During 1980-1991 there were 7700 birth-s in the middle district of Saga Prefecture. Of these, 6960 infants aged two to twelve months had their hips examined at public health centers. Af this examination 14 cases of treated congenital dislocation of the hip were found and 10 new cases of congenital hip dislocation were reported which had previously been missed despite their having neonatal examination. The average age of the infants with previously missed dislocation at the time of diagnosis was 3.2 months, and all were immediately reduced with a Pavlik harness. This investigation suggested that the incidence of CDH was 0.345%.
We report on 21 cases (23 joints), with congenital dislocation of the hip joint (CDH) which were treated by open reduction between 1980 and 1989. None of the cases were Successfully reduced by Successfully Pavlik harness or other closed metheds. We studied eight cases (10 joints), which were followed for more than tnree years. Average age at follow up was seven years and three months (range: 4.7-10.5 years). Five cases (six joints) were female, and three cases (four joints) were male. Surgical treatment was open reduction for five joints and open reduction with acetabuloplasty for five joints. All cases were judged as good or excellent using Mckay, s clincal evaluation and seven cases (nine joints)
Fullowing on from experimdntal results, we have used the technique of vascular bundle transplantation in cases of Perthes' disease. The results of three cases are described in this paper. The follow-up period ranged from 7 to 10 years' and the results of the operation were examined roentgenographically and clinically. On final examination, the J. O. A score was 100 points in all cases, and roentgenogenographical evaluation using the Mose method classified all cases as good.
Bone mineral densities (BMDs) around the stem of bipolar hip prostheses (OMNIFLEX or OMNIFIT) were measured in 41 hips of 33 patients by dual energy x-ray absorptiometry. Among 19 cases of OMNIFLEX (average 14 months after surgery) BMDs were higher in patients 1 year and over affter surgery than in those less than 1 year. The results suggest that active bone formation occurs around the stem about 1 year after surgery. Among 22 cases of OMNIFIT (average 45 months after surgery) no difference was found between BMDs of patients over 3 years after surgery and those less than 3 years which implies that the bone around the stem was already balanced before 3 years after surgery. The tip of the stem showed the highest BMD.
We have applied 15 Harris-Galante cementless porous-coated prostheses in 14 patients, comprising cases of intracapsular fracture, osteoarthritis, rheumatoid-arthritis, and femomal head necrosis. The patients were separated radiographically two groups based on the preoperative Singh index. Postoperatively JOA scores were compared between the two groups. Three patients were male, and 11 were female. The mean age at operation was 64.9 years (42-89 years). The mean followup period was 46.7 months (range: 27-74 months). The average post Sigificant correlation between preoperative Singh index and postoperative JOA score was observed. The average postoperative JOA score in the severe porosis group was 73.3 points (67-80); in the non porosis group the average post-opratve JOA score was 91.4 points (84-100). A radiolucent zone tended to appear more frequently and was assouafed with aggrawaton of severe conditions in the porosis group. Based on the results, we recommend the use of the cementless porous stem in patients without osteoporosis. Cement fixation sheuld be used in patients with severe porosis.
We radiographically examdned the results of bone grafting in 46 in hips lyear post-operahvely. We studied consolidation of grafted bone in the following situations: autografted femoral head and autografted ilium, tip-sized bone and block-sized bone, screw fixation and no screw fixation. Consolidation in autografted femoral head bone appeared as early as in the autografted ilium. Tip-sized bone consolidation may occur earlier than block-sized bone while consolidation seen in screw fixed bone appeared later than that seen in non-screw fixed bone.
Preoperative 99mTc-MDP scintimetry was compared with histomorphometry of the extrated femoral heads from 12 cases of femoral neck fracture and 11 cases of idiopathic osteonecrosis of the femoral head., Histomorphometrical parameters such as percentage of cancellous bone area, percentage of osteoid surface and percentage of resorption surface were measured using decalcified osteoid stained sections of the femoral heads. Radionuclide uptake values correlated well with those of the percentage of osteoid surface. These results suggest that 99mTc-MDP uptake indicates the degree of osteoid formation.
