Thirteen cases of pyogenic spondylitis were treated in our hospital from 1979 to 1993. Four cases were treated conservatively and nine cases which were resistant to antibiotics or had neuropathy were treated surgically. Early diagnosis is necessary to achieve good results in the treatment of pyogenic spondylitis. When patients complain of severe backpain with fever and inflammatory signs, we should suspect Pyogenic spondylitis and start antibiotic treatment as soon as possible. MRI and bone-scintigram are useful for aiding early diagnosis.
We investigated 8 cases of suppurative spondylitis and diskitis. The typical pattern of these diseases was seen more in the subacute phase than in the acute phase. The feature of these diseases in the acute phase was the poor demarcation between the disc and vertebral body and the brightness of the disc in the T2 weighted mage.
To investigate the effect of brace treatment in children aged under 10 years, we studied 12 children with idiopathic scoliosis and 19 with congenital scoliosis. Of the 7 with idiopathic scoliosis who followed the brace treatment faithfully, several kinds of improvement in the curvature were noted. In comparison curvature progression of occurred in the 5 cases who stopped using the brace midway through their treatment. The 19 cases of congenital scoliosis were classified as follows: one hemivertebra: 4 cases, two hemivertebra: 4 cases, many hemivertebrae: 6 cases, and unsegmented unilateral bar: 5 cases. Cuvature did not progress or improve in the 1 or 2 hemivertebra groups, but in other groups progression occurred in spite of the strict brace treatment. We found that the disc deformity around the deformed vertebrae in congenital scoliosis was corrected by the brace treatment. However it is still not clear whether or not bony deformities can be corrected at this time.
We report a new techique for correction of idiopathic scoliosis using percutaneous nucleotomy (P. N.). Four patients with idiopathic thoracolumbar scoliosis, had P. N. under local anesthesia. Subjects were four females, ranging in age from 13 to 17 years. Preoperative curve was from 28° to 41° in the standing position without corrective braces. P. N. was done at two disc levels, above and below the apex. These disc levels were confirmed as the transposition of the nucleus to the convex side by magnetic resonance imaging. Post-operatively all patients improved on average by 9.5°, ranging from 8° to 10°. No patients complained of severe pain during or after the operation. The transposition of the nucleus to the convex side is considered to be a mechanical disturbance to correction. P. N. in thocaco-lumber scoliosis is relatively safe and technically easy because of transposition of the nucleus, opening of disc space on the convex side, and rotation of the vertebral body. Percutaneous nucleotomy with a corrective brace is expected to be a new treatment for thoraco-lumbar scoliosis.
We report 20 cases (11 males, 9 females) who were operated upon between 1985 and 1993 for treatment of intradural spinal cord tumors using the posterior approach. The age of patients at surgery ranged from 8 to 70 years. They were followed up from 2 months to 6 years and 3 months (mean 2 years and 3 months). On MRI, posterior shift of the spinal cord was observed after tumor removal in 4 cases with intramedullary tumors, in one case with extramedullary tumor, and in one case with an arachnoid cyst. However, no cases with cauda equina tumors showed posterior shift. The dorsal tissue behind the shifted spinal cord was enhanced by gadolinium in a case with positive Lhermitte sign. Cine MRI revealed that the posteriorly shifted spinal cord stopped the cerebrospinal fluid flow in 4 cases. These results suggested that the posteriorly shifted cord resulted from adhesion of the spinal cord to the arachnoid membrane or the dura.
We reviewed 21 patients who were treated by postero-lateral fusion with the Diapason pedicular screw system for lumbar spinal disorders. Clinical and radiographic evaluation was carried out in these patients for a mean follow-up period of 7 months. The rate of solid fusion 6 months after surgery was 85.7% in 14 patients. Displacement of the rod was encountered in one early case, but no screw breakage and no device-related neural or vascular injuries occured. One significant advantage of this system is the relatively brief in comparison to other pedicular screw systems. Another advantage is that this titanium system possesses no risk for MR imaging and produces minimal artifacts on MRI and CT scans.
We used post operative CT imaging to evaluate 20 patients who were treated with Titanium spinal pedicle screws. We evaluated the appropriateness of screw insertions. Pedicle screw angles were measured in 96 screws. These were decreased in lower lumbar spines. Three screws penetrated medial pedicles 5 screws penetrated the lateral wall of pedicles and 8 screws penetrated anterior walls of the vertebral bodies. Incorrectly inserted screws which penetrated the anterior walls of the vertebral bodies had the qreater disparity between pedicle screw angle and transverse pedicle angle.
