. Care should be taken when one is designing treatment strategies for obese patients and/or patients with large correction angles. LEVEL OF EVIDENCE Level IV, retrospective case series.

Subcutaneous rupture of the flexor hallucis longus tendon: a case report.

It is well known that rupture of the flexor hallucis longus tendon can be associated with open injuries and that closed rupture of the flexor hallucis longus tendon is rare. Tendon injuries of the foot can occur secondary to direct, indirect, or repetitive injury. Repetitive tendon injuries can cause tendinitis or stenosing tenosynovitis. Tendinitis is associated with internal tendon injury that can present with tendon thickening, mucinoid degeneration, nodule development, or in situ partial tears. Stenosing tenosynovitis is the development of tendon adhesions within the tendon sheath that interfere with tendon gliding, known as trigger toe. The flexor hallucis longus tendon is susceptible to injury along its entire course. A total of 35 cases of complete or partial closed ruptures of the flexor hallucis longus tendon have been reported. We present the case of complete subcutaneous rupture of the flexor hallucis longus tendon associated with trauma at the proximal phalangeal head.

Assessing the safe direction of instruments during posterior ankle arthroscopy using an MRI model.

Background: The safety of posterior ankle arthroscopy is still the subject of debate. The purpose of this study was to evaluate the anatomical relationship between the posterior portals and the neurovascular structures using magnetic resonance imaging (MRI) to determine the safety of posterior portals in posterior ankle arthroscopy. Methods: Forty ankles from 38 patients who had undergone MRI scanning for ankle disorders were assessed (18 males, 20 females). For each ankle, the angles of the presumed position of the portals to the posterior neurovascular structures and the malleoli were measured on 4-mm proximal slices from the anterior tip of the fibula. The shortest distance from the sural nerve and the tibialis posterior neurovascular bundle to the position of the posterior portals was measured. Results: The average distance between the posteromedial portal and the tibialis posterior neurovascular bundle was 18 ± 3 mm, whereas the average distance between the posterolateral portal and the sural nerve was 15 ± 3 mm. In 100% of ankles, there were no neurovascular structures lying within the region between the anterior tip of fibula and the posteromedial portal or between the posterior tip of fibula and the posteromedial portal. In 32 ankles (80%), the medial neurovascular structures were present on the medial side of the line running between the anterior tip of medial malleolus and the posteromedial portal. Conclusion: The posterior neurovascular structures were not in immediate proximity to where we estimated the posteromedial and posterolateral portals to be located. Clinical Relevance: The findings of the present MRI-based study suggest that arthroscopic instruments oriented toward the fibula may be safely introduced into the posterior ankle without injuring the neurovascular structures.

Do labral tears influence poor outcomes after periacetabular osteotomy for acetabular dysplasia

AIMS Acetabular dysplasia is frequently associated with intra-articular pathology such as labral tears, but whether labral tears should be treated at the time of periacetabular osteotomy (PAO) remains controversial. The purpose of this study was to compare the clinical outcomes and radiographic corrections of PAO for acetabular dysplasia between patients with and without labral tears pre-operatively. PATIENTS AND METHODS We retrospectively reviewed 70 hips in 67 patients with acetabular dysplasia who underwent PAO. Of 47 hips (45 patients) with labral tears pre-operatively, 27 (25 patients) underwent PAO alone, and were classified as the labral tear alone (LT) group, and 20 (20 patients) underwent combined PAO and osteochondroplasty, and were classified as the labral tear osteochondroplasty (LTO) group. The non-labral tear (NLT) group included 23 hips in 22 patients. RESULTS There were no significant differences between groups for post-operative Harris hip scores, degree of progression of osteoarthritis or rate of reoperation. The pre-operative alpha angle was significantly larger in the LTO group compared with the other groups (p < 0.0001). CONCLUSION PAO provides equivalent short-term relief of pain and functional outcome in patients with or without labral tears. The rate of progression of osteoarthritis and reoperation was not significantly increased in patients with labral tears. TAKE HOME MESSAGE PAO provides equivalent short-term pain relief and functional outcomes in patients with acetabular dysplasia with and without labral tears. We did not find significantly increased risks of progression of osteoarthritis or re-operation in those with labral tears. Cite this article: Bone Joint J 2016;98-B:741-6.

