The authors evaluated the result of 12 patients who had meniscus tears treated by arthroscopic meniscectomy. There were 7 male and 5 female patients. The average age of the patients was 36 years (range 16 to 48 years). The average duration of follow up was 3 years and 5 months (range 12 months to 7 years and 10 months). This series did not include any patients with degenerative tears. The clinical results were evaluated with the Japanese Orthopaedic Association score (JOA score) and satisfactory of everyday life and sports. The average JOA score at the time of follow up was 98 points.
Everyday life were satisfactory in all patiants, but 4 patients were dissatisfied with sports.

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We report three patients (two males and one female) with partial or extensive defect of the clavicle. Their ages were 38, 20 and 48 years. The cause of the defect in the first patient was osteomyelitis after the osteosynthesis for fracture. Length of the defect was approximately 5 cm. The second patient suffered from alveolar soft part sarcoma in the chest. After chemotherapy and radiation, the surgery was performed. The clavicle was temporality osteotomized, and then fixed with a plate. Non-union occured, and the clavicle was gradually absorbed, resulting in partial defect of the clavicle. The third patient suffered from fibrous dysplasia. The entire clavicle was excised because of multiple episodes of fracture. The scapula of the third patient rotated and protruded, while neither of the other two patients revealed any deformity of the shoulder girdle.
All patients were light workers, and their occupational demand was not heavy on the shoulder girdle. Their daily activity was not disturbed. Reconstruction of the clavicle may not be needed, especially in patients with light work. Heavy workers may benefit from clavicular reconstruction, although a more invasive procedure is required.

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We report four cases of subcutaneous rupture of the flexor profundus tendon of the little finger. The patients were 3 men and 1 woman. The patients’ ages at the time of the injury ranged from 34 to 68 years (the mean age was 49). All patients were treated surgically by tendon graft (3 cases), and advancement method (1 case). All patients returned to their jobs.
The authors concluded that reconstruction of the flexor tendon of the little finger was crucial in the restoration of grasping power in these patients.

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Osteochondral lesions at the talar dome are common causes of ankle pain and disability, however bilateral osteochondral lesions of the talus are relatively rare. The authors report a case of bilateral osteochondral lesion of the talus, and the arthroscopic treatment results.
A 12-year-old girl had complained of spontaneous bilateral ankle pain during athletic activity for 2 years. In December of 1998, radiographs revealed bilateral osteochondral lesions of the medial talar dome, both ankles were Grade 1 according to Berndt & Harty’s classification, and both were Grade 2 according to Kumai’s MRI classification. Arthroscopic findings in both ankles were Grade 2 according to Pritsch’s classification, arthroscopic treatment was done to fix the large fragment (8 mm) in the right ankle with Poly L-lactic acid osteosynthetic implants, and to fix the smaller similar fragment in the left ankle, with Kirschner wires (1 mm in diameter). The preoperative JOA score improved from 85 points to 100 points at the 1 year, 6 months follow-up.

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The authors report findings of a retrospective study of 5 patients (4 men and 1 woman) with pyogenic arthritis of the knee who were treated between 1996 and 2001 with arthroscopic debridement and closed suction-irrigation. The patients were operated on 7 to 20 days (mean : 15 days) after the disease on set. The mean age was 55 years (range : 24 to 75 years). The mean follow-up interval was 9 months (range : 3 to 20 months). Infecting organisms were staphylococcus aureus in 3 patients, streptococcus pneumoniae in 1 and streptococcus agalactiae in 1.
Radiographs showed bony destruction of medial femoral condyle and medial tibial condyle in 1 case. The patients reacquired almost the same range of motion as before the infection. The infection was eradicated in all patients, with no recurrence. Arthroscopic debridement and closed suction-irrigation were considered to be effective for the early cases with few bone changes.

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We investigated the infections after implant arthroplasty. There are three types of implant arthroplasty including total hip arthroplasty (THA), bipolar hemiarthroplasty (BHA) and total knee arthroplasty (TKA).
The patients having infection after THA or BHA included nine cases-four men and five women. The primary diseases were four cases of osteoarthritis of the hip, three cases of femoral neck fracture and two cases of intertrochanteric fracture of the femur. The patients having infection after TKA included eight cases-five men and three women. The primary diseases were six cases of osteoarthritis of the knee and two cases of rheumatoid arthritis.
The period between primary operation and onset was longer in the case of infection after THA or BHA than in infection after TKA. Infection after THA or BHA had many risk factors for infection in comparison with infection after TKA because the knee joint exits the superficial layer and has many opportunities to inject into the joint, we believe.
We performed the operative therapy in the infection after THA or BHA with continuous irrigation in six cases, insertion to the cement spacer with antibiotics in four cases and insertion to AW glass ceramic with antibiotics in one case. In all cases we performed the removal of implants and re-operation in one case. In the infection after TKA case we performed the operative therapy, with continuous irrigation was in five cases and insertion to the cement spacer with antibiotics in two cases. In four cases we performed the removal of implants and in all cases the infection was controlled.
In the therapy for infection after implant arthroplasty, we had to understand and to control the risk factors for infection.

