Yasuyuki Ishida

Remnant-preserving, selective single-bundle augmentation of the anterior cruciate ligament using a bone-patellar tendon-bone autograft: A technical note.

BACKGROUND To the best of our knowledge, there has been no detailed study on bone-patellar tendon-bone (BTB) grafts for remnant-preserving, selective-bundle anterior cruciate ligament (ACL) augmentation. Therefore, we aimed to develop such a technique using a BTB graft. METHOD A total of five patients underwent surgery using the presented procedure. These patients were young, male, and with high body mass index, and hence required very high durability of reconstructed ACL. A femoral bone tunnel was created using the inside-out technique via an accessory far-medial portal, protecting the remnant using a probe, regardless of the presence of an anteromedial (AM) or posterolateral (PL) tunnel. A single tibial tunnel was drilled at the center of the AM or PL attachment and two transverse skin incisions were made in the ipsilateral knee. The central third of the patellar tendon attached to a patellar and tibial bone plug autograft with a width of seven millimeters was harvested by subcutaneous tunneling. The femoral side was fixed using a cortical fixation device for BTB and the tibial bone plug was fixed using an interference screw with the knee at an angle of 20° of flexion by applying maximal manual traction. RESULTS Bone tunnel enlargement, which was measured by computed digital radiography, was not observed in all cases. A BTB autograft for remnant-preserving, selective-bundle ACL augmentation offers reduced risk of tunnel enlargement. CONCLUSION The presented procedure might be considered one of the potentially available options for patients with ACL partial tear who require very high durability of reconstructed ACL. LEVEL OF EVIDENCE 5.

Translation of the humeral head scale is associated with success of rotator cuff repair for large-massive tears

BackgroundAlthough a loss of rotator cuff integrity leads to the superior migration of the humeral head, the parameters that characterize the anterolateral migration of the humeral head have not been established. The purpose of this study was to investigate the correlation between the translation of the humeral head scale (T-scale) and clinical outcomes of rotator cuff repair, as well as the correlation between the T-scale and radiologic parameters.MethodsOne hundred thirty-five consecutive patients with full-thickness rotator cuff tears underwent primary rotator cuff repair. The T-scale, which indicates the distance from the center of the humeral head to the lateral coracoacromial arch, was measured on axial computed tomography scans, and the acromiohumeral interval (AHI) was measured radiographically. The correlation of the two parameters with the clinical scores of the Japanese Orthopaedic Association and University of California–Los Angeles scores and active forward elevation (FE) were evaluated at the preoperative and postoperative stages, respectively.ResultsThe postoperative T-scale and AHI correlated well with the postoperative FE and clinical scores in the patients with large-massive tears but not in those patients with small-medium tears and preoperative large-massive tears. A significant correlation was observed between the postoperative T-scale and AHI. The T-scale was subject to cuff repair integrity.ConclusionsWe demonstrated that the postoperative T-scale was well correlated with the clinical results and postoperative AHI after rotator cuff repair for large-massive tears, indicating that poor outcomes are associated with combined superior and anterolateral migration of the humeral head following retears.

Clinical Results of Arthroscopic Surgery for Osteoarthritis of the Elbow

我々は疼痛や可動域制限を有する変形性肘関節症に対して関節鏡視下関節形成術を行なっている．今回，その短期成績を報告する．症例は変形性肘関節症に対し肘関節鏡を施行し術後4ヶ月以上経過観察可能であった5例5肘で男性5肘を対象とした．手術時平均年齢は54.0歳，平均経過観察期間は14.2ヶ月であった．評価方法として，術前後の日本整形外科学会肘機能評価法（JOAスコア）および可動域，合併症の有無で評価した．JOA肘スコアは平均69.0点から91.2点に，可動域は屈曲が平均106.4度から115.6度に，伸展が平均－12.4度から－3.6度と改善が見られたが，術前可動域制限が強い症例での改善度が低い傾向にあった．術後合併症は全例なかった．変形性肘関節症に対する鏡視下手術は組織への侵襲が少なく，有効な手術法であるが，術前可動域制限が強い症例では手術手技の更なる検討が必要である．

Follow-up studies for Femoral Head Replacement

We examined the clinical and radiographic results of femoral head replacement. We studied a group of 46 patients, 47 joints (18 males and 28 females) consisting of 35 cases of femoral medial neck fracture, 10 cases of avascular necrosis of the femoral head and 2 cases of coxarthrosis. They were treated by femoral head replacement during 1977-1996 and were typed as follows: Austin-Moore (5 cases), Harris-Galante (2 cases), Omnifit (4 cases), Omniflex (6 cases) and HA-TCP (30 cases). Age distribution of these cases were 18 to 89 years (mean: 67.9 years), and they were followed from 1 year to 19 years and 9 months (mean: 4 years and 7 months). The mean postoperative JOA score was 80.0 points (Moore: 76.6, H/G: 75, Omnifit: 76, Omniflex: 75.5, HA-TCP: 81). Radiographically, loosening was frequently seen in all patients except HA-TCP type.