Simultaneous Use of Lateral Calcaneal Ostectomy and Subtalar Arthroscopic Debridement for Residual Pain After a Calcaneal Fracture

Inadequate primary treatment of calcaneal fractures frequently results in persistent, residual pain. This can be caused by subtalar arthritis, an increased calcaneal width, and/or calcaneal fibular impingement of the peroneal tendons. Many patients experience multiple disorders simultaneously, requiring a combination of procedures to treat the injury. The purpose of the present study was to evaluate the clinical outcomes of arthroscopic debridement with lateral calcaneal ostectomy for residual pain after a calcaneal fracture. Four feet (4 patients) were treated with arthroscopic debridement and lateral calcaneal ostectomy. The patients were 3 males and 1 female, with a mean age of 55.3 ± 14.1 years. The mean follow-up duration was 33.5 ± 10.5 months postoperatively. Three patients received workers compensation as a result of their condition. The patients were examined for improvement in pain levels using the numeric pain intensity scale and healing was assessed using the Japanese Society of Surgery of the Foot score. The mean Japanese Society of Surgery of the Foot score improved from 64.5 ± 13.8 preoperatively to 82.5 ± 7.1 postoperatively. The mean postoperative numeric pain intensity scale score was 2.3 ± 1.9. No complications, such as deep infection or problems with wound healing, were observed in any of the patients. The simultaneous use of arthroscopic subtalar debridement and lateral calcaneal ostectomy is a valuable intervention for the treatment of residual pain after a calcaneal fracture in patients who present with increased calcaneal width and mild or no degenerative changes in the subtalar joint.

Surgical treatment of an osteochondral lesion associated with stress fracture of the tarsal navicular: a case report.

We surgically treated an osteochondral lesion associated with a stress fracture of the tarsal navicular. The surgical procedure involved the confirmation and complete resection of the lesion under direct vision, followed by the transplantation of block-shaped iliac bone grafts. The postoperative computed tomography scan showed that the lesions had disappeared, the grafted bone had fused, and the stress fracture had healed. However, the tarsal navicular joint surface was slightly irregular. The patient was able to resume her sports activities 15 weeks after surgery. We have described a novel method to reconstruct the tarsal navicular after osteochondral lesion resection.

Effect of the adjacent-joint osteoarthritis after arthroscopic ankle arthrodesis

Category: Ankle Arthritis Introduction/Purpose: Arthroscopic ankle arthrodesis (AAA) is a good clinical outcome, because the arthroscopic method has been deemed to have shorter union time, less blood loss, less morbidity, shorter hospital stays, and more rapid mobilization. However, it is unclear about the relationship between progression of adjacent-joint arthritis and clinical outcome at long-term follow-up. The purpose of this study was to investigate the relationship between AAA and adjacent-joint arthritis at 2 years postoperatively. Methods: We evaluated 17 feet of 17 patients at a minimum of two years after surgery that were able to be followed, from among 59 feet in 55 patients with ankle osteoarthritis who underwent AAA between January 2006 and April 2015. The mean age was 66.1 ± 8.1 (range, 57-79) years, and postoperative follow-up was performed at a mean of 4.5 ± 2.3 (range, 2-10) years after surgery. The radiographic evaluation examined a union rate of the ankle, and a progression of adjacent-joint osteoarthritis (OA) change. We examined the relationship between the presence of adjacent-joint OA and Japanese Society for Surgery of the Foot (JSSF) score before surgery and last follow up. Additionally, we examined the relationship between the presence of adjacent-joint OA and Self-Administered Foot Evaluation Questionnaire (SAFE-Q) at last follow up. Results: JSSF score was improved to 56.9 points before surgery and 89.2 points last follow up, and the union rates was 17 feet of 17 feet (100%). At the last follow-up, radiographic signs of developed or progressing arthritis were observed in ten feet at subtalar joint (58.8%) and in three patients at talonavicular joint (17.6%). The postoperative JSSF scale regarding the presence or absence of the adjacent joint OA, there were no significant differences (89.3 ± 6.0 points in the absence group and 89.2 ± 6.1 points in the presence group). Postoperative SAFE-Q was not significantly different, pain and pain-related physical functioning and daily living, social functioning, shoe-related, and general health and well-being. Conclusion: There was no significant difference in the JSSF score of presence or absence of the adjacent-joint OA before surgery and at the final follow-up. Additionally, there was no significant difference in the SAFE-Q of presence or absence of the adjacent-joint OA at the final follow-up. The adjacent-joint OA was progressed after AAA, however clinical outcome was relatively maintained.