Using a digitizer system, we histologically measured bone volume beneath the growth plate in the proximal femoral metaphysis of spontaneously hypertensive rats (SHRs) aged from 5 to 9 weeks. Wister Kyoto rats (WKRs) were used as controls. Histomorphometry was conducted in the lateral and medial portions of the metaphysis. In SHRs, bone volume in the lateral portions was less than that in the medial portions at 5, 6, 8 and 9 weeks of age. In comparison, in WKRs, there was no difference in bone volume between the two portions at the different ages. These results suggest that endochondral ossification in the lateral part of the plate is disturbed unevenly in early ages, that is before osteonecrosis occurred in SHRs.
We analyzed 29 THRs of 22 patients with bilateral dysplastic osteoarthritic hips. The patients rarged in age from 37 to 62 years (mean: 59 years), and were evaluated on average 5.8 years after the replacement. Clinical evaluations were performed using the JOA score, ROM, MMT for abduction and leg length inequality. X-ray results evaluted the socket position, height of the major and minor trochanter and prosthetic loosening. On the operated side, the lower the socket position, the better the functional results as assessed by ROM and MMT. Results led us to conclude that the upperlimit of socket height (measured from the cup center) may be 30mm from the teardrop-line in order to achieve functional and long-lashng THR. A lower socket position leading to leg lengthening on the operafed side might also lead to better clinical results through a varus effect on the unoperated femoral head.
Total hip arthroplasty in cases of protrusio acetabuli caused by rheumatoid arthritis, proximal migration of femoral head prosthesis, and cup loosening where there is less bone stock, can be technically difficult to treat with problems in fixing the acetalulum, and fixture strengh can also be problematic. In such cases we use bone grafts and a FS cup supporter. In protrusio acdtabuli, the bone graft is camel out on the base of the acetalulm and then a cup supporter is used. When there is less bone stock, bone stock is fixed with 3 or 4 screws on the upperpart of the acetabulum and again a cup supporter is used. In the last five years we have neafed 32 cases (37 joints) with the combined use of bone graft and FS cup supporter. All of these cases have made good progress post-operahvely.
Thirty hips in eighteen patients with avascular necrosis of the femoral head (ANF) were evaluated using magnetic resonance (MR) imaging and X-ray. In the preradiological stage, no casen showed a homogenous pattern. In the early stage, MR findings gave a variegated patterns and In the advanced stage, homogenous patterns appeared frequently. In two cases, specimens from the femoral head were obtained during surgery, and undecalcified sections with tetracycline labelling were made. Histological findings of the first case (52 y. o. male) showed a homogenous pattern indicating an infarct in an area where there was no tetmacycline labelling. The second case (59 y. o. female) with an inhomogenous pattern showed mixed tralecular bone with or without bone labelling in the necrotic ameas. These resulfs may suggest healing of the infarct bone.
We report a 25-year-old male with bilateral idiopathic transient osteoporosis of the hip. At first the left hip was affected. Six months later the right hip was affected. MR-imaging showed regional decreased signal intensity on T2-wei-ghted images bilaterally. This finding reverted to normal earlier than other radiographic findings. Bone scintigrams showed diffuse increased uptake in the left femoral head. A regional hot area was seen in the lateral joint surface of the right femoral head before coxalgia developed. This finding indicates that stress to the joint surface may be involved in the etiology of this disease.
Bilateral slipping of the upper femoral epiphysis in a 15-year-old boy with renal osteodystrophy caused by a right polycystic, and left dysplastic Kidney, is reported. Biplane intertrochanteric osteotomy (Southwick) was carried out to both hips. The left hip developed non-union and was successfully treated with a bone graft. JOA (Japanese Orthopedic Association) hip score improved from 55 to 98 after surgery. Slipping of the upper femoral epiphysis associated with renal osteodystrophy has rarely been an indication for osteotomy because of the high surgical risk. However, Southwick' osteotomy can be done with less risk with the progress in management of renal dysfunction. We conclude that even in children with slipping of the upper femoral epiphysis accompanied by renal osteodystrophy, adequate reduction of the deformity can be achieved by osteotomy leading to improvement in the activity of the patient.