We report a 44-year-old man who complained of low back pain and severe pain on the medial side of his right leg associated with a walking disturbance. We diagnosed lateral lumbar disc herniation at the L4-5 level with findings from the physical examination, myelography and CT myelography consistent with this. One week after these examinations, the patient complained of numbness on the lateral side of his right leg. We performed magnetic resonance imaging (MRI), discography, CT discography, myelography and CT myelography. These showed two pieces of disc material in the spinal canal and foramen. Which were irritating the right L4 and L5 nerve roots. We performed lateral fenestration and removed two pieces of disc material and an excellent surgical outcome was achieved.
In symptomatic cases of nerve-root irritation due to a herniated lumbar intervertebral disk without any myelographic findings, lateral lumbar disk herniation is most suspicious. However, when myelography is positive, lateral disk herniation may not be revealed. We report a rare case of intra-spinal canal and extraforaminal lumbar disk herniation. A 61-year-old woman complained of right anterior thigh pain. A right femoral nerve stretch test was positive, and knee reflex was absent. There was marked grade 4/5 weakness of the quadriceps, tibialis anterior and extensor hallucis longus muscles. Sensory disturbance was present on the medial aspect of the right lower leg. Anteroposterior and right oblique myelography projections revealed amputation of the right L4 nerve root and a major right lateral defect in the dural sac at the L4 level. We suspected that the herniated disk had migrated upward to the L4 nerve root at intracanal. However, CTM at L4/5 level showed extensive foraminal and far lateral disk herniation. The angled coronal MRI view showed that the right L4 root was displaced upward beyond the ganglion by an extraforaminal herniated disk with a intraforaminal component. Discogram depicted two herniatied masses lateral to the L4/5 interspace and at L4 intra-canal. At surgery, the two fragments of herniated disk were removed and nerve root compression was relieved. She had complete postoperative recovery.
1991 cases of lumbar disc herniation were surgically treated over the past 16 years. Of these, We investigated 79 patients who were aged over 60 years (4.1%). (1) Clinical symptoms and physical signs: Symptoms tended to be more severe than in younger patients. 23% were unable to walk because of severe leg pain. Intermittent claudication was found in 55%, motor weakness in 46%, sensory disturbance in 51%, recto-vesical dysfunction in 9% and foot drop in 8%. (2) Operative findings: Sequestration was present in 49%, extrusion (mostly massive) in 34% and proliferation of facet joints in 67%. From these results, in cases with severe leg pain, positive SLRT and drop attacks which appeared acutely a sequestrated disc herniation was the most comman cause. Postoperative course was more satisfactory than any other ages. Average improvement rate with JOA score (Hirabayashi) was 72.3% in 36 cases over a period of 3 years after surgery.
A hundred and sixty patients with whiplash injuries were evaluated clinically for 3 years. Eighty-three per cent (133 cases) of all patients were free from symptoms within 3 months. However, seventeen per cent (27 cases) had many symptoms including headache, numbness in extremities, vertigo, and accommodative disturbances for more than 3 months. These 27 patients with long term effects tended to be in their fifties and have Barrè-Lieou and radiculopathy type injuries. Clinical results in all patients were not related to the presence of degenerative changes, A-P diameter of the spinal canal, nor alignment of cervical spine on the x-p findings. MRI showed disc or bony abnormalities with dural compression in some patients with poor outcome. MRI evaluation may be useful for predicting final outcome.
We evaluated 287 patients with traumatic cervical symptoms treated in Tokyo Rosai Hospital between January, 1987 to February, 1993. 81.5 per cent of the patients (234 cases) were involved in traffic accidents and 45.3 per cent of these (106 cases) had been in cars which were struck from behind. According to Tuchiya's classification, we grouped our cases into the 5 following types: cervical sprain, radiculopathy, Barrè-Rieou syndrome, myelopathy, and radiculopathy and Barrè-Rioou syndrome. The mean duration of treatment was 47.7, 96.4, 140.6, 110.2, and 113.3 days respectively. The Barrè-Rieou syndrome type required a significantly (p<0.01) longer duration of treatment than the cervical sprain type's.
