Yusuke Akaoka

What Components Comprise the Measurement of the Tibial Tuberosity-Trochlear Groove Distance in a Patellar Dislocation Population?

BACKGROUND The tibial tuberosity-trochlear groove distance is used as an indicator for medial tibial tubercle transfer; however, to our knowledge, no studies have verified whether this distance is strongly affected by tubercle lateralization at the proximal part of the tibia. We hypothesized that the tibial tuberosity-trochlear groove distance is mainly affected by tibial tubercle lateralization at the proximal part of the tibia. METHODS Forty-four patients with a history of patellar dislocation and forty-four age and sex-matched controls were analyzed with use of computed tomography. The tibial tuberosity-trochlear groove distance, tibial tubercle lateralization, trochlear groove medialization, and knee rotation were measured and were compared between the patellar dislocation group and the control group. The association between the tibial tuberosity-trochlear groove distance and three other parameters was calculated with use of the Pearson correlation coefficient and partial correlation analysis. RESULTS There were significant differences in the tibial tuberosity-trochlear groove distance (p < 0.001) and knee rotation (p < 0.001), but there was no difference in the tibial tubercle lateralization (p = 0.13) and trochlear groove medialization (p = 0.08) between the patellar dislocation group and the control group. The tibial tuberosity-trochlear groove distance had no linear correlation with tubercle lateralization (r = 0.21) or groove medialization (r = -0.15); however, knee rotation had a good positive correlation in the patellar dislocation group (r = 0.62). After adjusting for the remaining parameters, knee rotation strongly correlated with the tibial tuberosity-trochlear groove distance (r = 0.69, p < 0.001), whereas tubercle lateralization showed moderate significant correlations in the patellar dislocation group (r = 0.42; p = 0.005). CONCLUSIONS Because the tibial tuberosity-trochlear groove distance is affected more by knee rotation than by tubercle malposition, its use as an indicator for tibial tubercle transfer may not be appropriate. CLINICAL RELEVANCE Surgical decisions of tibial tubercle transfer should be made after the careful analysis of several underlying factors of patellar dislocation.

Risk factors for the effect of anticoagulant and antiplatelet agents on perioperative blood loss following proximal femoral fractures

AbstractTo examine the effect of oral anticoagulant and antiplatelet agents on perioperative blood loss following proximal femoral fractures and to identify the risk factors associated with perioperative blood loss.Retrospective cross-sectional study.In a retrospective cross-sectional study, we treated 334 consecutive patients with proximal femoral fractures (100 who received anticoagulant or antiplatelet drugs and 234 who did not) and an overall mean age of 85.5 years (standard deviation 8.2 years). We performed retrospective multivariate analysis to determine the independent factors related to perioperative decreases in the hemoglobin (Hb) level, a proxy for blood loss.Multivariate analysis confirmed that anticoagulant or antiplatelet drugs significantly affected decreases in the Hb level (regression coefficient [RC], 0.61; 95% confidence interval [CI], 0.14–1.08; P = 0.01). In addition to anticoagulant or antiplatelet drugs, multivariate analysis confirmed that the fracture type (Orthopedic Trauma Association classification A2: RC, 1.19; 95% CI, 0.71–1.67; P < 0.01; A3: RC, 2.47; 95% CI, 1.41–3.53; P < 0.01), platelet count (RC, −0.08; 95% CI, −0.12 to −0.04; P < 0.01), and operative time (RC, 0.02; 95% CI, 0.004–0.03; P = 0.01) affected the decreases in Hb level.The use of anticoagulants and antiplatelet agents is an independent risk factor for perioperative blood loss following proximal femoral fractures. Fracture type, platelet count, and operative time also affect perioperative blood loss. The fracture type was the greatest contributing factor to perioperative blood loss.Level of evidence grade: Prognostic level III.

Tibial Tunnel Positioning Technique Using Bony/Anatomical Landmarks in Anatomical Anterior Cruciate Ligament Reconstruction

Because various biomechanical studies and clinical results have shown the effectiveness of an anatomical approach for anterior cruciate ligament (ACL) reconstruction, this approach has become gradually commonplace to improve postoperative performance. Standard tunnel positioning methods with accuracy, reproducibility, and adaptability to varied concepts are essential for the success of anatomical ACL reconstruction. However, there were no standard tibial tunnel positioning methods to satisfy these conditions. This technical note reports our tibial tunnel positioning technique using bony and/or anatomical landmarks for anatomical ACL reconstruction.

Intrameniscal Gouty Tophi in the Knee

Case:We report a case of recurrent acute arthritis and restricted range of motion in the knee joint, with magnetic resonance imaging subsequently detecting a nodular lesion within the lateral meniscus. Knee arthroscopy and histology revealed that the lesion was intrameniscal gouty tophi. After arthroscopic synovectomy and excision of the tophi, the symptoms resolved and the patient remained symptom-free at two years of follow-up. Conclusion:Surgeons should be aware of the presence of such pathology and consider arthroscopic surgery if the mechanical symptoms persist.

Percutaneous Transluminal Angioplasty for Axillary Artery Dissection After Open Reduction of Shoulder Fracture-Dislocation

Case: Injury of the axillary artery after shoulder-joint fracture or dislocation is uncommon. We describe the clinical outcome of an elderly patient with a dissecting aneurysm of the axillary artery following open reduction of a fracture-dislocation of the shoulder. The arterial dissection was successfully managed with percutaneous transluminal balloon angioplasty. Conclusion: This case report highlights the need for careful vascular examination of all elderly patients with a fracture or dislocation of the shoulder and the possible use of percutaneous transluminal angioplasty for the management of arterial dissection prior to proceeding with surgical exploration.

Early Postoperative Intratunnel Migration of an EndoButton After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction

Case: We report a rare case of early postoperative migration of an EndoButton following anatomic double‐bundle anterior cruciate ligament reconstruction with use of the EndoButton for femoral fixation. Although secure fixation of the EndoButton was confirmed during the operation, one‐week postoperative radiographs revealed an intratunnel displacement of the posterolateral EndoButton. We performed a reoperation and refixed the EndoButton to the surface of the femoral cortex; we also hooked and tied both ends of the sutures to make a knot in order to prevent remigration. Conclusion: Orthopaedic surgeons should be aware that EndoButton displacement and migration could arise at an early postoperative stage.