A rare case of pathological dislocation of the hip in von Recklinghausen's disease is reported. A 13-year-old boy suddenly developed pain and dislocation of his right hip with no obuious cause. He visited our department 8 months after onset of symptoms for right hip pain and a limp. He had many typical café au lait spots on his skin and bilateral anterior leg angulation. Neurofibroma were detected by skin biopsy. Radiographs demonstrated right femoral head deirtion to the supra-lateral side, t femur was atrophic femur and both acetabula were hypoplastic. Joint effusion of the right hip was seen on MR I and arthrtgraphy. CT showed hypoplasia of both acetabul a and an irregular margin of the right acetabulum with bone multiplication. We proposed that this pathological dislocation was caused by decreasing restriction and congruity of the hip joint. The former is due to relaxation of the joint capsle, and the latter is due to the irregular acetabular surface caused by invasion of neurofibroma.
We report on new criteria which we developed to evaluate arthroplasty carried out for treatment of rheumatoid arthritis of the lower extremity Characteristics of our evaluation include not only pain and function of an affected joint but also assessment of rheumatoid activity using activities of daily living and laboratory data. All criferia are arranged in parallel. Using this criteria, we of individuals 86 affected joints and found that our criteria may be especially useful in the follow-up of individuals, evaluated because it clafies the effect of rheumatoid activity on the joint.
Arthroscopic synovectomy of the Knee was performed on 18 joints in 21 patients with rheumatoid arthritis. The average follow-up period was 1 year 1 month, ranging from 6 months to 2 years. The procedure was performed using both shaver and punch. Synovial tissue in the suprapateller pouch and medial and lateral sulci was resected using a shaver, and synovial tissue at the intercondylar notch and above and below the meniscus was resected using a punch. We assessed the preoperative X-ray findings using 6 stages of Larsen's grading and the arthroscopic cartilaginous findings using 5 stages. The postoperative results were evaluated using the JOA score for the rheumatoid knee. Results for the early stage cases were superior to those for the late stage cases. However the procedure for the late stage cases was useful, even if the postoperative improvement was temporary. These results suggest that arthroscopic synovectomy is a useful method for local treatment of rheumatoid arthritis.
From 1978 to 1991, 82 cementless total knee replacements (Mark II or M/G) were performed in 61 rheumatoid arthritis (RA) patients in our clinic. Of these, we were able to follow 48 joints in 33 patients for more than one year. Clinical results were evaluated using the J. O. A. criteria of RA knee. At the end of the follow-up peried, the mean knee score had improved from 42.5 points preoperatively to 66.4 points postoperatively. The incidence of postoperative complications was 15 percent. Three revisions had been required, two for loose knee and one for posterior dislocation of the tibia. Factors which influenced postoperative clinical results were preoperative Class type and period of postoperative observation.
Eighteen cases (20 knees) of arthroplasty using the Whiteside Ortholoc II prosthesis were evaluated clinically and radiographically. Mean age of patients was 64.3 years (range, 44-83 years). The mean Peried of follow-up was 3.8 years (2.3-4.8 years). Oseoarthritis was diagnosed in 11 knees, rheumatoid arthritis in 9. Mean JOA rating score improved from 46.8 to 76.3 poists in the OA group and from 29.8 to 67.6 in the RA group. Radiolucencies, present in two knees, were less that 1mm. The patellofemoral joint on axial view showed dislocation and subluxation in 2 cases.
A case of Failed total knee arthroplasty with difficulty in reoperative planning is reported. A 65-year-old women with rheumatoid arthritis, complained of severe pain in her left knee. Radiographs revealed displacement and loosening of both femoral and tibial components with the femoral lateral condyle and tibial medial condyle refleching the amount of bone that had been lost. We reimplanted a Press Fit Condyler modular type with metal spacers using the thickest stabilized HDP spacer. Excellent results were obtained. Histological evaluation of synovial tissue revealed many lymphocytes and foreign-body giant cells containing polyethylene parhcles. It was suggested that polyethylene debris may have induced the osteolysis.