We studied the time course of changes in cervical disk hernia using MRI. Cervical disk hernia was diagnosed in 1942 patients using MRI, 72 cases of which had MRI performed twice. In 17 cases, we were able to compare MRI changes before and after clinical onset. For the remaining 58 patients, we were able to evaluate the changes seen in the prolapsed disk. In the latter 58 patients, the period from onset ranged from 24-39.1 months (mean 14.9 months). In 27 cases, the prolapsed disk reduced in size or disappeared, with one case decreasing in size after only 2.5 months. In these cases, the signal of the prolapsed disk was low or isointense. In comparison, no change in the size of the prolapsed disk hernia was observed in the 17 cases, and one case had no change for at least 2 years. In 12 cases, the size of the disk hernia increased. In ten of these 17 cases, who we performed MRI before and after clinical onset, the cases with augumentation of the size of the prolapsed disk hernia were observed. The increasing part frequently showed high signal intensity.
107 patients suffering from various disturbances following a whiplash injury were studieds retrospectively. Patients were divided into four groups based on clinical, radiological and MRI findings; 55 cases had soft tissue injury only of the neck, 25 cases had traumatic thoracic outlet syndrome, 18 cases had cervical radicular syndrome and nine cases had a combination of traumatic thoracic outlet syndrome and cervical radicular syndrome. Patients with whiplash injuries were treated using a soft neck collar for sprain injuries, a thoracic outlet syndrome pillow that we developed to relax neck muscles and decompress brachial neuro-vascular plexus in traumatic thoracic outlet syndrome and a firm cervicothoracic orthosis was used to treat cervical radicular syndrome. Furthermore, according to the situation, chronic cases were also treated by non-steroidal antiinflammatory agents, muscle relaxants, stellate ganglion block, epidural block and isometric muscle exercises of the neck and pectoral muscles.
The results of conservative and surgical treatment were evaluated in 50 patients with cervical sprain. Injuries were classified as sprain (21cases), sprain+Barr'e (17cases), radicular (6cases), medullary (5cases), and Barr'e-Lieou (1case). A questionnaire was used to follow-up these patients to which 18 of the 50 patients responded. Of these, one-third had residual symptoms of neck pain and headache, but almost all patients had returned to work. However one-half of these patients were not satisfied with their compensation.
The clinical effect of low power laser irradiation on the stellate ganglion was evaluated. Five males and ten females with traumatic cervical syndrome were irradiated with low power laser. In nine patients, head, neck and upper limb symptoms decreased. Two patients felt warm in their hands and eight patients had decreased pain during the irradiation. The mechanism of pain relief was thought to be via lowering of tension of the sympathetic nervous system and then increasing tissue flood flow. The low power laser irradiation around the stellate ganglion was safe and effective for patients with traumatic cervical syndrome.
We investigated by questionnaire the social prognosis of 55 patients (29 male and 26 female) with whiplash injuries caused by traffic accidents. Twenty-two patients who were treated for less than one month had no sequellae, however, 23 out of 33 patients treated for more than one month did have sequellae. Seventeen of 23 patients with sequellae were not payed compensation. Eleven patients with sequellae did not continue treatment after private settlement. 86% of the 55 patients were able to return to their former job. These results suggest that the usual sequellae caused by whiplash injury are not severe. However, 20% of patients had some social problems and difficulties remained after out of court settlement.
This study analysed 20 patients disabled with lumbar spinal problems and assessed personality factors using the Minnesota Multiphasic Personality Index. In 4 cases (20%) either Hs or D or Hy or Pd exceeded a t-score of 70. There were no significant differences in number of operations or kind of treatment. In this study MMPI results do not appear to be not related to surgical outcome. MMPI information must be used with considerable caution in MMPI scales and cord types.
The radiological features of “isolated disc resorption” (ISDR) as named by Crock, with special reference to slipping of the vertebral body (isthmic spondylolisthesis, degenerative spondylolisthesis, ante-position and retrolisthesis), were studied in 113 cases of ISDR and compared with 406 cases of lumbar disc lesions (DL group). In 68 patients the lesion was at the L5/S level, 42 at L4/5 and 3 at L3/4. The mean age was 53.8 years with the L5/S level group having a younger mean age than the L4/5 level. Sixteen patients (14%) showed isthmic spondylolisthesis, 10 of whom were seen at the L5/S level and 6 at L4/5. In comparison only 5.7% of the DL group had isthmic spondylolisthesis. The frequency of degenerative spondylolisthesis was almost the same in both the ISDR group (10%) and the DL group (12%). Ante-position was less frequent in the ISDR group than the DL group. Retroliosthesis was more predominant in the ISDR group (35%) than DL group (22%). Totally 71% of the ISDR group had slipping of the vertebral body. In conclusion, we believe that slipping of the spine is a special feature of ISDR.