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Since 1990 we have performed 16 arthroscopic subacromial decompression (ASAD) procedures on patients suffering from impingement syndrome laking rotator cuff tears.
This article describes two of those cases, both of which had calcific tendon. The first case was a sports-related injury in a 37-year-old woman who experienced right-shoulder pain when playing badminton. The calcification was discerned in the supraspinatus tendon. The second case was a 72-year-old woman who had rest pain and severe pain when elevating the arm. The calcification was discerned in the infraspinatus tendon.
The clinical symptoms in both patients improved greatly after treatment. Radiographs taken about 60 weeks after the procedures show that the calcifications have disappeared.
ASAD was effective in the treatment of impingement syndrome accompanied by painful calcific tendon in these patients.

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The cases of 20 children who had a displaced supracondylar fracture of the humerus treated between 1994 and 2000 were reviewed retrospectively. The fractures were managed initially by closed reduction and percutaneus pinning under general anesthesia. After fixation, the arm was protected in a posterior plaster cast. Three weeks later, the pins were removed and active ROM exercise was permitted. The results of the treatment were assessed using the criteria of Flynn et al. : 85% were excellent and 15% were good. There were no fair or poor results. Cubitus valgus or neurovascurlar disturbance occurred in none of the cases. The advantage of this method is that the mean follow-up in the hospital is shorter than with other methods, which allows children to return to school earlier.

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Sprengel’s deformity is a comparatively rare congenital abnormality wherein the scapula remains high on the chest wall. The authors treated a 3-year-old boy with the bilateral deformity. Preoperatively, the left scapula was located 11mm higher than the right scapula. The abduction of both shoulders was limited to 90 degrees. Multiple anomalies were noted, including the presence of the left omovertebral bone, congenital fusion of C2-3 and C5-6, spina bifida occulta of C5 to C7 and rib deformities. Woodward procedure was performed on each side five months apart. The supraspinous portion of the scapula was not excised on the both sides. An early postoperative X-ray demonstrated good correction. At the 3 year follow up abduction of both shoulders had improved to 140 degrees. The scapular lowering obtained on each side was about one level of the vertebral body compared to the preoperative level. But, a discrepancy of the scapular level remained, because a loss of correction occured in the left scapula after the operation. We consider that the pathological changes of the left shoulder girdle should be treated more aggresively in such a case in order to facilitate relocation and prevent the loss of correction.

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A 75-year-old man was diagnosed at a related hospital with mild ankylosing spondylitis in 1991, but did not seek further care for his spinal condition. In January of 2001, the patient presented with severe dysphagia. According to the speculation of an otolaryngologist at the authors’ hospital, his dysphagia was caused by osteophytes based on radiographs of the cervical spine. The images showed osteophytes at the C3/4 level and a large ossified lesion of the anterior longitudinal ligament below C4.
A fiber optic esophagoscopy revealed a distention of the posterior esophageal wall just posterior of the epiglotis. A dynamic esophogram showed abnormal movement of the epiglotis and contrast medium flowed into the trachea. The ossified lesion below C4 clearly was not involved and could be left untreated. Symptoms of dysphagia disappeared immediately after excision of the osteophytes at the C3/4 level. The patient was able to eat and drink comfortably. The dynamic esophogram provided the surgeons with a precise distinction of the causal structures and allowed them to limit the extent of the operation.

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A 75-year-old man had C5 unilateral facet interlocking after falling from the roof. He was neurologically intact. But after closed reduction with traction, the patient presented incomplete tetraplegia and sensory loss from the C6 level down. Emergency MRI demonstrated the presence of C5/6 intervertebral disc herniation. He underwent removal of the disc herniation and anterior spinal fusion as soon as was possible. Postoperatively, he experienced immediate neurological improvement.
It is important to evaluate the risk of disc herniation after reduction. If MRI reveals protrusive disc herniation beforer eduction, we should remove the disc herniation anteriorly and perform anterior spinal fusion.

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The authors operated on 2, 393 patients for cervical spine diseases from 1980 to 2000. About 80% were regressive and degenerative diseases including cervical spondylotic myelopathy (CSM), cervical disc herniation (CDH), ossification of posterior longitudinal ligament (OPLL), cervical spodylotic radiculopathy (CSR), etc. 6.5% required multiple neck operations (MON), 4.2% were cervical trauma and 9.4% were comparatively rare diseases. We examined retrospectively the charactaristics of the latter that tend to delay the proper diagnosis. A majority of atlantoaxial subluxations with neck pain, except those associated with trauma, infection or cervical spine tumors, were identified relatively early. 61 patients with spinal cord tumor presented numbness and pain equally. Most patients were adults with an average of 44 years. The young patients with congenital diseases as Chiari malformation and os odontoideum suffered from various symptoms.