The efficacy of disease modifying anti-rheumatic drugs (DMARDs) was studied retrospectively in patients with rheumatoid arthritis. Duration and continuance of medication was evaluated using the survival rate method (Kaplan-Meier) in four drug groups: Auranof in group (AF, N=52), Aurothiomalate Sodium group (GST, N=34), Bucillamine group (BUC, N=53), and the Methotrexate group (MTX, N=27). Sixty percent of patients in AF were found to still be taking the medication at 12 months, 50%, and 35%, at 24 and 36 months, respectively. Those in GST were 94%, 83%, and 79%, in BUC 79%, 60%, and 45%, and in MTX 75%, 55%, and 35% at 12, 24, and 36 months, respectively. We concluded Aurothiomalate Sodium is the most effective drug among these four drugs for the treatment of rheumatoid arthritis.
This study investigated the localization of proto-oncogenes and cytokine mRNAs in the synovium of rheumatoid arthritis. Synovial tissues were obtined from patients with rheumatoid arthritis (RA), osteoarthritis (OA), and traumatic arthritis (TA) at the time of Surgery. The sections were processed for in hybridization histochemistry using oligoncleotide probes for IL-1, IL-6, TNF-α, c-fos and c-jun. In the synovium of RA, IL-6mRNAs were expressed strolgly in the lining layer, sublining area and stromal area, while IL-1 mRNAs were detected in the stromal area where cells aggregated. TNF-α mRNAs were expressed in the stromal area, although weakly, Proto-oncogene, c-fos and c-jun mRNAs were expressed in the lining layer, and endoetheliocytes. Other synovial tissues from non-RA patients, the mRNAs were found weakly or were undtectaltable. These results suggest that activated cells in the synovium synthesized cytokines which then stimulate the expression of proto-oncogene. These phenomena may play an important role in the joint destruction seen in RA.
The induction mechanism leading to joint destruction in Charcot's arthropathy was studied by assessing patient's joint fluid with respect to bone resorption factors as well as active oxygen scavengers, including superoxide dismutase (SOD) and catalase. Joint fluid revealed bone resorbing activity, and this activity increased during the period of joint destruction. The activity of matrix metalloproteinase (MMP), SOD and catalase was also found to be increased in the fluid during this period. These results indicated that both MMP and active oxygen species may be associated with the induction of the joint desturction in Charcot's arthropathy.
Osteoarthritis is frequently associated with varus or valgus deformities and lateral thrust on walking, To examine the clinical significance of lateral thrust, we evaluated 20 normal and 20 osteoarthiritic (OA) knees using an accelerometer placed directly over the knee joints. The total value of peak acceleration in the medial-lateral direction was measured on a treadmill regulating the speed at 2km/h, 4km/h, 6km/h. In order to determine the absolute value of lateral thrust of the knee, we deducted medial-lateral acceleration of the ankle from that of the knee. Results showed that as walking speed increased, the lateral thrust of the knee tended to increase in both the normal and OA group. However it was noted that along with an increasing walking speed, lateral thrust had a greater tendency in the OA group than in the normal proup.
Manipulation for ‘frozen shoulder’ is a common practice. We describe one patient who developed anterior dislocation of the shoulder and brachial plexus palsy after shoulder manipulation carried out under general anaesthesia. A 54-year-old woman with a left ‘frozen shoulder’ had a manipulation after arthroscopy under general anaesthesia which achieved full elevation. The patient awoke from anaesthesia in severe pain and a few hours after manipulation extensive paralysis and loss of sensation in the upper limb had developed. Radiographs revealed anterior dislocation of the humeral head which was reduced without anaesthesia. Brachial plexus palsy had almost recovered six months later. Dislocation of the shoulder should be noted as a complication of shoulder manipulation.
Radiographs of 561 knees were examined to determine the incidence and size of fabella in radiographically normal knees as compared with knees with primary osteoarthrosis. To get an age matched control group, 302 knees from patients greater the 50 years of age were selected. Fabella was present in 144 of 244 (59.0%) primary osteoarthritic knees, and only in 20 of 58 (34.5%) radiographically normal knees (P<0.01). The length of the long axis of faballa averaged 8.5±3.1mm in primary osteoarthritic knees and 6.9±2.06mm in radiographically normal knees (P<0.05). Fabella size tended to increase as the stage of osteoarthrosis became more severe. The presence and size of fabellae may predispose the knee to osteoarthrosis.