This paper describes the relationship between recurrent lumbar disc herniation and canal stenosis. Between 1980-1993, 655 patients underwent operative treatment for lumbar disc herniation at our hospital. Forty-one patients with recurrent symptoms after lumber discectomy were evaluated, and 18 cases were examined with CT. Factors seen with recurrent disc herniation were as follows: 1) facet hypertrophy 2) yellow ligament hypertrophy 3) vertebral osteophytes 4) lateral recess narrowing 5) developmental canal stenosis In almost all recurrent cases, some factors of lumbar canal stenosis could be found.
Fifteen cases of foot drop associated with lumbar disorders were investigated to identify the factors influencing clinical results. Fifteen surgically treated cases, (9 males and 6 females) were followed up for an average period of 2 years and 7 months. The mean age at the time of operation was 54.1 years. Patients consisted of 10 cases of herniation of the nucleus pulposus (HNP), 4 cases with a combination of degenerative lumbar canal stenosis and HNP (combined stenosis), and one case of postoperative extradural hematoma. The results were evaluated using six grades of the tibialis anterior muscle strength with manual muscle testing (MMT). We considered the patients who were grade 4 or 5 by MMT to be recovered, the other 8 patients were judged to be not recovered. Results were compared and analyzed with reference to age, type of onset of foot drop, weakness of tibialis anterior muscle before surgery, type of lumbar disorder and the interval between onset of foot drop and surgery. In this series, older patients tended not to recover. Patients whose foot drop had appeared gradually and/or whose muscular contraction was weak did not recover. Foot drop did not improve in the cases of combined stenosis, and patients who had surgery 3 weeks or more after onset did not recover.
Nineteen cases of osteonecrosis-like syndrome of the tibial plateau were diagnosed. Characteristics of this syndrome are sudden onset of knee pain, associated with hydrarthrosis and tenderness in the upper tibia. Definitive diagnosis is made by pathological evidence of bone necrosis, but early stage cases are only diagnosed by intense radionuclide bone uptake in the tibial plateau. Cases were classified into 5 types according to X-ray findings. These were similar to the 4 classes of femoral condyle necrosis (by Koshino et al), and a new rapidly destructive type was added following the authors observations. Thus type 1 had 2 cases, type 2 had 2 cases, type 3 had 2 cases, type 4 had 9 cases and the rapidly destructive type had 4 cases. In this syndrome, cases that were Judged to be more advanced than type 2 required surgical treatment, and their prognosis was benign.
Generalized congenital insensitivity to pain with anhidrosis is an infrequent disease characterized by the absence of pain and temperature sensation and a lack of sweating. We evaluated a distal femoral osteotomy used to treat an epiphyseal plate injury in a charcot joint. A case of charcot joint of the knee due to congenital sensory neuropathy with anhidrosis is reported.
We report seven quadriceps tendon ruptures in four patients on chronic hemodialysis. The mean age of patients was 40.0 years and the mean duration of hemodialysis was 8.0 years. Five ruptures were developed, when the patients tried to stop falling to the ground after slipping, one rupture was developed after jumping from a one meter height and one rupture was developed spontaneously without any special strain. Ruptured tendons were sutured to the patella in all patients. After surgery and following physical therapy, all patients were able to walk without any support, but 3 of 4 cases needed a hand rail when going down stairs. In all cases, secondary hyperparathyroidism (PTH averaged 53.5ng/ml) was seen. Histological findings suggested that bone resorption at the tendo-osseous junction due to secondary hyperparathyroidism was a predisposing factor to quadriceps tendon rupture.