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Magnetic resonance (MR) images of 40 knees with chronic anterior cruciate ligament (ACL) injuries were retrospectively evaluated. They were defined as chronic if symptoms persisted at the follow-up examination than 6 months after injury. The 15 men, and 25 women patients ranged in age from 16 to 49 years (mean, 30 years). The MR imaging features of the ACL in sagittal images were classified into three types by one orthopedist : continuous low intensity band (8%), non-continuous band (58%) and non-visualized (34%). Posterior cruciate ligament (PCL) buckling was observed in 11 knees (28%) and anterior shift of the tibia was observed in 11 knees (28%). Disrupted femoral attachment of the ACL was observed in 38 knees (95%) in coronal images. The MR images of the knee with chronic ACL injuries were very variable and may occasionally be difficult to distinguish from an intact ACL.

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The Authors performed the posterior cruciate ligament (PCL) reconstruction using multiple hamstring tendons. Twenty patients (15 men and 5 women, mean 27.8 years old) who underwent this treatment were followed-up longer than 1 year (mean 2.2 years). Ten patients were injured in traffic accidents. Nine patients were injured in sports accidents. 1 patient fell down.
Clinical results were evaluated with Lysholm score, stress radiography and knee arthrametry. Lysholm score improved from 78.5±12.5 points to 93.8±16.2 points. Posterior instability on the stress radiography improved from 34.6±9.2% to 48.5±6.4%. Side-to-side difference of total displacement of the tibia assessed by the KT-2000 knee arthrometer improved from 9.0±3.0 mm to 4.4±1.3 mm. The authors found that PCL reconstruction using multiple hamstring tendons was effective in treating the isolated PCL injuries in these 20 cases.

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We report a case that had symptoms of lower extremity contralateral to the side of lumbar disc herniation. The patient, 84-year old man, found it impossible to stand up after a bath due to weakness, pain, and numbness in both legs. Symptoms of the left leg were severer than those of the right. A diagnosis of spinal canal stenosis and right lateral disc herniation at L4/5 level was confirmed by MRI, myelogram and CTM. The flavum of the right side at L4/5 level was thick and hard, and the bilateral face tjoints were asymmetrical. These factors resulted in segmental canal stenosis contralateral to the side of disc herniation. The authors concluded that the left side of cauda equina was entrapped between the right lateral disc herniation and the left facet joint at L4/5.
The authors performed fenestration at L4/5 level and removed the herniated disc material. After the operation, the pain disappeared, and numbness and weakness of the leg improved. Three months later, the patient was able to walk smoothly.

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We report the outcome of 24 patients (13 men and 11 women) treated with enlargement of the lumbar vertebral canal (developed in Yamaguchi University) for lumbar canal stenosis and lumbar degenerative spondylolisthesis patients from October 1999 to December 2000. Mean age at the time of surgery was 67.3 years (range, 49—75 years). The mean follow-up period was 12.4 months (range, 6—19 months). Vertebra treated included L4 in 15 patients, L3 L4 in 6 patients, L3, L2 L3, L2 L3 L4 in three patients respectively.
We evaluated the surgical outcome using the Japanese Orthopaedic Association back score (JOA score, full point is 29). The evaluations based on the Hirabayashi recovery rate were as follows ; 9 cases excellent (75100%), 7 good (5075%), 5 fair (2550%), 3 poor (025%). Complications included displacement of the replaced lamina in 2 cases (one of them was associated with nerve root compression), screw breakage in 1 case and nonunion in 1 case.
We think that this enlargement of the lumbar vertebral canal might be a worth while method if cases are selected carefully.

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The authors describe a new endoscopic technique to decompress the lumbar nerve root in elderly patients with spondylolysis. The decompression is less invasive with a small skin incision of 16 (mm). Patients are allowed to stand and to walk even on the day after surgery. Surgical indication of this procedure is as follows ; 1) without low back pain, 2) without spinal instability on dynamic radiograms, and 3) elderly.
We report two cases with spondylolysis who underwent this procedure. One patient was a 59-year-old man who is engaging in the desk work, and the other was 60-year-old woman, engaging in house work. In both cases, the L5 nerve root was compressed by the bony ragged edge of the lysis and fibrocartilaginous mass surrounding the nerve root. According to the MED method, the authors removed ligament flavum at the affected side of L4-5, and the L5 nerve root was identified. Then, the fibrocartilaginous mass and osteophyte compressing the nerve root were removed with a curette and rongeour. As a result, the leg pain disappeared, and both patients returned to their previous work three weeks following the surgery. The authors found that endoscopic decompression was an effective surgical option for treating these elderly patients with lumbar spondylolysis showing radiculolpathy. The procedure was revealed to be a useful and minimally-invasive technique that facilitated the early return to the previouswork of these patients.

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