It is well known that meniscectomy leads to deterioration of the articular cartilage, since first reported by Fairbank in 1948. We studied articular cartilage changes after partial meniscectomy and meniscal repair evaluated by a second-look arthroscopy. Thirty-two menisci in 30 patients were studied. Chondral lesions were mostly found in the medial compartment before operation (70%), but after surgery deterioration rate of lateral chondral lesions (50%) was higher than medial chondral lesions (20%). The lateral compartment of the meniscectomy group became significantly worse in comparison to the meniscal repair group (67%). In a few cases, cartilage deteriorated even after lateral meniscal repair. No difference was found during both operations in the medial compartment (meniscectomy-17%, meniscal repair-21%) Cartilage deterioration was often seen after lateral meniscal Surgery. This is probably because joint pressure supported by the lateral meniscus is higher than in the medial meniscus, and lateral meniscal repair prevents mobility of the meniscus. Cartilage changes after lateral meniscal repair must be looked for carefully.
In the acute knee injury accompanied by a fracture around the knee joint, diagnosis of ligamentous and meniscal injury is difficult. Neither the stress test nor arthrogram helps in the diagnosis of ligamentous and meniscal injuries because of instability at the fracture site and rupture of the joint capsule. We compared MRI findings with operative findings in eight acute knee injuries with fracture. Operative findings revealed lateral meniscus injury in three knees, ACL+MCL+LCL injury in one, ACL+MCL, injury in two, solitary ACL injury in one and no soft tissue injury in one. Accuracy of ligamentous and meniscal iniury diagnosed by MRI was 100% in ACL, PCL and MCL, 88% in meniscal (one false positive in MRI finding) and 63% in LCL (three false positives), False positive finding of LCL injury was mainly caused by misreading of a redundant LCL accompanied by lateral tibial condylar fracture which caused disruption of LCL. Accuracy of diagnosis will improve by aveiding this false positive finding of LCL injury. MRI was not only non-invasive but also a useful diagnostic tool for the evaluation of ACL, PCL, MCL and menisci even in acute knee injury.
Withi the past six years we had 4 patients with spontaneous hemarthrosis of the knee. The average age of our patients was 63 years. Two of them were men and two were women. They had no history of trauma or bleeding tendency. But two of them had a history of hypertention and two patients had experienced arthritic pains in the knee for some years. X-ray examination showed arthritic changes behind the patella and narrowing the femor-tibia space. Arthroscopically, the articular cartilage of the femoral condyle was defaced and subchondral bone was exposed. It has been suggested that hemarthrosis is due to scraping of the subchondral bone. In two of our cases the lower limb was immobilized on a gyps for a week and then mobilized. One case with medial compartmental arthritis treated by wedged insole. And one case which had torn meniscus we did menisectomy. After the treatment, hemarthrosis had not occurred in all cases.
Although an intra-articular ganglion of the knee joint is frequently found in meniscal fibrous tissue, a ganalion of the posterio cruciate ligament (PCL) is very rarelyseen, with no cases with recurrent hemarthrosis previously reported. A 32-year-old man was admitted to our hospital complaining of knee pain, restriction of knee motion and hemarthrosis. Radiologically there were no findings in the knee joint. An arthrogram and MRI showed a cystic lenion (30mm by 16mm) on the PCL, which was suspected an being an intra-articular ganglion. At arthroscopy a cystic lesion was found on the PCL and upon pushing it with a probe, clear mucinous fluid came out. All the patient's sympotoms improved after resection of the cystic lesion under arthroscopy. However the cause of the hemarthrosis was not determined, microtrauma and a ganglion may induce bleeding of the synovial tissue.
Caffey in 1947 described three cases of prenatal bowing and thickening of multiple long bones with overlying cutaneous dimples. The etiology of this syndrome is uncertain with several theories advocated. The following constitutes a report of congenital bowing of long bones with club foot in two sisters. Bowing was present in the upper and lower extremities, and there were cutaneous dimples in the legs. Clinical and radiological bowing of the long bones imprved with age in the elder sister. The club foot in both sisters responded well to treatment. A possible etiology for this syndrome is described.