The fabella has been rarely considered a possible cause of knee dysfunction. We report five cases of knee disorders caused by fabella. The first case was a 15-year-old female who complained of posterolateral pain and tenderness of the knee. Roentgenograms revealed the fabella with no obvious abnormalities. After failure of conservative treatment, the patient had gradual relief of symptoms following fabellectomy. The second case was a 22 year old male with similar symptoms to the first case. These two were diagnosed as the fabellar syndrome. The third case was a 60 year old male who complained of tenderness and extension pain in the fabellar region. On roentgenogram, a bipartated fabella was revealed. Two other cases were in 77 and 78-year-old females who both suffered from tenderness and extension pain behind the knee. In both cases, roentgenograms showed large and degenerated fabella and severe lateral femorotibial osteoarthritis. They were diagnosed as fabello femoral osteoarthritis.
Precise correction is an important factor in high tibial osteotomy. It is known that the angle of the articular surfaces (condylar-plateau angle) in the standing position changes after HTO. Changes in the condylar-plateau angle resulting from lateral shift of the heel stuck to the sole was studied in medial compartmental osteoarthritis of the knee. When the line from the center of the femoral head to the heel (mechanical axis) passes through the point between 60%-75% of the width of the tibial articular surface from its medial margin, the condylar plateau angle decreases markedly. Our results suggested that the corrected mechanical axis should pass through over 75% of the width of the tibial articular surface in order to achieve satisfactory post operative results.
Twenty-five patients (29knees) with osteoarthritis (21 patients, 23 knees) or rheumatoid arthritis (4 patients, 6 knees) treated with Miller-Galante or Omnifit total knee systems were reviewed clinically and radiographically. The mean age at surgery was 75 years (70 to 86) and the mean period of follow-up was 14 months (range, 4 to 29 months). Clinically patients were evaluated using the three universities' Knee rating score, and the femoro-tibial angle, setting position of the components, and appearance of radiolucent areas were observed on postoperative serial radiographs. The following results were obtained: All clinical symptoms improved after surgery. Patella dislocation or rupture of the patella tendon was observed in two cases. Components were satisfactorily placed. Radiolucencies mainly appeared at the medial and anterior areas of the tibial component.
Six cases of bilateral TKAs using the M/G-I prosthesis coupled by the Whiteside Ortholoc-II prosthesis were clinically and radiographically evaluated. Three cases were fixed with cement and the other three were fixed without cement. The follow-up period ranged from 3 years and 4 months to 5 years. No significant differences were found between the two types of prostheses in regard to improvement rate of clinical score and range of motion. No cases showed any remarkable loosening radiographically. Tangential views of the patellofemoral joint revealed better congruity in the Whiteside type prostheses.
We report on 83 patients (116 knees) who had Miller-Galante total knee arthroplasties. Thirty one knees had rheumatoid arthritis and 85 had osteoarthritis. Repeat surgery was performed in 6 knees (0.52%) due to postoperative complications. Five knees used the MG I type (0.6%) prosthesis and one knee used the MG II type prosthesis (0.3%). The causes necessitating secondary surgery were chronic hydrarthrosis in one knee, varus flail joint in one knee, patellar luxation in two knees, patellar component failure in one knee and patellar tendon rupture in one knee. In four of six knees, complications were caused by a disorder of the extensor mechanism. Four complications may have been prevented by proper alignment and soft tissue balance, precise operative technique and careful post operative treatment.
Reconstructive surgery using bone cement in total knee arthroplasties (TKA) for severe bone defects of the medial tibial condyle in osteoarthritis was reviewed in three patients. The mean duration of follow-up was 6 years and 10 months. At the time of surgery, several techniques were added to the typical TKA. The postoperative femorotibial angle (FTA) was corrected to 170°, and tibial component was shifted laterally rotational position. The preoperative Japanese Orthopaedic Association score of Knee Arthrosis averaged 37 points. The postoperative score averaged 86 points. The bony support of the tibial component in anteroposterior roentgenogram was about 77% postoperatively. The radiolucent area averaged 1mm at 6 years and 10 months after surgery, and loosening did not occur in any cases. In cases with more than 75% tibial bony support, good results were achieved using our surgical methods.
Twenty-two osteoarthritic knees treated by high tibial osteotomy were followed for at least five years. Average JOA score at follow-up was 78.9 points. Cases older than seventy years all achieved good results. The maximum flexion angle decreased by five degrees postoperatively and the mean femoro-tibial angle was 169.8 degrees at follow-up. Seven knees (4 cases) remained symptomatic, and osteoarthritic changes in the patello-femoral joint and lateral femoro-tibial joint were seen in these cases. In the other cases obesity was a predisposing factor.
We studied 34 severe osteoarthritic knees in 25 patients who underwent high tibial osteotomy (HTO). The mean age of the patients in the study group was 68.9 years at the time of surgery and the mean duration of follow-up was 6.6 years. Out of 25 patients 15 (60%) were farmers and of these 25, four patients underwent total knee replacement (TKR) on the other side. 88% of patients achieved good or excellent clinical results, and 3 out of 4 patients who had both HTO and TKR achieved good results on the HTO side. These results suggested that HTO is a suitable operation for patients with severe osteoarthritic knees and also for those in higher age groups, particularly if they wish to continue active work post-operatively.
Twenty-eight osteoarthritic knees in twenty-seven patients who underwent high tibial osteotomy were followed for mean duration of 1 year and 5 months, and evaluated through clinical, radiographic, and arthroscopic examinations. Arthroscopically, six knees showed an improvement of more than one grade by Kosino's criteria. Eight knees did not show an improvement of more than one grade, but slight regeneration of cartilage was observed. Twelve knees did not change and two knees worsened. In patients who showed improvement arthroscopically of more than one grade, the femoro-tibial angle (FTA) was below 168°, and the mechanical axis was over 40% in all knees.
High tibial osteotomies, both the wedge or dome type, are common in the treatment of osteoarthritis of the knee joint. However there is still some controversy remaining over whether the proximal fragment is too small to achieve a stable union using this technique. We performed proximal low tibial osteotomy (PLTO) to resolve the above. This technique offers the following advantages: (1) By using an equilateral triangular wedge osteotomy, the lateral cortical line is also adapted, and therefore a stable shape is maintained. (2) Using the May plate, rigid fixation is obtained. (3) Early rehabilitation is able to be carried out. We report on nine cases (11 knees), 2 male and 7 female, whose ages ranged from 52 to 72 years (mean 63.5) who were operated on using the PLTO technique from April 1990 to October 1992. The follow-up interval was from 6 to 32 months (mean 63.5). The JOA score was used for the clinical evaluation, and for the radiological evaluation, mechanical axis (MA), femorotibial angle (FTA) and condylar plateau angle (CPA) were measured. Good clinical and radiological results were obtained. On average the JOA score improved from 60 to 85 points, MA improved from 108.6% to 45%, FTA from 185° to 169° and CPA from 6.3° to 2.3°. We concluded that proximal low tibial osteotomy (PLTO) was a useful technique especially for treating the moderate osteoarthritic knee joint in which the mechanical axis passes within the medial joint surface.
Meniscal repair is an effective treatment for longitudinal peripheral meniscal tears. However, the conventional method of meniscal repair often needs additional incisions and in the case of posterior horn sutures has the risk of potential posterior neurovascular structure injury. We have developed a new method of arthroscopic meniscal repair using knotted absorbable strings, which is a simple intraarticular procedure. Strings are inserted into the torn meniscus using a needle with a cleft at the tip and these are left inside the meniscus when the needle is pulled out. This study evaluated the fixation rigidity of this method using a simple tensile test. Bovine menisci were cut into rectangular sections of 6×6×10mm and a string with knots was inserted. These specimens were mounted in a methylmetacrylate cylinder and fixed in a mechanical testing machine. Maximum tensile strength of a string with three large knots was more than 20N, which is comparable to the conventional method. Our method is so simple that it is much easier to use multiple sutures, which would provide adequate stability. Furthermore, the method does not require additional incisions and can be indicated for repair of posterior tears without the risk of popliteal neurovascular injury.
We made a clinial study of 15 patients (16 knees) with hypermobile menisci. The mean age of patients was 16.3 years, ranging from 13 to 22 years. Three patients were male and 12 were female. All menisci were affected on the lateral side. McMurray test was positive in 87.5%, but the Apley test was only positive in 12.5%. These were considered to be characteristic findings. Arthroscopic partial meniscectomy was performed in 4 patients (4 knees), arthroscopic meniscoresis in 5 patients (5 knees), and 6 patients (7 knees) were treated conservatively. In principle conservative treatment is the treatment of choice for hypermobile menisci. Surgical treatment should be done only for cases with significant meniscal lesions and a long history.