This report discusse the treatment and mechanism underlying the development of osteochondritis dissecans of the talus with a flat top talus assouted with congenital club foot. We experienced five cases of osteochondritis disecans of the talus. All patients were males and the time of appearance of the lesion ranged from 9 to 14 years of age. Allfive cases had a prominent flat top talus and had an adduction and an entropion deformity. In all five cases, bone tip only appeared in circumscibed regions anterior to a pulley of the talus. We propose the following factors in the development o osteochondritis dissecans in patients with previously treated congenital club foot; stress of the flat top talus, stress of the retention foot deformity, and increasing activity.
In March 1986, a 33-year-old man sustained a spinal fracture resulfing in cauda equina paresis. He subsequently injured his right foot in May 1991. Roentgenograms revealed an oblique fracture of the distal shaft of the first metatarsus without displacement. After 1 month in a plaster cast, roentgenograms showed an indistinct fracture line. Immobilization was discontinued and the foot was loaded gradually. The noted swelling on the dorsum of the foot and 2 months afoer the accident roentgenograms showed an abnormal shadow around the first tarsometatarsal joint. The patient was referred to our hospital and admitted for operation. Arthrodesis of the first tarsometatarsal joint with plate and inlay bone graft using an iliac bone was performed following a diggnosis of Charcot arthropathy. The the patient was Neated by immobilization do a plaster cast for 5 weeks. Bone union was detected with roentgenograms 2.5 months after the operation, The plate was extracted 9 months after the operation. Thirteen months after the first operation roentgenograms showed good healing and the patient remairs asymptomatic.
This is study analysesthe relatinship between leg rotatin and the maedial arch of the foot. Materials were three amputated legs. Which were rotated internally and externally 15 times. We measured the angles of the ankle and subtalar joint and the length of hte medial arch simultaneously. When the leg was rotated internally, the subtalar joint became everted and the medial arch lengthensd. However when the leg rotated externally, the subtalar joint inverted and the medal arch shortend. The angle of the ankle joint was not changed. Therefore rotatin of the leg related to change in the medial arch.
Accelerometric measurement of gait ananlysis is a simple, inexpensive and effective way to evaluate gait and was first introduced by Liberson and colleagues. Smidt applied accelerometry to the normal and abnormal patterns of gait. Ogata used accelerometry to quantitatively vevaluate the lateral thrust of the knee and investigated the dynamic effects of a wedged insole on the thrust of OA knees. In the present study, we used an accelerometer, strain gauge and goniometer to inveshgate the effects of accelerometry on heel strike in gait analysis. The acceleration placed on the calcaneal region on heel strike appeared faster than any other measurement. Our results suggest that an accelerometer placed on the calcaneal region provides the most useful information on the exact moment when the heel strikes the ground.
Analysis of acceleration in the knees is very difficult due to the high sensitivity of the acceleration sensor. However this method is important for measuring the force directly. Other kinematic techniques, such as the use of a goniometer are assoaoted with a lot of procedural noise and require the calculation of acceleration by a differentialequation. Therefore we selected an accelerometer to measure acceleration of the lateral thrust. Date was integrated and accuracy checked for comparison with image analysis using a video camera. Femoro-tibial angle (FTA) and mechanical axis (MA) are indices of static analysis using X-ray image. We compared these indices with acceleration kinetics. Accelerography results are highly reproducble and the results of comparison with image analysis indicate that accelerography has excellent accuracy and sensitivity for measuring insole effects. All cases of medial compartmental OA knees indicated a lateral thrust pattern (LTP) and accelerography of the wedged insole effective knee showed disappearance of LTP or a decreased first peak (FP) just after heel contact. FP related to the height of the wedged insole. FP with medial wedged insole increased in proportion to height but decreased with the lateral wedged insole. There was no correlation between FTA, MA and FP.
We have investigated prostheses in 19 patients aged over 60 years with amputation of their lower extremities. Amputation had been carried out in 63% of the patients due to peripheral circulatory failure. Almost one quarter of the patients had no indication for prostheses because of various complications. In approaching the problem of prostheses and rehabilitation in the older age group, it is important to consider the general physical condition of the patient and any other diseases they may have. In general, the prosthetic approach for an aged amputee is recommended in order to improve their activity of daily living and quality of life.