Magnetic Resonance Imaging (MRI) and arthrography were performed on about 400 menisci (200 knees) before arthroscopy was done. In those cases, 8 menisci which appeared normal when visualized by arthrography were diagnosed as having meniscal tears by MRI. In these menisci, 6 were horizontal tears at the posterior horn of the medial meniscus, 1 was a tear in the capsular margin of the medial meniscus and 1 was an intra-meniscal tear of the lateral meniscus. MRI is a valuable for diagnosic test for meniscal tears and an aid to effective preorperative planning.
Evaluation of the diagnostic value of two different types of tests for meniscal tears was carried out through examination of 200 menisci. A practicing surgeon and orthopaedic residents diagnosed the meniscal tears of viewed through each imaging test. The accuracy for MR imaging and arthrography was 98.5% and 86.5% respectively by the practicing surgeon, and 89.5% and 81.0% by the residents. We concluded that MR imaging of meniscal tears was a more accurate non-invasive and helpful examination than arthrography.
Twelve children with thirteen symptomatic discoid lateral menisci were reviewed after a mean follow-up of 11 months. Their mean age at operation was 11.2 years. Twelve knees were treated with arthroscopic subtotal meniscectomy and one knee was treated with arthroscopic meniscal repair. This study evaluated the relationship between radiological changes and clinical results after the operation. Clinical results were analyzed using Ikeuchi's grading system. Excellent results were achieved in 7, good in 2, fair in 1 and poor in 2. One of the knees judged as poor, developed a new tear in a repaired meniscus 5 months after the operation. Radiologic examination revealed osteoarthritic changes in 2 of 9 knees, and mild changes in 4 knees. There was no relation ship between clinical results and radiologic changes. Meniscectomy for the discoid lateral meniscus does not always develop deterioration in the articular cartilage in children, but does in adults. However we found cartilage deterioration in one case after second-look arthroscopy. Therefore, even if patients are asymptomatic, we must follow them up for a long period.
This study assessed differences in reaction speed of hamstring muscles between knees with chronic anterior cruciate ligament injuries (an ACL group; n=10) and healthy subjects (a control group; n=10). All subjects were instructed to react to a sudden forward movement caused by the KIN/COM Isokinetic Dynamometer with hamstring contraction 10 times. The input arm of the Dynamometer located at the posterior side in the middle of the calf was unexpectedly moved 15° forward at a speed of 30°/s. Response time was divided into premotor reaction time (PMRT), electromechanical delay (EMD) and reaction time (RT). Results showed that the PMRT of the medial hamstrings was significantly shortened (p=0.046) and EMD lengthened (p=0.009) in the ACL group compared to the control. There were no differences in PMRT of the lateral hamstrings nor in RT between the two groups. Whether compensatory mechanisms for ACL-deficient knees were obtained was determined by this study.
Twelve patients who were treated with reconstruction of A. C. L. using the bone-patellar tendon-bone method were evaluated. Eight cases were augmentated with Kennedy-LAD. Five cases with isolated torn A. C. L. with augmentation achieved full range of movement two months post-operatively. Eight isolated or combined injury patients who received augmentation were able to return to pre-injury recreational sports. We concluded that for A. C. L. reconstruction, R. O. M. exercises and muscle training could be started early following bone-patellar tendon-bone augmentation with Kennedy-LAD. In addition, the isometric points of A. C. L. in the joint were very important for reconstruction.
Injuries to the lower extremity happen frequently in judo, and in particular knee injuries may be severe. This study evaluated isometric muscle strength of knee extension and flexion in athletes performing Judo by using KIN-COM500 (CHATTECX, USA). We clinically examined 19 amateur judo athletes with or without knee injuries. Ten of them had symptoms or episodes of knee injuries during their judo carreer. They had a high level of muscle strength in their thigh muscles. Maximum power of knee extension was 11.02N/kg at 60deg. flexion posture, and knee flexion was 7.36N/kg at 30deg. flexion posture. In the group with meniscal injuries, quadriceps muscle weakness was found. In cases with meniscal injuries, it is important to do muscle strength ening exercises for knee extension.
Muscle force has been commonly used to estimate physical function. However, muscle reaction time should not be considered for this purpose. This study evaluated the relationship between force and muscle reaction time. The subjects are 20 university students (11 men, 9 women, whose average age is 19). Peak torque under isokinetic and concentric and eccentric contraction of the knee extensor and flexor muscles were measured by KIN-COM isokinetic dynamometer. Muscle reaction time was measured by electro myographic activity sensed by surface electrodes. There was no relation between peak torque under any contraction styles and premotor reaction time. Also, peak torque time had the same result. However, a weak relationship was shown between peak torque and electro mechanical delay. Also, reaction time had the same result.