Isokinetic strength of the muscles moving the shoulder was evaluated in 47 university baseball players and 33 non-baseball players. Baseball players were classified depending on the position and presence of any shoulder impingement signs. The CYBEX 350 isokinetic machine was used to evaluate the strength of the shoulder muscles at 60 degree/second. Muscle strength was evaluated using three parameters (peak torque, muscle strength ratio and peak torque angle). Baseball players hadahigher peak torque at horizontal shoulder abduction than non-baseball players at 0° flexion averaged 7.1° in pitchers, -9.0° in infielders and -14.8° in non-baseball players. Thirteen players with positive impingement signs had a higher strength ratio of shoulder external and internal rotation in the shoulder at 90° of flexion than 34 players without any impingement signs (p<0.05). The peak torque angle of baseball players showed more flexion, extension, abduction, and less external rotation in 90° of shoulder flexion, compared to without any signs of impingement. These results suggest that muscle strength is related to torque and angle, making necessary when studying muscle strength to not only study peak torque and muscle strength ration but also to study torque angle.
Chronic compartment syndrome is a cause of pain in the lower extremity, and is a common disability in athletes. The significance of intracompartmental pressure in the diagnosis of chronic compartment syndrome is controversial. We measured anterior intracompartmental pressure in five healthy men before, during, and after exercise, using the Millar catheter system. The exercise consisted of activedorsif lexion for 3 minutes and running on a treadmill for 5 minutes. The results were compared with those of a previous study.
One case and one study of an atrophy of the vastus medialis (VM), which might be caused not by disuse but by neurophysiological factors, are presented in this paper. (1) A 17-year-old boy showed an acute atrophy of the VM on day 3 after injury of ligaments and menisci of his left knee. This atrophy was demonstrated on MR imaging. (2) The right knee of 11 healthy students was braced for 8 weeks to investigate effects of knee bracing on muscle. Cross-section area of the VM was significantly (p<0, 05) in 8-week braced side. Reflex inhibition of the VM via modulation of afferent activity of the capsule or ligament and meniscus, in response to capsular compression with bracing or acute swelling or injury to the mechanoreceptors in involved tissues, might lead to this muscle atrophy.
Two cases of quadriceps hematoma are reportd. Both patients sustained their injury by falling down onto a large rock. Knee flexion in both patients was limited (one case had 35 degrees and the other 80 degrees of knee flexion). Magnetic resonance imaging showed a hematoma within the quadriceps femoris. Surgical excision of hematoma was carried out and knee flexion improved within 2 to 3 weeks. In the literature, many patients presenting with an indurated tender thigh accompanied by 90 degrees or less of knee flexion have been reported to develop ossification. Therefore I recommend that a quadriceps hematoma should be removed if it severely limits knee flexion.
Forty six knees in 36 patients with Osgod-Shlatter desease were treated conservatively and followed for an average of 2 years 9 months (range; 8 months to 4 years 9 months). Patients included 29 males and 7 females ranging in age from 9 to 14 years (mean 12.3 years). Retrospective studies investigating physical activity and radiographic changes were performed. Pain relief and recovery period from this disease was much shorter in patients who stopped physical activity. Patients who had radiographic evidences of a tibial tuberosity suffered from this disease for a longer period than those patients without such deformities.
Long term results of Osgood-Schlatter's disease are reported in 54 knees. There were 32 male patients and 10 female patients ranging in age from 20 to 37 years (mean, 27.7 years). The period of follow-up ranged from 7 to 23 years (mean; 14.5 years). Clinical results were evaluated by questionnaire. Eighteen knees had a deformity of the tibial tuberosity and 16 knees were painfull. Radiography at follow up classified the knees into three types as defined by Maruyama: N type (50%), I type (30%) and F type (20%). Patella height was measured using Blackburne's criteria. Clinical results were poor and patella alta was found in the F type.
We surveyed a group of sports players to investigate the reasons why they retire with particular respect to injury characteristics. Subjects included baseball players (67 males), rugby players (65 males) and basketball players (47 females). Nineteen baseball players, 4 rugby players and 5 basketball players had decided to retire because of injuries and disorders that happened during playing. Among baseball players, lumbar spinal disorders were the most prevalent and they were also characterized by elbow and shoulder disorders. No characteristic disorders were found to be associated with rugby players. In basketball players, knee joint injuries were characteristic, with rerupture of the anterior cruciate ligament a serious injury for them.
Stress fractures are common skeletal injuries found in athletes. However it can be difficult to differentiate stress fractures from other diseases at the first examination after the onset of symptoms, and to decide the time to begin exercises. We used MRI to evaluate 15 cases of stress fratures that we had seen among 62 cases in our sports clinic over the last two years. In these cases, the clinical course was followed and the MRI findings were compared to the findings of plain radiography and bone scintigraphy. Particular emphasis was placed on investigating any factors which may be useful in differentiating stress fractures from other complaints, especially shin splints.
A comparative study between percutaneous repair and surgical repair of subcutaneous Achilles tendon ruptures is presented. There are no significant differences between the two groups. The technique of percutaneous repair is easy and achieves satisfactory results.
Selection of the operative procedure for treating multiple disc lesions is often difficult. We adopted anterior vertebral fusion (AVF) for the lowest double disc lesions, particularly for manual workers under 30 years of age. In these cases, over a period of 10 years after surgery stenosis of the canal at the L3-4 level has rarely been found although incomplate union of the L5/S disc space has sometimes been reported. In additoin, in cases of AVF for L4-5 disc lesions with L5-S disc degeneration, herniation of the L5-S has rarely occurred. These results meat that since 1986 we have carried out AVF for L4-5 and anterior discectomy without fusion for L5-S. We clinically evaluated 36 cases all with a post-operative follow-up of at ledst 12 months. Results are as follows: (1) Radiological Findings: 1) Narrowing of L5-S disc space and posterior displacement of L5 were found relatively early after surgery 2) The range of motion in L5-S disc space tended to decrease after 2 years post-operatively, but its ROM was greater than other disc spaces. (2) Clinical findings: 1) Clinical improcement was noted shortly after operation. 2) Improvement in ADL, as evidenced by improvement in the range of movement and the ability to life heavy things, was mostly found withinl-2 years after operation.
This study was carried out to clarify the biomechanical characteristics of the lumbar intervertebral disc using a three-dimensional finite element method. The geometry of the finite element model is based on the movement of the L4-5 segment without a posterior element in a 29-year-old man, obtained from 2mm thick computed tomography scans. The finite element model included material properties of the cortical bone, cancellous bone, end plate, nucleus pulposus and annulus fibrosus. Simulated loads were applied at the top of the upper vertebral body, while the lower vertebra was fixed. Strain distribution results indicate that the highest tensile strain occured in the innermost annulus fibrosus at the posterolateral location during flexion. It is suggested that increase in the strain at the posterolateral location of the annulus fibrosus in flexion with other loads is an important factor in the mechanism leading to disc prolapse.
The peridiscal and nuclear (uncleus pulposus and inner layer of annulus fibrosus) signal intensities in 500 discs of teen-age patients were compared with common degenerative lumbar disc disease. Images were taken with a 7mm slice thickness and T2 wighted (TE 80-90mS, TR 2000-2200mS) midsagittal imaging. Clear correlation between these intensities was found. The signal intensity primarily decreased in the peridiscal tissues and secondarily decreased in the nucleus pulposus and inner layer of annulus fibrosus. These findings suggest that peridiscal disorders cause degenerative changes of the nucleus pulposus. Additionally, in the early degenerative stage of the teen-age lumbar disc, a decrease of nuclear signal intensity insicated that degenerative changes originated from the anterior portion and extended posteriorly.
Degeneration of end plates and the nucleus pulposus of the lumbar intervertebral disc in 100 patients with low back pain and/or leg pain, were evaluated by plain films. Degeneration of end plates progressed with age. Degeneration of mucleus pulpousus, disc protrusion and disc space narrowing progressed with the degeneration of end plates. The end plates degenerated more than the nucleus pulposus at all levels and all ages. Therefore, we concluded degeneration of end plates is preliminary to degeneration of the nucleus pulposus in intervertebral disc degeneration.