Five cases (4 males, 1 female) with ACL insufficiency were evaluated by frequency analysis of surface EMG. Subjects ranged in age from 17 to 41 years (mean 27 years). Surface EMG was recorded from above the quadriceps musle during sustained (30s) isometric contraction. The recorded EMG was computerized by spectrum analyzer. Results were as follows. Double peaks were seen in the frequency distribution in the range of 20-40Hz and 70-90Hz. Mean power frequency in the normal side gradually decreased, but no change was seen in the uninjured side. The higher (>81Hz) frequency zone in injured side decreased in comparison with the normal side. We concluded that type II fibres of knee extensors were dysfunctiond in patients with ACL insufficiency.
We investigated the relationship between pathological findings and MR images of 5 resected soft tissue tumors. These included desmoid, hemangioma, liposarcoma, schwannoma and malignant schwannoma. The increase of collagen was an important histological feature of tumors, and this was seen on MRI as a decrease in signal intensity, especially, on T2 weighted images. Minute amounts of fat tissue appeared as high intensity on T1 weighted images on MRI. This study suggested that MRI may reflect minute histological changes in the matrix of soft tissue tumors.
We have developed a new system for three-dimentional (3D) reconstruction of bone and soft tissue tumors from magnetic resonance images. Data from transverse T2 weighted images of MRI were transferred to a personal computer. Extraction of tumors, major vessels, nerves, and bones was performed manually. The 3D data were then processed into 3D display using a solid model. The 3D images of bone and soft tissue tumors were beneficial first for determination of chemotherapeutic effect, second for understanding of the relationship between tumors, major vessels and nerves and finally were of use in planning the operation.
Magnetic resonance imaging is useful for the diagnosis of bone and soft tissue tumors. We experienced 7 cases of schwannoma in peripheral nerves or cauda equina, which were treated by surgical extirpation. This study reports the correlation of MR imaging and pathologic findings of schwannoma. MR imaging reflected the pathologic view of the tumors, cyst and hemorrhage. Proton-density-weighted images were useful for imaging tumors in the spinal canal.
This is a retrospective review of 24 cases of simple bone cysts of the humerus as seen and treated at the authers' institution from 1966 to 1991. The subjects comprised of 18 males and 6 females, ranging in age from 4 to 47 years. The average duration of follow-up was 27 months, ranging from 3 to 85 months. Twenty cases of them were treated with the curettage and packing of the cavity with bone grafts. Two patients were treated with steroid injections. The rate of recurrence were 20% in the surgery and none in the injection of steroids. Two of the 16 cases complicated with pathological fracture were observed their natural healing process. One of them healed completely, but the other incompletely. We concleded as follows, 1) The cases with the pathological fractures may be treated conservatively up to two months, we expect natural healing because it is able to limit ADL in cases of humeral bone cysts. In other words, observation of their natural healing is necessary. If the lesion isn't healed, steroid injection is performed. 2) The cases without pathological fractures are treated with steroid injection for children and with an operation for adults.
Three treated groups totaling 60 patients with solitary bone cysts were evaluated. Curettage and bone graft, methylprednisolone acetate (MPA) injection, and curettagehydroxyapatite (HA) filling were performed in 20, 32, and 12 patients, respectively. Four patients were treated with two different interventions. The healing rates (complete healing plus incomplete healing evaluated by Campanacci's criteria) in the three groups was 85%, 83%, and 100%, respectively. Although the healing rate of HA filling appeared to be best in this series, the average duration of follow-up was less than two years. Therefore, MPA injection should be the preferred method for its greater simplicity and the absence of complications.
We treated 23 patients with small round cell sarcomas of bone and soft tissue from 1968-1992. All patients were treated with adjuvant chemotherapy and 14 (60.9%) also received radiotherapy. Six of 20 patients who received surgery, had local recurrences within one year. In this series, small round cell sarcomas occurred predominantly in the trunk (47.8%). Prognosis was evaluated by length of survival. The overall survival rate of small round cell sarcomas of soft tissue (15.6%) was significantly lower than that of other high grade sarcomas.